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.


Acute Groin Injuries in Gaelic Football

We recently had the pleasure of having Mark Roe present on the “Managing Injury Risk when Performance is the Focus” in Sports Physio Ireland as part of our Educational Seminars. A lot of the data presented was related to the GAA, which is highly relevant as they would make up most of the sporting population that Physiotherapist’s and Sport Therapist’s would see in the clinic setting. A few things really stood out in the seminar, mainly the injury burden that some injuries have on Gaelic Football and Hurling.

Mark presented data that showed that Groin injuries accounted for 14% of the total injury incidence in Gaelic Football, with adductor related accounting for 39% of those groin injuries. What was interesting to note was that out of all those groin injuries 72% where acute in on-set. This goes against the popular belief out there that all groin injuries are chronic in nature, with only 28% of groin injuries classified as chronic in this population. Of the groin sub-classification of injuries (based on the Doha Consensus Statement), pubic-related pain accounted for the greatest time-loss of player availability (Mean Time-Loss 49 days). Thus, knowing that adductor related injuries account for a large portion of injuries in Gaelic Football it’s important to consider injury reduction strategies for this group.

This data follows on nicely from some of Andreas Serner work on acute adductor related injuries. His work has looked at the anatomical location of acute adductor related injuries in a sporting population and found that the adductor longus was involved in 87% of all cases. Isolated injuries accounted for 65% of athletes with multiple muscle injuries in 35% of cases, these with a combination of adductor grevis, pectineus etc. The majority of injuries were graded as 1 or 2 (83%) with 17% grade 3 injuries. Of the avulsion injuries, all where proximal adductor longus avulsions, which where combined with at least two other adductor injuries in all cases. Thus a relatively severe injury.

So as a professional working with GAA teams, knowing that groin injuries account for a large portion of lower limb injuries and which the adductor longus will largely make up the majority of those, putting in strategies looking at training load, strength, hip mobility etc to help reduce these injuries is vital.

 

Thomas Divilly


First of all, to all the people who attended, I hope you enjoyed the seminar as much as I did. Fearghal gave a great overview of all things related to Hamstring Injuries. It’s a complicated area and while we have made large strides in the past few years, I do think from the research that we are only beginning to really understand the issue.
Normally when we go to these Seminars, we often don’t reflect and learn from them as much as we should (I have been guilty of this). So I would encourage you all to give yourself an hour or two and review the slides over the next few weeks, notebook by your hand and scribble your learning points down. Practice some of the exercises that we did, review the methods of assessment and reflect on how you can upgrade your clinical management of these injuries. The easiest way to re-inforce the information and learn is to chat to people about this and discuss some of the main points.
A few things I took away from the seminar I will outline below.
  • Don’t be afraid to load the hamstrings as soon as the athlete can tolerate the load. This is helpful, not harmful.The traditional conservative approach is not going to help in the long term. The research has shown that having hamstrings long and strong is really important to protect against injury. Fearghal touched on how they use Nordics and other very high load hamstring exercises early in their program, and there will be more research published later this year on this early stage intensive loading. Watch the space!

 

  • Always start from the end. What do you want your athlete to be able to do before returning to play in order for you and the athlete to have full confidence in their hamstring?
  1. Most don’t have access to Nordbord, so maybe a certain number of repetitions of Nordic Hamstring Exercise? Certain amount of strength measured using a Dynamometer.
  2. Minimal amount of loading through a range of exercises e.g. RDL, SLDL, TRx Rollouts etc.
  3. Minimal number of training sessions completed?
  4. Hitting certain speed markers?

 

  • Assess, re-assess, re-assess… As you progress through the rehab programme, are you actually getting better? Fearghal spoke about re-assessing the assessables. Unless the markers you have used during the initial assessment are improving, how do you know that your rehabilitation programme is working?
    1. Is the site of palpation smaller?
    2. Is their pain during rehab? During specific exercises?
    3. Has their passive knee extension improved?
    4. Has their outer range knee flexion strength improved?

 

  • Know the running demands of the sport. This is extremely important. Are you giving out a generic rehab programme or preparing that individual for their sporting demands?
    1. What sport does that person play?
    2. What are the positional demands of that sports? Defender vs Midfielder?
    3. What is the overall running volume of that sport?
    4. How many max speed runs will that person be potentially exposed to during a game situation?
    5. Is that person ready for the worst case scenario or minimal demands?
    6. How can you replicate those demands in rehabilitation?

 

  • Always be on the watch out for the unexpected.
    1. Know your mechanism of injury. This can give you a better idea of the potential area of injury and also give you a better prognosis in the timeline to return to play (Askling, 2013).
      • Sprinting? Probably the Biceps Femoris Long head
      • Stretch? Potential for more proximal tears of the hamstring group. Time to return to play will be longer, median 50 days.
      • Position of knee and hip during injury?
    2. Be aware of pop and loss of function that may suggest an avulsion.

 

Thomas Divilly
Chartered Physiotherapist, MISCP, CSCS