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


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 


                   

 


Tips to Avoid Muscle Fatigue during Fitness Workouts

 

Most people who have just begun their fitness training at the gym have experienced this sensation: a sudden inability to go further, to take one more step on the treadmill or to do one more push-up or crunch. It is called muscle fatigue and it can occur even among professional athletes. Therefore, since it is such a common problem for people training intensively, it is worth our attention.

Tips to Avoid Muscle Fatigue During Fitness Workout

Muscle fatigue is an insidious condition, in the sense that it does not give you any warning signs. In other words, your body does not give you specific hints to slow down your training. It just stops obeying your commands at a certain moment. There are several causes which favour muscle fatigue, and they are all simple and easy to correct. Thus, we decided to have a talk with professional trainers and find out their best tips for preventing muscle fatigue.

 

What we found out was rather encouraging – it is in everyone’s power to take the necessary steps to fuel and strengthen their bodies adequately, and to increase their endurance for intense training. Therefore, without further delay, these are the top recommendations from professional trainers to avoid muscle fatigue:

 

  1. Fuel Your Body Properly

Adequate nutrition is the key to everything you do – from the ability to focus on complicated tasks at work to your body’s endurance during fitness training. A well-balanced diet includes lots of fruit, vegetables, proteins and carbohydrates. Carbohydrates are of a particular importance. They help your muscles store glycogel, which is depleted during training, leaving you with the sense of fatigue.

 

If you are planning to start fitness training, you should change your nutrition habits 10 days to a week before you hit the gym for the first time.

 

  1. Hydration

Yes, once again we touch on this subject because it is as critical as proper nutrition. We will never tire of reminding amateur and professional athletes that the human body is made of 70% water and it loses lots of it through sweating during intense physical training, along with essential minerals and electrolytes.

 

Staying hydrated involves drinking water and sport drinks before, during and after training and avoiding at all costs the sensation of thirst. The moment you feel thirsty, your body already experiences dehydration, your muscles are prone to cramps and fatigue and you will not be able to complete your training schedule.

 

  1. Use the Correct Posture

One of the reasons why people feel muscle fatigue, especially at the beginning of training, is the fact that they do not maintain an adequate posture on the treadmill, on the elliptical bike and during weight training. The first consequence of a wrong posture is the fact that one group of muscles takes the brunt of all your efforts, while others are not properly exercised. It also means that you will develop an unnatural posture, unless you correct it, with long terms effects such as a predisposition for injuries and chronic pain.

 

  1. Build up Lung Capacity

In most cases, muscle fatigue is accompanied by shortness of breath. This means that your lungs are not working efficiently to deliver oxygen to all the cells in your body during training. The best way to correct this is to start your fitness training with a series of exercises which are meant to improve your aerobic capacity – that is, the quantity of air you intake with each breath. In many sports, learning how to breathe in and out and synchronise your breathing with the movements of the body are the main keys to pushing your endurance and performance further.

 

  1. Do Not Skip the Rest Day

For beginner athletes it is very tempting to push themselves to the maximum capacity. They will go to the gym every day of the week, ignoring the trainer’s recommendation for a rest and recovery day after each two days of training. The result of pushing yourself too hard is suffering from dead leg, muscle cramps and losing your enthusiasm in the training, due to the soreness you will have to endure at the end of your first week of fitness.

 

Rest days are important, even for professional athletes who win Olympic medals. The human body is a fine tuned machine, which needs time to recoup and regain strength. If you keep the machine working for too long without a break, something will snap sooner or later.

 

Now that you know what you need to do to keep your body working properly, you can certainly avoid any further muscle fatigues by sticking to a healthy and balanced diet and training regime.

 


Helpful Tips Every New Runner Needs

Helpful Tips Every New Runner Needs to Know

If you have just started running, congratulations! You are making the right decision to stay fit and healthy and, with proper training, you may even achieve a professional level. There are some hurdles to overcome, one of them being the first occurrences of muscle fever, but with diligence you will certainly succeed in reaching your running goals.

 

In today’s article we will try to dispel a few myths by offering you helpful and valid tips which will help you stay focused, and make the right choices in your training and running style.

These tips were compiled by various trainers and coaches who observed their students along the years and noted the common mistakes they were all making.

 

By following the advice we offer here, you will be able to develop a correct running gait, effective warm-up and cool down techniques, and will certainly not fall victim to ineffective, or even dangerous, “tips and tricks” shared on the internet.

 

Here we go:

 

  1. Breathe Naturally

You do not have to develop any specific breathing technique to gain more endurance on the running track. Running is natural to the human body, so breathing during running should also be natural. Of course, as you continue running, your body will need more oxygen, so your breathing will become heavier. This is perfectly normal. Instead of worrying about how you breathe, keep your eye on the track and free your mind from worrisome thoughts.

 

  1. Walking in the Middle of a Run Is Not Cheating

As a beginner, your body is not fully trained to withstand a long run without taking some breaks. Slowing down your running to a brisk walk is not cheating on your training. You simply need to allow your muscles to get used to the new kind of effort they are subject to. As you gain more endurance, you will be able to run a longer distance, without taking walking breaks.

 

  1. Drinking Water Does Not Cause Side Stitch

Side stitch is a sudden pang of pain which runners feel in their side, under the ribs. For a long time there has been a myth running around (pun intended) that drinking while running causes the side stitch. This is absolutely not true. On the contrary, you are encouraged to stay hydrated, especially during the hot season or during long distance runs. The side stitch is most likely caused by not breathing correctly (see item 1 in this article).

 

  1. Do Not Just Sit Down during a Resting Day

Training schedules have a few resting days during the week. You may be tempted to take the “resting” literally, and sit on the sofa watching TV. It is a resting day, right? Not exactly. If you are not running, you should be doing other forms of cross-training to improve your muscle flexibility and endurance. Stretching exercises, swimming, or cardio exercises are a perfect way of keeping your body focused during the resting day. If in doubt, always consult with your coach and discover the ideal training schedule for you.

 

  1.  Injuries Do Happen

No matter how careful you are, you will get a running injury at a certain point. You may suffer a sprain, or the runner’s knee, or a hamstring strain. This does not mean that you should stop running or refrain from becoming a better runner out of fear of injury. Instead, learn what you have to do after you suffer an injury and how to minimise your recovery time.

 

As a parting thought, remember that running is your choice and the only person you are in a competition with is yourself. Take your time to build a training system which works for you and helps you reach your fullest potential.


How to Select Adequate Running Shoes

How to Select Adequate Running Shoes

The most important accessory for any runner is the shoes they wear. High quality shoes, which offer adequate support to your sole, ankle and lower leg, will help you run smoothly, and to your fullest performance and endurance. On the other hand, wearing inadequate, old and worn out shoes may even lead to serious injuries such as a sprain, Achilles’ tendonitis or plantar fasciitis.

 

For these main reasons (and many others), you should always wear specialised running shoes which fit your foot perfectly and offer you adequate support for your specific type of gait (we have touched on this subject already when we discussed the importance of knowing your type of pronation).

 

So, if you are just starting your running routine or you are a seasoned runner in need of a new pair of shoes, these are some of the things you should keep in mind when going shopping:

 

  1. Select a Specialised Sportswear Store

It may seem more affordable to buy no-name running shoes from your retail store (especially if you are a newbie amateur runner), but these are usually generic shoes which are not specifically adapted for running and will not offer you the benefits of a quality brand running shoe.

 

Plus, specialised stores have trained employees who can help you select the ideal type of shoes for your gait and pronation. You could either bring your old shoes with you, for the store staff to observe the wear-out pattern on your soles, or ask them to put you through a gait observation test to determine your type of stepping and running.

 

  1. Choose Shoes Adapted to the Running Surface

It makes a big difference if you run on a track, in a park, or on a treadmill. Each surface has different characteristics and degrees of hardness. Thus, if you run on asphalt alleys in a park, you will need light and flexible shoes to minimise the impact of the hard surface on your sole. If you select an off-road trail, your shoes need to have a denser sole to absorb the impact of stepping on uneven surfaces. These running shoes are also waterproof, to offer you adequate protection and comfort in case of a sudden rainfall.

 

  1. Make Sure the Shoe Fits Perfectly

Feet are just as varied in shape and size as hands. Some people have long and thin feet, while others have shorter and wider feet. It is very important to check that the running shoe you select fits you perfectly from the moment you try it on for the first time. For instance, if the shoe fits perfectly in length but your toes are squeezed together tightly, that is not a good shoe for you. Do not bet on it becoming looser as you wear it – that is not going to happen, instead it will affect your running gait.

 

  1. Select Shoes That Fit Your Arch

The foot arch is the portion between the heel and the ball of your foot, which is more or less concave. Some people have a completely flat arch (the whole surface of the sole makes contact with the ground), while others have high arch. Depending on the type of arch, your shoe needs to have a thicker or thinner midsection to offer adequate support to your foot arch.

 

  1. Wear Your Usual Running Socks When Trying on the Shoe

This may seem like pointless advice, but it makes all the difference in the world. Running socks are different from your regular cotton socks in terms of thickness. If you do not wear adequate socks when you buy your shoes, you may find out that they are too tight or too loose.
These simple tips will help you find the right pair of running shoes for your specific gait and foot type. Remember that you can always count on your physical therapist to give you further advice and even recommend you a specific running shoe model.

SPI Team

P.S Why not book a session with us and we can advise you on the best course of action to take …


Lower Leg Injuries in Running: Common Causes and Treatment

Lower leg injury is quite common both among professional and amateur runners. It occurs due to undue strain on the muscles and ligaments – generally caused by pushing yourself beyond your fitness abilities. Today we will cover some of the most common types of lower leg injuries and offer helpful advice for treating them.

 

Shin Splints

The most frequent type of lower leg injury is the shin splint (more commonly referred to in the plural, shin splints). Shin splints cause you to feel pain along the inner edge of the shin bone, between the knee and the ankle. Other symptoms of shin splints of varying degrees of severity are:

  • Increasing pain in the front lower part of the leg (above the ankle) as you continue training
  • Mild swelling of the lower leg
  • Numbness and weakness in your foot, causing an inability to support your body weight properly
  • Tenderness or soreness along the inner part of the leg starting from the knee down

 

The main cause of shin splints is infrequent exercising, following a pattern of intense training (running), taking a break from physical exercises and then returning to intense training. It is not an injury which happens overnight, but as an accumulation of stress and effort.

 

Shin splints can be treated by following the RICE method: rest, ice, compression and elevation. Your doctor may also prescribe pain medication or send you for further tests and investigations in case the symptoms persist. In some cases, the symptoms associated with shin splints are for more severe conditions such as fracture or compartment syndrome.

 

Tendonitis

Tendonitis is another form of common lower leg injury in runners. The most frequent type is Achilles tendonitis. The main cause for this injury is a sudden increase in uphill or speed running. Also, if you switch from wearing running shoes to wearing racing shoes without allowing your legs to get used to the new type of shoe progressively, this can also cause Achilles tendonitis.

 

The symptoms of tendonitis are:

  • Pain when stretching and contracting the muscles in your lower leg
  • Reduced mobility and flexibility
  • Swelling and tenderness in the back of your leg, above the heel

 

Tendonitis is also treated using the RICE method. In addition, your physical therapist may recommend a series of exercises to gradually increase the strength and endurance of your muscles and tendons. Only rare and severe situations (such as the breaking of the Achilles tendon) lead to surgery.

 

Compartment Syndrome

As we mentioned above, some of the symptoms of compartment syndrome can be mistaken for shin splints. In order to understand how compartment syndrome occurs, you have to know what happens inside your leg while you are running. Fuelled by the effort and increased blood flow, muscles will expand their volume by up to 20%. If the fascia (the tendon tying them to the muscles) is too tight and preventing the expansion,

it will cause strangulation, blocking the blood inside a muscle compartment and putting pressure on the nerves.Lower Leg Injuries in Running

 

Thus, your muscle will feel numb and painful, and will not work properly (contract or relax according to the movements you want to perform). In case of severe compartment syndrome, the pain in your lower leg will only start at a certain point during running and quickly increase to an unbearable level. The pain and swelling subside as you cease running, this is why it is difficult to diagnose this condition.

 

Surgery can be an option to treat compartment syndrome. However, patients experience complete recovery after the surgery, even returning to their professional athlete activities.

 

Apart from these types of lower leg injury, there is also inflammation of the large muscles in the posterior part of your leg – but this is a very common and simple to treat condition, requiring only the RICE method and a progressive increase of your fitness training.

 


Getting Back to Your Running Routine After Injury

Injury is an unavoidable aspect of physical exercise – for both amateurs and professionals. Some injuries are easier, while others will keep you away from exercising for weeks. Whichever the case may be, always wait until you get the green light from your doctor to start training again.

Since every injury is different, every training plan to return to your previous performance is different.

The factors which affect your training plan are:

How severe your injury was,

How long you had to rest your injured leg (not walking or putting pressure on it),

How fit you were before the injury, and

What type of physical therapy you were allowed to do during the recovery process.

The key to successfully getting back in shape is moderation. Many athletes feel pressured to get back to their level of fitness and performance as soon as possible, and set up an unrealistic training plan. For the purposes of this article, we will use the case study of a runner who had to spend eight weeks recovering from a serious leg injury.

 

1. The First Week of Training

 

Before you consider running, you should be able to walk at a brisk pace without pain and without getting tired for about half an hour without a break. Therefore, your first type of training should be walking.

Your initial walks should not exceed 1-2 miles on alternating days (maximum four walks per week). Allow your leg and foot to regain mobility naturally by progressively increasing the pace and briskness of your walk.

 

2. Weeks 2-5

 

By the second week, you should be able to walk up to four miles on alternating days. At this point, you will be able to keep up a brisk pace and, by the start of the 3rd week of recovery training, you should be able to do the first light jogs.

Jogging should not exceed 10 minutes during the 3rd week, with a 5-minute walking break in the middle. Allow your muscles to cool down with a brisk walk and then focus on resistance training through brisk walking.

During the 4th and 5th weeks, your jogging sessions should increase to 15 minutes per day, four days per week. Two days should be taken up by 3-mile walking combined with cross training or using the elliptical stationary bike for 30 minutes, and one day you will rest and focus on light mobility exercises.

 

3. Weeks 6-8

 

During this period you will focus on rebuilding muscle strength and resistance with intensive jogging sessions of 20-25 minutes four days per week, and walking and cross training two days per week.

The elliptical stationary bike will also help you build flexibility and strength (which is why you should include it in your cross training routine starting with the 4th week of recovery).
By the end of the 8th week, you should have regained your former level of strength and resistance. As you can see, the recovery training will take as much time as you spent recovering from the injury itself. While this is not a fixed rule, the main take-away from this article should be this one: getting back to your typical running routine is not achieved overnight and you should not try to push yourself too hard. You may risk reactivating your injury and make matters even worse.

Check out our recommended products to help you recover.

 


Runner’s Knee

Runner’s knee is also known as Patellofemoral pain syndrome, or runner’s knee, is one of the most common types of injuries occurring in professional or amateur runners, accounting for 20% of all types of injuries.

The symptoms of runner’s knee start with mild pain under your kneecap while you are running. In the early stages, pain stops as soon as you stop running, so many people do not seeking medical help at once. However, if left untreated, the pain will increase in severity and will continue to affect you even after you have stopped running.

Recognising and Correcting Running Form Mistakes

The good news is that treatment for runner’s knee is simple, non-invasive and you can do it at home with minimum medical supervision. However, the most severe cases, left untreated for a long time, may require surgery. This should be a powerful enough reason not to ignore pain in your knee while you are running, and seek the doctor’s advice as soon as possible.

This being said, the usual path to recovery from runner’s knee looks like this:

First Stage: 2-3 Days of Complete Rest

You should avoid all types of effort and putting your body weight on the injured leg.

Runner’s knee is not only painful, it also causes swelling and inflammation in your knee,

so you should apply ice packs for 20-30 minutes every four hours.

It is also useful to find a pillow on which you can rest your injured knee in an elevated position. This will improve blood flow through the leg and help reduce swelling. During this period, you should keep your movements to a minimum and use crutches when you have to walk, so that you spare the injured knee all kinds of efforts.

Second Stage: First Light Exercises

There is no specific timeline for the recovery from runner’s knee, except for your doctor’s recommendations. However, as soon as you are cleared to start walking and applying some weight on the knee, you should do so wearing an elastic bandage to offer as much support to your knee as possible.

In parallel, your doctor may prescribe certain anti-inflammatory and pain relief medication of the non-steroidal type. This medication should be taken strictly according to the doctor’s prescription, because its side effects include bleeding and occurrence of ulcers.

Third Stage: Mobility and Strength Exercises

Once you can take off the elastic bandage, you should start a routine of specific exercises to regain mobility and strength. Stretching exercises are extremely effective and recommended by all physical therapists.

In parallel, you may use arch support for your foot, to correct your walking posture. Arch supports, or orthotics, are inserted in your shoes and offer firm support to your soles. They can be bought online or from shops, or they can be made bespoke; before you decide, ask your doctor or Physiotherapist about this. 

Complete Recovery

Just as with every other stage of runner’s knee treatment, you should ask your doctor before returning to your regular running routine. In general, you are completely cured when you feel absolutely no pain in your knee during walking and exercising, when you can fully bend and extend your knee with no pain and you can place as much body weight on it as you can on the healthy knee. It can be tricky and tough to come back from Runner’s Knee patellofemoral pain syndrome, but we are here to help. 


In conclusion, the runner’s knee is a frequent occurrence in runners, which can be treated very easily and without complex medical procedures if you seek medical advice as soon as you notice its first symptoms. So if you feel pain in your knee under your kneecap, even at bearable levels, do not ignore it. The sooner you act, the faster your recovery will be.


Achilles Tendon Injury – What Rehab is Forgetting

The Achilles tendon is at risk of injury with high load. Runners have a 15 times greater risk of Achilles rupture and 30 times greater risk of tendinopathy than sedentary individuals.

The Achilles tendon is the thickest and strongest tendon in the body. The three calf muscle attach to the heal via the Achilles tendon.

“Overcoming what was deemed impossible is what I will take with me and cherish the most…That (coming back from injury) will be the number-one thing that stands out because I wasn’t even able to walk.”

– Donovan Bailey (Olympic 100 m sprinter talking about his rehab for his Achilles tendon rupture). After rehab he ran sub-10 seconds for the 100 metres.

Out of the 5 clinicians in Sports Physio Ireland, two of us were unfortunate to have suffered Achilles injuries. Myself a partial tear and Joey Boland a tendinopathy.  Depending on the severity of the injury the road to recovery is slightly different. The outcome of rehabilitation is positive, however, with us both returning to our representative sports. The partial tear taking slightly longer to adapt to return to play.

Recognising and Correcting Running Form Mistakes

Overuse Achilles tendon injuries (tendonopathies) can arise with increased training volume or intensity. This happens because the load is too much for the tendon to withstand. Decreased recovery time between training sessions may also be a factor. The combination of stiffness (especially in the morning) and pain at the back of the heal is a key sign of Achilles tendinopathy. Pain often reduces during activity and may be pain-free during training only to come back with a vengeance a few hours later. Continuing to train through this causes the structure of the tendon to weaken and puts you at an increased risk of rupture.

As well as looking at injury to the Achilles itself, it is important to determine the causes of the injury in the first place. Injury is often linked to calf tightness or weakness and ankle joint stiffness. Abnormal lower limb biomechanics has been shown to cause torsional stress through the tendon. Weakness around the ankles can cause a whipping like action on the Achilles. A change in playing surface or footwear or poor footwear should also be considered.

Tendons take longer to adapt to training due to their poor blood supply. Rehabilitation takes longer than muscular injuries and is generally in excess of 3 months. Rehabilitation should include loading the tendon appropriately and correcting of predisposing factors that were linked to the injury. Progressing to plyometric and sports-specific activities when the ability to withstand load increases. `

When running approximately 5 times your body weight goes through your foot as you land. The Achilles needs to be strong enough to withstand this force before you go back to running, jumping and landing. Rehabilitation often does not put enough weight through the structure during closed change activities before progressing to running. Heal raises with 15-20 kg, Reverse lunges with greater than 20kg, Squats of greater than 20kg and SLDL of 20 kg should be a realistic expectation for everyone before returning to play or their chosen activity. Distributing the weight through two separate dumbbells makes this achievable for those who struggle with upper body strength. When thinking about the high level of repetitive load that goes through the body when running these weights are not that heavy and are what the body needs to adapt.

Soft tissue therapy including mobilisation and  fractioning across the tendon are useful in improving the glide of the tendon in it’s sheath. As stickiness around the tendon is often associated with injury to the tendon.

Return to activity should be gradual.

Activity should be resumed only when local tenderness has settled and weights during rehab exercises achieved.

If long distance running is not the main aim then I would argue that the repetitive loading of that nature should be avoided. If sports are the main aim then interval running should be the focus. This is the nature of the activity they are trying to return to and also allows the tendon brief recovery periods.

Catherine Simpson

MISCP, MSc Sports Medicine

www.sportsphysioireland.com

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Speed For GAA Players

Speed is defined as the rate at which someone moves.  We can divide speed into an explosive phase and a knee drive phase. A lot of GAA players spend far too much time developing muscles to move slowler, simply because this is an easier way to train during a gym session. We have to look at the relationship between gym sessions and the game played. GAA involves a lot of acceleration and deceleration, but many gym programs don’t reflect the two patterns.

There is a huge role for both strength and hypertrophy in athletic development but speed is often ignored. Reasons for this include;

It’s Time Consuming

In order to train absolute speed it can take up to 40 minutes to properly warm up and activate the muscles and patterns required. This can be slow and tedious. Quite often this part is skipped or sped up in order to get to ‘the good stuff,’ such as sprinting. Athletes can be resting for up to 4 minutes between exercises which can result in sessions lasting up to 2 hours . These sessions are regularly omitted from training plans because of an already busy schedule.

It Is Perceived As A Light Session

There is a ‘if its not hard its not worth doing’ mentality in GAA. Quite often coaches would rather see teams out of breath rather than doing a pure speed session. Athletes don’t get their heart rates up too high or break a sweat. For coaches and some athletes the temptation to work hard can be too much. Working smarter is better for athletic development.

Too Tired After Heavy Training Loads

Heavy weights, long training sessions and matches make it hard to fit speed work into a training regime. You need to prioritise it in your training week for when you are at your freshest. Typically GAA matches are on a Sunday so a speed session would be optimum on a Wednesday. Pitch sessions and gym sessions are regularly prioritised ahead of this, with pitch sessions regularly on a Tuesday and Thusday and gym sessions on Mondays and Wednesdays.

Joey Boland,

Head Physiotherpaist

www.sportsphysioireland.com

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