Preview of Fearghal Kerin’s Seminar on The Assessment and Management of the Sporting Hamstring

Hamstring injuries have been a hot topic of debate over the past few years, with many debates on Twitter and Facebook between academics and clinicians alike on injury mechanisms, treatment strategies and reduction methods. Everyone has their own interpretation of the literature and arguments have ensued. Stretching vs Strengthening? Eccentric vs Isometric action? Nordics vs Functional? Its a complex topic and people get passionate, whatever side of the fence they sit on.
Some of the arguments however seem quiet reductionist. Putting together what we know works from clinical trials, and what has worked in clinical based practice seems a more sensible approach that more should base their treatment approaches on. Also, in my experience, the individual seems to get lost in the argument. The complex nature of human locomotion means that individual differences for hamstring strains need to be examined for every athlete/patient e.g. strength deficit vs over stride pattern.
Putting together the information that we know to optimise treatment strategies can be the complex part.
  • When do I begin loading the hamstrings?
  • How do I know when to progress loading?
  • What exercise selections target the area?
  • When do we begin running again?
  • How do I put a rehabilitation program together?
We at Sports Physio Education are delighted to welcome Fearghal Kerin of Leinster Rugby & Dundalk FC to help us answer those questions and give us the latest evidence and clinical based strategies to manage the sporting hamstring. Below is the agenda and link for the Seminar.

Agenda:

Sports Physio Education Seminar

– Friday 16th February, 6pm – 9pm.

– Fearghal Kerin of Leinster Rugby and Dundalk FC.

– Sports Physio Ireland, 29 Upper Fitzwilliam Street, Dublin 2.

https://goo.gl/838M9V


We are delighted to welcome back Fearghal Kerin for his second seminar on the Assessment and Management of the Sporting Hamstring. Fearghal works as a Rehabilitation Physiotherapist in Leinster Rugby and the Head Physiotherapist with Dundalk FC. He brings a wealth of experience from the Elite level of sport on the management of hamstring injuries, and he is going to share with us his insights and the latest research around hamstring injuries. Fearghal’s last seminar with us in July was a sell out so we are looking forward to what’s in store for us this time round.

Seminar content:

  • Challenges of the Hamstring Strain
  • Prevention, Prediction and the Nordic Hamstring Exercises
  • Criteria based Assessment and Rehabilitation
  • Exercise Selection
  • Return to Running and Return to Performance

With most of the seminars we will be holding, there will be a large emphasis on practical assessment and interventions, so you can take away some ideas that you may integrate into your own practice. This seminar will be 1 hour of theory and 2 hours of practical assessment and treatment. Plenty of engagement and lots to learn. This seminar is open to physiotherapists, students, physical therapists, S&C coaches and healthcare professionals.

If you have any questions, don’t hestitate to contact us at info@sportsphysioireland.com.

**REFUND POLICY**

No refunds at any time.


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


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How to Prevent the Most Common Inline Skating Injuries

Inline skating is very popular among people of all ages, but especially among children and teenagers. It offers more freedom in movement than riding a bicycle and also a considerable speed. For this reason, a lot of people use it as a means of doing sports, having fun, and getting quickly from one point to another without the hassle of taking the car or the bike.

How to Prevent the Most Common Inline Skating Injuries

However, many people who practice inline skating are prone to accidents – these accidents being quite prevalent among novices. Statistics say that out of the most serious inline skating injuries which ended in the ER, 14% are suffered by beginners who do not yet master the art of swerving or stopping their inline skates properly.

 

What Kind of Injuries Are Involved in Inline Skating?

By far, the wrists are the most exposed body parts to injury while inline skating. This is generally due to the fact that the natural instinct when you trip while skating is to put your hands forward to break the fall. A research study conducted by the Medical Clinic and Polyclinic, Department of Sports Medicine, University of Tubingen, Germany showed that the overall percentage of injuries in inline skating is:

 

  • 38% to the shoulders, arms and torso;
  • 31% to the legs;
  • 21% to the pelvis and hips, and
  • 10% to the head.

 

Understanding these statistics is important, because it shows the mechanics of injuries and helps us become more aware of the dangers. For example, although the head injuries have the smallest proportion in the above percentages, they also tend to be the most severe. For this reason, you should always wear a protective helmet, even if the statistics say you are the least likely to injure your head.

 

What Are the Best Ways of Preventing Inline Skating Injuries?

There are no specific injuries or conditions related to this sport – injuries are strictly related to accidents. For this reason, our list of tips will refer to the prevention of such accidents, rather than the prevention of specific injuries.

 

  1. Beginners Should Practice on Special Lanes

There are special lanes for inline skating in parks and sports facilities. These are the ideal places to practice until you master your skating technique. The lanes are smooth, in a straight line and with very wide curves, helping you learn how to advance forward, swerve and stop. There is no pedestrian or bike traffic on these lanes, so you will be able to concentrate on skating itself without fear of accidents.

 

  1. Wear Protective Gear All the Time

Accidents can happen even to seasoned inline skaters. A sudden bump in the road, a person unexpectedly appearing in front of you are enough to cause you to fall down. The most common items of protective gear are the helmet and the knee, elbow and palm pads. If you take part in a high speed skating race, you should also wear a mouthpiece to protect your teeth in case of a violent impact with another competitor.

 

Apart from these protective items, inline skaters are recommended to wear long sleeve shirts and full length trousers in order to minimise the amount of cuts and bruises in case of an accident.

 

  1. Learn How to Fall

This is one of the first lessons an inline skate trainer would give to all beginners. Learning how to fall safely is a must if you want to reduce the extent of your injuries. The best way to fall, when it is inevitable, is on your sides – right or left. Falling backwards should be avoided at all costs because you could injure your spine or neck. When you fall forward, do not lock your elbows, but let the shock travel up your arms and along the muscles. This will avoid a serious wrist sprain, or even a fracture of the metacarpal bones.

 

  1. Warm up Before Skating

Warming up should be done in two sessions: the first before you put on your inline skates, and the second with your skates on, before you start gaining speed and swerving. For the first part of the warm-up, you should focus on flexibility by doing a series of stretches. For the second part, assess your range of movements, practice various stops (in a curve, all of a sudden, at various speeds) and build up momentum gradually.

 

  1. Keep a Close Eye on Your Surroundings

Once you leave the sanctuary of specially designed lanes for skating, anything could happen. For this reason, you must be very careful at what is ahead of you and around you, navigate carefully in traffic, never skate behind a car or a bike, and pay special attention to the potential bumps and irregularities in the road.


Treadmill or Free Running? Find out Which Has the Lowest Risk of Injury

When it comes to running, there are two kinds of people: those who prefer running outside, and those who love going to the gym to run on the treadmill. Each of these two groups of people will defend their option with countless arguments.

 

In the end, it is a matter of preference, but we would like to take a closer look at the level of safety of each option. This article is not aimed to create a rift between free runners and gym goers. It is meant as a helpful guide both for beginners who have not made a choice, and as an eye opener for more seasoned runners, so that they can avoid injury while doing their favourite running routine.

 

Therefore, let us examine the conditions for each type of running and try to determine which one is safer.

 

Free Running

Either on a closed track or in the great outdoors, free running is the number one option for keeping fit for millions of people. Its number one advantage is that it does not cost too much (except for the running apparel and shoes). It is also great because you do not get bored, with the ever-changing scenery around you.

 

But this advantage can turn into a risk as well. If you are easily distracted by things you see around you, you may miss a bump in the track and fall down, possibly spraining your ankle. This risk of injury is multiplied by the fact that a lot of people (even some professional athletes) choose to listen to music on MP3 players while they are running, thus becoming oblivious to any warning noises.

 

On the other hand, free running helps you exercise your muscles better and helps you gain a correct gait. Every movement you make when your foot makes contact with the soil is different, and exercises all muscle groups in your legs. However, if you are running on a hard surface with inadequate shoes, running outdoors can cause shin splints and hamstring injuries.

 

Main Take-Away: Free running is great if you are a professional runner, and are good at focusing on your training and not getting distracted. Also, you need to use professional running shoes and know which type is adequate for the terrain on which you will be running.

 

Treadmill Running

Treadmill running is a great option for cold, rainy days. Even if you are a staunch lover of free running, you have to resort to going to the gym during late autumn and winter.

 

Treadmills are safer overall for amateur runners. They are provided with padding, so the impact on your muscles and joints is softer compared to free running. If you are just beginning to exercise and are a bit overweight, it is a great idea to start with the treadmill.

 

However, the main disadvantage of the treadmill is that your legs are not fully exercised. You are basically repeating the same type of step, and are not compelled in any way to correct your gait and vary the groups of muscles you are exercising. This repetitive exercise of the same groups of muscles leads to recurring cases of shin splints and IT band pain.

 

Observations by professional trainers have shown that treadmill runners tend to develop longer strides on the treadmill, trying to minimise the time when their feet are in actual contact with the treadmill. Several studies have also proven that running on the treadmill for a long time can change your posture, favouring the inward rolling of the ankle.

 

Also, if you happen to stumble on a treadmill, the consequences can be more serious than those of the same accident taking place on stationary ground.

 

Main Take-Away: The treadmill is a great complement to running outdoors, when inclement weather prevents the latter. However, continuous use of the treadmill may change your running posture, favouring the occurrence of accidents. It also favours repeated injury to the shins and IT band, which are the most exercised muscle groups during treadmill running.

 

The Verdict: Free running is healthier and better adapted to a complete work-out of your muscles. While the treadmill is great to keep fit during those days when you cannot do your running routine outside, you should not use it as a replacement for free running – both for fitness and health reasons.

 


Avoid These 4 Mistakes When Warming Up Before a Run

Running is one of the most popular forms of exercising and keeping fit. Whether you do it on the treadmill or out in the park, one thing is always the same before you get started: warming up. Of course, every amateur or professional runner knows this and we are confident that you never start your running without going through your warm-up routine.

But now comes a critical question: are you sure that your warm up is adequate and prepares your body for the physical strain of running? Doctors and professional coaches took a look at how athletes and amateur runners are warming up and identified several mistakes in the way they prepare their body for the effort.

For example, a lot of runners start with stretching. There are correct ways and wrong ways to do the pre-run stretches, and many people do them the wrong way. However, from now on you will know how to warm up your muscles for a good run because we will show you exactly what you have been doing wrong.

1. Static Stretching

We hinted at the right way and wrong way of doing stretches, so we will start with them. Static stretching is a wrong way to do your warm up before running. You definitely know and do this routine: stand with your legs wide apart, bend down till your forehead touches the leg, hold the position for 10-20 seconds, and repeat on the other side.

Here is why this is wrong: your tendons are like rubber bands. The wider you stretch them, the more lax they become when they have to snap back into place. With the type of static stretches described above, your tendons are stretched too much and will do you a disservice during your run (possibly even leading to injuries from wrong stepping and gait).

Do this instead: dynamic stretching, such as hopping, lunges, walking with your knees lifted as high up as they go, and hip lifts.

2. Doing Core Exercises

Since you are doing your pre-run warm up, shouldn’t you also throw in a few sit-ups and push-ups for good measure? No, you should not. Core exercises and cardio routines are not similar to a proper warm-up routine. They put a lot of strain on your body and leave you tired and unable to do your usual run without being out of breath.

Remember that the whole point of your warm-up routine is to prepare your body for the actual running, not strain your muscles and consume all your energy.

3. Not Focusing On Knee and Hip Flexibility

Flexible knees and hips are crucial for safe running. A stiff knee can lead to a misstep and a serious injury – a sprained ankle, for example. If you want to ensure that your knees and hips work properly during the run, you should focus on stretch exercises for the rectus femoris muscle, which runs behind your leg between the knee and the hip. Just be careful to do these stretches at least 30 minutes before the run.

4. Not Wearing Sweats

Sweats are the ideal exercising clothing. They may not appear to be a critical part of your warm up, but if you exercise outdoors it is very important to avoid getting your muscles chilled. The inner heat released as you warm up, combined with the chilled weather outside, will make your muscles contract and not work properly during your run.

These four mistakes in your warm-up routine could lead to serious injuries during your run. It is not hard to avoid them – all you have to do is not overdo your warm up and choose the types of exercises that prepare your muscles for the run without straining them.


The Hip Flexor Stretch

The Hip Flexor stretch is a common exercise used in both gym and rehab settings. Personally I use it a lot in conjunction with many other movements, in the treatment of musculoskeletal disorders and sports-related injuries.

While it can be an excellent prescription for many individuals, it is very often performed wrong. Some simple queues to help make sure your technique is spot on are:


– Tighten your tummy
– Squeeze your bum (glutes) on the side being stretched
– Try not to arch through your lower back
– ‘Spread the ground’ with your feet

Hip
Once your form is correct you can play around with the angle of the stretch for even greater results. Because of the oblique orientation of the iliopsoas muscle (hip flexor) I find that adding a slight degree of rotation towards the opposite knee can allow for further lengthening of the muscle and a better all around stretch.

This stretch, when prescribed in conjunction with good strength-based rehab exercises, can help to improve reduced hip mobility. And improved hip mobility has strong links to decreasing low back and knee pain.

Give it a try and let us know how you get on.

Riain Casey, M.I.S.C.P.