"ITFC has often sought the advice of Ian Sadler for players suffering foot pain or with problems, such as knee and back pain, resulting from the way they walk or run. I have found the assessment Ian provides extremely thorough and have been very satisfied with the treatment provided. The assessment, diagnosis and treatment have greatly improved the speed of recovery and rehabilitation for players".
Matt Byard - Head Physiotherapist Ipswich Town Football Club (ITFC)
How do muscle, bones, ligaments , tendons etc work?
Tissue Deformation Graph
When human tissue (for example a muscle or tendon) is subject to a loading force (known as stress), from standing, walking or running, they deform, either stretching or compressing (known as strain). The relationship between stress and strain is referred to as the deformation curve when displayed graphically (see right). For the cells that create your tissue to be replaced effectively they must be placed under the correct stress’ (elastic region on the graph below (1)), the greater the frequency of the correct stress the more efficient the cell’s metabolic processes, the healthier the cell.
Your tissue has some active cells and some that are at rest. These resting cells, once repaired, then become active cells. In this way the tissues of a structure, for example the achilles tendon, are continually slightly damaged causing the stimulation of new cells which are better able to cope with the stresses that are placed on them. This is also how muscle and other soft tissue grows as we develop, or as you build muscle.
Therefore, normal activity like standing, walking, running for a bus or even sport should take place within the elastic region. This means that when you go for a walk your tissues are placed through stress to deform them and when not being used they return to their original size and shape. This process is essential for your feet legs and back to function correctly, pain free and to recover form injury.
Why do my flat feet, high arches, knock knees, posture or even bunions cause my pain?
If you have poor biomechanics, for example flat feet or knock knees, your movements place uneven stress on different tissues. If, for example, you have anterior knee pain (pain in the front or inside of your knee), you have a knee position that places too much stress on the front of your knee and the tissues there will be put through stresses that are too great for them to deal with, especially on activities like walking up stairs or playing football.
If your body’s tissues are placed through repetitive or high stresses they operate in the microfailure zone (zone 3 on the deformation graph) resulting in the wrong cells being produced and breakdown of existing cells. This is when you experience a ‘niggling pain’ which may then lead on to permanent deformation of the tissue where it becomes ‘plastic’ and does not return to its original shape (zone 4 on the deformation graph). In this plastic region cell metabolism is inhibited meaning that resting cells are no longer repaired.
Again, using our example of the Achilles tendon you would experience niggling pain in your Achilles tendon as the cells became over stressed and damaged (Achilles Tendinopathy) and then a nodule would form, which consists of none active cells and is less flexible (more plastic) than the rest of your Achilles tendon.
How does my body recover from these injuries?
The old adage of ‘rest and recuperation’ being ‘necessary for your body’s tissue to recover’ is always a good starting point. However this is not always easy as you need to keep using your feet and legs all day to walk around or even drive the car.
Your body will go through inflammation, this is necessary to heal and will last several days. Treatments such as ice therapy will help control the inflammation (swelling) and stop it becoming excessive.
Once the initial inflammation period is controlled your body will start laying down new tissue. The fibres in the new tissue must be aligned correctly to ensure correct function and prevent adhesions and scaring of the tissue. They therefore must be placed under the correct stresses so the adaptive mechanism of recovering damaged cells can take place.
How can I help my body heal?
Your body must operate within its normal or elastic stress : strain ratio. To help your repairing tissues lay down new fibres correctly your body must go through appropriate exercises, stretching and strengthening, and may be helped by techniques such as mobilisation and manipulation of your joints.
Orthotics are often essential for the recovery of your injury; by stopping the damaging movement and allowing your soft tissue to operate in the correct manner while laying down repairing fibres. They will also prevent you for future damage by stopping your tissue from going into the plastic phase so it can operate normally.
Again, using the example of the Achilles tendon; pronation and having flat feet often results in abnormal stresses through the Achilles as it is twisted by the rolling out of your heel bone (Calcaneious). An orthotic would reduce the pronation and realign the Achilles tendon, therefore placing the tissue back into the elastic region and allowing normal healing processes to occur. Without this support the cells would be laid down in the wrong direction and disproportionately, leading to long term weakness in your Achilles tendon and continual niggling Achilles Tendinopathy.
Am I at greater risk if I play sport or run?
To get used to your sporting activity you will have to put your body under stress. As long as these stresses are in the elastic region your body will build new and stronger cells in the tissues used for your activity. If you overtrain, overload or otherwise stress your body too quickly, particularly after a period of injury, your cells will go into the microfailure zone (3) as they are not yet ready for the strain. Another old adage of ‘use it or lose it’ seems applicable here, as if you stop your activity, even for a short time you will start to loose resilience within your tissues.
Has my age got anything to do with my pain?
Unfortunately as we age the repair mechanism of your tissues slows down meaning it is easier for your cells to enter the microfailure and plastic phase. However with appropriate ‘building up exercises’ and correct footwear and orthoses the load can be reduced, keeping your tissues in the elastic phase so the cells can rest as they repair.
