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Maintaining the best results requires knowledge and expertise. Our athletes train and so do we, through our professional development program. Meaning that when a practitioner the treats you, they have the most advanced injury care knowledge. Read about what our practitioners are thinking in the injury blogs below.

Blog Series Part 1: Running In Plain English

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Technique in running is something that is often overlooked in the casual competitive runner, and in many cases can lead to the development of an overuse injury. In gait (running movement) patterns, maximising your efficiency during gait will prevent joint overloading and thus prevent the onset of load induced injury.

Common technique habits that can increase your risk of injury include overstriding, heavy heel striking and crossing the mid line of your body. Those might all seem slightly complicated to diagnose when heading out for your daily run.

Over a four part series, we will look at some common running technique mistakes and how they can affect you putting one foot in front of the other!

It is quite common in the running game to use certain terms to describe your running pattern and the impact you have with your technique. All over the internet you will find running blogs which implement different terms and try and guide you in the right direction, but we’re here to help you understand and use this information to become a better runner.

Stride
The actual impact from one foot meeting the ground, transferring through the foot, taking off, swinging though and contacting the ground again.

Stride Length
The distance of one stride, generally measured from initial contact point to initial contact point on the same leg. 

Gait
In health terms, we use this term to describe your movement style. It encompasses both walking and running, both foot contact and flight time.

Midstance

The stage in your gait where your foot is flat on the ground, and taking the full weight of your body. This time in your gait cycle is commonly where compensations can occur through your foot, knee or hip.

Toe-Off

The propulsion phase where your foot leaves the ground.

Heel Strike

The initial ground contact generally made by rearfoot and midfoot runners. 

Load

Commonly referred as “training load” it refers to the forces coming through the body. 

 

Now you know the lingo, next week in Part 2 we will delve into Overstriding. Watch this space!

 

 

Blog Series Part 2: Overstriding

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BLOG SERIES: Part 2 Overstriding

Technique in running is something that is often overlooked in the casual competitive runner, and in many cases can lead to the development of an overuse injury. In terms of gait (running movement) patterns, maximising your efficiency during gait will prevent joint overloading and thus prevent the onset of load induced injury. In this blog series, we have already gone through running lingo - this week we look at overstriding.

As the term indicates, overstriding is where our stride length (the distance between the same feet contacting the ground in one stride) is influencing our ground contact. If there is excessive stride length and our ground contact is occurring well out in front of our body, by contacting the ground in front of our body, our ability to hold the load changes as we are unable to recruit the knee and the hip to manage the load and notoriously the muscles below the knee must take the load. 

This can cause overuse injuries such as Medial Tibial Stress Syndrome (MTSS-Shin Splints) as the anterior leg musculature overreacts to the load and can cause irritation to the tibia bone. Patella-femoral joint pain is also common with an over-strider not being able to utilise the upper leg complex to process the body weight load as it meets the ground reaction forces. Calf, achilles and hamstring injuries can all be related back to overstriding.

These conditions unfortunately are not quick fixes, and can take time to repair and rehabilitate. 

So how do you know if you're overstriding? The best way is through video analysis. Whether that be through a directed video gait analysis with a trained professional, or getting a mate to take a video on their smart phone of you running along from the side. You may also know by symptoms of pain just below or behind the knee cap, anterior leg soreness or inflammation of the lower leg. 

Treatment for overstriding involves including some gait retraining cues to decrease the impact of overstriding and look at greater efficiency, potentially soft tissue work depending on the health of your lower limb and occasionally orthotics to alter the mechanics. For something that can seem so miniscule, the reality of the situation is that it can cause chronic activity pain. By working through these difficulties we can get long term outcomes, which not only resolve your pain, but can keep you running for longer and help you hit your targets!

About the author

James Unkles is one of our Podiatrists here at Camberwell Sports & Spinal Medicine. A casual runner in his spare time, he understands the nature of the industry and how little imperfections can become big issues.  

Reference

Rowlands, A., Eston, R., & Tilzey, C. (2001). Effect of stride length manipulation on symptoms of exercise-induced muscle damage and the repeated bout effect. Journal of Sports Sciences, 19(5), 333-340.

Next week: Heavy heel striking. Stay tuned!

Blog Series Part 3: Heavy Heel Striking

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Part 3: Heavy Heel Striking

Are you wearing out of the rear of your runners much more quickly than the rest of your shoe? You may have a heavy heel strike in your running style. This is commonly paired with a very “loud” running style, where you can commonly hear the contact that you make with the ground. So take out your headphones, and listen to your style! 

Heavy heel striking is not only unattractive to watch when observing gait, it is extremely taxing on the body. That large impact sends load through the posterior leg and can lead to longstanding conditions such as ankle instability, shin splints, muscular overload and even stress fractures. It even relates to the topic we covered in the last blog in this series - looking at how overstriding can affect your gait. If you are a chronic overstrider, you may also be contributing to your injury risk heavily loading on the rear-foot. 

Research conducted at Curtin University in Perth looked at the relationship between “running quietly” and vertical ground reaction forces (how much load is impacting the body during ground contact). Their study found, particularly with male participants, their peak loading rates and forces were reduced when asked to “run quietly.” This important piece of research backs up many coaches and health professional’s beliefs that potentially altering a runner away from a heavy heel striking gait, can help to prevent further injury.

This is not to say that heel striking is a terrible gait characteristic. A large percentage of the population do run with a heel strike style gait, and can be seen in many endurance athletes across the world. What is important to remember is that any type of instability associated with the rear foot can largely effect how we manage the increased load of running through the lower limbs. 

To assess the effect of this characteristic, having your running technique analysed by a running coach or health professional is the best way to prevent any injuries that may develop. 

About the Author

James Unkles is a Podiatrist at CSSM, who enjoys running as part of a balanced lifestyle. His passion in biomechanical analysis will help you get the most out of your running.

References
Xuan Phan, Tiffany L. Grisbrook, Kevin Wernli, Sarah M. Stearne , Paul Davey & Leo Ng (2017) Running quietly reduces ground reaction force and vertical loading rate and alters foot strike technique, Journal of Sports Sciences, 35:16, 1636-1642, DOI: 10.1080/02640414.2016.1227466

Blog Series Part 4: Crossing The Midline

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Here’s an exercise for you: head down to your local oval and use the boundary line and run directly along it. If you notice your feet crossing over the boundary line to the other side of your body, you are most likely crossing the midline of your body. This may be a result of muscle tightness/weakness across the pelvic and hip region or could be coming from your foot posture. Persistent crossing the midline in association with loading increases have shown to increase your chances of lower limb injury, and may require intervention.  

Crossing the midline is also referred to having a “narrow base of gait” which identifies that rather than having your feet strike the ground in alignment with your lower limb, you become more ‘adducted’ and have both feet strike the ground closer towards, or cross over the midline of your body (an imaginary line from the top of your head, dissecting the body in to two). Overloaded foot structure from pronation can be made worse for lower limb function if you have a narrow base of gait, and can lead to increases in the average vertical rate of force in the body (Napier et al., 2015).

Intervention programs can involve stretch and strengthening, dynamic exercise prescription, gait retraining or even the use of orthotic devices to prevent you overloading from midline infringements. 

Every runner is different. We all have different styles, strike patterns and muscular status. If you’re wanting to get the best out of your running to propel you to the next level, getting your technique analysed is the best way to get to the bottom of any issues and help your program for the future.

We offer a Running Gait Analysis’ at CSSM.

 

About the Author
James Unkles is a Podiatrist who has also completed his Bachelor degree in Exercise and Sport Science, and loves the finer details of running and how it effects the body.

References

Napier C, Cochrane CK, Taunton JE, et al. Gait modifications to change lower extremity gait biomechanics in runners: a systematic review. Br J Sports Med 2015;49:1382-1388.

If The Shoe Fits

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It’s back to school time! Hard to believe the summer break is already over! Parents - it’s time to check up on all things uniform based, seeing how much kids have grown over the break and whether or not they still fit in their shoes!

Getting the right school shoe can be tricky, some are too heavy, some are too bulky and some are too expensive. We’re here to help put you on the right track, to not only get the best value for money, but to get the right fit for your child.

Before you purchase the shoes, ask your child:

-How much running do they do in their shoes?

-How many days per week do they wear them?

-And how old are their school shoes?

It’s important to ask these questions, as shoe technology has improved significantly over the previous couple of years. Companies such as Ascent are making school shoes with running shoe technology to increase movement efficiency and decrease the overall weight of the shoe, whilst still sticking to uniform guidelines. The only issue is with these shoes is that they do wear out in less time than traditional shoes. So be aware when purchasing.

It’s common for parents to purchase shoes so that children “will grow in to them” which is a big NO! Having a shoe that is too big can lead to blisters and musculoskeletal conditions of the foot and lower leg, which can lead to big problems going forward. A perfect shoe fit is 0.5-1 size on top of your measured foot size to allow for the foot to swell during activity without restricting motion.

Key Features:

  • Rigid “heel counter” enabling the rear foot to be locked in to the shoe and prevent slippage
  • Fixation through laces, or velcro to prevent midfoot movement
  • Nil flexibility through rotation of the midsole. In simple terms: not being able to scrunch the shoe in to a ball. A little bit of flex is good, but it should be free moving.
  • Width across the forefoot - should not rub on the foot.

Remember to take care of those shoes, get them fitted properly by the experts, and if there’s anything we can do to help, come and see the Podiatry team here at CSSM.

A Pain In The Backpack

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By Kobi Phelan

With textbooks, computers, lunch and sporting equipment, backpacks can be heavy. This is particularly concerning for junior students as the spine is at a critical stage of development between 12 and 14 years of age.

According to the Australian Physiotherapy Association, 70 per cent of children will suffer back pain because of heavy backpacks.

Backpacks should weigh no more than 10 per cent of a child’s weight. However, recent studies have shown that the school bags of more than half (61%) of school aged children exceed that.

Studies have reported the highest level of discomfort is in the shoulders and back as well as the neck.

In extreme cases, overloaded backpacks can cause headaches, pins and needles and numbness in the arms.

Ideally, you want to lower the backpack weight but here are a few things you can do to eliminate discomfort and injury: 

-Get organised. Only take the books you need for that day and leave the rest at school or in a locker.

-The ideal school bag is a backpack with wide shoulder straps that are comfortable and sit well on the shoulder and a padded back support that fits snugly on the back. 

-Parents should look for bags with compartments that allow you to pack the heaviest items at the base of the bag closest to the spine.

-Don’t make the mistake of thinking your child will grow into a backpack. The backpack shouldn’t sit higher than the child’s shoulders when sitting down.

-The straps should be shortened until the bottom of the backpack is just above the child’s waist, and not sitting on their buttocks.

Our team is more than happy to answer any questions or help to fit a backpack properly.

Blisters

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It’s time to burst some bubbles, pop the stigma and talk about the really irritating problem of blisters. They’ve been in the news recently with South Korean tennis superstar Hyeon Chung having to retire from his Australian Open semi-final clash with Roger Federer (heard of him?). It has to be a serious blister to cause someone to retire from playing in a grand slam semi-final, but it goes to show how important blister prevention and management can be!

If blisters are left untreated and not offloaded they can eat away at the epidermis (the outermost layer of the skin) and reveal the dermis; a part of the skin that is easily prone to nasty infections. The last thing we want to happen after developing a blister, is to see an infection take over the region on the foot and lead to time off your feet.

With the new football season about to kick off (pun intended) and with events such as the 100km Oxfam Trailwalker happening soon there is a lot of blister talk around the clinic at the moment.  

As most people know, a blister can really ruin your day.  In fact for the Oxfam walkers, blisters are the most common reason that participants seek medical attention or even pull out of the walk, so managing them is super important if going ahead with the challenge.

Tips for Avoiding Blisters

  • Wear good quality socks: that form well to the foot and size well.
    In vigorous situations, having a sock too small can increase the area of pressure due to the seam contacting with the foot. Likewise, socks that are oversized can increase the friction over bony landmarks and cause a “hot spot.”
  • Wear in your footwear!
    Seems simple, but testing your shoes and gradually wearing them in before vigorous exercise is the best way to avoid blisters. Hiking, construction and leather boots are the main culprits. Preventative taping using sports tape or underwrap (Hypafix or Fixomull) will decrease the friction caused and leave your feet a lot happier.
  • Manage hotspots early.
    If you feel the blister starting to form, cease activity and inspect the area. If a fluid sac has not appeared, commence management involving a non-stick dressing over the area and tape it well. Your podiatrist can also help by applying felt offloading padding, particularly for those pesky blisters in the arch and under the big toe.

Managing Blisters Once Formed

  • Don’t pop the blister unless you can do in a sterile manner, apply an anti-bacterial agent (such as Betadine) and an appropriate bandage. If not, protect using blister packs for protection and reabsorption. 
  • If these can be achieved, create a small insertion to the fluid sac and the most distal point (lowest gravity point) using your sterile implement. Use gauze (or similar products) to absorb the fluid as you gently drain the blister. Once the region is inspected, apply Betadine and dress.
  • This is a great time to adjust the lacing on your shoes, or change shoes all-together to protect the area going forward.

Blisters can be detrimental to the best athletes and for the weekend warrior. If you have any further questions, or want advice and strategies to protect yourself in whatever challenge you face, pop in (pun intended) and chat to the Podiatry team at CSSM.

 

About the Author: James Unkles is a Podiatrist who has also completed his Bachelor degree in Exercise and Sport Science. He loves the finer details of running and how it effects the body. He hates blisters with a passion. 

Free Foot Checks

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Feet are funny things.  26 Bones, 33 Joints, over 100 muscles, tendons and ligaments.  That is a lot that can go wrong. 

Too often at CSSM we see patients who present with long standing foot pain. Invariably this pain starts as a little niggle, which progresses to pain that doesn’t go away and eventually can become quite painful and disabling.

Now we understand when people say, “It didn’t seem too bad so I didn’t bother to get it checked out,” however identifying issues before they become a problem is a key philosophy of CSSM. With this in mind Camberwell Sports & Spinal Medicine is giving you the opportunity to quiz our experts and receive a free foot check. It is time to get those little niggles checked out!

The Free Foot Checks are conducted by our Podiatry team. The assessment involves a half hour session and will include a biomechanical and video gait analysis. Suitable for children and adults alike, these sessions are focussed on giving the participant a clear understanding of how their foot functions, outlining any evident biomechanical issues, the cause to these problems and suggestions on various management options all with a written report. Designed to answer any questions that you may have, we can also give other specific advice regarding shoe selection and self-management of foot conditions. This will all be provided free of charge with no obligation.

Servicing the general public and athletes from recreational to elite, our podiatrists pride themselves on providing services which have measurable outcomes.

The Free Foot Checks are available until April 15th 2018. Sessions are by appointment only, with only limited spaces available each day. 

Free Foot Check Appointments cannot be made online.

Find out more about the podiatry services available at CSSM on our website www.cssm.com.au/podiatry

*The Small Print:

  • This offer is obligation and commitment free.
  • This offer is available for a single use only and is open to both new and existing patients of Camberwell Sports & Spinal Medicine.
  • Free Foot Checks are a temporary service available from Camberwell Sports & Spinal Medicine until 15th April 2018.   
  • This offer can only be redeemed by calling Camberwell Sports & Spinal Medicine for an appointment on 03 9889 1078.  Free Foot Check Appointments cannot be made online. 
  • The purpose of this offer is to enable patients to access the Podiatry services of Camberwell Sports of Medicine and to experience our philosophy on injury management.
  • Camberwell Sports & Spinal Medicine reserves the right to amend these terms and conditions without prior notice.
  • In the event of any dispute, the decision of Camberwell Sports & Spinal Medicine is final.