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


Groin injuries in Athletes

Groin injuries are typically associated with athletes involved in multi-directional fast paced sports such as Hurling and Football.

The incidence of groin injuries in elite Gaelic footballers was shown to be as high as 9% (Murphy et al, 2012).

There are many different causes of groin pain in the sporting athlete, the most common diagnoses including acute groin strains, adductor tendinopathy and osteitis pubis. It can be an extremely debilitating injury associated prolonged periods on the sideline. There are many structures around the hip and groin region that must be considered when managing a groin injury, for instance there are 5 different muscles that act as adductors of the hip. When too much pressure is put on a certain part of the pelvis during movement this can lead to failure of other local tissues. This is often seen in sport when players have an unusual way of cutting/turning which can become problematic over time, thus leading to a groin injury as an example.

Red flags for groin injury often seen in GAA are limited hip ROM, reduced groin strength (groin squeeze) and poor lumbopelvic control, characterised by a player leaning excessively over their planting foot during a cutting movement.

Treatment begins with accurate diagnosis of the pathology as without clarifying the exact cause it is hard to implement a fully functional rehab programme due to the complexity of the hip/groin region. Muscle control and de-loading of affected tissues are two components that I like to focus on when approaching these injuries initially. It is important to introduce sports specific drills when suitable especially in multidirectional sports as the groin muscle has a massive role in decelerating the hip movements during quick turns.

 

Paddy Hannon, MISCP


21 Day PT Trial

Want a 21 Day PT Trial?

Right now Sports Physio Ireland is offering you the chance to come in and try out our services for 21 days for only €59!

The 21 Day PT Trial will cover everything from strength and conditioning training to rehabilitation of an injury under the watchful eye of our chartered physiotherapists/trainers who will also be providing dietary advice to help you balance your eating habits.

Space is at a premium and we can only offer this trial to a limited number of people.

This is a HUGE discount and is definitely not to be missed!

We strive to provide the highest quality service in order to help you achieve your goals.

Sign up now by clicking the link below & and an expert trainer will be in touch.

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Sports Physio Ireland Team


Groin Injury Screening In Gaelic Football

 
The role of musculoskeletal screening has been a hot topic in recent time, see here, with the debate on the validity and efficacy of some tools. It can cause serious confusion for some clinicians on whats the most effective strategies to put into place, what is worth measuring etc.
The past 10 years clinicians have been sold false promises on the role of the FMS and other such tools in predicting and preventing injuries.
And while we shouldn’t abandon the screening process to reduce injuries, we need to be a bit more aware on what they actually measure and does it even help the clinician? 
 
A recent paper by the group led by Dr. Eamonn Delahunt has looked at the adductor squeeze test and the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire to assess its ability to identify Gaelic Football players at risk of developing groin injury. There was 55 players within the cohort and they where followed over a 9 month period. The chartered Physiotherapist during pre-season as part of an injury screening evaluation included both the adductor squeeze test and HAGOS. No groin injuries or other injuries where found during the pre-season testing. 
 
Results revealed a significant difference in pre-season adductor squeeze test scores between those players who did (median = 210 mmHg, n = 10) and did not (median = 260 mmHg, n = 45) sustain a groin injury, U= 107.5, z =  2.58, p = 0.01, r = 0.35.
The optimal cut point for the squeeze test to discriminate between players who did and did not sustain a groin injury, to be 225 mmHg. 
 
Results of the Mann-Whitney Test revealed a significant difference in pre-season HAGOS function,sport and recreation subscale scores between those players who did (median=76.56, n=10) and did not (median=96.87, n=45) sustain a groin injury, U=114.5, z=2.48, p=0.01, r=0.33. With regard to the HAGOS function,sport and recreation subscale score, the cut point with maximal sensitivity (0.70) and specificity (0.73) to discriminate between players who did and did not sustain a groin injury was 87.50.
 
What should be of great interest to clinicians when reading this study is both the ease to administer of both tests and the cost-effectiveness. Unlike many studies which look at expensive and time-heavy methods, these are available to all clinicians with no heavy burden also. While the relative sample size was small, it does give clinicians both some normative data and cut off points to make some meaningful decisions within the team setting. It may also allow the clinicians to individualise both Strength and Conditioning programs and injury prevention methods within a group setting. 
Thomas Divilly

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


Fatigue Markers in Sport

Following on with some of our most recent posts on training load and injury/illness as we prepare to welcome Mark Roe for our August Seminar “Minimising Injury Risk and Maximising Performance in the GAA”, we will look at fatigue as a useful marker to monitor the athletes that we work in day to day, especially within the team setting.

Management of fatigue is important in mediating adaption to training and ensuring the athlete is prepared for competition. These training responses can be both positive and negative, and helps both the Strength and Conditioning and Medical staff see how the athlete is responding to the training load prescribed.

Different times of the year, different objectives will always make these slightly open to interpretation of the support staff e.g. during a period of planned overreaching,

the support staff will expect to have changes in fatigue markers that may be negative. Fatigue can also give us a better ability to reduce the athletes’ susceptibility to nonfunctional over-reaching, injury, and illness, by picking up signs and symptoms of difficulties to the training load early.

An excellent recent systematic review in Sports Medicine highlighted the role of fatigue on injury rates and illness in athletes. Below I have outlined some of the main findings from the review on fatigue markers and injury within that paper.

Fatigue Markers and Injury

The review showed that only 9 studies investigated fatigue–injury relationships, seven of which used perceptual wellness scales.

  • In soccer players 3 studies showed greater daily hassles to be associated with increased injury, using the Hassles and Uplifts Scale (HUS) (Ivarsson et al., 2010; Ivarsson et al., 2013; Ivarsson et al., 2015)
  • Laux et al. (2015) further support the positive perceptual fatigue– injury relationship in their findings, which reported that increased fatigue and disturbed breaks, as well as decreased sleep-quality ratings, were related to increased injury.

However, In contrast rating of perceptual fatigue showed slightly different findings in other studies:

  • Killen et al. (2010) found increased perceptual fatigue (measured via worse ratings of perceptual sleep, food, energy, mood, and stress) was associated with decreased training injury during an elite rugby league preseason.
  • Similarly, King et al. (2010) showed increased perceptual fatigue (measured via various REST-Q factors) was associated with decreased sports performance training injuries and time-loss match injuries.

The authors theorise that these unexpected findings may be due to the fact that when players perceive themselves to be less fatigued they may train/play at higher intensities, increasing injury likelihood.

Most of the studies used wellness scales that take approximately 1–4 min to complete. These are extremely practical to administer to athletes and are quick and not too time consuming. The Rest-Q has been also well-validated within the literature.

The review also showed that current self-report measures fare better than their commonly used objective counterparts. In particular, subjective well-being typically worsened with an acute increase in training load and chronic training load, whereas subjective well-being demonstrated improvement when acute training load decreased. Using quick subjective questionnaires and “knowing” the athletes is vitally important. Earning the trust of the athlete and building a strong relationship over a period of time, is just as useful as any expensive monitoring system.

The authors also noted the poor investigation within the literature of the relationship between sleep and injury.

Sleep is a vital part of the body’s recovery process and has been well highlighted in recent times on it’s relationship to productivity, chronic pain and depression (Rosekind, (2010); Smith (2004); Tsuno (2005). The review showed that three studies assessed sleep–injury relationships via sleep quality ratings, with only Dennis et al. (2015) investigating objective measures of sleep quality and quantity in relation to injury. No significant differences in sleep duration and efficiency were reported between the week of injury and 2 weeks prior to injury.

fatigue

While the number of studies is quiet limited in the review, evidence of the use in the team setting to monitor the role of fatigue on injuries is supported. However, anecdotally and from experience within the field the importance of speaking to people, building strong relationships and creating a supportive environment cannot be underestimated. An athlete who trusts your role and job in helping their performance and having their wellness as a priority will often speak to you sooner than any subjective or objective marker can pick up.

So while using these tools is of great importance, don’t forget the strength of building personal relationships with your athletes.

Thomas Divilly

  • Ivarsson A, Johnson U. Psychological factors as predictors of injuries among senior soccer players: a prospective study. J Sports Sci Med. 2010;9(2):347.
  • Ivarsson A, Johnson U, Podlog L. Psychological predictors of injury occurrence: a prospective investigation of professional Swedish soccer players. J Sport Rehabil. 2013;22(1):19–26. 93.
  • Ivarsson A, Johnson U, Lindwall M, et al. Psychosocial stress as a predictor of injury in elite junior soccer: a latent growth curve analysis. J Sci Med Sport. 2014;17(4):366–70
  • King D, Clark T, Kellmann M. Changes in stress and recovery as a result of participating in a premier rugby league representative competition. Int J Sports Sci Coach. 2010;5(2):223–37.
  • Kinchington M, Ball K, Naughton G. Reliability of an instrument to determine lower limb comfort in professional football. Open Access J Sports Med. 2010;1:77–85.
  • Kinchington M, Ball K, Naughton G. Monitoring of lower limb comfort and injury in elite football. J Sports Sci Med. 2010;9(4):652.
  • Killen NM, Gabbett TJ, Jenkins DG. Training loads and incidence of injury during the preseason in professional rugby league players. J Strength Cond Res. 2010;24(8):2079–84.
  • Laux P, Krumm B, Diers M, et al. Recovery-stress balance and injury risk in professional football players: a prospective study. J Sports Sci. 2015;33(20):2140–8.
  • Rosekind, Mark R., et al. “The cost of poor sleep: workplace productivity loss and associated costs.” Journal of Occupational and Environmental Medicine52.1 (2010): 91-98.
  • Smith, Michael T., and Jennifer A. Haythornthwaite. “How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature.” Sleep medicine reviews 8.2 (2004): 119-132.
  • Tsuno, Norifumi, Alain Besset, and Karen Ritchie. “Sleep and depression.” The Journal of clinical psychiatry (2005).
  • Dennis J, Dawson B, Heasman J, et al. Sleep patterns and injury occurrence in elite Australian footballers. J Sci Med Sport. 2015;19(2):113–6.