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


As we gear up to present our next speaker Mark Roe, who will speak on training loads and injuries, we will begin to explore the role of training load on both athletic performance and injury reduction.

Training load is currently the hot topic within Sports Medicine and Sports Performance. But what is it? Training loads can be broken up into both internal or external variables. Internal training loads are the biological stressors imposed on the athlete during training or competition, these are commonly measured by heart rate, blood lactate, rating of perceived exertion etc. External training loads are objective measures of the amount of work completed during training or competition and common measures include GPS parameters. 

The importance of monitoring training loads has come to prominence over the past few years as its role in enhancing athletic performance and injury reduction has come to light through research. Traditionally the model to stress response imposed on the biological system has been based on the General Adaptation System Model proposed by Hans Selye in 1931. As John Kiely outlined in his article “Periodization Paradigms in the 21st Century: Evidence-Led or Tradition-Driven”, the periodization philosophy of training hinges on the presumption that biological adaptation to future training is largely predictable and follows a determinable pattern. However, we know that individual athletes will respond differently to each other even when doing the same training program/session. Biological stressors are often neglected as just training stress alone, however it comes in many different forms. For example, a wide range of imposed stressors emotional, dietary,social, sleep, academic have been demonstrated to variously down regulate the immune system, dampen adaptive response, and negatively affect motor coordination, cognitive performance, mood, metabolism, and hormonal health, consequently reducing performance and elevating injury risk. These all add up, and both the sports medicine professional or coach needs to be aware of these factors. Therefore, the ability to monitor the training loads of athletes, both internal and external, and their individual response is vitally important to enhance performance and prevent injury.

Thomas Divilly
Chartered Physiotherapist, MISCP, CSCS

What are Shin Splints?

 

What are Shin Splints? Shin Splints is a common term used among people to describe a pain in the leg in and around the area of their shin bone. A more specific diagnosis must be made however to successfully treat the symptoms. The traditional clinical use of the term shin splints is to describe medial tibial stress syndrome, pain on the lower inside of the leg. Often people use it as a term to describe pain and swelling of the muscles to the outside of the shin (anterior compartment syndrome) as well.

 

Chronic symptoms of shin splints may lead to stress fractures so symptoms must not be ignored if they continue to persist. Abnormal biomechanics may lead to a greater risk of pain around the shin bone. A high rigid arch effects shock absorption increasing the forces on the bone. In individuals whose arches fall from normal into a flattened position (excessive pronation) overuse, fatigue and excessive pull of the muscles that support the arch can lead to medial tibial stress syndrome, otherwise known as ‘shin splints.’

 

Weakness of the tendons or ankle instability from previous sprains may also contribute to overuse of muscular and tendinous structures leading to shin splints. Tight calf muscles can also lead to shin pain, excessive tightness can prevent normal ankle movement increasing the load on muscles surrounding the shin.

 

A full history and physical examination including biomechanical assessment with reproduction of symptoms is needed to find the true cause of the symptoms, so a progressive rehabilitation programme can be implemented.

 

Treatment may consist of reducing the repetitive training load, stretching and loosening out tight muscles such as the calves and improving strength. If it is a chronic issue, training to improve shock absorption will be required through altering running mechanics. Assessing and treating the origin of the problem is the key to full recovery.

 

Catherine Simpson

MISCP, MSc. Sports Medicine

www.sportsphysioireland.com

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Five Tips So You Can Avoid Injury

Sports Physio Ireland’s physiotherapist Riain Casey talks us through five tips so you can avoid injury.

Many injuries can be easily prevented. Some times small adjustments to our everyday lifestyle can have a big impact in injury prevention.

Simple things like correctly fuelling the body and a good healthy sleeping pattern are key to aiding the body recover from on-field activity. Coupled with a specific warm up to prep the body for the demands on field, good proper movement based training and maintaining fitness levels to meet the demands of the activity can greatly help reduce the risk of injury or re-injury.

Try out the tips and let us know how you get on.

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How To Fix Your Push Up

The push up is one of the most basic exercises that you can do, but time and time again it is technically performed poorly.

We see issues from poor technique contribute to low back pain, knee issues, along with a number of other issues. So technique is vital to keep the body healthy.

So how do I, and the rest of the team in Sports Physio Ireland, see a push up? Simple really, think about a dynamic plank.

Quiet simply, the core should be engaged throughout the total body movement, and 9/10 in most injured or poorly trained clients this is the last thing that is thought about!

So How To Do The Perfect Push Up

• Hands directly under the shoulder, screw them into the ground.
• Squeeze the ass, tuck the tail bone under until you feel the lengthening of the abdominals
• Drive the heels to the back wall
• Slowly and controlled bring the chest to the ground, keeping the elbows close to the rib cage and drive up through the heels of the hand.

Harder than you think, but more bang for your buck!


MCL Injuries

We recently seen Karl Lacy tog out and play against Mayo with heavy taping on his leg to protect a recent Medial Collateral ligament (MCL) injury.

The medial collateral ligament is a band of tissue that connects the thighbone to the lower leg and helps prevent the knee from buckiling inwards. It can be injured when twisting or landing or when a standing leg is tackled from the outside forcing it to buckle inwards.

Initial management should be

  • Compress with a bandage
  • Use crutches to take the weight off
  • Apply ice pack

What are the symptoms?

  • Swelling.
  • Pain.
  • Local tenderness on the inside of the joint.
  • Bruising.

Specific tests and scans can diagnose the extent of the damage and the length of time the player will be out of action for. In Karl’s case, he obviously needed more time to regain 100% confidence in his ability the twist and turn to make those turn overs he has been famous for over the past few seasons.

Mild or Grade 1 injuries usually get better in 1 to 3 weeks and may only needhome treatment along with using crutches for a short time.

Moderate or Grade 2 injuries usually get better in about a month. You may need to wear a hinged knee brace and limit how much weight you put on your leg.

Severe or grade 3 injuries may require wearing a hinged brace for a few months, and limiting weight on the leg for 4 to 6 weeks.

 


Hamstring Rehab

The most commonly injured area that occurs in field based sports is the Hamstring. But why the hamstring? It’s an interesting question, with many different potential reasons.

Is it strong enough for the sport? Does it fatigue easy? Is it working too hard, making up for lack of support? Have you done enough sprinting in your training program?

Here is a few exercises that we have in our bag, that can help recruit better hip and hamstring strength and control.

We aim to get you strong to help prevent the possibility of injuring you Hamstring again.

Thomas Divilly