Rachel our new Acupuncturist at Rothery Health is offering free 15 min acupuncture consultations

Glutes is a catch-all term for a series of muscles in the butt, the gluteals. Strong glutes are essential for running your fastest and remaining injury-free.

There are three gluteal muscles: gluteus maximus, gluteus medius, and gluteus minimus. Gluteus maximus is, as its name implies, the largest of the three. It’s the large, rounded muscle that originates from the inner pelvis and sacrum. Your gluteus maximus is what someone is talking about when they tell you that you have a nice butt. The two smaller glute muscles are located on the side of your butt, near and slightly above your hip joint.

Glutes play a key role in good running. The two smaller ones, gluteus medius and gluteus minimus, are abductors, meaning that they move the leg away from the body. Gluteus maximus is responsible for hip extension, or raising your leg behind your thigh and knee behind you after pushing off with your foot.  Good hip extension channels the energy of that leg swing into forward motion. Without good hip extension your stride will never be powerful as it can be, or you’ll never be as fast as you can be.

The other key role of glutes for runners is providing stability for the pelvis and knees. Strong glutes help maintain a neutral base and reduce wasted side-to-side motion. This stability helps you to direct your energy forward, resulting in faster running at the same effort level. Also, when the glutes aren’t working properly, some of the impact forces are transmitted elsewhere down the legs. Weak and/or tight butt muscles have been linked to common injuries such as runner’s knee, iliotibial band syndrome, and Achilles tendinitis.

One challenge for modern runners is that too much sitting can lead to weak and tight butt and hip muscles. Over time, your glutes can lose their ability to fire properly, and your hip flexors, located along the front of your body, can become shortened. Both of these problems can lead to core instability and limited hip extension when you run.

Most runners will benefit greatly from two or three butt-strengthening workouts per week. Speak to your osteopath regarding gluteus medius strengthening exercises if unsure.

Last week Rothery health and Sports injury clinic here in Saundersfoot , West Wales held a bike fitting evening with one ofPembrokeshire’s finest triathletes Dave Francis a World Champion Hawaiian Ironman qualifier & John Rothery the principal Osteopath . This proved to be a fascinating educational evening for everyone who liked riding around on two wheels. Dave who for many years has competed at a high level level on the track and Road was keen to impart his knowledge learnt from his recent training course on bike fitting & injury prevention at the world-renowned NJD centre in Lancashire.
Using cleat adjustments , saddle checks ,bike adjustments & video position analysis Dave demonstrated on a volunteer cyclist how the machine and rider can be perfectly intwined to achieve the best results. During the evening John the principal osteopath at Rothery health also explained how he assessed/screened the rider in order to pick up any abnormalities that may affect the bike fit process which can be critical if not identified.
John also demonstrated some practical warmup and warm down ideas before and after cycling. If you require a bike fit please contact the clinic on 01834 813975 or visit the web site at www.rotherybikefit.com

What are the causes of ITB tendinitis in runners ?

1) HIP FLEXOR IMBALANCE
One biomechanical flaw that will case a increased strain of the Iliotibial Band(ITB) is Hip Flexor imbalance.

Poor Iliopsoas function (a muscle in your hip) will result in a compensatory firing of Tensor Fascia Lata (TFL)which has the ability to assist with hip flexion because of its anatomical lever arm . Over a period of time, the length of the Tensor Fascia Lata will become tighter (hypertonic), which means that the ITB origin is moved AWAY from the insertion.

An underactive Iliopsoas muscle is very common within running athletes who have a tendency to use Rectus Femoris, the main Quadricep muscle, to generate hip flexion, instead of Iliopsoas. This is an extremely common running technique flaw.

The hypertonicity of Tensor Fascia Lata can be effectively treated with targeted soft tissue release.

2) DYNAMIC KNEE VALGUS
The most commonly seen biomechanical flaw in the running population is dynamic knee valgus, a combination of femoral internal rotation with adduction and tibial internal rotation . This will result in the insertion of the Iliotibial Band being moved AWAY from the origin.

Dynamic knee valgus can occur as a result of several muscle imbalances but the most common pattern that we see is a weakness/inhibition of Gluteus Maximus. I feel that Gluteus Maximus is more influential than Gluteus Medius in this presentation as it is a three dimensional single joint muscle, the most powerful external rotator of the hip and the superior fibres contribute significantly to hip abduction. Gluteus Medius contributes by fixing the pelvis relative

3) CONTRALATERAL PELVIC DROP
A highly relevant biomechanical flaw within ITBS is a contralateral pelvic drop. This occurs in single leg stance, with the pelvis dropping down on the non-stance leg relative to the femur in the sagittal plane.

This will result in a subsequent lift of the pelvis on the stance leg, meaning that the origin of the IT Band is being moved AWAY from the insertion. This occurs as a result of a much more specific pattern of muscle imbalance, whereby Gluteus Medius (stance) and Quadratus Lumborum / External Oblique (non-stance) fail to fix the pelvis relative to the femur.

This pattern often results in over-activity within the lateral trunk on the stance limb and can be a significant contributing factor in patients with unilateral spinal pain.

Botox
Botulinum toxin injections, such as Botox and Dysport, are medical treatments that can also be used to help relax facial muscles.
This makes lines and wrinkles, such as crow’s feet and frown lines, less obvious.
They can temporarily alter your appearance without the need for surgery.
When Botox or Dysport injections are used in this way for cosmetic reasons, they are not available on the NHS.
Before you go ahead
If you’re considering Botox or Dysport injections, be certain about why you want to have them.
The injections are expensive, and have their limitations.
Cost: In the UK, botulinum toxin injections cost £150-£350 per session, depending on the amount of product used.
Limitations:
The effect isn’t permanent.
There’s no guarantee the desired effect will be achieved.
The ageing process will still happen elsewhere – for example, Botox will not fix sagging eyelids.
Safety: Take time to find a reputable practitioner who is properly qualified and practises in a clean, safe and appropriate environment. Ask the practitioner what you should do if something were to go wrong.

A

recent study by British journal of SportsMedicine of MRIs of the athletes at Rio 2016 revealed the following…

That aquatic diving had

highest sport-specific rates of spinal pathology, with one positive study per 33 divers (135 divers,

sting of the lumbar spine that a diver must perform while plunging 3–10 m into the water.

Weightlifting had the second highest sport-specific rate of spinal pathology, with one positive case per 63 weightlifters (256 weightlifters, four MRIs). All positive studies seen in weightlifters were of the lumbar spine.With degenerative disc disease and/or moderate to severe canal narrowing were the most common spinal pathologies.

Spinal stenosis can lead to a wide variety of neurological disorders. These pathologies are likely chronic in nature and may be secondary to lifting technique. Adequate precautions by focusing on improved training and lifting techniques should be considered to prevent this type of spinal pathology.

Other sports with notable spinal pathologies include judo (390 athletes) and athletics (2367 athletes). Five of the judo participants, or nearly 1 in 77, and 15 of those in athletics, or 1 in 167, had moderate to severe spinal pathology. Judo involves throwing and striking opponents, which may lead to overuse issues and trauma for the athlete. Athletics involves speed and strength with significant risk of overuse and acute injuries.

Rate and incidence of pathology by age
Athletes over 30 years old had higher rates of moderate to severe spinal pathology on MRI, with 1 athlete per 120 (24 out of 2910) demonstrating moderate to severe spinal disease.

One athlete per 333 (27 out of 7753) between 20 and 29 years of age demonstrated moderate to severe spinal pathology. Only 1 of the 611 athletes under 20 years of age demonstrated moderate to severe spinal pathology. As previous studies have demonstrated, high-level athletes are more commonly affected by disc degeneration than non-athletes

The increased rate with age is likely the result of accumulation and progression of chronic injuries; however, these athletes may be prone to more acute injuries as well.

The lumbar spine was the most frequently imaged portion

of the spine on MRI, accounting for 80 of the 107 spine MRIs. The highest number of positive lumbar spine studies was seen in athletics, with 12 athletes demonstrating disc disease, 2 demonstrating moderate to severe canal narrowing and 4 demonstrating moderate to severe neural foraminal narrowing.

European athletes had more spinal MRIs during the Rio Games than the rest of the world combined. There are likely many factors influencing this disproportionate utilisation of spinal MRI, but most likely it is the result of the medical staff and trainers’ input into who is scanned.

Acute spine pathologies, such as stress reaction oedema and muscle injury, were more commonly seen in female than male athletes. While there is no clear explanation for this predominance, all of these injuries involved the lumbar region, suggesting that chronic pathologies of the lumbar spine may first start as other injuries and progress to degenerative changes.

One question is how elite athletes, such as those participating in the Olympics, can compete at the highest level with the kind of severe spinal pathology seen in our study. A previous study found that athletes with low back pain perceive less impairment compared with non-athletes.

Perhaps, elite athletes have different coping mechanisms for pain to endure the demands of elite competition in which they place their body at risk for acute or overuse injury.

Conclusions

A significant number of athletes demonstrated advanced spinal disease on MRI during the 2016 Summer Olympics in Rio de Janeiro, with approximately 1 athlete per 200 demonstrating moderate to severe spinal pathology. The lumbar spine was the most commonly affected site of disease. Many of the Olympic sports rely on strength, speed, force, bending and twisting. Even with excellent preparation and training, the spine is at risk for moderate to severe injury. The highest rates of spine injury were seen in women and athletes over 30 years old. Recognition of these risks is important, as there should be efforts to avoid the long-term sequelae of spinal pathology. Spine-conscious training, routines and manoeuvres are recommended to prevent the development and progression of these acute and chronic spinal pathologies. Our hope is to better direct injury prevention strategies in future2017;51:1265–71.doi:10.1136/bjsports-2017-097956 Abstract/FREE Full TextGoogle Scholar

3.↵ Junge A , Engebretsen L , Mountjoy ML , et al . Sports injuries during the Summer Olympic Games 2008. Am J Sports Med 2009;37:2165–72.do and illnesses during the Winter Olympic Games 2010. Br J Sports Med 2010;44:772–80.doi:10.1136/bjsm.2010.076992 Abstract/FREE Full TextGoogle Scholar
5.↵ Engebretsen L , Soligard T , Steffen K , et al . Sports injuries and illnesses during the London Summer Olympic Games 2012. Br J Sports Med 2013;47:407–14.doi:10.1136/bjsports-2013-092380 Abstract/FREE Full TextGoogle Scholar
6.↵ Soligard T , Steffen K , Palmer-Green D , et al . Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games. Br J Sports Med 2015;49:441–7.doi:10.1136/bjsports-2014-094538 Abstract/FREE Full TextGoogle Scholar
7.↵ Ong A , Anderson J , Roche J . A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Br J Sports Med 2003;37:263–6.doi:10.1136/bjsm.37.3.263 Abstract/FREE Full TextGoogle Scholar
8.↵ Jenis LG , An HS . Spine update. Lumbar foraminal stenosis. Spine 2000;25:389–94.CrossRefPubMedWeb of ScienceGoogle Scholar
9.↵ Guermazi A , Roemer FW , Robinson P , et al . Imaging of Muscle injuries in sports medicine: sports imaging series. Radiology 2017;282:646–63.doi:10.1148/radiol.2017160267 Google Scholar
10.↵ Pfirrmann CW , Metzdorf A , Zanetti M , et al . Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 2001;26:1873–8.doi:10.1097/00007632-200109010-00011 CrossRefPubMedWeb of ScienceGoogle Scholar
11.↵ Bethapudi S , Budgett R , Engebretsen L , et al . Imaging at London 2012 summer Olympic Games: analysis of demand and distribution of workload. Br J Sports Med 2013;47:850–6.doi:10.1136/bjsports-2013-092345 Abstract/FREE Full TextGoogle Scholar
12.↵ Swärd L , Hellström M , Jacobsson B , et al . Disc degeneration and associated abnormalities of the spine in elite gymnasts. A magnetic resonance imaging study. Spine 1991;16:437–43.CrossRefPubMedWeb of ScienceGoogle Scholar
13.↵ Heidari J , Mierswa T , Hasenbring M , et al . Low back pain in athletes and non-athletes: a group comparison of basic pain parameters and impact on sports activity. Sport Sci Health 2016;12:297–306.doi:10.1007/s11332-016-0288-7 Google Scholar
View Abstract
Footnotes

Provenance and peer review Not commissioned; externally peer reviewed.

Data sharing statement Our study and intent to publish the data were approved by the IOC (R2C10).

Competing interests AG is the president of Boston Imaging Core Lab (BICL) and a consultant to Merck Serono, AstraZeneca, Pfizer, GE Healthcare, OrthoTrophix, Sanofi and TissueGene. FWR, AZM and MDC are shareholders of BICL. LE is a consultant to Arthrex and Smith & Nephew. DH, MAK, MSW and MJ have nothing to disclose.

Ethics approval This study obtained ethical approval from Medical Research Ethics Committee of the South-Eastern Norway Regional Health Authority (2011/388) and from Boston University (IRB no: H-36593).

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A recent study by British journal of SportsMedicine of MRIs of the athletes at Rio 2016 revealed the following…

That aquatic diving had the highest sport-specific rates of spinal pathology, with one positive study per 33 divers (135 divers,

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