Paddling induced injury

As a result of Physio's post in the Leg Drive thread this thread is to deal with what if any injuries paddling is causing you?

Physio wrote:

Kocho wrote: OK, Leg Drive observation (back on topic)

Whatever these muscles on the sides of my butt are, now the hurt pretty good...

piriformus

I have been finding the better a paddler is the more knots, trigger points they get in the piriformus and glute med and min. I found this by accident when I was looking for a reason my multisport athletes were getting calf pain/injuries when running after paddling or especially when really good paddlers tried to transition into events with running in.

But how the hip controlling muscles work is as complex as picking the right length hull and shape of a ski for all wave conditions.As they can either externally or internally rotate the leg dependent on the angle of the hip.

I initially suspected the muscle tightness was due to the need to alter hip position as the core rotated , however I am leaning towards it being from a strong leg drive(I dont get it and have a weak leg drive), and if all kocho changed during yr paddle was the drive and are getting pain/tiredness in this region it would support this theory.

If anyone else is out working on leg drive cld they report back what is more tired than usual .

Physio, those on the site long enough may remember I came looking for answers to my ITB syndrome about a year ago.



This has really stuffed my Adventure Racing, so much so that a few months ago I threw in the towell after spending a small fortune on Physio, Chiro, Sports massage, Podiatrist and a Sports Doc with his various injections into the muscles in the area.

ITB syndrome has stopped me from being able to run distance. I can still manage short sharp runs (up to about 6km at 4.15 pace) with no training (I was doing it around 4 min pace before this injury came along) I have kept cycling paddling and occassionally swimming but have recently returned to the gym as I am throwing all my eggs in the paddling basket for this upcoming AR season to at least have some good results from paddling in teams.

As I have become quite strong through the core and my paddling has improved I have noticed less TFL soreness but the glute medius has been really sore after big sessions, especially in cross chop conditions.

I briefly flirted with the idea of stopping paddling to see if it came good but I am hopelessly addicted

I am hoping that the gym may get me to the point where there is no weakness and this rectifies itself over time, it's been bloody hard sitting on the sidelines of solo AR's for around a year but at least I have enjoyed the improved paddling.

Interested to hear of anyone else who has overcome ITB syndrome brought on by paddling.

I believe most hip related problems in paddling occur due to the fact the hip is operating in an internally rotated position, in comparision to its normal position during stance, or the gait cycle. I believe if you are able to position your feet in a more out toe position on the footboard, it will externally rotate the leg into a more normal position and allow the muscles to work in a more effective way.

Quickly before I give any opinions, anything I write is purely my opinion (research on physical medicine is problematic at best, and just plain self serving mostly). every person is an individual and how people respond to types of treatment is individual, so please don't jump up and down shouting that i'm talking crap because you don't agree with me. I can only comment on what I have found, I certainly haven't had success with every patient I've treated..


Interesting, none of my paddlers have complained of ITB issues, it is very common with cyclists and there is "runners Knee" which is ITB related.

1. ITB stretches DO NOT WORK don't waste your time.
2. I have been getting good results with using a foam roller for self massage and also a ball for triggers point type massage into glute med/min. and cupping therapy for ITB, due to the shape and direction of fibres in the ITB, to stretch you need to pull the outer fibres away from the bone(femur)The fibres are quite short and travel from just below the skin inwards to the bone, (think of a feather, or fletching on an arrow).
3. The most common finding i see with my athletes that do flexion sports like paddling, rowing,cycling. Is a tightness in the Rectus Femorus, which is the quad muscle that crosses both the hip and the knee. when this muscle is tight it prevents the action of trying to kick your bum with your heal when that knee is behind the other as you run, this resistance causes you to lift your heal early, sometimes your knee slides slightly inwards and you push off harder with your calf muscles. Or alternatively it can cause you to slightly fold at the waist as you try and lift your heal behind and bring that knee forward early.
This may cause no issue at all or it could increase the load on the plantar facia of the foot, the tarsal bones, cause a twisting force on the shin bones increase loading on the big toe flexor (shin splints) if the knee moves in then increased pronation force and a twist on the ITB.
to stretch this muscle requires hip extension and knee flexion. I usually to this lying face down, effected knee off the floor on a wedge, block etc, and bend the knee up towards the bum.

Obviously that was a quite generalist rant, but it's snowing here so none of my "soft" patients are arriving.(I'm sure the adventure racers will get here)
AR I'm not convinced that anything you have said indicates a weakness, not that I want to discourage you from the gym there is a lot you can do achieve there. But start with basics control and balance type exercises like lunges working on keeping your knee directly over you 2nd and 3rd toe with absolutely no side to side movement, working at different speeds etc single leg squats doing the same. And stretching, foam rollering.

Carps wrote: I believe most hip related problems in paddling occur due to the fact the hip is operating in an internally rotated position, in comparision to its normal position during stance, or the gait cycle. I believe if you are able to position your feet in a more out toe position on the footboard, it will externally rotate the leg into a more normal position and allow the muscles to work in a more effective way.

I dont think i really agree.
1. during gait as soon as the swing leg passes the supporting leg the pelvis is rotated towards the supporting leg which results in the supporting leg being internally rotated which is almost the entire time its on the ground,( unless you are running with a large heal strike in front of you, (that's a whole nother can of worms)in fact it doesnt then externally rotate until it swings past again.

2. If you point your toes out you need to then keep your knees apart when your drive and bend to keep your kneecap over your middle toes, otherwise you will load up the outside of your knee and stretch the inside. I havn't seen any ski K1 paddler with there legs apart.

3. A lot of Multisport paddlers paddle like this with there legs often braced to the outside of the deck, but they struggle to get good leg drive due to the lack of space. And they get just as many hip issues.


It makes sense to me that the important factor is that the path your knees take during driving is straight and not in some sort of arc as the hip and knee works well like this. So like cycling I would assume the lowest adverse loading is foot straight forward back and knee travelling with no lateral movement.

As you can guess its still snowing here.

AR. Glut medius is primarily an abductor of the hip...however when your hip is flexed, such as in paddling it exerts an internal rotation force on the femur. When you're paddling and using strong leg drive or stabilizing with your legs, there is a tendency to rotate the leg externally slightly. That would explain the glut soreness. Maybe lengthening the foot plate one notch will reduce the tension on the muscle. If you feel you have more drive with the plate shorter, maybe lengthen the plate every other paddle and shorten it for racing. Overcoming overuse injuries is about isolating the cause of the injury and then changing something. It can be that simple. If someone tells you they have a sore thumb, and you ask them why, and they tell you they get up everyday and hit it with a hammer, it doesn't matter how many tablets you take or people you see, it won't get better till you stop hitting it with the hammer. Overuse injuries are the same.
If your ITB is caused by your paddling you need to change something. Play with your pedal length first, cos that's easy. Have you strapped your knee when paddling?

Thanks for your observations and input Guys.

Believe me when I say I have spent a great deal of time thinking through what led to this injury. Without wanting to restate all the previous history I shared in the previous threads from last year I had upped my training for a ironman type distance AR and had put the ITB issues down to overtraining.

The fact that it has gone on so long and I have been able to rule out many things. A couple of months ago I thought I had beaten it when a new set of orthotics had provided relief and allowed me to return to running for about 5 weeks before it came back.

I started using my old orthotics against my footplate and have also found that to help.

Getting back to the leg drive equation, I believe that my problems probably started about the time that I really started pushing on the footplate with leg drive. That would explain why I had a lifetime of triathlon without any ITB issues and a few years of AR training with all these sports without issues, until in the search for more speed I really started to push hard on the plate.

I will try lengthening my footplate, no idea how I would go about taping?!

I wonder if the orthotics on the footplate has done a couple of things.
a) increased your external rotation and b) effectively shortened your footplate length....which may explain the glut pain.

Try McConnell taping. Leg straight and relaxed. With some fixamul or 1" sports tape force your kneecap towards the centre (medially) apply 3 strips of tape from the outside to the middle. Sometimes it helps, though I think changing pedal length is more likely to help.

The orthotics are effectively adding a varus wedge to your foot pedals (I did read that correctly didn't I. You have orthotics on your pedals)
There are simpler and more effective ways to do this. Contact me if you need a hand.

Dicko wrote: I wonder if the orthotics on the footplate has done a couple of things.
a) increased your external rotation and b) effectively shortened your footplate length....which may explain the glut pain.

Try McConnell taping. Leg straight and relaxed. With some fixamul or 1" sports tape force your kneecap towards the centre (medially) apply 3 strips of tape from the outside to the middle. Sometimes it helps, though I think changing pedal length is more likely to help.

The orthotics are effectively adding a varus wedge to your foot pedals (I did read that correctly didn't I. You have orthotics on your pedals)
There are simpler and more effective ways to do this. Contact me if you need a hand.

Thanks Dicko, I might just take you up on that.

I did adjust the footplate out after starting to use the orthotics.

I only started using them a couple of months ago when I had them replaced by a more effective pair. When the new pair seemed to help in my shoes I though the old pair would provide some better support while paddling if the force of my foot on the footplate was causing the arch to collapse.

So just to be clear the ITB issue's including glute pain were around along time before the orthotics use in the ski. It's just that at it's worst all 3 of the muscle bundles that are attached to the ITB were tender and inflammed so it was hit and miss trying to identify which one may have been compromised intially before the other two came to the rescue only to be stressed as well. I tend to think it is more Glute Med now that it is settling down again with no running and reduced cycling.

Then one notch longer on the adjustment will ease the strain on the gluts slightly. Even try one paddle with the adjustment longer and the next at the current length. I found that adjusting the length of the pedals would ease or create hamstring or groin pain. It was a matter of experimenting until I got a compromise length. I suspect that changing footplate length wil change the angle of your knee and change the single area of irritation of your ITB on the epicondyle on the knee.(assuming the usual area of irritation).

I have been getting hip cramps when climbing.
Mainly when bridging.
I wonder if this is related.

I also have some sort of strange injury that I though initially may be ITB, but having had that years ago, this was different and was bought on by walking down a really steep hill after doing a hill session on my bike.

It is getting better though and responds to high power work on the bike well.
Spinning for a long time will annoy it though, but I can keep on riding without it getting worse.



AR, it sounds as though simply altering anything gives you some sort of temporary relief.
Maybe that is the key, keep revolving your setup to prevent an injury, just like rotating through several sets of slightly different shoes to prevent running injuries?

Hey Dicko, since injuring my foot (lisfranc) I tried wearing orthotics but found that they give my back curry.
Mind if I contact you for any sort of suggestion you may have as it sounds like this is your area?

RAB... an orthotic is generally used to reduce the amount of, or slow down the speed of pronation (rolling in)at your subtalar joint. This excessive pronation also translates into significant internal rotation of your leg which then causes a slight forward tilt of your pelvis, theoretically increasing the curve at the base of the spine.
In some people, limiting this pressure on the lower back is a good thing and makes you look like you know what you're talking about. However if you have a limited range of movement or a fusion or a previous injury the orthotic may change the situation for the worse.
The dilemma is if the device helps your foot but buggers your back what do you do.
Decrease the correction in the device, change your wearing pattern,
ie, wear them less often. Wear them when you run only, or walk only or at work only. etc until you find a combo that works.
If they don't help your foot.....use them as door stops.