At Sports Physio Ireland, one of our main priorities is a client’s initial functional movement assessment. Without a thorough physical assessment, an appropriate rehabilitation programme cannot be planned.

We spend less time focusing on individual parts and aim to analyse full body movements (referred to as patterns) in order to gain as much ‘movement information’ about the client as possible.

From looking at knee & hip dominant, push, pull and core patterns we can ascertain the source of an individual’s problems, as opposed to having them lying on a bed, analysing individual body parts.

Often, an ankle or a hip issue might be contributing to a shoulder problem or vice versa. We need to look at how the body moves as a whole. We run, sit, reach, pick up, jump, push and pull in our everyday lives so our belief is that is what the assessment of an individual should be based around.

I often hear clinicians saying that their ‘client population can’t be assessed in this way’. I don’t agree. Can your client get up and out a chair (squat)? Can they push themselves off the ground if they fall then up into a half kneeling position and then stand from there (Plank – push up – lunge)? Can they pick something off the floor efficiently or ensure they don’t trip over a curb (Single leg balance / Single leg deadlift)?

Naturally, knowing your regressions and progressions for each functional movement pattern is a must, but regardless of age or ability, individuals should be working towards achieving adequate functional movement capacity for everyday life. Once you know your athlete (given age and ability) and understand the movement screening procedure you can plan appropriately.

Our movement assessment is standard operating procedure at Sports Physio Ireland. This ensures our clients get the best possible treatment.

Some Examples of Movements Analysed;

Overhead Squat, Squat.

Lunge / Side Lunge

Single leg balance / Single Leg Deadlift

Plank / Shoulder blade push up / Push Up

Side Plank

Walk / Run / Hop / Jump / Land


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


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

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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

 

 


5 Lessons Learned from Lateral Ankle Sprain Seminar

 

  1. Ankle Joint injuries contribute substantially to the total injury burden in field and court based sports.
  • Gaelic Football 11%
  • Hurling 9%
  • Elite level soccer 14%
  • Elite level rugby 5.6%-6.8%

 

Knowing and understanding the epidemiological data on the sporting population/groups you work with, allows the practitioner to put into place evidenced based injury reduction programs to help reduce the number of these injuries. Be aware of the extent of the potential problem, so you can be proactive in the management of the playing group

 

  1.  The mechanism of injuries can be broken into two sub-groups: contact vs non-contact.

 

 

  • Contact:

 

    • In soccer there are two main contact mechanisms
      • player-to-player contact with impact by an opponent on the medial aspect of the leg just before or at foot strike, resulting in a laterally directed force causing the player to land with the ankle in a vulnerable, inverted position
      • forced plantar flexion where the injured player hit the opponent’s foot when attempting to shoot or clear the ball.

 

  • Non-Contact:

 

    • An inverted position of the ankle joint at initial contact is a particularly vulnerable position and has been identified as a key characteristic feature of lateral ankle sprain injury mechanisms.
      • Kinematic and kinetic studies have shown an increase in internal rotation of the ankle joint on initial ground contact and an increased internal rotation moment on the ankle joint.

Mechanism of injury is vitally important to know when getting subjective information of the patient. It will identify the structures that are most vulnerable to structural damage and thus help you narrow down your objective testing.

 

  1.     Ankle joint injuries are extremely poorly managed. They are often not taken seriously as some other injuries, with studies shown that median return to play time post first time ankle sprain 3 days and recurrent sprain 1 day. While this is only one study finding, it does highlight how both clinicians, patients and player management don’t often take ankle sprains as serious as some of the work that Dr. Eamonn Delahunt and Dr. Cailbhe Doherty have highlighted. Their work has shown that up to 40% of ankle sprains will still experience symptoms one year on. Take your time with these injuries, and make sure your patients don’t take them too lightly.
  2. It’s not just a structural injury.

This point can’t be emphasised enough.

Deficits in static balance, postural control, gait and landing mechanics have been highlighted at both 6 and 12 months post ankle sprain, in bilateral limbs. This highlights the central changes that occur as well as the structural issues.

 

  • Challenge the uninjured limb during the initial acute stage.
  • Develop and recreate an ankle strategy in static balance once tolerated, as these patients display a dominant hip strategy post ankle sprain.
  • Improve foot positioning that are related to the patient’s sport/hobbies
    • Use marching drills/ladders/cutting and change of direction drills. Video analysis can be really helpful to provide feedback.

Ankle Seminar

 

  1. Outcome measures.

 

This is something that we all fall down on when working in a busy clinic. We often are happy enough that our eyes tell us the best picture. It is important to use valid and reliable outcome measures to see progress for both yourself and the patient. How else will we be able to know if our treatment interventions are positive or not?

 

  • For the ankle joint some useful measures
    • FAAMadl or FAAMsport
    • Cumberland Ankle Instability Questionnaire
    • Knee to Wall as a measure of Dorsiflexion
    • Balance Error Scoring System (BESS)
    • Star Excursion Balance Test (SEBT)
    • Jump Mat
      • Using contact time for Fast SSC plyometrics
        • Under 0.250 milliseconds (See work by Eamon Flanagan and Tom Comyns)

Thomas Divilly


Our latest Seminar is on Ankle Instability

SPI Education June Seminar

Topic

Management of Lateral Ankle Sprains and Chronic Ankle Instability

Speaker

We are delighted to have Dr. Eamonn Delahunt , Associate Professor School of Public Health, Physiotherapy and Sports Science, UCD giving this talk, the first of number of speakers SPI Education has planned over the next few months.
Dr. Eamonn Delahunt is an Associate Professor in the University College Dublin School of Public Health, Physiotherapy and Sports Science. He graduated with a first class honours BSc [Physiotherapy] in 2003. Upon graduation he was the first-ever physiotherapist to receive an Irish Research Council for Science Engineering and Technology postgraduate research scholarship. He completed his PhD in the minimum time required graduating in 2006. Dr. Delahunt is committed to the philospohy of the protection of athlete health and the prevention of illnesses and injuries in sport. He has published more than 80 peer-reviewed articles. Dr. Delahunt has an active research group, including 8 PhD students and 4 research MSc students. Dr. Delahunt has extensive clinical experience in the area of sports physiotherapy and is a Specialist Member of the Irish Society of Chartered Physiotherapists
Twitter: @EamonnDelahunt
Saturday, 3rd June 2017  9-12:30
Sports Physio Ireland, 29 Fitzwilliam Street Upper, Dublin 2.
This lecture is aimed at all health care professionals: Physiotherapists, Sports Therapists, Massage Therapists, S&C Professionals. All are welcome to come along.
Cost: 65 euro.  (Early Bird and Members of SPE 50 euro)
 

 


Golf Fitness by Moss Landman

Golf has come a long way in the past few years, from a fitness point of view in particular. It doesn’t seem too along ago people joked that you could be a quality golfer but significantly over-weight and unfit. The reality is that these days, players along with the game itself, are developing quickly with guys hitting it further, maintaining concentration for longer in all sorts of weather conditions and they’re not breaking down with injuries as much.

At Sports Physio Ireland we train golfers of all playing levels – from beginner through to professional players and it’s paramount for club golfers and tour players alike to keep up with these developments whether you’re looking to win your weekly singles stableford or the next major.

At the top level, Gary Player was one of the first players to advocate fitness for golfers back in the 1950s.

People thought he was crazy lifting weights back then. But today he is one of the fittest 75 year old men you will meet out there. I have a lot of admiration for Gary as even though the concept of Strength and Conditioning was so new back then, he was smart enough to take recovery and specificity (more on this later) into account with his training regime. He really was ahead of his time.

When Tiger Woods first broke onto the scene it seemed he put on a lot of muscle during his first few years on tour. He hit the ball hard and swung it as fast as anyone. He developed himself into an incredible athlete and although he had a huge amount of success early on, the idea of ‘golf-fitness’ still took a few years to take hold on tour. 

Nowadays a huge chunk of tour players are in the gym. At the time of writing, 8 of the 10 top ranked players are established gym-goers.

Rory works out twice a day, Adam Scott works out 5 times a week while Dustin Johnson’s preferred training choice is Olympic Weight Lifting.

Here are some videos which give an insight into some of the World’s best player’s routines and thoughts on fitness

 

Golf fitness doesn’t just apply to tour players. Ask yourself if you’d like to hit the ball a little further?

If you hit it 250 off the tee now maybe adding 10-20 yards to your drives, which by the way is without doubt possible, could mean hitting one of your club’s par 5s in two? If you it it shorter than than that maybe it is the difference between hitting an iron on some of your par 3s rather than a wood. 

What about the longevity of your playing career? The beautiful thing about golf is that we can play until we’re more or less knocking on death’s door. However, how often have you heard of people in your club complaining of neck, back, elbow or wrist pain preventing them from playing regularly or playing pain free?

Getting fit helps keep injuries at bay which will allow you to enjoy your golf for many years to come. Not many sports can offer that. Aside from the benefits on the golf course, getting fitter and stronger will help you live longer, stay healthier and feel better about yourself every single day. It will make you a happier person. 

So..

How can you benefit from golf-specific fitness training?

When I think of golf-fitness there are a few things that spring to mind. We must ask ourselves what it is we are looking to achieve from the development of a golf-specific training programme. For example, golf is a sport that does not require the highest levels of human strength at the expense of function or mobility compared with contact based field sports such as GAA, soccer or rugby. Equally, we walk when we play golf, we don’t run. Golf is a slow endurance sport with intermittent complex swings that require sound technique, speed and power, all in a controlled and consistent manner. For correct technique we not only require the knowledge to swing it right, but also the correct balance of flexibility, control and strength in combination to execute consistent golf shots. 

In my view, functional training is the best way to train golfers in the gym. (Functional Training is summed up well by Dr. Steve McGregor here https://www.youtube.com/watch?v=tJPK3WLTjqI.)

Functional training is a process.

Before a golfer should be concerned with lifting weights, we must ascertain whether he can move well enough to get into the correct positions in order to lift efficiently, without risk of injury. We must also ensure the golfer has the capacity to move into the correct positions to swing the club efficiently in order to hit the ball as consistently as he/she can. At SPI we focus on developing a golfers functional ability, which includes working on coordination and the correction of aberrant movement patters in order to make them more athletic, reduce their risk of injury and help them swing the club better.

Once the movements patterns are on-song we load our clients up using weights, challenging the golfer’s function at a higher level. 

There are many sub-categories of and compliments to functional golf training. Things such as foam rolling, stretching, core work, swing speed work, plyometric & power development, cardio vascular fitness and on-course nutrition are all components of functional training on one level or another and can add to your performance as a golfer. I like to think of these aspects of a golfer’s fitness as ‘boxes to tick’ along the journey to becoming a better golfing athlete. It is important to remember that not one size fits all and some individuals need specific focus on some components of functional training more so than others.

My view is that an individual should train based on what they need to improve (relative to their sport) and to get better at what they’re already good at. Generally, I want golfers to have strong, stable lower bodies and quick, powerful upper bodies. I always aim to keep my programming simple and relevant working towards short medium and long term goals.

At SPI, our initial golf-screening process will establish where your weaknesses lie and we will develop a programme for you to right these wrongs.

We also arrange nutritional consultations to help you make the necessary changes to your body along your journey, particularly helping you manage your energy levels on-course to get the best out of yourself during those 4+ hours of play.

Our goal is to make you a better athlete. No matter what your level of fitness is, we can help improve your performance on and off the golf course. For more information on pricing, our packages and to book in click the button below. 

Moss Landman MISCP

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Drop us a line today and book a session. 


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