When working with sports teams, you meet a mixture of people working within the management and administration of the club/county. As it is still firmly an amateur organisation, the clubs and counties still rely heavily on the volunteerism that has built the foundation of the GAA, and please God may this never change! These people have a mixture of skills and experiences that make the GAA so unique to our country and culture. Everyone has different backgrounds that make trying to mesh an amateur ethos and drive with the professional demands needed to compete at inter-county and club levels easier. And yes, not only are inter-county setups extremely professional, a lot of clubs are following closely. Managers and coaches are extremely ambitious nowadays and want to create the most professional setups in the country.
And so often Physiotherapists, Strength and Conditioning Coaches and other related professionals are greeted with a mixed reaction within different setups, depending on people’s past experiences. Some are lauded as essential and necessary for continued success on the pitch, while some are greeted with a mixture of suspicion at our role within the team. We have all been in that situation, when you meet a coach or manager who doesn’t understand what your skillset involves, what you can do to help a team succeed. Physiotherapists are seen as giving out “rubs” and S & C professionals are seen as “doing the gym”. And while these may have been our role historically, we have moved on well from this! We have greater skillsets than this and we can heavily influence both the welfare and performance of the athletes we come in contact with.
And so like any profession I believe we should justify our roles within these groups:
  • Are we addressing intrinsic/extrinsic factors that may influence injury risk?
  • Are we putting in injury prevention programmes that have been proven to reduce rate of injuries?
  • Do we use the most up to date methods of preparing our players for their performance demands?
  • Are we continually up-skilling and increasing our knowledge?
  • Are we educating the people who make the important decisions on best practices?
These are all questions that we should be continually asking ourselves when working in these environments. So how do we justify our role first and foremost? What is the one thing every coach and manager puts the most weight on when making decisions? What can they not ignore. They are all striving for the same thing.
Success.
And while talent is important.
We know that team success is heavily influenced by player availability.
In this study by Hagglund et al. (2013) they looked at the injury incidence and injury burden on performance measures in soccer. What made this study unique is that the clubs that participated included the likes of Barcelona, Manchester Utd etc. So massive clubs at the elite level! And over an 11 year period they found that a team that had both decreased injury rates and injury severity compared with the preceding season had a statistically better chance of improved team performance, based on final league standing and league points per match. This is massively important!
The study concluded that the “association between injuries and performance is probably one of the most important messages to convey to management and coaching staff, as well as to other stakeholders in clubs, in order to continue to improve medical services for the players and to increase efforts to prevent injuries”.
Therefore, while we can’t prevent every injury, there is no magic bullet! We can use the best of our knowledge and our understanding of the science out there, how to put in programmes to help reduce the injury risk.
Read the data out there. Collect your own data. React to the data if needed.
Put into place some high quality injury reduction programmes.
Work as a team within the medical and performance department.
Help each other. Don’t let egos clash.
You should have a common goal. Work together to make it happen.
Thomas Divilly
Chartered Physiotherapist, MISCP, CSCS

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

As some of you may be aware we are hosting a Hamstring Seminar at the start of next month, and in preparation we are catching up on some of the latest research surrounding this topic. It can be an extremely confusing area as much has been done in the past 10 years, however people are still unsure of how to properly manage this injury. We are trying to get some of the best clinicians and researchers to give us an insight into their methods of assessment and management of some of the most complex topics. They will try to give us the most up to date research that they are using on their patients, hopefully helping us to stay up to date with best methods and practices.

 

So I would encourage everyone to have a read of the following few articles that have come out recently and consider how they may influence practice

 

 

  1. Hansen et al. Peak medial (but not lateral) hamstring activity is significantly lower during stance phase of running. An EMG investigation using a reduced gravity treadmill. Gait & Posture. (2017). 57 (7-10).

 

  • They discovered that increased hamstring muscle activation occurs with increased speed
  • The pre heel strike (swing phase) muscle activity peaks are higher than the post heel strike (stance phase) peaks for both the medial and lateral hamstrings.
  • The peak activation for both phases was slightly (but not statistically significantly) higher for the lateral hamstrings throughout the gait cycle whereas the medial hamstring peak was approximately 20% lower during stance (large effect size).
  • The reduction in peak activity of the medial hamstrings during swing phase suggests that there could be a relatively higher load being borne during running by the lateral hamstrings as the medial hamstrings are effectively afforded a slight “rest” during the swing phase.

 

We know that Nordics preferentially target the semitendinosus muscle (still has a large effect on muscle activation of the  BFlh). Maybe the role in Nordics is by increasing the load capacity of the semitendinosus?

 

 

  1.   Bourne et al. Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention. BJSM. (2016). 0 (1-9).

 

  • This study compared a 10 week programme between Hip Extension at 45 degrees, Nordic Hamstring Exercise and a control on measures of Bicep Femoris Fascicle length, muscle volume, architectural cross-sectional area (ACSA) and strength.
  • Some of the main findings:
    • BFLH volume increased significantly more in the HE than the NHE, however no significant changes were noted between the NHE and HE on semitendinosus muscle volume
    • The percentage change in BFLH ACSA was greater in the HE training group than in the NHE.
    • Participants increased their fascicle lengths from ∼10.6 cm prior to training, to 12.8 and 12.0 cm in the NHE and HE groups, respectively, which would likely result in large reductions in hamstring injury risk.
    • This study shows, for the first time, that the limited excursion of the hamstrings during the NHE does not prevent the exercise from increasing BFLH fascicle length. Indeed, the exercise resulted in greater fascicle lengthening than the HE, although the current study lacked the statistical power to distinguish between the two.  
    • Both exercises resulted in significant strength increases, which were similarly evident in the NHE and HE strength tests.

 

This study expands our understanding of other exercises often used in the rehabilitation and performance setting. The next step would be to do an RCT looking at the ability of the HE exercises to reduce Hamstring injuries across a season.

 

 

  1. Lovell et al. Hamstring Injury Prevention in Soccer: Before or After Training?. Scand J Med Sci Sports. (2017). Ahead of Print Online.

 

  • This article is an essential read if you are working in team sports whether as a Physiotherapist or Strength & Conditioning professional. It’s always a worry to carry them out before training, however post training fatigue may reduce the quality and compliance rates.
  • Three groups underwent a 12 week program, before training NHE group, after training NHE group and a core stability group.
  • The main findings from the study:
    • Changes in eccentric hamstring peak torque were greater in both NHEBEF (+11.9%; 3.6% to 20.9%) and NHEAFT (+11.6%; 2.6% to 21.5%) versus control (likely moderate effect), with no difference denoted between NHEBEF and NHEAFT .
    • The estimated change in biceps femoris fascicle length (expressed in both absolute, and relative to muscle thickness terms) was higher in NHEBEF versus both NHEAFT and CON.
    • Strength adaptation in the NHEBEF group was characterized only by an increased BF fascicle lengthening, whereas the NHEAFT cohort demonstrated the typical hypertrophic response, identified by an increased muscle thickness and pennation angle.
    • explained by the increased fascicle length that was exclusive to NHEBEF, the magnitude of which (12.9%) exceeded the minimum detectable change thresholds previously reported.
    • This study has demonstrated that scheduling Nordic hamstring exercises before or after football training has similar eccentric strengthening outcomes, but divergent architectural adaptations.

 

We know from some of the work done by David Opar and Dr. Anthony Shield group in Australia that the main protective mechanisms from Hamstring injuries is high eccentric strength and long fascicle length. The architectural adaptations for the NHE before group may be more advantageous however these may need to be explored in more detail over a longer period of time.

 

Let us know your thoughts!

 

Thomas Divilly

MSc MISCP CSCS

 

 


Avoiding ACL Re-Rupture

I find that the main reasons why people re-rupture or injure their old ACL knee is because they simply take their eye off the ball and stop doing their prehab or gym based rehab.

A knee that has been reconstructed in the past needs constant maintenance and reviews to make sure it is not getting weaker over time without the person knowing.


Weakness leads to muscle wasting which can lead to altered landing and running mechanics which can lead to injury.

I would advise people who have have an old ACL reconstructed knee to get it reviewed every year to avoid major issues in the future.

Joey Boland

 


Top Foods You Should Eat to Speed up the Healing of Injuries

 

Injuries are a key reason why many people quit fitness training or do not start it in the first place. It is understandable – we all try to avoid being in pain, incapacitated or unable to move freely and go about our daily business. However, injuries can happen even when you are not doing fitness exercises, for example as you try to fix something around the house, or as you walk down the street. In fact, chances are that people who are not fit and toned are more accident prone than those that are.

top-foods-you-should-eat-to-speed-up-healing-of-injuries

Suffering a fitness-related injury is quite a drawback for anyone, halting their progress and causing them to go back and rebuild their strength and endurance after they recover. This is yet another reason why many people will likely give up their gym subscription. What if we told you that there are ways in which you can speed up your healing and get back to your training sooner than you thought? One of these ways relates to your diet.

 

Yes, what you eat can prove critical in helping your injury heal faster, without side effects or visible scars. Today we will share with you the top foods to include in your daily menu, and not just when you suffer a fitness injury, but also as part of a healthy and nutritious diet.

 

  1. Citrus Fruit

Oranges, lemons, tangerines, kiwis – these are delicious citrus fruits, rich in Vitamin C, which should not be left out of your menu for any reason. Whether you prepare a freshly squeezed juice to quench your thirst or eat them in fruit salads, include as many citrus fruits in your daily meals.

 

Vitamin C has a key role in healing injuries by creating new protein for cells, scar tissues, muscles and tendons. It is also beneficial in maintaining the health of cartilages and bones. Since the human body does not naturally produce Vitamin C, it is essential to procure it from natural sources, such as citrus fruit or vegetables (peppers, for example).

 

  1. Broccoli

This vegetable which looks like a tiny tree belongs to the cruciferous family of vegetables, like cabbage and cauliflower. The main benefit of eating broccoli is the intake of phytonutrients. These compounds help reduce inflammation and boost the immune system – two key actions in speeding up the healing of an injury.

 

Broccoli is also rich in Vitamin C, making it your superhero food in your fight against fitness injuries.

 

  1. Tomatoes

This delicious fruit (yes, tomato is a fruit, not a vegetable) can be easily included in any diet, no matter what your tastes in food are. If you enjoy sandwiches in the morning, add a few slices of tomato atop your bacon and cheese. Need a cool drink? Tomato juice is both refreshing and tasty.

 

In terms of benefits for healing injuries, tomatoes are rich in the antioxidant called lycopene. Lycopene prevents open wound infections, strengthens the immune system to fight against viruses and microbes, and protects your body from oxidation caused by pollution and an unhealthy diet.

 

  1. Salmon

Healthy, nourishing and delicious, salmon is one of the most popular types of fish worldwide. You can either cook it or buy it smoked and serve it as a snack or in a sandwich.

Salmon is rich in Omega-3 antioxidant. Medical studies conducted on patients with rheumatism found that Omega-3 helps reduce inflammation and manage pain, to the point that painkillers were no longer necessary. In the case of an injury, such as a sprained ankle or a strained ligament,

Omega-3 will reduce both the swelling and inflammation, and help you heal faster.

 

  1. Soy

You do not need to be a vegan to include soy in your diet alongside meat and dairy products. Soy is rich in Vitamins A, C, D, E and K and also in proteins. These combined substances will protect the injured areas from infection, help build tissue, enhance the immune function and thus lead you to a faster recovery.