Hi Jeremy
I’m trying to improve your profile:
Please answer the “City News” magazine questions below regarding your experiences as a Multi-Sport Racer; recovery routine and your next mission.........

• Where in the world are you at the moment?
Canberra – Australia’s great bush capital

• What’s your most memorable sporting moment? That you’ve achieved personally!
I would have to say winning the Noosa Triathlon All Age group category in 1996. I had not raced an Olympic distance Triathlon before so I had no expectations, but I had done a full pre-season of training in Ballarat’s infamous winter – sort of like Canberra just wetter!! Everything went to plan on race day and I had such a lead after the bike leg that I had a chance to back-off of the pace over the last three kilometres and enjoy the crowds and the moment. I still hold the All Age group race record 11 years later.

Even though, Noosa was my most memorable sporting moment, the most satisfying was a simple triathlon outside Albury after recovering from a bad LisFranc Fracture of my right foot. I was told by the surgeon that running after this type of injury would be difficult. Subsequently, it took over ten months surgery and rehab to learn to jog again. At my first triathlon after rehab I remember arriving at the end of the bike leg feeling so nervous but excited. Soon I was running – not fast – but running. It felt awesome to be competing and running again.

• What is your next goal for 2007/08 season?
To have a solid race at the Australian multi-sport Championships in Freycinet, Tasmania, and finish in the top three at the Lorne Multi-sport race.

• How many km’s would you do per week (types of sessions)?
I don’t go by kilometres, only time. Run – 5hrs, Swim – 2hrs, Ride (MTB & Road) 12hrs, Paddle – 4-5hrs.

• How do you best recover? Stretch, spa, recovery jog, thoracic rack, etc
I eat, eat, eat and eat. I’m a big believer that your body cannot recover without plenty of food and fluid. Your body needs the fuel to repair itself, and also for energy for the next day of training. I believe sleep is important as well. When I can, I’ll try and get a deep muscle massage once a fortnight, and I stretch a lot in front of the TV.

• Who motivates you?
My wife Meg is a great motivator, but a lot of other people inspire me as well - all for different reasons. Some of my best mates are remarkable athletes and I get a lot of inspiration from them. I respect anyone who puts in an honest 100%, and that’s enough to inspire me to do the same.

• What motivational advice would you give “the everyday pleb”?
Well I’m an ‘everyday pleb’ who just puts in 100%. I like to think that consistency is one of the key factors to success. It is amazing what you can achieve - in anything - if you work at it in a systematic, and consistent way.

• Your favourite saying:…..?
“Never give up, and never give in”

Yours in Sport!

Kirra Rankin
Krankin Co-Director
Rehabilitation Exercise Physiologist (AAESS)
Level II Middle Distance Coach
Pilates Instructor
Soft Tissue Therapist

The Achilles is the tendon that attaches the soleus (deep calf muscle) and the gastrocnemius (superficial calf muscle) to the Calcaneous (heal bone).  It is a thick, cylindrical, easily palpated tendon just above your heal bone.  If you palpate the tendon inferiorly (towards the foot), you will notice the tendon blending into the Calcaneous (heal bone) to the point where it is difficult to tell what is tendon and what is bone.  If you palpate superiorly (upward) you will notice the tendon grows thick and flat as it becomes musculotendonis (the transition from tendon to muscle).  Eventually the tendon disappears and the only tissue you will be palpating is the superficial calf – gastrocnemius.

The purpose of any tendon is two fold, each having a nuance of course.  The first is to transmit force developed by the attached muscle contraction to enable movement (the two ends of the muscle coming closer together).  For the Achilles, this is when the soleus and gastrocnemius concentrically contract (when a muscle shortens via contraction).  This contraction causes the heal to become closer the back of the knee (or toe pointing) as in the exercise heal raises. There is also a mild action to bend the knee via the gastrocnemius (as the gastroc attached above the knee).  The other mechanism is to bare load when a muscle is forced to lengthen.  For the Achilles this is when the foot hits the ground when running (or walking) and the calf muscles eccentrically contract (lengthen as they contract) to soften the heal strike and control movement of the lower leg just after the heal hits the ground.

So what goes wrong with the Achilles?  Most runners will have experienced some sort of pain associated with their Achilles.  More often than not it will be an acute episode of inflammation (swelling with inflammatory cells) that occurs due to tissue damage about the Achilles.  It is usually associated with (but not limited to) a palpable nodule on the Achilles that is very sensitive, stiffness initially in the morning but warms up as you become active and pain to hop.  Hill running will be very difficult.  If treated with (but not limited to) rest, anti-inflammatories, ice and treatment (assessment of possible causes and treatment of these), you will recover.  If you ignore the pain, the problem can become chronic.  The inflammation will disappear but the Achilles will become degenerative (the Achilles tissue will break down).  This can lead to the Achilles becoming very thickened and the calf muscles will become very weak.

So what causes this?  There are numerous causes for Achilles pain.  Start looking at the very obvious.  Has your training load increased?  Do you have very old shoes that have worn?  Brand new shoes?  Camber running or excessive hill running?  Has your dorsiflexion range of motion decreased?  Have you changed your type of training (track running, flats instead of joggers, spikes, plyometrics are all examples of what often cause acute onset Achilles pain).  You can often self assess and figure out what is causing your pain.  Change these immediately.  If you can’t see anything obvious then make a visit to your health practitioner.

What can you do?  For acute onset of Achilles pain, try to assess what has caused your pain and change that immediately.  For the Achilles itself, ice the affected area, put a heal raise in your shoe for a few days to take the load off the Achilles, cross train and gently mobilise the Achilles.  How to mobilise? 

Pincer grip (grip with forefinger and thumb) just below and just above the nodule on the Achilles, or at least the most painful portion, and bend the Achilles back and forward.  Do this for a couple of minutes at a time, three to four times a day.  This will often decrease the amount of pain felt when hopping and walking and promote recovery. 

For chronic Achilles pain, eccentric calf exercises are the most important part of treatment.  The concept is to put load through the Achilles (which is now devoid of inflammation and becoming degenerative), to create a healing inflammatory response, and more healthy connective tissue will be laid down to heal the tendon.  How to do this?  Stand on a step, heal raise on both legs, now with your body weight on the painful side, slowly allow your heel to drop below the step height, and repeat.  For a hypothetical set, try three sets of six to begin with.  Be prepared for the Achilles to initially become more painful.  This will subside and slowly the Achilles will become less painful and your typical signs and symptoms will decrease.  By all means, please consult your health practitioner if you need direction.

To prevent Achilles pain, be careful with major changes to your training method and load.  Also, do preventative exercises as suggested above, including Achilles mobilisation.

Happy running.

Further anatomical considerations
The origins of these three muscles are quite diverse.  Anterior (in front of) to the hip, originating from the anterior superior iliac spine (boney prominence at the front of the hip) is the sartorius.  Deep in the adductor (groin) region, originating from the inferior ramus of the pubis, is the Gracilis.  And the Semitendinosus is one of the hamstring muscles and originates from the Ischial Tuberosity (the ‘sit bone’ or the boney prominence at the base of your buttocks).  All three muscles are superficial and can be palpated easily although the Gracilis is quite difficult to identify as it is quite thin. 
Importantly, there is a bursa lying underneath the three tendons as they attach into the tibia.  Bursa are fluid filled sacks that can be found all over the body and are there to protect against two unyielding tissues frictioning on each other and causing tissue damage.  In this case the two surfaces are the three tendons (as they traverse over the medial tibia) and the boney surface of the tibia itself.

Function
As a group the sartorius, gracilis, and semitendinosus muscles are primary flexors of the knee. These 3 muscles also influence internal rotation of the tibia and protect the knee against rotary and valgus stress.
The individual function of the these three muscles is quite diverse.  In brief, the sartorius which has a nick name of the ‘tailors muscle’ acts to hip flex (bring knee towards thorax) and laterally rotate (rotate the thigh outwards) the hip, as well as flex the knee (bend the knee) and laterally rotate the tibia (outwardly rotate the lower leg).  It was called the ‘tailors muscle’ as this was the position tailors would sit in to sew.
The Gracilis is one of the long adductor group and is thought to adduct (bring towards the midline) the thigh as well as flex the thigh.
The Semitendinosus being one of the hamstring group helps extends the thigh as well as being a stabiliser of the medial thigh.

Pathologies/Injury
The Pes Anserenus is not a commonly discussed area unless there is pathology to the area.  The most common injury is to the bursa that lies under the tendons and over the tibia.  What is assumed to occur is that the friction between the tendons and the tibia becomes too much for the bursal tissue to handle and it fails and becomes inflamed.  The result is a painful, aching sensation that is sometimes red, hot and swollen (inflamed) but not always.  Running becomes painful and pain only subsides when you stop.  Rubbing the area will further inflame the area as you will be further irritating the bursal tissue.

Treatment
Depending on the severity of the bursitis, you may have to decrease or stop running for a brief to extended time to allow the bursa to settle.  Because the bursa in this area is quite superficial, topical anti-inflammatories may help.  Simply place a large dobble of gel over the painful site (don’t rub it in or you risk further irritating the bursa) and put glad wrap over the area to keep it on the focal area and off your bed sheets.  Sleep in this over night for a couple of nights.
Before diving into stretching it would be best to consult your Health Practioner.  Stretching may further compress the tendons over the angry bursa and exacerbate the problem.  Figuring out why these three tendons are creating excessive friction is necessary to objectively treat this condition.  It quite simply might be one or all three of these muscles become tight and shortened or it could be a more complex pelvis issue that your Practioner can assess and treat.

Self Treatment
Instead of stretching these muscles and risking further irritating the bursa, try self massage to these three muscles.  Use some form of cream, sorbelene for example and slowly glide your thumbs or fingers along these muscles.  Identifying them may be a bit tricky so either consult someone to help you out or go for the global approach and work the surrounding area, as close to these muscles as possible, spending time on what you palpate as tight.  Alleviating this muscular tightness may help reduce the load on the bursa that is inflamed but keep in mind that once a bursa is angry, they tend to take a while to settle down.  And note, if self massage to these muscles makes things worse, stop and consult your Health Practioner.
Cortisone may be an option for persistent Pes Anserenus bursitis.  Clinically this type of cortisone injection shows excellent results but of course; try your conservative treatment first.

Summary
Your Pes Anserenus is the attachment of three thigh muscles that traverse from the pelvis to the medial lower knee.  The bursa that stops over frictioning of the tendons over the tibia may become inflamed if the friction is excessive.  Sort advice before stretching but certainly self massage the muscles involved.

Happy running.

The Achilles is the tendon that attaches the soleus (deep calf muscle) and the gastrocnemius (superficial calf muscle) to the Calcaneous (heal bone).  It is a thick, cylindrical, easily palpated tendon just above your heal bone.  If you palpate the tendon inferiorly (towards the foot), you will notice the tendon blending into the Calcaneous (heal bone) to the point where it is difficult to tell what is tendon and what is bone.  If you palpate superiorly (upward) you will notice the tendon grows thick and flat as it becomes musculotendonis (the transition from tendon to muscle).  Eventually the tendon disappears and the only tissue you will be palpating is the superficial calf – gastrocnemius.

The purpose of any tendon is two fold, each having a nuance of course.  The first is to transmit force developed by the attached muscle contraction to enable movement (the two ends of the muscle coming closer together).  For the Achilles, this is when the soleus and gastrocnemius concentrically contract (when a muscle shortens via contraction).  This contraction causes the heal to become closer the back of the knee (or toe pointing) as in the exercise heal raises. There is also a mild action to bend the knee via the gastrocnemius (as the gastroc attached above the knee).  The other mechanism is to bare load when a muscle is forced to lengthen.  For the Achilles this is when the foot hits the ground when running (or walking) and the calf muscles eccentrically contract (lengthen as they contract) to soften the heal strike and control movement of the lower leg just after the heal hits the ground.

So what goes wrong with the Achilles?  Most runners will have experienced some sort of pain associated with their Achilles.  More often than not it will be an acute episode of inflammation (swelling with inflammatory cells) that occurs due to tissue damage about the Achilles.  It is usually associated with (but not limited to) a palpable nodule on the Achilles that is very sensitive, stiffness initially in the morning but warms up as you become active and pain to hop.  Hill running will be very difficult.  If treated with (but not limited to) rest, anti-inflammatories, ice and treatment (assessment of possible causes and treatment of these), you will recover.  If you ignore the pain, the problem can become chronic.  The inflammation will disappear but the Achilles will become degenerative (the Achilles tissue will break down).  This can lead to the Achilles becoming very thickened and the calf muscles will become very weak.

So what causes this?  There are numerous causes for Achilles pain.  Start looking at the very obvious.  Has your training load increased?  Do you have very old shoes that have worn?  Brand new shoes?  Camber running or excessive hill running?  Has your dorsiflexion range of motion decreased?  Have you changed your type of training (track running, flats instead of joggers, spikes, plyometrics are all examples of what often cause acute onset Achilles pain).  You can often self assess and figure out what is causing your pain.  Change these immediately.  If you can’t see anything obvious then make a visit to your health practitioner.

What can you do?  For acute onset of Achilles pain, try to assess what has caused your pain and change that immediately.  For the Achilles itself, ice the affected area, put a heal raise in your shoe for a few days to take the load off the Achilles, cross train and gently mobilise the Achilles.  How to mobilise?  Pincer grip (grip with forefinger and thumb) just below and just above the nodule on the Achilles, or at least the most painful portion, and bend the Achilles back and forward.  Do this for a couple of minutes at a time, three to four times a day.  This will often decrease the amount of pain felt when hopping and walking and promote recovery. 

For chronic Achilles pain, eccentric calf exercises are the most important part of treatment.  The concept is to put load through the Achilles (which is now devoid of inflammation and becoming degenerative), cause a healing inflammatory response, and more healthy connective tissue will be laid down to heal the tendon.  How to do this?  Stand on a step, heal raise on both legs, now with your body weight on the painful side, slowly allow your heal to drop below the step height, and repeat.  For a hypothetical set, try three sets of six to begin with.  Be prepared for the Achilles to initially become more painful.  This will subside and slowly the Achilles will become less painful and your typical signs and symptoms will decrease.  By all means, please consult your health practitioner if you need direction.

To prevent Achilles pain, be careful with major changes to your training method and load.  Also, do preventative exercises as suggested above, including Achilles mobilisation.

Happy running.

Yours in Sport!

Kirra Rankin
Rehabilitation Exercise Physiologist (AAESS)
Level II Middle Distance Athletics Coach
Pilates Instructor
Soft Tissue Therapist

I probably could have started this race report before the race as the result was inevitable for me. An X-ray and CT scan upon returning from the World Championships confirmed an unfortunate fracture in my little toe joint from the crash I sustained in Hamburg. The insignificant little crash in transition from swim to bike that caused me to pull out on the run leg will mean I’m not able to run for about 4 weeks. The good news is that the joint isn’t displaced and should heal quickly and smoothly. Also, I can swim and ride with minimal discomfort and threat of delaying the recovery process.

With the ability to do two out of three legs it was decided that I should still travel to Beijing on a reconnaissance mission. There is no better way to get a feel for the course and the way the race is likely to pan out in 2008 other than by seeing it from the inside. It’s never easy starting a race knowing you are not going to finish, but my job there was very clear and I was determined to do it as professionally as possible.

The course and protocols expected in 2008 were applied and perhaps the only thing missing was the oppressive heat and humidity. The constant, thick smog cloud was still clinging to the course as it does to the entire city, but generally the conditions were ideal for the men’s race on Sunday morning. Many countries were using the event as a selection race for their individual teams and this would impact fairly dramatically on the way the race was played out.

85 men leapt from the pontoon into the Chang Ping reservoir (1-3hrs from the city centre depending on traffic) with a very smooth 565m straight line to the first buoy. The 1-lap course certainly makes it a much fairer and slightly less brutal swim than a 2-lap course and the field was fairly evenly matched throughout the 1500m. Through transition a large group of 25 formed a small break onto the first of 6 laps.

The bike leg is very exciting as it immediately takes you along the dam wall in front of thousands of spectators in the natural amphitheatre and down the spill-way onto the main loop. After a fast and sharp left-hand bend the course then makes a significant climb before a sharp decent, followed by a gradual decline that the charged along at over 60km/h each time through. It took a little over a lap for the chase pack I was in to reel in the early leaders, but the pace remained high for the rest of the ride. Unusually, athletes from different countries were more intent on marking their countrymen than they were about specifically winning the race. Any break-away attempts were fairly quickly shut down and everyone seemed content to try and run for their place on their respective Olympic Teams. As such it was a massive bunch that charged off the bike into T2 and out onto the 1st of the 4 lap 10km run. This was the end of my race for the day, I pulled to the side as we came to the end of the bike leg and handed in my chip to the officials and found a vantage point in the stands to watch the run played out by the rest of the competitors.

Current World Number 1 Javier Gomez from Spain took revenge on his 2nd place at World’s and showed why he had the Number 1 on his arms for the day. He tore to an early lead and never looked back. The lead swelled to about 40secs over the chasing pack before he backed off on the final lap to cruise to an impressive victory. All the action was going on behind him as athletes fought for every position to try and satisfy their different selection criteria. Australia’s Courtney Atkinson managed to hold off the 2 Kiwi’s Beven Docherty and Kris Gemmel for 2nd place and Simon Whitfield from Canada rolled in 5th place. The rest of the field filed in close behind as they sprinted for every single position.

I’m on my way back to Australia now with 4 weeks until my next set of races. While my toe tries to heal back together I’ll be in for a few big weeks of swimming and biking to prepare for 3 non-drafting races in Dallas, Bermuda and Noosa as well as the XTerra World Championships in Maui.

Simon Thomo

Simon Thompson
Australian Professional Triathlete
http://www.simonthompson.com.au

PO Box 547
Dickson ACT 2602
Australia
simon.thomo@bigpond.com
+61 (0)408862366 m

The Plantaris is a muscle that attaches on the posterior aspect of your femur (upper leg bone) just above the back of your knee on the lateral side (outside).  This muscle has a very small muscle belly in comparison to its incredibly long tendon.  The muscle belly runs from approximately just above the posterior knee crease for about 4-6 cm inferiorly before becoming a tendon.  The tendon then runs medially (on the inside) of your calf, sitting on top of your soleus (deep calf muscle) and underneath your gastrocnemius (superficial calf muscle).  The tendon continues to run down the inside of your calf.  It eventually becomes more superficial (the gastrocnemius doesn’t hide it anymore) and can be palpated on the inside of your calf.  At the level of your calf where you Achilles becomes evident, the Plantaris tendon runs along side, just medially to your Achilles.  The tendon can be easily palpated on some people but not all.  The tendon then continues down along side your Achilles, often feeling like the same tendon, before inserting into the Calcaneous (heal bone) next to the Achilles or with the Achilles.

This muscle has lost its importance as humans have evolved.  In Apes in continues to the toes and is important in tree climbing and mobility.  Its function is so insignificant that it can be harvested for surgical replacement of damaged tendon elsewhere, with little to no loss of complete function of the knee and ankle.  In a recently published study, it was found that 3% of those people viewed didn’t even have a Plantaris tendon.

So why discuss it?  Because it has the ability to cause pain in runners.

The Plantaris muscle, although relatively useless, can be torn or ruptured.  You may feel a whip-like sting in the calf while pushing off with that leg, or when accelerating.  There may be a ‘snap’ heard at the time of injury.  There will be consistent calf pain associated with swelling.  The function of the foot and ankle will remain in tact however.  This type of injury can be very difficult to assess.  It is often misdiagnosed for Achilles tears and an MRI of the area is still not 100% accurate.  Hence, keep it in mind when the standard symptoms of treatment for an Achilles tear/rupture doesn’t seem to be working.

Secondly, the tendon as it runs along side your Achilles can inflame.  This will give vague aching pain along side the medial side of your Achilles and sometimes into the insertion onto the Calcaneous.  Again, this is unusual and difficult to assess.  Hence, when standard assessment and treatment is not working for you, think Plantaris.  Go and visit your local Sports Physician or Sports Doctor and see what they think.

How to treat it yourself?  If the area seems inflamed to you then treat it as such.  Icing after exercise.  Anti-inflammatories that can be obtained from your local chemist – please consult your medical practitioner if you are at all apprehensive about side affects.  Functional rest – get into the pool (yes, that ugly word,…the pool) and cross train for a small period to allow some rest and recovery.  Don’t push off anything too quickly or accelerate to quickly.  Be careful of stairs.

Soft Tissue work to the muscle belly itself will help.  The difficulty is having enough anatomical knowledge to find he little critter.  Treatment to the calf and about the Achilles tendon may also help.  The two tendons (Plantaris and Achilles) may become adhered (stuck together) via inflammatory processes and therefore lose their ability to slide over each other as they should.  Get this treated and ask for some self massage clues to self treat at home.  For starters, try gently frictioning the site with your fingers (gentle, rhythmical backward and forward movements) for 2-3 minutes a couple of times a day.  This may be enough to mobilise the adhered area and improve your symptoms,

Happy running.

Anatomy
The biceps femoris (long head) is one of the hamstring group.  It has it’s origin on your Ischial tuberosity (base of your buttock/top of your hamstring) or what is often called your ‘sitting bone’.  Its insertion is on the head of your fibula, just below and lateral to your knee (a palpable boney protuberance).  There is a short head of your biceps femoris that originates at the distal (lower) portion of your femur (thigh bone) and inserts into the same fibula head.  We will discuss the long head of the biceps femoris.

Further anatomical considerations
There is some other important information regarding the biceps femoris anatomy.  At its origin, it lies just medial (to the middle) of the sciatic nerve.  It also has a close relationship to the sciatic nerve as it traverses through the hamstring.  With this in mind, these two structures are often in cohort when pain occurs.  Furthermore, the biceps femoris has a direct relationship with a large ligament in your gluteal region called your sacrotuberous ligament (a ligament that generally attaches your ischial tuberosity to your sacrum [bone at base of spine]).  Hence, it is difficult to isolate the biceps femoris in its function and pathology due to its close and integrated relationship with these structures.

Function
The biceps has two basic functions of flexing the knee (bending the knee) and extending the hip (propelling your thigh behind your body).  Because of its direction of fibers and its anatomical set up and relationship to other structures, it is often described as a ‘force transfer’ hamstring (in comparison to a stability hamstring).  Hence, it bears considerable load when you are trying to develop force when running and is therefore vulnerable to load bearing injury and strain.

Pathologies/Injury
The biceps femoris is by far the most strained hamstring.  This occurs mostly when developing explosive force when running, hence not a typical injury for the distance runner.  It does however become involved with injury relating to the sciatic nerve due to its close anatomical relationship.  A common injury for distance runners is a ‘tethering’ (stickiness between two structures, usually relating to nerve) of the sciatic nerve to the upper portion of your biceps femoris.  This ends in pain about the base of your buttock (top of your hamstring) that can cause nerve type pain radiating down your leg.  If you experience this type of pain, you will need to have it assessed immediately as this injury can become chronic and WILL stop you running for a very prolonged period, if not stop you running.  Early intervention (stretching regimes, treatment of the soft tissues, alteration of your posture and gait, nerve related stretches) will help remedy the situation.  Prolonged pain may end in injection measures or even surgery to remove the scar formation from the biceps femoris and sciatic nerve (to allow them to slide normally past each other)
Again, due to anatomical set up of this muscle, any load that is born about your lumbar spine, mid back (just for example) can and will end in extra load on your biceps femoris.  This may end in a tendonitis (inflammation) and/or tendinosis (tendon degeneration).  If you have this type of pain, you will need to have more than just your biceps femoris assessed.  All other structures that are involved with this muscle group will need to be assessed, including a functional assessment of your gait if necessary.

Self Treatment
Obviously regular stretching of this muscle is a necessity.  I wouldn’t attempt to gain extra length in this muscle as a degree of stiffness actually helps propel you (elastic energy development).  I would however mildly stretch it, on a regular basis, to alleviate any pain restriction as well as using the stretch to assess whether or not it has become extra ‘stiff’ due to training or racing.  In this situation, you will simply stretch to regain what is your usual flexibility.
Self massage with a tennis ball is a simple to use modality.  Place the tennis ball under your leg (under your biceps femoris) while sitting on a chair.  You can simply apply force by applying body weight (looking for trigger points for example) or you can extend your leg while in this position which creates a focused stretch where the ball is place (giving you the ability to alleviate focal stiffness within your biceps femoris).

Summary
Your biceps femoris is a vital muscle in running.  It helps propel you, it controls your leg and eventually foot when it lands, it is a vital lynch pin in the way your body transfers force when running.  Get to know them, look after them.

Happy running.