Sports - Sports Injury

$fibula stress fracture$

Do I have a Fibula stress fracture?

by Pete Colagiuri - Sports Physiotherapist

Fibula stress fractures are less common that Tibial stress fractures and much harder to detect!

That’s because the Fibula isn’t like other leg bones – it’s not a weight-bearing bone!

Most leg stress fractures happen due to forces associated with ground impact.

But Fibula stress fractures are unique – the injury occurs due to muscles pulling on the bone.

What are the symptoms of a Fibula Stress Fracture?

The first warning sign is a vague pain on the side of the calf.

It feels similar to an overworked or sore muscle.

That can get confusing because the most likely cause of lateral calf pain IS an overworked muscle.

Initially it only feels sore after exercise.

The more intense the exercise, the greater the post session soreness.

Next phase of the injury, the soreness begins to last longer.

What used to resolve in a few hours now takes longer that 24 hours to disappear.

In the last phase before a stress fracture, we often see the symptoms become more constant.

The intensity may vary but it’s still aching day and night, regardless of exercise.

How is a Fibula Stress Fracture diagnosed?

The first step for most people is a clinical diagnosis – that is, getting assessed by a doctor or physio.

The is usually enough to suspect a Fibula Stress Fracture but not enough to CONFIRM a stress fracture.

From here, imaging is needed to get a confirmed diagnosis.

MRI is the best option, but also the most expensive. It can see bone reactions as well as cracks in the bone. It gives the whole picture.

X-ray is not sufficient as it’ll only see a bone that has already cracked. Even then, it’ll only spot it if the crack is at a particular angle (relative to the image).

Bone scan is helpful as it shows the bony reaction around the stress fracture. It can’t see the fracture itself but it’s good enough to confirm a significant bone reaction.

CT scan shows a much more detailed picture of the bone but, like an X-ray, will only see a bone that’s already cracked. It can’t spot the reaction that’s the immediate precursor to a fracture.

What’s the rehab plan for a Fibula Stress Fracture?

Fibula stress fractures tend to occur because of the actions of FHL (big toe muscle) or Peroneals (lateral ankle and medial foot stabilisers).

The first step in the rehab is to back off the causative activity.

That doesn’t mean rest!

You can still keep active, provided it doesn’t cause pain or load on the stressed bone.

Then you’ll need to add in a strength program to maintain muscle function while you’re not as active.

Lastly, you need to rebuild the causative activity.

For example, if faster running has caused the problem, it might be linked to FHL loading.

You can return to running after 4-6 weeks but you’ll need to back off the pace.

Over the next few weeks or months, you can gradually return to fast paced running as the bone adapts and strengthens.

It’s important that you listen to your body and give yourself enough recovery time between training sessions.

Remember that you’re recovering from reduced activity, so you can’t flick a switch and be back to normal in a week.

Should I run with lower back pain?

by Pete Colagiuri - Sports Physiotherapist

Ever been stuck in bed and wondering if you should run with lower back pain?

It’s a tricky question that poses more questions:

Is it even possible to run with lower back pain if it’s severe?

Are you doing more damage?

If you run with lower back pain, will it help it to free up?

What causes lower back pain with running?

We see lower back pain more often in male runners and runners over 40 years old.

It affects new runners as much as experienced runners.

It’s often linked to an increase in training load, such as running further or faster, or adding a strength program.

The #1 cause of lower back pain in running

The most common cause of lower back pain in runners is reduced hip range of motion, particularly hip extension (leg moving behind you.)

As the runner strides out to run faster or on a downhill, the leg moving behind the body runs out of hip range.

This causes the pelvis to forcefully rotate forwards, jamming the back and overloading the lumbar spine joints.

The other main cause of lower back pain in running

Another common cause of lower back pain in runners is muscle overwork.

If muscles around the spine need to work harder to maintain trunk position, due to a braced or upright running posture, the muscles fatigue and cause pressure across the lower back.

This muscle overactivity can continue after a run as the muscles become painfully tight.

How can you tell which is causing your pain?

As a general rule, one sided lower back pain is more likely due to a stiff hip joint.

Generalized lower back pain, affecting both sides equally, is more likely due to muscle overwork.

Can you run with lower back pain if it’s severe?

If you’re trying to run with lower back pain but the pain stops you from getting into your normal running stride, you shouldn’t be running.

If you can’t move properly, trying to run with lower back pain will worsen muscle fatigue and increase protective bracing around the back, known as lower back muscle spasm.

Long story short, trying to push on will make your back more painful and take longer to recover.

Swap the run for a comfortable walk for a few days until you feel like it’s freeing up.

Are you doing more damage if you run with lower back pain?

In 99.99% of cases, you won’t cause more structural damage to a back injury if you try to run with lower back pain.

Almost all lower back pain cases don’t have a structural cause as we’d see with a knee or ankle injury. There’s no damage to ligaments or joints that we can detect on imaging.

However there are some injuries, like a Pars Defect (stress fracture in the spine) that can worsen if you run with lower back pain.

Remember that this category of injuries is extremely rare!

If in doubt, see our checklist at the bottom of this post about when to seek medical attention.

If you run with lower back pain, will it help it to free up?

Most cases of lower back pain have a mix of muscle spasm and joint irritation.

Once the muscle spasm passes – it’s the nasty grabby pain you get on movement – then trying to run with lower back pain is worthwhile.

As you run with lower back pain, it’ll feel more comfortable and looser.

Don’t get too cocky and try to run faster! Just enjoy the freedom and let the back continue to loosen up.

How can you avoid or fix lower back pain with running?

Avoiding or fixing lower back pain with running can be done by correcting the biomechanical deficit or reducing the load on the back.

Correcting the biomechanical deficit

Managing hip mobility issues can be achieved with exercises like a walking lunge or a sumo squat stretch, in addition to regular running.

The exercises safely push the hip towards the end of its range while regular running can improve the quality of tissue in and around the hip joint.

Reducing the load on the lower back

To reduce load on the lower back, you can modify your sessions to Fartlek sessions (mix of fast and slow running) and even swap your long run for a run:walk (eg. 10 minutes running to 1 minute walking).

Both types of sessions reduce the consistent muscle loading around the back by changing your running posture and pace.

This gives the muscles a chance to recover and avoids cumulative muscle fatigue.

If you’re training on hills or hill repeats, swap it for a stair session.

Stairs limit your stride length, which avoids overextending the hip, and reduces the backwards tilt of the trunk on descending, which reduces the compression on lower back joints.

When should you seek medical help for lower back pain with running?

If you’re not sure about whether medical help is required, remember that mild transient lower back pain is common.

If you have any of these features, it’s best to seek a medical opinion:

> pain referring down your leg/s

> any weakness, pins & needles or numbness in the legs

> the pain is worsening week on week

> constant pain that doesn’t settle within 24 hours after a run

> night pain that keeps you awake

8 best running shoes for bad knees

by Pete Colagiuri - Sports Physiotherapist

If you’re searching for the best running shoes for bad knees, you’re probably at a stage where your knees are starting to restrict your running.

Most knee pain during running is a result of the way the knees being loaded and the pressure it puts on an already vulnerable area.

Once the pain starts, pushing on with running in maintain the ongoing irritation to the area.

Rest from running will temporarily relieve the pain but it also leaves you weaker and more likely to cause irritation when you return.

One of the best ways of being able to redistribute the load away from the cause of your knee pain is to get footwear that matches your needs.

The best running shoes for bad knees are able to move the pressure away from your knees and on to the muscles around the area. Some shoes will even do a lot of the work for you.

List of the best running shoes for bad knees

Our physiotherapists have compiled a list of the best running shoes for bad knees based on the features that match different injuries around the knee.

> Front of knee issues

These issues include patellofemoral (knee cap) pain and patellar tendinopathy.

Hoka One One Bondi

This shoe provides an extremely plush cushion to run on. This allows you to land with your knee in a straighter position to minimise pressure on the front of the knee.

Hoka One One Arahi

Much like the Bondi, this shoe provides a plush cushion along with additional stability. This means you can land with a straighter knee as well as getting support from twisting pressures on the knee.

> Medial and/or lateral knee pain

The list of causes for medial or lateral knee pain includes osteoarthritis and cartilage issues.

Asics Kayano

This popular shoe has been around forever. It provides a great amount of stability under the arch along with a comfortable feel. That stability reduces the twisting motion on the knee during running, one of the main irritants of meal and lateral knee pain.

Saucony Guide

Another sturdy shoe, the Saucony Guide provides similar stability to the Kayano but fits better for narrower feet.

> Bad knees and wide feet

Wide feet are often associated with bad knees as they’re caused by the same biomechanical forces.

Asics GT-2000

This classic running shoe provides moderate level stability with good cushioning. Aside from being one of the best all round shoes, it’s also available in a wide fit (2E for men, D for women).

Brooks Adrenaline

The Adrenaline has undergone a makeover in recent years, and all for the better. It’s lighter, more comfortable and better fitting than previous models. It’s also available in a wide fit (D for women, 2E for men).

> Trail options

Hoka One One Speedgoat

This shoe combines Hoka’s plush cushioning with a snug fit and amazing grip. It’s only been on the market for 4 years but has become one of the most popular trail options for good reason.

Salomon Speedcross

A solid shoe is perfect for rugged, mountainous conditions and provides a firm, well-fitted option for running trails with bad knees.

>> Take home message

Bad knees are one of the most common causes of early retirement in runners. But consistent running, a good strength program and the best running shoes for bad knees can postpone that retirement and keep you moving.

2 reasons to avoid hip flexor stretches

by Pete Colagiuri - Sports Physiotherapist

Hip flexor stretches are commonly used yet poorly understood by many trainers and athletes.

The hip flexor group involves a number of muscles, some of which originate from the lumbar spine (aka. lower back). Their main function is to bend the hip forward so they’re quite active during running and abdominal exercises like planks.

Who should do hip flexor stretches?

As fatigued muscles often shorten for a few days after exercises, stretches generally can help relieve post-exercise tightness and associated soreness.

Hip flexor stretches are great for anyone who has performed exercise that has vigorously loaded the area – fast or downhill running, abdominal exercises and kicking sports (field sports and martial arts) are all examples of sessions that should benefit from post-workout hip flexor stretches.

Why might hip flexor stretches cause problems?

Contrary to popular belief though, the use of hip flexor stretches needs more caution in those prone to lower back pain or in stiffer body types.

This is due to the involvement of the spine as a muscle attachment point and the potential for other factors limiting the stretch.

During the stretching movement, the muscles pull firmly on the lumbar spine. If the spine can effectively brace itself, the stretch works as intended. If the spine is fatigued and isn’t braced well, the joints in the back are compressed and can cause lower back pain.

In stiffer body types, hip flexor tightness is often caused by hip joint compression rather than muscle fatigue. In a long lunge hip flexor stretch, the hip joint then limits the movement and prevents the muscles from stretching effectively.

The stretch then inadvertently overloads the hip joint and lower back, which needs to arch backwards to accommodate the hip stiffness. In this situation, you’ll often hear the comment that the stretch isn’t felt in front of the hip regardless of how hard the stretch is pushed.

Who should avoid hip flexor stretches?

If hip flexor stretches are not felt in front of the hip and/or upper thigh, or if you feel it in your lower back, these stretches should be avoided.

If the stretch can’t be felt without really forcing the position, avoid it.

Otherwise if the stretch position is comfortable and only felt in the muscles in front of the hip and upper thigh, it’s worthwhile adding it to your regular mobility routine.