Ask the Sports Physiotherapist
By: Shirley Kushner, M.Sc.P.T., R.C.A.M.T.,
Diploma Sports Physiotherapy

WHAT IS THE DIFFERENCE BETWEEN A SPRAIN AND A STRAIN?

A Strain is an injury to a muscle , its tendon and/or its attachment. A strain occurs when the muscle has been overstretched or overloaded. There are three degrees of severity. A 1° strain is an overstretching of the muscle. A 2° strain is overstretching of the muscle where some of the fibres are torn. A 3° strain is a complete rupture of the muscle or tendon. Luckily, the 3° strain is rare as it results in loss of function and may require surgery. Muscle strains or pulls occur as a result of a sudden force applied to the muscle or a sudden stretching of the unprepared muscle. A common area that is strained is the achilles tendon by lunging forward while playing squash. Most strains are first degree and will resolve with a few days of rest and application of ice several times a day for 10 minutes per time. Strains can be prevented by a proper warm-up, keeping the muscle flexible by stretching once warm and after the activity, and keeping the muscles strong.

A Sprain is an injury to a the ligament which is the fibrous band connecting bone to bone at a joint. A sprain occurs when the joint has been pushed beyond its normal range of motion. Like strains, the severity varies from first to third degree and depending on the amount of pain and swelling and may require medical attention. A 1° sprain is caused by overstretching of the ligament. A 2° sprain occurs when some of the ligament fibres have been overstretched and some have been torn. A 3° sprain is extensive tearing and a rupture of the ligament. Sprains are often the result of a sudden twisting motion. The outside of the ankle has the most commonly sprained ligaments. Most sprains are first degree and will resolve with a few days of rest and application of ice several times a day for 10 minutes per time. Keeping your muscles and joints strong and flexible will help prevent sprains as will a good warm up. Good balance will also help prevent ankle sprains. Ankle
sprains are reduced with high top running shoes, and lace up ankle braces or having the ankle taped.

WHAT IS A FRACTURE ?

A fracture is simply a break in the continuity of bone or a broken bone. It can be simple (closed) when there is no wound extending to the surface of the skin or open (compound) when there is an open wound with the skin. There are many different types of fractures ranging from a greenstick to a compression type fracture.

WHAT IS A BURSA ?

A bursa is a closed fluid filled sac found in areas of the body subjected to friction, such as where the achilles tendon inserts into the heel bone, or just outside the tip of the shoulder. It can become irritated and inflamed and is then called a bursitis. An acute bursitis responds to rest and gentle range of motion, and as it resolves, increased mobilization and strengthening.

WHAT IS TENDONITIS ?

Tendonitis is inflammation of the end of the muscle (or the tendon) at its attachment to the bone. It can be caused by overuse, poor posture, poor warm-up, or malalignment. After the initial inflammatory stage it may continue to degenerate without the inflammation called tendinosis. Tendonitis will often occur at the muscles around the shoulder (the rotator cuff) or at the achilles tendon in the ankle. It will often improve in the shoulder with postural correction, avoiding overhead activities and restoration of proper balance of muscle strength around the shoulder and thorax. In the achilles it is often treated with stretching and eccentric (negative) strengthening and evaluation of the foot alignment and footwear and possible orthotics. In both cases the activity which caused the irritation may have to be modified.

Shirley is a physiotherapist from Alberta with a private clinic in Westmount, Quebec. She has been in practice for 25 years and has traveled with Canadian Teams to the Pan American, Commonwealth, Maccabi and Olympic Games. She has recently returned from the 2002 Commonwealth Games in Manchester, England where she was the head therapist for the Canadian Medical Team. She was also the head therapist for the 2001 Canadian Maccabi Team in Israel.

Doc Talk
By: Dr. Tommy Bacher

We’re off and Running!

Spring is a much-anticipated time of year for all, but the ones who look forward to this season more than most are the runners. For us, year round runners, it’s off with the five layers of clothing, on with the shorts and tees, and plunge into the year’s fitness program. The surge of people running is inevitably accompanied by many injuries which physicians aptly termed overuse injuries: too much, too fast, too soon. These injuries include plantar fasciitis, an inflammation of a tough fibrous band that runs along the sole of the foot from the heel to the toes. Also included are stress fractures, muscle strains, and other areas of tendonitis. Here are a few suggestions to help you make a good safe start to your running season.

1. Make sure your shoes are not worn down. Consult a specialty store for the best advice on new shoes with adequate support.
2. Start with short runs, at a comfortable pace, before you advance to that longer run.
3. Start your runs slowly to warm up your muscles before you pick up the pace.
4. Build up your distance by approximately 10% per week.
5. Drink enough on your runs, especially during long ones in hot weather: drink 150-250cc every 15 minutes, and approximately 500cc. ½ - 1 hour before all long runs.
6. Flexibility is important so remember to warm up, and then stretch. Consider stretching after all runs.
7. Vaseline all areas that may chafe such as groins, underarms and nipples.

These tips are meant to help you run safely and allow you to reach your goals. If you do develop a potential injury, seek help sooner rather later.

Watch our web site for details of the establishment of a Maccabi Running Club in Vancouver.

Happy running! I hope to see you on the road.

Third Run from the Sock
By: Michael Brennan

You’re cruising down a deserted country road in January for a 20-miler when all of a sudden a bright light stabs your periphery. You wonder, could this be another overturned transport truck?? No, not enough wreckage. Could it be aliens here for Scully and Mulder? No, not weird enough. You strain your eyes for a closer look... no, it can’t be them... Sweat beads on your forehead, your hands shake, your pace slows to a crawl... “Why me?” you moan to yourself, “Of all days to be caught by the Hit and Run Golf fashion police.” You’re doomed...

Before I finish the story, I want you to know that this article is the most important thing you’ll read this year. You may be like most smart runners, always ensuring your safety is a priority on winter runs, getting enough fluid even on cold days, running facing traffic on narrow roads, but I wonder if you take into account that most important aspect of running... clothing coordination.

There are the usual things to consider about running clothing, following the ‘layering’ principle, with an inner layer of ‘wicking’ material next to your skin, a middle insulating layer (could be another wicking shirt or fleece vest) and a windproof outer layer, windproof mitts (warmer than gloves), hat, tights or windpants, and balaclava if very blustery (this is not to be confused with Greek baklava which can be very messy around the ears). But what most people don’t consider is how the ensemble is coordinated... Do the brown tights clash with the black socks? Do you have 2 shades of purple that don’t work together? Do you wear blue mitts with a black jacket? Does your hat only match your shoes? Or not match anything? Hit and Run Golf developed a code of clothing ethics for runners a few years ago but since few know about this code, it’s worth sharing. Memorize it so you can share this information with running friends. Nothing perks up a group run like a lively discussion, okay, actually a ribbing, about clothing. Always ensure you’re impeccably coordinated or the Hit and Run Golf fashion police, never mind your running partners, will be on your case.

Things to steer clear of:

• Shorts outside tights. You’ve been running long enough to know it’s the norm to wear tights by themselves, you don’t need to hide your bony butt with 1970 shorts that are three sizes too small.
• Socks that don’t match. Come on, have some pride in yourself. Make sure both have the same stripe along the toe box. And no black socks.
• ‘Reflective’ nosestrips.
• Strings connecting your mitts.
• Cotton briefs. They stay damp too long, get heavy when wet, smell. And they get worse once you start running. The longer you’re out on a winter workout in anything cotton, the faster you’ll chill down. Get modern and comfortable, get synthetic.
• Snowproof running shoes. Heavy and awkward on snow-cleared sidewalks. Also known as ‘snowshoes’. To be innovative you can paint stripes or a swoosh on duck boots.
• Balaclavas or face masks of any kind upon entering banks or convenience stores.

You DO want to be safe on your winter runs so remember these suggestions:

• Wear bright clothing that ensures drivers will see you (they may gag but they’ll see you).
• Run with a friend who’s in bright clothing, you wear your usual stuff and look normal.
• Wear reflective accessories & gear for dark periods... these would either be night/early morning runs or when you’re upset at losing a client, job or VCR directions.
• Carry ID and money. If you time it right between coffee shops, you can get a latte every half hour of your run.
• Let someone know your route. They’re bound to get a good chuckle at the ridiculous route you’ve got planned during the blizzard.
• Keep your hands free, no gadgets in your hands. If you fall, two hands will protect you more, plus you’ll make snowballs faster to toss at rude drivers.
• Take smaller strides across icy patches. If you do find yourself losing balance and wiping out, grab the nearest runner and take them with you. You have a better chance of landing safely on top of them.
• In minus wind chill weather, cover exposed facial skin. Helpful are old Halloween masks, saran, or any indoor track.

The Hit and Run Golf fashion police are especially watchful for clothing & coordination infractions but they also watch for all athletes contravening the above rules. You can help them. If you see an athlete in a hideous outfit, if you spy a runner crossing ice with his hands full of bright, ugly clothes, make an anonymous tip call to 1-800-DUDS FUZ. You’ll be glad you did.

(Michael has never been caught by fashion police in his cow tights.) Now a running coach, Michael was one of the first Toronto runners to dare to wear tights when they came out in 1984. He's still getting over the teasing trauma.

Visit his company at www.marathondynamics.com.

Click here for the archives of previous Health Tips from the Pros articles.