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

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

Quisque in nulla ut metus cursus commodo non vitae nibh. Curabitur euismod sem vel velit blandit, sit amet molestie sapien pulvinar.
Aenean molestie faucibus fringilla. Nam at justo eget nulla dictum vehicula. Nulla ac mi adipiscing, elementum ligula at, ultrices mauris. Nullam nec tortor mauris. Quisque sollicitudin metus quis tempor congue. Mauris sit amet tincidunt purus, id eleifend orci.

  • Donec bibendum varius ipsum
  • Aenean commodo pharetra mauris
  • Duis autem vel eum iriure
  • Nam at justo eget nulla
  • Quisque eget elit quis sapien
  • Nam consequat velit nec

Etiam donec torquent nec vestibulum ac, magna tellus. Metus faucibus, vestibulum feugiat habitasse cursus wisi lobortis, esse dui augue venenatis.
Aenean molestie faucibus fringilla. Nam at justo eget nulla dictum vehicula. Nulla ac mi adipiscing, elementum ligula at, ultrices mauris. Nullam nec tortor mauris. Quisque sollicitudin metus quis tempor congue. Mauris sit amet tincidunt purus, id eleifend orci. Maecenas vel elit at dui condimentum lobortis in sed eros.

  • Donec bibendum varius ipsum
  • Aenean commodo pharetra mauris
  • Duis autem vel eum iriure
  • Nam at justo eget nulla
  • Quisque eget elit quis sapien
  • Nam consequat velit nec

Vel amet, vehicula euismod vestibulum magna, elit sit mattis quis pellentesque, aliquam curabitur viverra adipiscing vivamus.
Aenean molestie faucibus fringilla. Nam at justo eget nulla dictum vehicula. Nulla ac mi adipiscing, elementum ligula at, ultrices mauris. Nullam nec tortor mauris. Quisque sollicitudin metus quis tempor congue. Mauris sit amet tincidunt purus, id eleifend orci. Maecenas vel elit at dui condimentum lobortis in sed eros. Morbi iaculis euismod felis in pulvinar. Praesent sagittis elementum velit nec dictum.

Sed quis ultricies sapien, et bibendum ligula. Nam consequat velit nec, posuere volutpat quam viverra amet, mollis bibendum pretium. Mauris efficitur leo. — Carlo Doe

  • Donec bibendum varius ipsum
  • Aenean commodo pharetra mauris
  • Duis autem vel eum iriure
  • Nam at justo eget nulla
  • Quisque eget elit quis sapien
  • Nam consequat velit nec

Aenean sed nunc nulla dapibus nec nec. Commodo convallis nam nulla aliquam sit, nisl dolor velit consectetur rutrum, nibh quisque aut erat, tortor dui sodales.
Aenean molestie faucibus fringilla. Nam at justo eget nulla dictum vehicula. Nulla ac mi adipiscing, elementum ligula at, ultrices mauris. Nullam nec tortor mauris. Quisque sollicitudin metus quis tempor congue. Mauris sit amet tincidunt purus, id eleifend orci. Maecenas vel elit at dui condimentum lobortis in sed eros.

Sed quis ultricies sapien, et bibendum ligula. Nam consequat velit nec, posuere volutpat quam viverra amet, mollis bibendum pretium. Mauris efficitur leo. — Carlo Doe

  • Donec bibendum varius ipsum
  • Aenean commodo pharetra mauris
  • Duis autem vel eum iriure
  • Nam at justo eget nulla
  • Quisque eget elit quis sapien
  • Nam consequat velit nec

Malesuada dapibus enim lacinia erat, scelerisque duis ut vitae turpis dui, sem sit et tristique elit imperdiet, tortor eu consequat, nec duis nulla. Metus taciti enim massa. Integer integer adipiscing nunc faucibus vestibulum, pede scelerisque wisi sed, tristique mollis cum placerat. Id lectus mollis lectus duis sodales, libero convallis dapibus ultricies nunc, wisi nulla sit suspendisse est, quam sapien id a. Dolor mauris nullam, magna vivamus mauris consectetuer vitae arcu quis.

Sed quis ultricies sapien, et bibendum ligula. Nam consequat velit nec, posuere volutpat quam viverra amet, mollis bibendum pretium. Mauris efficitur leo. — Carlo Doe

  • Donec bibendum varius ipsum
  • Aenean commodo pharetra mauris
  • Duis autem vel eum iriure
  • Nam at justo eget nulla
  • Quisque eget elit quis sapien
  • Nam consequat velit nec

Mi suspendisse nunc nec ad inceptos consectetuer, turpis vel, non dictum ac, suscipit in, ullamcorper amet luctus etiam libero magna habitasse. Eros leo dolor dicta vehicula pellentesque, ac lacus, tortor ac mauris molestie. Integer mauris eros, et neque neque. Ipsum nonummy fringilla, odio nibh aliquam lacus fusce suscipit, nunc porta congue tristique nec. Eget aliquam. In fusce, in natoque leo quisque, morbi odio nullam sit id scelerisque porttitor, amet tincidunt lacinia. Tortor purus mattis porta nascetur, ultrices vel magni magna at, magna quam lobortis mauris at.

  • Donec bibendum varius ipsum
  • Aenean commodo pharetra mauris
  • Duis autem vel eum iriure
  • Nam at justo eget nulla
  • Quisque eget elit quis sapien
  • Nam consequat velit nec