Blog

The hamstring muscle is in fact a group of three muscles –  the semimembranosus and semitendinosus medially (more inward) and the biceps femoris laterally (more outward) which is divided into a long and short head. ( see picture)

A substantial force is usually required to develop an acute muscle strain in the hamstrings. This is so much the case that individuals can typically recall precisely when their injury took place. A few risk factors are listed below:

• Age – the older athlete has an increased risk of acute hamstring strains.
• Previous injury – a prior history of acute hamstring strain increases the risk of future injury
• Hamstring:Quadriceps strength ratio – the weakness or strength of the hamstrings and quadriceps n relation to each other are seen as a risk factor.
• Poor lower limb proprioception( knowing where your limb is in space)

There are 2 distinctly different types of acute hamstring strains. The more common of the two, Type 1 hamstring strains usually occur during high speed running when the hamstrings is working eccentrically and involve the long head of biceps femoris most commonly at the upper muscle-tendon junction. These types of strains seem worse in the early stages of the injury with a marked acute decline in function but respond well to treatment and typically require a shorter rehabilitation period than the type 2 hamstring strains.

Type 2 hamstring strains occur during movements leading to extensive lengthening of the hamstrings into hip flexion such as high kicking or sagittal ( front) splits and are typically located close to the ischial tuberosity (high up the leg, in the bum region) and involve the uppermost free tendon of semimembranosus. These types of injuries can have less dramatic acute limitation but their rehabilitation period is often longer than that of type I strains.

The most common cause of posterior thigh pain is hamstring muscle strains but that does not rule out referred pain into this area from other structures such as the lumbar spine, the sacroiliac joint and trigger points in the gluteus minimus and meduis, as well as the piriformis muscles.

Management of the acute hamstring strain starts off in the acute phase by following the RICE (rest, ice, compression, elevation) principles in the first 48 hours as well as commencing with early pain-free muscle contractions. Subsequently recovery moves onto moving onto stretching, neural mobilisation, soft tissue treatments, strengthening and assigning a running program and/or individualised sport-specific training.

Acute hamstring strains are common injuries in most popular sports and have a very high recurrence rate of injury. Therefore having a good prevention program is essential. It has been suggested that a balance/proprioception program, regular soft tissue therapy and eccentric hamstring exercises may help prevent hamstring injuries.

Some of the best eccentric exercises for prevention of hamstring strains are Nordic Drops and Askling’s gliding exercises  and it’s important to see your physiotherapist for assistance in this regard.  But, be aware that in those new to eccentric muscle training, it can result in muscle damage and delayed onset muscle soreness. Therefore, any eccentric strengthening program should factor in adequate time for recovery.

Andrew@PhysioPRO

This one is mainly for the ladies, but given some of today’s men’s shoes (think Nike Air Max), guys listen up…

Lets start off by saying: Women’s legs look great in high heels, and ladies do love their heels, but from a bio-mechanical point of view, they are the devil! Apart from nasty looking toes and blisters, they are actually causing serious damage to your back, hips, knees and ankles.

Do this quick test- take off your shoes and stand sideways on to a mirror. Now go up onto your toes whilst watching yourself in the mirror. What you will notice is that your body moves FORWARD (because your centre of gravity also moves forward). To stop yourself from falling forwards, your lower back has to arch BACKWARDS (thus moving your centre of gravity back again). Net result, you are putting a lot of extra strain on your lower back…

It does’nt stop there though…Now that you are on your toes, your Achilles Tendon (and Calf muscle) is in it’s SHORTENED position, so over time, you get a shortening of this tissue and less ankle movement. As a result, you will very likely over-pronate (to try get normal ankle motion during walking) and that sets up a whole host of other problems (e.g. shin splints, knee pain, ITB etc…).

In our previous three part series on running barefoot we discussed how you should be wearing  thin, flat and very mobile shoes and this also applies for your everyday shoes.

So if you have been wearing heels a long time (or even a slightly elevated heel in the case of guys shoes) and want to start helping yourself out a bit, start doing these stretches for tight calf muscles and ditch the heels.

Also, please do your kids a favour and don’t let them get into these bad habits. I strongly recommend letting your kids run barefoot around the house as often as possible.

You evolved over millions of years to have Achilles tendons that allowed your heel to rest on the ground…don’t mess with Evolution!

I recently read an interesting article on risk factors associated with Anterior Knee Pain, or otherwise known as Patello-Femoral Pain Syndrome (PFPS). PFPS describes pain under or around the small bone on the knee (patella). The pain usually increases after sitting for long periods, squatting, kneeling, and stair climbing. We mostly see cyclists and runners with this condition, and the common name for it is “runners’ knee”.

Too much, too quick, too soon….

PFPS usually arises from a sudden increase in training or overuse of the joint (I’ve seen quite a few prospective Comrades runners with PFPS this year due to the increase in their training), however there has been a lot of research into the risk factors in people who develop PFPS with some conflicting results. The study I read tried to make sense of all the research…

The study was a systematic review…basically a study on all the research conducted on this particular topic. To give you some idea, they started with 3845 articles and using specific criteria to eliminate articles that were not well researched, they narrowed this down to only 7 studies. All studies were “prospective”, meaning that they used healthy subjects with no knee pain and assessed different factors. Later on they noticed who developed PFPS and compared their data to the still healthy subjects.

Here’s the relevant summary of their findings:

• Physical Fitness-those people who trained more hours per week were at higher risk
• Flexibility-tight hamstrings and calf muscles were associated with the future development of PFPS
• Strength-Less knee extension (straightening) strength was a significant risk
• Posture-Having a dropped foot arch was significant at increasing risk
• Gender- Females were more likely to develop PFPS

So how does this help you?

Well, if you are thinking of taking up a new sport or just increasing your training for a specific event, have a look at some of the possible problems and try correcting them before it becomes YOU with painful knees…

Build up your training slowly and don’t over-train, stretch your hamstrings and calves, strengthen your quadriceps, wear the correct shoes/orthotics and if you are female…well sorry, I don’t think plastic surgery will help with this!

“Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review” (J Orthop Sports Phys Ther 2012;42(2):81-94. doi:10.2519/jospt.2012.3803)

Ric@PhysioPRO

Many patients come into my practice with various complaints of knee, hip and sometimes ankle pain. They give me a rather strange look when I ask to test their bum muscle strength (more specifically a muscle called Gluteus Medius).  Invariably, most end up shocked at how weak this muscle is when it only takes one of my fingers to push down their whole leg…

So why is the strength of this muscle SOOO important? Well, of late, researchers have found that this muscle is possibly one of the most important muscles when it comes to pelvic, hip, knee and ankle stability. It controls rotational as well as vertical movement of the pelvis and lower limbs, and as such has a massive influence on how ones leg moves and functions during activities.

For example, a common knee condition known as ITBFS (Ilio Tibial Band Friction Syndrome) was once believed to be the result of the ITB being tight and thus “rubbing” on the femoral condyle, leading to inflammation and pain. We now know that a major cause is in fact due to the femur (upper leg bone) ROTATING inwards and the ITB remaining almost STATIONARY. This means that to fix the cause of the problem, the femoral ROTATION needs to be addressed. This is where the Gluteus Medius (GM) comes in, as it controls rotational stability.

ITBFS is not the only problem that can be attributed to a weak GM. Other common injuries include:

• Trochanteric bursitis
• Medial knee ligament sprain
• ACL (Anterior Cruciate Ligament) Sprains/tears
• Patellofemoral Pain Syndrome
• Achilles tendinopathy
• Lower Back Pain and the list goes on…

Due to its influence on biomechanics, it can also have an effect higher up the Kinetic “chain”, and as such, a shoulder or elbow problem could in fact be stemming from a weak GM!

It’s worth mentioning that this muscle appears to be weaker in female athletes, and accounts for the higher incidence rates of ACL tears in this population. The USA is implementing preventative programs in order to reduce the rate of a possible career ending injury. A complete program can be downloaded from www.smsmf.org/pep-program.

A very basic exercise to start training the GM is called “the clamshell” exercise (see images below). Try to complete three sets of fifteen repetitions. When done correctly, you should feel a deep burn on the side of your bum.

If you are suffering from any of the above mentioned injuries or you would just like to prevent them, come in to your nearest PhysioPRO branch where you will be assessed for GM weakness, and then given the appropriate training program depending on your needs.

Till next time, TIGHT BUMS…quite literally

Ric@PhysioPRO

I’m sure you’ve heard of the term “tendonitis” before, and you probably know of someone who has (or had) “tendonitis” of the elbow I.e. Tennis or Golfers’ elbow. Technically they are wrong, and it could be hampering their recovery!!

In actual fact, tendonitis is a very short lived and infrequent tendon condition. What they most likely have is actually TENDINOSIS, or otherwise known as a tendinopathy.

So what’s the big difference you ask? Well, medical terms that end in “itis” usually indicate inflammation and swelling, however in these tendon conditions, no inflammatory cells are present. This then has a direct impact on the way in which we treat the condition. So if you or your friend has tendinosis, taking anti-inflammatory medication is actually having no effect, and you may as well be taking Smarties instead…

If its not inflammation, then what is it exactly?
Without getting too technical, the substance that makes up tendons (collagen) is in a big tangled mess instead of a nice, neat and tight parallel bundles of fibers. There is also increased fluid around the fibers and lots of small, poor quality blood vessels. This can occur in various tendons, but the most commonly affected are those of the elbow (Golfers’ and Tennis Elbow), knee (Jumper’s knee), hip and ankle (Achilles Tendinosis).

So if you shouldn’t take anti-inflammatories, what should you do?

Tendinosis is usually as a result of repeated OVERloading of the tendon and therefore the CAUSE of your problem needs to be addressed. It could be as simple as a lack of rotation at the shoulder that could be causing your tennis elbow, or over-pronation at your ankle causing Achilles tendinopathy. Your physio should evaluate all likely factors and address these to prevent re-occurrence of your injury.

Where previously we were concerned not to inflame the tendon, treatment now focuses on actually CAUSING an inflammatory reaction, thus increasing blood supply and stimulating healing. Although painful, eccentric loading exercises are the “gold standard” of treatment to improve these conditions.

Nitric oxide donor patches and Shock wave therapy have some evidence to suggest they work, and a relatively new technique known as PRP (platelet rich plasma) injections (a topic we will discuss in future posts) are showing positive short term results at reducing pain and improving function.

I would highly recommend wearing a counterforce brace or getting strapped, as this will reducing the mechanical load on the tendon and alleviate pain.

One last thing you need to know. Tendon injuries usually take a long time to heal, especially if you’ve had it for months, so be prepared for some rehab and don’t wait till your pain is excruciating before you seek medical advice.

Ric@PhysioPRO