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Sports Physio Ireland Team

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

How To Take 10 Years Off Your Sprint Speed

Runner's Knee patellofemoral pain sprint speed

What is the key to playing sport in your forties? To me, it’s getting rid of your excuses. Excuses not to train are easy to find in winter, but two fears loom large when you hit your forth decade. First off I’m more likely to get injured and secondly, I’m getting slower and going to find it harder to keep up to speed.

The first fear, of injury, is the reason I went to Joey Boland and the SPI team.  Having put in 3 years of weekly sessions, I’ve not only managed two injury free seasons, but have also ironed out a few long term issues, such as lower back pain and a ten-year-old shoulder strain.  More importantly, i feel like I’m in great shape every time I hit the pitch.

The big one though, is the fear of losing speed.  Cher isn’t the only one that wants to turn back time.

Before we get into how we tackled this, it’s worth looking at how much speed we actually lose with age.  If we look at the world record data for the 100M “Masters”, we can see the clear decline over the years is inevitable, but measurable.



Sprint Speed
Is anyone else disappointed that they could be beaten over 100M by a 75-year-old German?

For those of you not familiar with it, this is the story of how fast you can run.  You start out slow, as a child, then hit close to max around 18, plateau until approx 35, the decline after that is clearly shown in the results above.

If we look at little more closely, we can work out the rate of that decline.

sprint speed


That works out as an average decline of 3.6% every 5 years, or 0.72%/year. The reality we would rather not face in those numbers, is that we lose 7.2% of our sprint speed in 10 years. Yikes.

So how did we front up to father time?

Well, I teamed up with Catherine Simpson of SPI, who believed that the best first step was measuring where we were.  We thought that a 30M sprint test was the best and most useful measure, so she took me out to a local park with measuring tape and stopwatch in hand.  It turned out that my 43 year old, 6’2″, 15 stone frame could move 30M in 5.05 seconds.

While I wasn’t going to be breaking any records, I felt that I had a decent result for someone in reasonable shape.  Catherine had other ideas, so we spent November, December and January working hard to improve things.  Over that period, I doubled up my sessions to twice weekly with Catherine.  We also expanded the scope of my training regimen to include some basics of sprint mechanics.

Hopefully Catherine can follow up this post with a bit more detail on the path she brought me on.  I’m not expert enough to give you the detail, but in rough outline, I can tell you a little about my experience.

Prior to this, I though sprinting was running faster; turns out it’s not.

Sprinting seems closer to skipping than running.  There is requirement that you get “up” on the front of your feet.  There is technique in this, many hours spent marching/skipping to Catherine’s command helped get this part right.

When you get up there, you need to manage the transfer of the energy you create.  That means avoiding any power “leak” by keeping a solid core, hips tucked, ribs pulled down.  If you can manage that, you then have to deal with the power transfer between leg thrusts.  There is a tendency to push your knees forward with your quads, it seems that reaching that knee out will drive you forward.

In reality, it’s more about the large muscles at the back of your legs than the front, making full use of your glutes and hamstrings.

You’ll need a knee lock, which, after a while, you’ll feel transferring the power over towards the opposites leg’s next extension.

Easy, right?  You can imagine these things come with much repetition, many hours.  But when you feel it, you feel it.  I still remember the first time I got “up” and sprinting at training, it felt like I had found a new gear.  This creates a problem, in that it takes new strength as well as concentration to sprint correctly, I can run in that new gear for a few seconds, but I am then exhausted.  So we have a new problem to solve.

You might be wondering how this changed my sprint times?  Well, after three months of work, we went back out to the park and timed my 30M sprint for a second time.  The result? 4.78 seconds.  That’s a 5.6% reduction from the 5.05.  It’s not quite the 7.2% you’ll lose in ten years, but close to it.  It was a great way to spend the cold dark months of winter, a bit of pre-season that has me chomping at the bit for the year ahead.   Knowing Catherine, it won’t be long before she’s given me a bit more power, ironed out a few glitches in my technique and has knocked those last few years off my sprint speed.

This article was written by LB, an SPI Client, not for financial reward, but as a mark of gratitude to Catherine Simpson, Joey Boland and all the team at SPI for all their very expert help, diligence and enthusiasm in keeping me keepin’ on!


Ref: http://speedendurance.com/2010/02/04/masters-age-related-differences-in-100m-sprint-performance/

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


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The Likely Causes of Calf Pain

Calf pain is a common compliant and if not managed correctly, they can persist for months and cause a lot of frustration. The calf muscles refer to two major muscles; the gastrocnemius and soleus and the small plantaris muscle. These muscles have a joint tendon called the Achilles tendon, which inserts into the heal.

As the upper part of the calf crosses both the knee and the ankle, it is more susceptible to injury. Muscle strains generally occur on the inside of the calf muscle. Soleus muscle strains are also common; tenderness is more often felt on the outside of the leg deep to the calf muscle. Stressing the muscles with the knee straight or bent can differentiate between the two injuries.

A sudden burst of speed, over-stretching or direct contact with a player or equipment may cause an acute injury. With chronic injury people often present with cramping pain in the calf that seems to come and go. This may be due to previous calf strains and weak scar tissue that hasn’t recovered fully.

Certain individuals can naturally be more susceptible to calf cramps, these may occur during exercise or at rest after activity. This is most likely due to excessive fatigue. Improving the strength and endurance of the calf muscles can improve these symptoms.

Collapsing of the upper part of the foot can overload the calf muscles as they are trying to push the body forward during running. This can lead to muscle tightness and soreness and increase the risk of muscle strains or tendinopathy.

Recovery from calf strains require progressive loading to prevent tight scar tissue developing, helping the tissue to repair. Chronic strains require more time to heal as scar tissue remodelling is necessary to reduce the chance of a recurrence. This is achieved through loading the tissues as they are lengthening  and shortening. Assessing the movement patterns during functional activities such as jogging, lunging, jumping and landing is used to help find the route cause of the issue. Looking at how the individual is adsorbing, distributing and creating forces that push them forward is a key component to understanding the cause of the injury. If necessary corrective training can then be used to help prevent injury reoccurring.

Catherine Simpson

MISCP, MSc Sports Medicine


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Anterior Knee Pain

Anterior knee pain is one of the most frequently seen symptoms in the clinic at Sports Physio Ireland. Common causes of this pain in athletes and the general population is patellofemoral pain syndrome. Another common cause mainly in sportspeople is patellar tendinopathy (injury to the tendon running from your knee cap to the front of your shin). Osgood Schlatter’s disease is often the cause of anterior knee pain in young athletes. If a sudden growth spurt occurs the plate can overgrow and cause irritation of the insertion of the patellar tendon.


Patellofemeral syndrome is generally the result of a movement or mechanical abnormality. Whereas patellar tendinopathy is generally caused by overuse but mechanical abnormalities may predispose the tendon to being stressed excessively.


Distinguishing between the two is sometimes difficult as the clinical signs and symptoms can be similar. Running downhill, steps and repetitive activities like distance running are the common aggravating activities at the onset of pain in patellofemoral syndrome, although it may present in the sedentary population with gradual onset or after a dramatic episode such as falling on the knee. Patellar tendinopathy is mainly brought on by a history of repeated loading of the patellar tendon such as jumping and landing. The specific location of the pain is the main determining factor between the two injuries.


Knee injury associated with pain and or swelling may result in the quads not firing correctly. This can set up imbalances on the forces acting on the knee cap, with a tendency to patellofemoral pain. The same is true with excessive tightness of the IT band and hip muscles that could also cause your knee cap to be pulled outwards. More commonly, it’s weakness in the glutes that results in your hip and knee dropping in. Causing the structures on the outside of the knee to be in a lengthened position and pull on the knee cap.


The majority of the client’s that come in with knee pain tend to be knee and quad dominant which means they load these structures excessively during everyday movements. If the glutes are not activated then there can be excessive force through the knee, creating irritation at the back of the knee cap on the thigh bone. This is purely due to overuse and degeneration of the structures. If the knees are painful, using the glutes to offload them is a key component of retraining movement patterns.


Examination will include a thorough history taking, observation, palpation, special tests and functional tests to determine the cause of the client’s pain. For an example a squat done on a decline will stress the patellar tendon more and is therefore more specific to patellar tendinopathy.


Treatment will depend on the underlying cause of the pain and may focus on lengthening structures in one person and strengthening of the quads or glutes in another. One of the main components of the treatment is looking at how the individual naturally moves and ensuring they are not loading their knees excessively.


Catherine Simpson

MISCP, MSc. Sports Medicine


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What are Shin Splints?


What are Shin Splints? Shin Splints is a common term used among people to describe a pain in the leg in and around the area of their shin bone. A more specific diagnosis must be made however to successfully treat the symptoms. The traditional clinical use of the term shin splints is to describe medial tibial stress syndrome, pain on the lower inside of the leg. Often people use it as a term to describe pain and swelling of the muscles to the outside of the shin (anterior compartment syndrome) as well.


Chronic symptoms of shin splints may lead to stress fractures so symptoms must not be ignored if they continue to persist. Abnormal biomechanics may lead to a greater risk of pain around the shin bone. A high rigid arch effects shock absorption increasing the forces on the bone. In individuals whose arches fall from normal into a flattened position (excessive pronation) overuse, fatigue and excessive pull of the muscles that support the arch can lead to medial tibial stress syndrome, otherwise known as ‘shin splints.’


Weakness of the tendons or ankle instability from previous sprains may also contribute to overuse of muscular and tendinous structures leading to shin splints. Tight calf muscles can also lead to shin pain, excessive tightness can prevent normal ankle movement increasing the load on muscles surrounding the shin.


A full history and physical examination including biomechanical assessment with reproduction of symptoms is needed to find the true cause of the symptoms, so a progressive rehabilitation programme can be implemented.


Treatment may consist of reducing the repetitive training load, stretching and loosening out tight muscles such as the calves and improving strength. If it is a chronic issue, training to improve shock absorption will be required through altering running mechanics. Assessing and treating the origin of the problem is the key to full recovery.


Catherine Simpson

MISCP, MSc. Sports Medicine


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Shoulder Stabilisation


Shoulder stabilisation exercises make up a large part of our preventative programmes at Sport Physio Ireland. But what exactly is shoulder blade stabilisation and why is it important?


Essentially what we are talking about is the development of good posture during exercise and activity through ‘switching on’ or ‘activating’ muscles around our shoulder blades and mid-upper back. This is essential for the maintenance of shoulder health and for the prevention of injury.


The way in which our society has developed means that most of us spend large parts of the day in seated positions working at desks and slouching over computer screens. This can lead to individuals developing what is known as a ‘forward shoulder posture’ as a result of structures around the front of the shoulder becoming stiff and tight. This in turn can cause muscles of our posterior shoulder to become lengthened and become under active.


This phenomenon is not limited to those working in offices. Many individuals who spend large amounts of time training in the gym tend to overtrain these muscles at the front of the shoulder such as biceps and pecs and fail to realise the importance of complimenting this training with some stabilisation work. This is often referred to as ‘all show and no go’.


Over extended periods of time, in either one of the scenarios mentioned above, means an individual can lose the ability to recognise how to actually utilise these important structures around our posterior shoulder. They then will often begin to compensate by using other muscle groups to carry out everyday tasks that can place unwanted tension/stress on other areas such as the low back, neck, and elbow.


This is where we come in.


Demonstration of shoulder protraction (left) and shoulder retraction (right)

Demonstration of shoulder protraction (left) and shoulder retraction (right)


In order to combat this issue, you must start with the basics first. Learning to engage or activate these muscles in a non-weight bearing situation is the first step. Once this has been mastered you can then begin to introduce exercises such as shoulder blade push ups (as seen in pic above), or lat pull downs in order to strengthen and stabilise further. This will ensure that when you return to your normal everyday lives, you are at a much lower risk of injury recurrence.

Riain Casey

Chronic Ankle Instability

Chronic ankle instability is an encompassing term used to classify an individual who presents with both mechanical and functional instability of the ankle joint following an initial lateral ankle sprain injury.


Mechanical Instability refers to measurable laxity of the ligaments, i.e. ligaments that are less stiff following injury, with some joint restrictions and synovial changes. Functional Instability is the lingering feeling of giving way or unsteady feeling which is generally attributed to neuromuscular and proprioceptive deficits.


Research has identified a number of potential reasons for long term issues with ankle instability after a sprain. One theory is that the ankle proprioception, where the joint is in space, is impaired creating an impaired reflex arc of the muscles that help stabilise the ankle joint. Swelling of the joint can cause the feedback system of the ankle joint to also alter and cause long term neuromuscular deficits.


So clinically, what can we do to help and reduce this occurring?


  • Reduce pain and swelling of the joint
  • Loading in functional tasks as soon as possible e.g. walking, running, cutting
  • Establish baseline strength and power
  • Improve proprioception of the ankle joint
  • Practice tasks that are important to your need
    • Cutting
    • Agility
    • Deceleration
    • Landing/jumping mechanics


Thomas Divilly

M.I.S.C.P., C.S.C.S.

Five Tips So You Can Avoid Injury

Sports Physio Ireland’s physiotherapist Riain Casey talks us through five tips so you can avoid injury.

Many injuries can be easily prevented. Some times small adjustments to our everyday lifestyle can have a big impact in injury prevention.

Simple things like correctly fuelling the body and a good healthy sleeping pattern are key to aiding the body recover from on-field activity. Coupled with a specific warm up to prep the body for the demands on field, good proper movement based training and maintaining fitness levels to meet the demands of the activity can greatly help reduce the risk of injury or re-injury.

Try out the tips and let us know how you get on.


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