Physiotherapy for Hamstring injuries

Watching and enjoying a Gaelic football game at the weekend I witnessed the all too common occurence of the hamstring injury. Unfortunately the player had to stop play and immediately began his rehabilitation with his soon to be close acquantence, the ice pack.It has been a while now since I hung up my boots but I clearly remember the sickening feeling of tightness in the hamstring at  the start of every season. Would this be another injury interupted season spent stretching on the floor, collecting balls behind the goals at training sessions and and lying face down on the physiotherapists table? Or my personal favourite, listening to the coach tell me how in their day there was no such thing as a hamstring injury.

Gaelic Football injuries

So what has changed over the last 20 years in regards to hamstring injuries in Gaelic Games and by obvious extension all field sports including football, rugby and Australian Rules. Hamstring injures still represent the single biggest injury cited for missing games in Gaelic games and Australian rules,

 

The make up  of our muscles hasn’t changed nor has the healing process. What has changed is our knowledge and ability to facilitate recovery, identify and reduce risk factors and the importance we place on pre season conditioning.

We know that the location of the hamstring tear can determine the average time out of sport, with a tear in the upper hamstrings at the musculo-tendo junction requiring more time away from competition than a a tear in the belly of the hamstring. We better understand the relationships between both flexibility and strength of the hamstrings and the risk to injury. We also understand how best to facilitate increases in flexibility and strength of the injured hamstring.

We know that the majority of hamstring inuries occur in the stretch-contract cycle of the game i.e. during kicking or accelerating / decelerating. During this stage the hamstring is working eccentrically.We know therefore that eccentric strengthening of the hamstrings should play an important part in pre season conditioning and rehabilitation post injury. We also know that hamstring injuries occur more in the final quarter of games and training suggesting that strength and flexibility conditioning of the hamstrings should help reduce injury.Gaelic Football, Sprinting with Ball

We also know there are multiple factors hypothesised to contribute to the risk of hamstring injury. These include inadequate warm-up, fatigue, previous injury, knee muscle weakness or strength imbalance, increasing age, poor movement discrimination, poor flexibility, increased lumbar lordosis and poor running technique. We hope that by addressing these and others with each individual we can help reduce the risk of injury.

Recent research suggests that strengthening the hamstrings pre season and especially post injury plays an important part in the reduction of injury. Currently the most efficient form of hamstring strengthening is thought to be eccentric exercises. Eccentric training should be prescribed by a physiotherapist or suitably qualified member of the team’s medical team and is worlds removed from simply sitting in the gym preforming hamstring curls (the only function of which may be to tighten your hamstrings.) One form of eccentric training used is the nordic hamstring raise.

Our understanding of the predisposing factors to hamstring injuries and what constitutes best treatment practice continues to evolve. The challenge as with all injuries is to keep up to date with current research and best practice, hopefully reducing the occurrence of injury and the length of rehabilitation time.

 

 

New Sports Massage Therapist

We are delighted to announce that Lynne Taylor from Global Therapies is our new Sports Massage Therapist at JUMP Physio. We met Lynne and her partner Tim Budd (another great sports massage therapist) just over a year ago and were very impressed with both their work and the feedback from clients.

When we realised JUMP Physio were moving at to a larger clinic the first thing we did was ask Lynne and Tim whether they’d be available to do some work with us. We’re delighted Lynne is starting with us and look forward to working with her in the clinic and maybe availing of the proximity of a great sports masseuse ourselves every so often. Lynne will initially be working with us on Thursday afternoons and appointments can be booked in the usual way of either e-mailing us on info@jumpphysio.com or calling us on 0161 832 3334.

Below is a brief bio on Lynne.

As a massage therapist Lynne brings together her love of sports with her knowledge and experience of sports injuries to help improve the quality of life for her patients. She gained her qualification- Level 5 Sports and Remedial Massage Therapy at the NLSSM, and has been actively practicing and treating clients since 2009.

Away from work, Lynne’s main focus is running, particularly fell running, She is an active member of Glossopdale Harriers and has a number of fell races planned in 2012. She also regularly cycles, climbs (indoors and on grit) and swims. In the past she has been involved with caving, paragliding and scuba diving.

As evidence of Lynne’s ability and excellence as a sports masseuse Lynne has been accepted as a sports masseuse at the London 2012 Olympics providing Sports & Remedial Massage Therapy for the athletes. 

 

 

New Physiotherapy and Pilates Clinic

Please forgive this non clinical blog.

After 3 years in our old clinic and 6 months of telling everybody we were moving, we at JUMP Physiotherapy have finally moved to a bigger space. No new maps are needed, no change of address required and no new telephone number. We are still situated in the same building on the same floor just in the office next door.

Why have we moved? When you see our new bigger clinic it’ll all become obvious. We  now have available a separate Pilates studio, Physiotherapy clinic and Sports Therapy room. The new Pilates studio means we’ve been able to offer more Pilates classes (see our class timetable) as well as add to our Pilates large equipment. We now have a Pilates reformer and tower of power, a Combo chair as well as a Pilates Arc on top of all our small equipment. The Pilates studio also doubles as a Rehabilitation area for our Physiotherapy clients. So we now have an even bigger gym area for post surgery rehabilitation and physiotherapy.

We hope to be able to announce shortly a Sports Therapist and Masseuse joining our team who’ll be available for regular weekly appointments. Kieran O’ Donovan continues as our clinic’s Lead Physiotherapist, Naomi Gill continues as our Womens’ Health Physiotherapist and Andy Bond continues as our Pilates Instructor as normal. To coincide moving to a bigger Physiotherapy clinic we also launched our new website recently (JUMP Physio). Please let us know what you think. You can now follow us on Twitter @jumpphysio and @jumppilates . For those of you who don’t tweet.. we now have a newsletter you can subscribe to. Our monthly newsletter will contain updates on any new classes, special offers (yes they will be special) as well as providing, tips from our  Pilates, Physiotherapy and Sports Therapy teams. We don’t send spam or use existing e-mail addresses to contact you about changes and offers at our clinic so this will be our way of letting you decide how much information you’d like from us.

 

Of course all of these changes are done to enhance the experience of everyone attending JUMP Physio whether it is for Physiotherapy, Pilates or Sports Therapy so please let us know what you think of the space and of your experience here. Suggestions on how to improve are always taken on board.

 

JUMP Physio

 

 

Stress Fracture of the Tibia.

Although stress fractures of the tibia are a pretty rare occurence in the running population, we’ve seen two in our sports injury clinic in the last month. The causative factors in both cases were similar and caused by a combination of tight calves and insufficient recovery periods between runs. Rather than an in depth look at the causative factors and treatment of shin splints this is short post on the questions asked by our two clients in the last few days
1) Can I run with a stress fracture

No, No. No. Absolutely not, if it still hurts stop running. There is no option b.
2) How do I know if I have a stress fracture?

Clients often have pain on walking which intensifies and worsens on running with a local area of tenderness on the front of the shin. Clinically it can be diagnosed with the help of a thorough subjective history and with pain on direct or indirect percusion over the area. Although the first line of investigation is often the x-ray, it tends to be picked up earlier with both an MRI scan or a bone scan and sometimes a combination of two scans will be used to confirm the diagnosis.

3) What causes the stress fracture? -

Stress fractures can can occur in elite runners as easily in novice weekend plodders. They are thought to be the long term consequence of overloading the tissues on the anterior shin. As mentioned in a previous post  one of the the long term effects of training is bone thickening or the osteoblastic formation of new bone. Before this happens however in the short term the tissues fatigue leading to osteoclastic re absorption of bone resulting in a weaker bone. A stress fracture occurs when the weakening phase outstrips the strengthening phase and is the long term result of overloading your tissues when you run. This can be due to direct pressure on the tibia (shin) or indirect pressure through the tissues that attach onto the shin bone. A number of intrinsic and extrinsic factors are thought to contribute to the over load injury including things as varied as  duration, frequency and intensity of exercise, shoe wear,decreased flexibility, changes in muscle strength leg length discrepancies, age and sex.

4) What do I do? Rest the injured area and address any mechanical issues with a health care professional such a Physiotherapist. Assessment and prevention of recurrence may include a gait analysis, biomechaical analysis as well as a re-think of how you train. In consultation with your Physiotherapist or coach try to maintain cardio vascular fitness without directly loading your tibia or surrounding muscles.

What are overuse injuries?

With the London marathon and Manchester 10km now begining to loom on the horizon we have seen the  familiar increase in overuse type injuries  here at JUMP Physio. These have been especially in but not limited to to the running population. The inevitable question always arises. What causes over use injuries? Well, without stating the obvious it is usually a combination of factors such as the training load, the biomechanics of the movement and physiological state of the tissue.   Needless to say here at JUMP Physio we don’t see athletes with excellent biomechanics, normal tissue and subjected to appropriate training load  presenting themselves in the clinic. We do however see a whole bunch of frustrated people of all abilities presenting with one or more of the above  contributory factors. Such as the runner who has gradually being building up their mileage with appropriate recovery periods, developing shin splints, anterior knee pain, achilles tendinopathy or ITB problems due to altered mechanics caused by tight calves or weak glutes.  We also see people with optimal mechanics, present with similar injuries because of inappropriate loading or lack of recovery between runs.

Every time you exercise your tissues are loaded causing physiological change and structural adaptation. In running or with any other  training stimulus this can lead to muscle hypertrophy, thickening of bones, enhancement of neural pathway’s, the strengthening of tendons. These changes take time however and before all these positive adaptations occur the short term effects of training are that tissues fatigue and become less resilient to load. Continuing to apply load to these tissues increases the risks  associated with tissue break down and injury.

Management of these injuries therefore focuses on addressing the relevant biomechanical faults, identifyng the state of the underlying tissue and prescribing a suitable load and recovery plan. Of course it also helps if you understand what has caused the injury so it doesn’t happen again.

The run at Clearwater

If you feel like you may have over done the training or can’t figure out why your body hurts so much after an easy run give us a call at JUMP Physio to see if we can help.

Jemma Oliver Sports Physiotherapist

We are delighted that Jemma Oliver Sports Physiotherapist will shortly be joining our team at JUMP Physio. Having trained in Sports Science in Leeds and graduating as a Physiotherapist from Sheffield in 2007, Jemma has spent the last few years working privately in the sports rehabilitation and sports injury settings. She enjoys all aspects of musculoskeletal Physiotherapy however her specialist interest is in sports injuries and lower limb biomechanics. Jemma is near completion of an MSc in Sport Injury Management.

Jemma’s work in sport makes an impressive CV  to date and includes working with various squads and sports including the Sheffield United Football Academy, Sheffield Hockey Club, the U21 Wales Hockey Squad and more recently work with the GB Bobsleigh and the GB Womens Volleyball team in their run up to the 2012 Olympics.

Jemma describes herself as a friendly and passionate individual with an aim to try and help empower individuals to become more self aware of their own bodies and lifestyle in order to rehabilitate from injury, improve their sport performance or increase their own quality of life through healthy living and exercise.

A full list of the services Jemma will be offering at JUMP Physio will be available shortly on our web site www.jumpphysio.com . In the meantime if you have any questions about sports injuries or rehabilitation you can ask Jemma at info@jumpphysio.com

The importance of Gluteus Medius Strengthening in Runners

One of the single biggest culprits of overuse injuries in runners is weakness in the hip muscles especially the Gluteus Medius muscle. It is one of the single most important muscles for runners with its action aiding run efficiency and controlling load through the lower limbs.
Poor Gluteus Medius strength or early fatigue can contribute to a multiple of biomechanical adaptations and consequent over load injuries. It is not clear why gluteus medius weakness is more prevalent in runners than other sports but it may be due to the fact that running in straight lines engages the hips muscles less rigorously than sports such as football where side to side movements are required.
The Gluteus Medius muscle is located on the side of your pelvis between the bony protuberance of your hip and the top of your pelvis. The muscle is responsible for both abducting (raising out to the side) and externally rotating the leg. However it’s most important function in running occurs when your leg is in contact with the ground when it acts as a pelvic stabiliser. For example when your right foot hits the ground, your right gluteus medius muscle contracts to slow down and prevent excessive downward rotation of the left side of the pelvis. When the runner does not have adequate strength/ control in the Gluteus Medius muscle it can have implications all the way down the leg causing
 the knee to drop towards the centre and internally rotate excessively
 the leg to rotate internally relative to the foot
 an increase in weight transfer to the inside aspect of the foot.
As a result the athlete is at increased risk of any condition relating to excessive and/or prolonged pronation of the foot, such as shin splints, achilles tendinopathy and ITB friction syndrome.
There will always exist a temptation to search for the quickest cure to an injury with minimal interruption to training. In the case of lower limb injuries which involve over-pronation the search often ends with new shoes, cushioned inserts or custom made orthotics which can unload the injured area and give instant relief. The problem is, these remedies can be expensive and in the case of gluteus medius weakness the pain returns unless the primary driver of the injury is addressed. More and more research has begun to point towards the connection between gluteus medius muscle weakness and altered lower limb mechanics and overuse injuries.
For a muscle so important to a smooth and efficient running stride it makes sense to regularly train the area.

Enjoy your running from JUMP Physio

ITB friction Syndrome

With marathon and triathlon season started we are seeing more and more running related injuries at JUMP Sports Injury Clinic. By far the most common type of running injury/ sports injury we see is an over load injury to the Ilio Tibial Band (ITB) called ITB friction syndrome. Here is a brief discription of the injury and some common causes.

The Ilio Tibial Band  (ITB ) is a thickened band of connective tissue  that runs down the outside of the thigh. As the knee flexes and extends the ITB glides over the lateral femoral condyle, a bony prominence.

If the load across the ITB is increased the point where the ITB runs over the femoral condyle can become inflammed leading to pain and to what is commonly called ITB friction syndrome.

ITB Syndrome commonly presents with the following symptoms.

  • A dull ache on the outside of the knee that increases during a run gradually getting worse for the duration of the run., Pain is often worse the next morning. It can be aggravated further by running downhill, on cambered surfaces or walking downstairs.

ITB friction syndrome is an over use injury with several proposed potential contributory factors.

  • Run technique: Stride length has been proposed to affect both the size of knee bend and thus the load across the ITB. Excessive stride length seems to aggravate the ITB where as pain is often reduced when the length of the stride is reduced.
  • A tight ITB as measured by the Ober’s Test is thought to be a contributory factor to ITB friction syndrome.
  • Training Error: As with all over load injuries doing too much of a particular type of training places excessive loads across the joints. Even if cardiovascularly you feel fine you need to gradually build up your training. What is too many miles unfortunately depends on the individual. In clinic the most common training error we see are runners running the same route 3 times a week at the same pace and gradually increasing the times spent running. If you run the same route night after night at the same pace you are loading your joints muscles in the same way on the same surface night after night. Try varying the length of your runs, the speed of your session and the terrain you run on. 
  • Anything that causes the knee to track medially (towards the mid line of your body loads the ITB. This increases the load over the femoral condyle. Various bio mechanical reasons can cause your knee to drop medially
  1. Weak Hip Abductors. The muscles on the side of your pelvis namely the gluteus medius muscles help control your pelvis when you run.  When you lift your left leg off the ground your right gluteus medius muscle contracts and stabilises the pelvis keeping it level. When your gluteus medius muscles are weak the left side of you pelvis drops and the right knee is pulled across the midline as run. This is repeated endlessly as you run.

Reference : http://www.physio-optima.ca/bibliotheque/bit.pdf

  1. Over pronation of the feet. Feet that over pronate on impact cause the knee to follow the foot and drop medially. By far the most common and correctable cause of over pronation in runners are tight calves.

 

Treatment

  • Have yourself assessed by a chartered Physiotherapist who can diagnose the problem, identify your unique contributory factors and get you back on the road to recovery.
  • Rest from running until the inflammation decreases.
  • Avoid downhill running and running on cambered surfaces.
  • Speak to your pharmacist. Take a course (5 – 7 days) of non-steroidal anti-inflammatory drugs.
  • Apply ice to the knee (for 20minutes every evening ) in order to reduce the inflammation
  • Self-massage/ stretching on a foam roller
  • Remember to stretch well before running
  • Address any training errors

 

Recovery: Time to full recovery depends on the extent and cause of the injury. But a general rule is the earlier you address the problem the quicker you’ll recover.

Preventative measures:

  • Regular stretching of the ITB, quadriceps, hamstring, and gluteal muscles.
  • Gradual progression of training program
  • Avoid excessive downhill running, and cambered roads (stay on the flattest part of the road)
  • Working on run efficiency and stride efficiency.
  • Build some regular core strengthening exercises such as Pilates into your routine.
  • Regular sports massage

Fore Foot Running

Following the first JUMP Physio run clinic last week, people have asked for more information on forefoot running and barefoot running. I’ve found and attached the following videos that help explain the reasoning behind forefoot running and its possible relationship with a decrease in running injuries. Our sports physiotherapist will be advertising dates for the next run clinic shortly through this blog.

http://www.youtube.com/watch?v=1fBh2qH4QbM

http://www.youtube.com/watch?v=7jrnj-7YKZE