Recurrent shoulder injuries in athletes can often be troublesome and difficult to treat. To date there is no consensus on specific return to play tests for the shoulder that indicate return to sport will be successful and not result in re-injury. This often creates a dilemma for physiotherapist as some guess work is often required when considering whether the athlete can return to sport. That being said, many athletes do fully recover from recurrent shoulder injuries but not always as quickly as they would have liked. Interestingly, it is what injured athletes have been doing with other parts of the body during rehabilitation which has given us insight into how important muscle strength and balance is in the rest of the body for the shoulder to perform at its best. 

Boxing for fitness has become a popular exercise in the active community however like any new activity the body will take time to adapt, so how can we protect ourselves from becoming injured? 

 

Common hand injuries seen in boxers often affect the knuckles, the thumb or the carpo-metacarpal joints (joints in the hand where the long bones of the hand (metacarpals) join with the smaller bones of the wrist/hand (carpals)). Stability of the wrist and hand during impact plays an essential part in injury prevention. 

Pronation (the movement of the rear foot inwards) is a naturally occurring movement that happens in the foot when we are walking or running. It allows weight to be transferred from the outside of the heel (contact phase of stance) to the inside of the foot and big toe before our foot leaves the ground (end phase of stance or toe off). Some of us naturally stand with our heels in a pronated position and are advised to buy shoes which have anti-pronation to correct this position and protect ourselves from injury, however there is little evidence to suggest that a shoe can provide significant protection from injury. Like any movement the risk of injury to soft tissue is greater when the movement is poorly controlled and pronation is no exception. 

Hip extension or the ability to move your thigh in a backward direction towards or behind your body is an important component of running which is sometimes under-utilised. 

 

Good extension of the hip optimises your propulsion angle (angle that you leave the ground and enter the flight phase of running), and allows the achilles (tendon at the back of your leg) and plantar fascia (ligament that runs underneath your foot) to store more energy while your foot is in contact with the ground which can then be used as kinetic energy to push you up into the air. 

Osteoarthritis or joint degeneration are often words that provoke fear of movement and a reluctance to participate in physical activity. However in most cases avoiding activity is the wrong thing to do. 

 

There are different grades of Osteoarthritis and in some cases surgery to replace a joint is required, however for the majority of people with degenerative changes in joints exercise and activity is likely to be beneficial and helpful in reducing discomfort 

Over stride in runners occurs when the foot (usually heel) strikes the ground a reasonable distance away from the body’s centre of gravity, increasing leverage between ground force and the centre of the body. 

 

 

Common observations made when a runner is over striding are heel strike away from the body with increased upward flexion of the ankle and landing with a straighter knee. These positions if repeated can cause anterior shin or knee and foot pain and increased strain on the hamstring tendon attachments at hip or knee. 

Over the last few years there has been quite a lot of debate about running styles or whether we should run with a shoe that provides maximal or minimal support to prevent running injury. Although characteristic of running style or running shoe may have some influence on injury the majority of non-traumatic running injuries that I see in clinic are predominantly due to excessive increases of running load (run distance/time) or a lack of consistency of running load. 

 

Examples of these presentations could be a client who is training for a marathon and has got behind with their training programme, then suddenly increases their weekly mileage; or a regular 3-4 day a week runner not training for 2-3 weeks and then returning to their previous running schedule. 

When stride width is narrow the foot lands more centrally to the hip joint which increases the forces required for the hip muscles to control movement of the pelvis and lower leg. Increasing stretching forces of tissue on the outside of the leg and compressive forces on the inside of a leg. Some of the common problems we see in clinic if the soft tissue of the body is unable to cope with the forces associated with narrow stride width are lateral thigh/knee pain, ITB syndrome or medial tibial stress syndrome (shin splints).