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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

Training is the pursuit of any activity that will ultimately lead to an increase in performance in a specific sport. That’s what we mean when we talk about training!

So, training should be directed at bettering performance in an athlete’s chosen sport. As physiotherapists we should identify the most important components of fitness for each particular sport and tailor an athletes training toward improving these particular components.

Different training methods exist. These include aerobic training, anaerobic training, plyometric training, agility training, strength and power training – the list goes on. Today we are going to talk specifically about two of the most common types of training…. aerobic and anaerobic training.

Aerobic training or endurance training is performed to increase aerobic capacity or fitness. We measure aerobic capacity by measuring VO₂ Max or the maximum oxygen an individual is able to utilize in one minute, per kilogram of body weight. VO₂ Max can be measured in a fancy laboratory, but unfortunately most of us don’t train in this sort of setting, rather opting for the sports field or the gym. Luckily there is a simpler, albeit less exact method, known as predicted VO2 max which is estimated by measuring the heart rate at a specific workload which is a method commonly used.

It’s reported that aerobic training effects occur while maintaining a heart rate of between 70% and 85% of one’s maximum heart rate. Maximum heart rate is estimated by subtracting your age from 220. So it is pretty easy to do: for a 30 year old like me, max heart rate would be 220-30=190 beats per minute. And the ideal range of heart rate for me to produce an aerobic effect would be between 135 (70%) and 160 (85%) beats per minute.

 And you thought jocks didn’t do maths!

Many sportspeople find benefit in the endurance and fitness gains made by training aerobically as well as the health benefits of a stronger cardiovascular system and resultant weight loss.

Anaerobic training burns glucose as an energy source but does this without oxygen present, to produce energy. Oxygen is absent because this sort of training is typically high intensity for a short period of time and there isn’t time for full oxygen delivery to the muscle cells using the glucose. This pathway utilizes ATP as its energy substrate. The process produces less energy per molecule of glucose utilized than aerobic exercise does when burning up that glucose with oxygen present.

Anaerobic training improves the capacity to maintain a high rate of power production at very high intensities for short period of time. This type of training helps maintain muscle recruitment and muscle contractile function after training so that the onset of fatigue is delayed, as well as improving the body’s tolerance to lactic acid build up. Lactic acid is a by-product of training anaerobically and contributes to the discomfort felt while training.

Interval training or intermittent exercise is the most efficient method of increasing anaerobic fitness. Such training involves bouts of exercise separated by periods of rest or recovery. The principle behind this type of training is to achieve a level of lactic acidosis with one individual effort and then allow the body to recover from its effects before embarking on another bout of exercise. This is done to train the body to cope with higher levels of lactic acid before shutting down and to recover faster.

As mentioned, to obtain maximum gains from interval training it must be activity/sport specific. Also remember that because of its increased intensity, the potential for injury is a little higher than that presented by aerobic training. It’s therefore beneficial for athletes to use a variety of training methods to take advantage of the benefits offered by each and allow time for rest and recovery of the body.

Andrew@PhysioPRO

Following on from Andrew’s last article on joint laxity, I expect many of you would have felt that touching your toes was impossible due to the pull in your hamstrings. But was it your hamstrings…?

Just like muscles get placed on stretch during certain movements, so too do your nerves. Very often, what we perceive to be the “muscle” pulling tight during a stretch, is often the nerve being stretched or “tensioned”. The ability of your nerve to tension to its normal length is referred to as Neural Mobility. A trained Physio will often test your neural mobility to detect if your symptoms are due to reduced movement/tension of the nerve.

Now before you do this next quick test, PLEASE READ CAREFULLY: If you have back or posterior thigh pain (or both) at present then avoid this test as it may flare up your symptoms. Rather go see a trained Physio who can assess the appropriateness of this test for you.

The SLUMP TEST

1) Begin by sitting on the edge of a desk or chair with your thigh fully supported by the desk/chair (FIG 1.1).

2) Place your hands behind your back, sit badly (get your shoulders down towards your hips, thus curving your upper back) and drop your chin to your chest by flexing your neck (FIG 1.2) *At this point, if you already feel lower back or posterior thigh pain, then STOP. That would be considered a positive test and you definitely have NEURAL TENSION**

3) With your neck still flexed, try straightening your ONE knee until you feel the tension/pain in your posterior thigh develop (FIG 1.3).

4) Now bring your toes up towards your head, by moving your ankle (FIG 1.4)

5) Keeping your knee, ankle and back in that position, look up at the ceiling (i.e. ONLY move your neck backwards- FIG 1.5)

6) What happened?

If the tension/pain at the back of your thigh got better when you looked up, that would indicate you do have NEURAL TENSION. Think about it, we didn’t move your leg, so if the tension/pain got better, it could only be related to something else-your nerve.

If there was no change to the symptoms with the neck movement, then your hamstring is most likely the culprit.

Now try it with the other leg. There could be a side to side difference.

So you had a positive test and have neural tension, now what? Its advisable to go see your Physio at this point so he/she can assess the extent of your symptoms and advise an appropriate stretching program. One exercise we at PhysioPRO recommend to try “lengthen” or loosen up the nerve is neural flossing/sliding.  We use a similar setup as above, however, we don’t  “tension” the nerve, but rather “floss” the nerve.

So start as per steps 1 and 2 (see image below)

Then, as you straighten your leg (step 3), SIMULTANEOUSLY extend your neck (step 5).

Do 10-15 repetitions per side, 2-3 times per day. This “flossing” technique has been proved to result in the greatest tensioning of the sciatic nerve in recent research, and is an effective tool at improving your neural mobility.

Once you have done your flossing, try stand and touch your toes again. If you had neural tension, you should notice a significant improvement now…

Happy Flossing

Ric@PhysioPRO

Our bodies are all different. Some are tall, some short, some big, some small and the same variety is found when it comes to the tissues within. Some people have more collagen in their ligaments and tendons which means they tend towards being more rigid and stiff. Others have less collagen and are far more flexible. As with most things in life, problems can occur on either extreme.

Let’s deal with one side of the spectrum – being very flexible or ‘hypermobile’.  The problem here is that increased laxity or flexibility in the joints makes the joints more unstable and puts a person at a greater risk of injury, especially for those involved in contact sports. As we get older the body naturally stiffens up so hypermobile individuals that avoid injury early on in life are generally able to be more active older adults.

The Nine-Point Beighton Hypermobility Score is a quick and easy test to rate how hypermobile you are. It’s a simple 9 point system where the higher the score the higher the laxity. It is scored as follows:

Scoring high on the Beighton scale doesn’t necessarily mean you have Hypermobility syndrome as you could be hypermobile with no adverse symptoms (which include pain in the muscles and/or joints). Generally if you score either 4 or 5 out of 9 you are on the hypermobile end of the spectrum and should take precautions to prevent injury and work on stabilising and proprioceptive exercises, such as balancing on different surfaces while performing sports specific exercises, so that you can stay fit and healthy into your old age.

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!

With the Olympics currently in full swing, I’m sure many of you are enjoying all the top class sport showing on our televisions. Olympic athletes compete at the highest levels for consecutive days – sometimes even twice in the same day. How quickly and how well they RECOVER is vital for their optimal performance and could be the difference between going for Olympic gold and going home early.

The main aim of a post-game/event program is to enhance recovery, to maximize performance and minimize potential for injury at the next event. Recovery programmes have the following objectives:

• Restoration of function
• Neuromuscular recovery
• Tissue repair
• Resolution of muscle soreness
• Psychological recovery

A number of recovery methods are used by sportsmen and woman. Though there’s limited research in to the efficacy of most of them, let’s look at a few of the most popular techniques used:

Warm-down (active recovery)

Most athletes perform a warm-down of between 5 and 15 minutes after intense exercise followed by stretching of the muscles used in their specific sport. The warm down is also generally specific to the nature of their particular sport.

Cold Water Immersion (CWI)

As the name suggests, players immerse themselves in ice baths ranging from 5-15°C for up to 5 minutes at a time. This has a cooling effect on the body tissues. CWI is associated with a peripheral vasoconstrictive response, reduced perfusion, and a decrease in oedema (which all help control the inflammatory response). However sportsmen with a history of cardiac problems such as arrhythmias should avoid CWI as it results in “cold shock” with associated increase in heart rate, blood pressure, respiratory minute volume, and metabolism, thus placing extra stress on the cardiac system.

Massage

Intense training causes prolonged elevation of muscle tone in both resting and contracted states. This increased tone or “muscle tightness” limits the extensibility and shock absorbency of soft tissue and thus predisposes the tissue to strain. Active trigger points that result from heavy training may reduce muscle strength. All these problems can impair training and competition and can progress to injury if they are not resolved. Soft tissue therapy is thought to work by reducing excessive post-exercise muscle tone, increasing muscle range of motion, increasing the circulation and nutrition to damaged tissue, and deactivating symptomatic trigger points. It also helps to identify any soft tissue abnormalities, which if untreated could progress to injury.

Nutrition

Nutrition aids in the recovery from intense exercise by replenishing glycogen stores and providing necessary protein and water. Repetitive bouts of activity can cause profound glycogen depletion and substantial breakdown of muscle proteins which could lead to impaired sporting performance. Athletes are encouraged to consume a carbohydrate rich snack/meal that provides 1-1.2g of carbohydrate per kg of body weight as well as 10-20g of high-quality protein within the first hour post exercise, as this is when rates of glycogen synthesis are greatest. Glycogen is the major energy source for muscular activity in the body. Large amounts of fluid may be lost during exertion, especially with increased intensity and in hot conditions. Rehydration is vitally important to replace the lost fluid as well as electrolytes (especially sodium) lost through sweat.

Deep-water running

This recovery method involves running in the deep end of a swimming pool using a buoyancy vest. It is a form of cross-training that reduces the impact put on your joints and thus reduces overuse injuries.

Compression Garments

Lower limb tights and below-knee socks are advised for athletes soon after finishing their event. Athletes should leave them on for the next 24 hours. This aids in recovery from post-event muscle soreness.

Lifestyle factors such as adequate rest and sleep as well as the psychology of the athlete have also shown to influence recovery times.

As you can see what the athlete does off the track/field might be as important as what they do on it and coaches should be encouraged to incorporate recovery time into athletes’ schedules.

Andrew@PhysioPRO

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

So as promised, following my last article “Sitting posture and (D)evolution of man”, here are a few stretches that you can do at your office or home to help loosen up those stiff muscles affected by poor sitting posture.

Please note that these are general stretches for people without neck or lower back pain. If you are already suffering from pain,  you should rather consult your physio before attempting any of these stretches.

1)Neck Retractions- Whilst sitting upright, try bringing your chin in, towards your neck.

You want to imagine that you are trying to make the back of your neck get longer (as if someone is pulling you up by your hair), whilst still looking forwards. If you are tight, you may feel a stretch at the base of your skull. Hold 10 seconds and repeat 10 times

2) Neck flexion stretch- First retract your neck as shown above. Then, whilst still holding your chin tucked in, grab the top of your head using both hands and gently pull down.

If done correctly, you should feel the whole back of your neck getting stretched. Hold 30 seconds and repeat 2-3 times.

3) Seated rotations- Whilst sitting, turn to your right. Use your right arm to grab the back of the chair. Place your left hand on your right knee and then gently pull. Hold 30 seconds and repeat to the other side

4) Seated back extensions- Interlock your fingers behind your head. With your elbows pointing upwards, towards the ceiling, extend your upper back and try push your elbows further back. Hold 30 seconds and repeat 5 times.

5) Side stretch-This stretch targets those tight muscles on the side of your neck (scaleni and upper fibres of trapezius) where most of us feel “knots”.

Whilst sitting, grab the seat of the chair with your left hand (this stops your left shoulder from lifting up). Bend your neck to the right side as shown, and using your right hand, gently assist the stretch to the right.

You should feel a stretch down the left side of your neck. Repeat to the other side, holding each stretch for 30 seconds.

NB-If you feel pain on the right hand side whilst bending to the right, then please STOP, and consult your physio.

6) Corner chest stretch-this stretch can’t be done in sitting, however it is one of the most important stretches to do as it stretches your chest, the culprit for your rounded shoulders.

As shown, stand facing a corner and place your elbows at about 90 degrees, forearms resting against the wall. Then step forward with one leg and allow your chest to fall in, towards the corner. You should feel a stretch in the front of your shoulder and into your chest. Hold 30 seconds and repeat 2-3 times.

7) Lying McKenzi stretch- The last stretch I want you to do is one we often use in Physio to help people with lower back pain caused by a disc problem.

You should start by lying on your stomach with your arms at your sides. Gently push up onto your elbows at first, and allow your lower back to completely relax. Repeat 8-10 times.

As the stretch improves, you might be able to lock your elbows out as shown in the picture, but do this slowly as sudden extension may cause some pain.

This stretch also targets your hip flexors (front hip muscles) which get shortened over time by sitting.

NB-If you have pain referring down your leg/s or into your bum then please stop and see your physio

So there you have it, a few stretches to get you going and hopefully reverse some of your poor posture. You should try aim to do these stretches at least once a day (even if its not all of them at once) and the more often you do them, the less painful and more flexible you will become.

Ric @PhysioPRO

I thought I would just share  a neat little trick that I teach most of my patients to manage their own muscular issues. Its so easy and effective that most of my patients end up saying ,”Why didn’t I think of that??”.

All you need is a wall or floor and a tennis ball….Place the tennis ball against the wall or floor (depending on the area you are treating) and then find that knot (trigger point) with the ball. Now apply pressure to the area using your body weight.

You want to apply a even steady pressure at first, till you feel a moderate ache and hold it there. You should feel it easing off after 30-45 seconds, so either push harder or find a new spot. If you feel up to it, you could even rub up-and-down or side-to-side over the ball to free up that tissue.

Whats so great about this technique is that YOU can decide how much pressure to apply and the ball never gets tired (unlike your partner). This also works great for loosening up stiff muscles after a heavy training session. Just make sure you are not doing this with an acute muscle tear (i.e. a “pulled” hamstring) as it could cause further damage.

So there you have it, your very own “physio” that fits in the palm of your hand and you can even take him on holiday with you…

Ric@PhysioPRO