At Sports Physio Ireland, one of our main priorities is a client’s initial functional movement assessment. Without a thorough physical assessment, an appropriate rehabilitation programme cannot be planned.

We spend less time focusing on individual parts and aim to analyse full body movements (referred to as patterns) in order to gain as much ‘movement information’ about the client as possible.

From looking at knee & hip dominant, push, pull and core patterns we can ascertain the source of an individual’s problems, as opposed to having them lying on a bed, analysing individual body parts.

Often, an ankle or a hip issue might be contributing to a shoulder problem or vice versa. We need to look at how the body moves as a whole. We run, sit, reach, pick up, jump, push and pull in our everyday lives so our belief is that is what the assessment of an individual should be based around.

I often hear clinicians saying that their ‘client population can’t be assessed in this way’. I don’t agree. Can your client get up and out a chair (squat)? Can they push themselves off the ground if they fall then up into a half kneeling position and then stand from there (Plank – push up – lunge)? Can they pick something off the floor efficiently or ensure they don’t trip over a curb (Single leg balance / Single leg deadlift)?

Naturally, knowing your regressions and progressions for each functional movement pattern is a must, but regardless of age or ability, individuals should be working towards achieving adequate functional movement capacity for everyday life. Once you know your athlete (given age and ability) and understand the movement screening procedure you can plan appropriately.

Our movement assessment is standard operating procedure at Sports Physio Ireland. This ensures our clients get the best possible treatment.

Some Examples of Movements Analysed;

Overhead Squat, Squat.

Lunge / Side Lunge

Single leg balance / Single Leg Deadlift

Plank / Shoulder blade push up / Push Up

Side Plank

Walk / Run / Hop / Jump / Land


Preview of Fearghal Kerin’s Seminar on The Assessment and Management of the Sporting Hamstring

Hamstring injuries have been a hot topic of debate over the past few years, with many debates on Twitter and Facebook between academics and clinicians alike on injury mechanisms, treatment strategies and reduction methods. Everyone has their own interpretation of the literature and arguments have ensued. Stretching vs Strengthening? Eccentric vs Isometric action? Nordics vs Functional? Its a complex topic and people get passionate, whatever side of the fence they sit on.
Some of the arguments however seem quiet reductionist. Putting together what we know works from clinical trials, and what has worked in clinical based practice seems a more sensible approach that more should base their treatment approaches on. Also, in my experience, the individual seems to get lost in the argument. The complex nature of human locomotion means that individual differences for hamstring strains need to be examined for every athlete/patient e.g. strength deficit vs over stride pattern.
Putting together the information that we know to optimise treatment strategies can be the complex part.
  • When do I begin loading the hamstrings?
  • How do I know when to progress loading?
  • What exercise selections target the area?
  • When do we begin running again?
  • How do I put a rehabilitation program together?
We at Sports Physio Education are delighted to welcome Fearghal Kerin of Leinster Rugby & Dundalk FC to help us answer those questions and give us the latest evidence and clinical based strategies to manage the sporting hamstring. Below is the agenda and link for the Seminar.

Agenda:

Sports Physio Education Seminar

– Friday 16th February, 6pm – 9pm.

– Fearghal Kerin of Leinster Rugby and Dundalk FC.

– Sports Physio Ireland, 29 Upper Fitzwilliam Street, Dublin 2.

https://goo.gl/838M9V


We are delighted to welcome back Fearghal Kerin for his second seminar on the Assessment and Management of the Sporting Hamstring. Fearghal works as a Rehabilitation Physiotherapist in Leinster Rugby and the Head Physiotherapist with Dundalk FC. He brings a wealth of experience from the Elite level of sport on the management of hamstring injuries, and he is going to share with us his insights and the latest research around hamstring injuries. Fearghal’s last seminar with us in July was a sell out so we are looking forward to what’s in store for us this time round.

Seminar content:

  • Challenges of the Hamstring Strain
  • Prevention, Prediction and the Nordic Hamstring Exercises
  • Criteria based Assessment and Rehabilitation
  • Exercise Selection
  • Return to Running and Return to Performance

With most of the seminars we will be holding, there will be a large emphasis on practical assessment and interventions, so you can take away some ideas that you may integrate into your own practice. This seminar will be 1 hour of theory and 2 hours of practical assessment and treatment. Plenty of engagement and lots to learn. This seminar is open to physiotherapists, students, physical therapists, S&C coaches and healthcare professionals.

If you have any questions, don’t hestitate to contact us at info@sportsphysioireland.com.

**REFUND POLICY**

No refunds at any time.


Proximal Hamstring Tendinopathy (PHT)

 

What is it?

A tendinopathy is a change in the tendons structure, usually in response to overload. Unlike what was previously thought, there is no real inflammation happening. The pain is due to the changing and swelling of the tendon’s structure.

PHT manifests itself as a deep pain in the glute. (literally a pain in the butt) .Pain is felt on or around the sitting bone(ischial tuberosity). Pain comes on gradually with no acute onset or mechanism of injury.

PHT is common in runners, but also occurs in the non-athletic population. Oftentimes people can have these symptoms for a long time, and they try to ignore it, until the stage where everyday activities are painful- sitting, going from sit to stand, stretching, sitting on hard surfaces.

 

How did I get this?

If you think you may be suffering from PHT you might ask why me? How did this happen?

Oftentimes a PHT develops after a period of increased training load. Have you increased your mileage, starting adding in hill workouts, more speedwork? All of these disrupt the balance in the tendon, not allowing the tendon enough time to respond and adapt, causing the tendon to become irritable and sore.

Similarly movements which put a compressive load on the hamstring tendon can cause symptoms. Excessive Yoga and pilates stretching positions which involve deep lunging can aggravate the tendon.

 

What do I do?

If you think this sounds like you book in with your physiotherapist for a thorough assessment. There are differential diagnoses which need to be out-ruled such a low back pain, stress fracture of the hip or an SIJ problem.

Keep on top of your pain. NSAIDS (anti-inflammatories) have been seen to be effective in reducing tendon pain. Discuss this with your GP or pharmacist. These should not be taken as a means to mask symptoms while running, but rather if pain is limiting your everyday activities. Heat/Ice can also reduce  your pain, see which works for you.

Gentle isometrics- shown in the picture. These exercises stimulate the muscle, maintaining your strength and have been shown to reduce pain symptoms. Aim to do 5 reps of up to 45 second holds, so long as there is no increase in pain. You may feel some tension but not pain, and symptoms should reduce after the exercise.

 

What do I not do?

There are certain positions and activities to avoid, particularly when the tendon is irritable.

Don’t

-Periods of prolonged sitting, get up and move about to avoid compression on tendon.

-Don’t stretch: allow it may feel like this is what your tendon wants, it is not what it needs. Stretching places further compressive load on the tendon

– Deep lunging/ squatting

-up-hill running

– Don’t ignore your symptoms

 

How long will it take?

The sooner you get assessed the sooner you can get on the road to recovery. Tendon healing and restoration of full strength can take between 3-6 months. Within this period you may have resumed your activity fully and may be completely symptom free.

Once the cause of the tendinopathy has been found, you can start working with your physiotherapist to address this, whether that be pre existing weaknesses, training load management or other areas in your day to day which have led to PHT.

 

 

Ellie Harnett, MISCP


Join us here at Sports Physio Ireland on the 1st December 2017 for our 6th educational seminar for health professionals.

The seminar will be hosted by Mr Paul Kirwan who will be discussing the management of the achilles tendinopathy.

Paul Kirwan is a Chartered Physiotherapist and Clinical Research Fellow with over 20 years of clinical experience. Currently, he works as a physiotherapist in Connolly Hospital Dublin in an advanced practice role in Rheumatology/MSK and is completing his PhD through the Royal College of Surgeons in Ireland. His research is investigating the role of Glyceryl Trinitrate and exercise in the treatment of midportion Achilles tendinopathy (the NEAT trial).

Paul also works in private practice and with Bohemians FC. He graduated from Trinity College School of Physiotherapy in 1994. After this he worked in numerous hospitals in lreland, the Middle East and the United States gaining experience in treating a wide variety of MSK conditions and treating recreational to professional athletes as well as non sporting individuals. He became a Certified Strength and Conditioning Specialist (CSCS, NSCA) in 1999.

He returned to Ireland in 2003 and commenced working in Connolly Hospital with the Rheumatology team. While here he commenced working as an advanced practice physiotherapist working alongside the rheumatologists as a first point of contact clinician, and has also completed training in injection techniques.

He completed his MSc in Sports and Exercise Physiotherapy at National University of Ireland, Galway in 2009 graduating with first class honors and was awarded the Mary Sullivan Gold Medal for best student in discipline over the course of his Masters degree. He was awarded a prestigious HRB research fellowship in 2014 to complete his PhD, which he is currently pursuing in RCSI with a special interest in tendinopathy.

Paul has presented research nationally and internationally, and won a research award from EULAR in 2014, this was the first time an Irish physiotherapist has received this prestigious award in recognition for his work in this field.

If you have any questions, please don’t hesitate to contact us at info@sportsphysioireland.com.

We look forward to welcoming you into the clinic on the 1st December.


Achilles Tendinopathy in Runners

Unfortunately Achilles pain can become the bain of many runner’s careers. Whether you are an elite or a recreational runner it can affect you.

Achilles pain can come on acutely or more gradually with a seemingly insidious onset. Acute pain with a loud audible pop is known as an achilles rupture, and one which is difficult to miss. This article will deal with the less acute, grumbly tendons namely- achilles tendonopathy.

 

What is a tendinopathy?

A tendinopathy is a change is the tendon’s structure. When we overload the tendon, and do not allow it sufficient time to heal the tendon develops a ‘stress shield’.

Unlike what was commonly believed previously, there is not inflammation going on, and so the shift from tendonitis to tendinopathy

 

Tendinopathy can be divided into 3main stages

  1. Reactive- acute,painful, swollen, tender tendon following rapid increase in load(mileage, hills, speed)
  2. Dysrepair-follows on from the acute phase, tendon structure starts to change
  3. Degenerative- chronic, common in the older athlete, thickened with nodules. There is risk of rupture at this stage.

 

What to do?

What to do, will very much depend on stage your tendinopathy is at:

*Reactive stage/early dysrepair*

 

Reduce load

Decrease your running load. This may mean  full rest when the tendon is particulararily angry. You need to be pain free at rest and during walking before you consider running.

When you commence running again bear the following in mind- pain should not go above 3/10 pain. Allow adequate rest between runs (24hrs+). Pain should resume to pre run level by 24hrs post.

Purchase a heel Cushion. These can be bought for approximately 7 euro from Murrays Pharmacy. The small elevation the cushion gives you, ensures you avoid compressive load on the tendon which is provocative for the tendon.

 

Pain Relief

Consult with your GP/Pharmacist regarding pain relief. Anti-inflammatory medications have been shown to be of benefit in managing tendonopathies, despite there being no inflammation.

 

Increase strength

During the reactive stage, exercises such as heel drops are likely to aggravate the tendon. Opt instead for isometrics. Perform these on 2 feet on a step. Go up onto your tip toes, then return to neutral( rather than going into full heel drop) Aim to build toward 10-15reps and 3 sets of these.

 

Avoid the following:

Stretching

Although it may feel like this is what the tendon needs, stretching can compress the tendon and aggravate it more.

 

Very flat shoes/pumps

As with the stretching, flat shoes can aggravate pain with compressive loading

 

**Late dysrepair/degenerative**

 

Increase your strength

Unfortunately you can have a reactive tendonopathy going on alongside a degenerative tendinopathy. In this case management is similar to above.

 

With a more chronic degenerative tendonopathy you can start to increase strength training more without aggravating symptoms. You can progress toward eccentric exercises which ‘strengthen and lengthen’ the tendon such as heel drops

 

Gradually increase your mileage

As a general rule, increase your cumulative mileage by no more than 10% per week.

 

Address weaknesses elsewhere along the kinetic chain

As with many injuries, the area you feel pain may not be the source of your problems. Get assessed by a physiotherapist to address any weaknesses you may have. Runners need to perform strengthening exercises at least once weekly to  prevent and treat injury.

 

Listen to your body

If you have a painful achilles which fails to improve with rest, get it looked at. Don’t ignore your symptoms.

 

Ellie Hartnett, MISCP 


                   

 


Acute low back injuries can be caused by a disruption to the muscles/ligaments supporting the lower back.

The area around the compromised structures can become sensitised due to spasm or strain in the affected tissues.

It can be a very debilitating injury but early activation and relaxation techniques are important in the early stages of treatment to promote mobility and desensitisation of the muscles involved.

Check out these simple exercises we like to use here at SPI for early rehab of acute low back injury.

SPI Team


Groin injuries in Athletes

Groin injuries are typically associated with athletes involved in multi-directional fast paced sports such as Hurling and Football.

The incidence of groin injuries in elite Gaelic footballers was shown to be as high as 9% (Murphy et al, 2012).

There are many different causes of groin pain in the sporting athlete, the most common diagnoses including acute groin strains, adductor tendinopathy and osteitis pubis. It can be an extremely debilitating injury associated prolonged periods on the sideline. There are many structures around the hip and groin region that must be considered when managing a groin injury, for instance there are 5 different muscles that act as adductors of the hip. When too much pressure is put on a certain part of the pelvis during movement this can lead to failure of other local tissues. This is often seen in sport when players have an unusual way of cutting/turning which can become problematic over time, thus leading to a groin injury as an example.

Red flags for groin injury often seen in GAA are limited hip ROM, reduced groin strength (groin squeeze) and poor lumbopelvic control, characterised by a player leaning excessively over their planting foot during a cutting movement.

Treatment begins with accurate diagnosis of the pathology as without clarifying the exact cause it is hard to implement a fully functional rehab programme due to the complexity of the hip/groin region. Muscle control and de-loading of affected tissues are two components that I like to focus on when approaching these injuries initially. It is important to introduce sports specific drills when suitable especially in multidirectional sports as the groin muscle has a massive role in decelerating the hip movements during quick turns.

 

Paddy Hannon, MISCP


21 Day PT Trial

Want a 21 Day PT Trial?

Right now Sports Physio Ireland is offering you the chance to come in and try out our services for 21 days for only €59!

The 21 Day PT Trial will cover everything from strength and conditioning training to rehabilitation of an injury under the watchful eye of our chartered physiotherapists/trainers who will also be providing dietary advice to help you balance your eating habits.

Space is at a premium and we can only offer this trial to a limited number of people.

This is a HUGE discount and is definitely not to be missed!

We strive to provide the highest quality service in order to help you achieve your goals.

Sign up now by clicking the link below & and an expert trainer will be in touch.

https://functionalt.wufoo.eu/forms/p7b2w0s1qz85lt/

Sports Physio Ireland Team


Groin Injury Screening In Gaelic Football

 
The role of musculoskeletal screening has been a hot topic in recent time, see here, with the debate on the validity and efficacy of some tools. It can cause serious confusion for some clinicians on whats the most effective strategies to put into place, what is worth measuring etc.
The past 10 years clinicians have been sold false promises on the role of the FMS and other such tools in predicting and preventing injuries.
And while we shouldn’t abandon the screening process to reduce injuries, we need to be a bit more aware on what they actually measure and does it even help the clinician? 
 
A recent paper by the group led by Dr. Eamonn Delahunt has looked at the adductor squeeze test and the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire to assess its ability to identify Gaelic Football players at risk of developing groin injury. There was 55 players within the cohort and they where followed over a 9 month period. The chartered Physiotherapist during pre-season as part of an injury screening evaluation included both the adductor squeeze test and HAGOS. No groin injuries or other injuries where found during the pre-season testing. 
 
Results revealed a significant difference in pre-season adductor squeeze test scores between those players who did (median = 210 mmHg, n = 10) and did not (median = 260 mmHg, n = 45) sustain a groin injury, U= 107.5, z =  2.58, p = 0.01, r = 0.35.
The optimal cut point for the squeeze test to discriminate between players who did and did not sustain a groin injury, to be 225 mmHg. 
 
Results of the Mann-Whitney Test revealed a significant difference in pre-season HAGOS function,sport and recreation subscale scores between those players who did (median=76.56, n=10) and did not (median=96.87, n=45) sustain a groin injury, U=114.5, z=2.48, p=0.01, r=0.33. With regard to the HAGOS function,sport and recreation subscale score, the cut point with maximal sensitivity (0.70) and specificity (0.73) to discriminate between players who did and did not sustain a groin injury was 87.50.
 
What should be of great interest to clinicians when reading this study is both the ease to administer of both tests and the cost-effectiveness. Unlike many studies which look at expensive and time-heavy methods, these are available to all clinicians with no heavy burden also. While the relative sample size was small, it does give clinicians both some normative data and cut off points to make some meaningful decisions within the team setting. It may also allow the clinicians to individualise both Strength and Conditioning programs and injury prevention methods within a group setting. 
Thomas Divilly