THE PROBLEMS WITH THE CLAM EXERCISE: an emphasis on Greater Trochanteric Pain Syndrome 2018 Update

Tanya Bell‐Jenje (MSc physio)

Part 1:

Traditionally, the Clam exercise & the Figure 4 are used to strengthen the hip muscles (Glute Medius, Minimus & Maximus) in order to improve hip control. They are often used as an early stage of rehabilitation after hip surgery to facilitate control around the femero‐acetabular region. The theory is that the external rotation moment assists in strengthening the gluteal muscles & posterior rotators of the hip.

Hot under the collar

Visualise a cyclist crashing and you’re bound to picture an outstretched arm
trying to cushion the blow. The shock from the impact travels up the arm to the collarbone strut. No wonder then, that fractures to the clavicle or injuries to the acromioclavicular joint (ACJ) and the surrounding ligaments are among the most common traumas seen in cyclists.

Don’t back down

Cyclists are vulnerable to lower back pain, but you can protect yourself by working on your core strength. The flexed posture that cyclists have to sustain, while pumping their legs through the down and upstroke, results in progressive overload of the lumbar discs, facets and ligaments, as well as fatigue of the back muscles. All of this causes lower back pain – a common complaint in riders.

Are you a heavy breather?

When you are riding at pace, are you breathless and wheezing like a fish out of
water? Do you suffer from back or neck pain or both? Read on to find out why. First we need to understand the role of the diaphragm in breathing, core stability and as a source of pain. Practitioners often ignore diaphragmatic bracing or splinting, or misdiagnose it as exercise-induced asthma when the cyclist complains of back pain or shortness of breath during intense exercise.

Your ankles matter

In recent years, a wealth of valuable research has been done into
hip biomechanics. It is well known that the weakness of certain hip
muscles, particularly the hip extensors, abductors and lateral rotators
(such as Gluteus Maximus and Medius), and the tightness of other
hip muscles, especially the hip flexors, adductors and medial rotators,
predispose us to poor lower limb alignment, resulting in torsion at
the hip, knee and ankle during loading. More detailed discussions
of tensor fasciae latae/ITB issues appeared in the July and August
editions of Ride.

Why is cycling such a pain in the neck?

Studies show that 45 per cent of cyclists suffer from chronic neck pain,
which is often worse after a ride (Wilber et al, 1995). Many complain of bilateral
upper trapezius (shoulder) pain after cycling for more than 20 minutes and the
resulting headache is often compared to a hangover. Traditional neck stretches don’t seem to help, so read on to understand the biomechanical causes of neck overload and to learn some exercises to correct the aggravating muscle imbalances.

Cross-training is essential to improve performance

So often you’ll read that spending time in the saddle gives you well shaped and toned buttocks. Alas, this couldn’t be further from the truth. For riders who put in extra hours of riding per week, but neglect to train off the bike, the net result can be a weak core, persistent pelvic girdle pain and a visibly wasted butt!
One study found that whereas normal humans could hold a static gluteal contraction (hip extension) for 35 seconds, a competitive cyclist could only sustain the same contraction for 5 seconds – that’s a potential weakness of 85% compared to a non-cyclist! Read further to understand how this happens and why cross-training is essential to improve performance, decrease pain and tone that ass.

The Iliotibial Band Syndrome Debate: What it is and how to fix it

‘ITBS’ or Iliotibial Band Syndrome is described as a severe sharp or stabbing pain on the outside of the knee; worst at about 30 degrees of knee flexion. It was first thought that ITB syndrome was aggravated in sportsmen by the flexion and extension of the knee during downhill running, or in cycling, especially when the saddle was too high. It was proposed that this repetitive bending of the knee caused excessive friction between the iliotibial tract and the lateral femoral epicondyle on the outside of the knee, inflaming the tract.

Secretly strengthening your child’s core: Fun with the physio Ball

As adults, most of us have heard of the ‘core’’ or stabilising muscles of the trunk. They are vital to assist in trunk stability, and joint control. The muscles of this ‘abdominal canister’ co‐contract to produce and control intra‐abdominal pressure and assist in stability and load transfer across the lumbo‐pelvic area. These muscles, or ‘core’’, atrophy, or weaken, due to pain and/or sustained postural dysfunction (eg slump sitting).

Correcting Faulty Biomechanics in the Growing Child

So often we hear parents bemoaning their child’s posture. “Stand up straight”, “Get your shoulders back”; “stop stooping”; “stand upright” and so on. Parents, quite rightly, blame the advent of television, Playstation, Blackberry’s and the like. “In our day we used to ride our bikes and play outside”. Also accurate,but in today’s world of ever advancing information technology, coupled with increases in traffic and crime, opportunities to allow our children to run amok in safety are few & far between. As we are unable to fight the technological advances, we need to optimise our child’s potential by ensuring correct biomechanics,
so that time spent exercising is well utilised.

Tendinopathy Pathogenesis, Diagnosis & Rehabilitation

A Tendon injury is known as a tendinopathy (NOT tendinitis). It is a non-inflammatory degenerative condition,most commonly due to too much loading. Histologically (at cellular levels) it is associated with changes in the collagen bundles, the tenocytes & the ground substance (proteoglycans, aggrecan & decorin). The end stage is when the disroganised infiltration of new blood vessels into the holes of disrupted matrix is seen. This increased vascularity is not helping to heal, only to fill the holes.
The Achilles is the only tendon that can have a midportion tendinopathy. All other tendinopathies are at the tendon attachment to the bone.

Gluteus Medius facilitation using Kinesio Taping in the Treatment of Chronic Iliotibial Band Syndrome

Objective: To determine whether Kinesio Taping (KT) can effectively facilitate Gluteus Medius (GM) and if KT of the GM is effective in the management of a runner with chronic Iliotibial band syndrome (ITBS).
Background: ITBS is one of the leading overuse injuries in runners. Despite its
prevalence, few biomechanical studies have been done and little is known about its aetiology. Poor hip biomechanics and specifically GM muscle weakness is thought to contribute to the development of ITBS. KT is a specialized tape developed in Japan andhas been claimed to facilitate muscle activation.

The ‘Sway Back’ Posture: Identification, correction and its effect on injuries and sports performance

Posture and Postural Types are a source of constant debate, with some authors saying there is no relationship between abnormal posture and pain and dysfunction. Others, however (Kendall, 1992; Sahrmann 2002), have addressed & identified postural dysfunctions and how these change loading on weightbearing joints and affect the biomechanics and kinematics of the adolescent and active individual.

Tennis Elbow – Best Management in 2017

Tennis Elbow (or Lateral Elbow pain) is one of the most common overload injuries that we see in the over 35’s. It is characterized by pain on the outside of the elbow, usually near the prominent bone where the tendon attaches, aggravated by gripping or wringing activities. This report summarises some of the common causes, presentations, treatment myths as well as best current treatment Tips and Tricks as at 2017!