Running Talk – Can We Run Without Getting Injured?

So the short answer is probably no, most of us would get injured eventually. But… there is an interesting discussion to have along the way and we can maybe reduce the risk of injury.

On Friday 22nd February 2019, I will be giving a talk at Northallerton Leisure Centre, where I will discuss running injuries and how we might reduce them. Including:

  • Training,
  • Footwear,
  • Gait retraining,
  • and more.

If you would like to attend the cost is £5, 100% of which will be donated to the British Heart Foundation (via the Rock Up In Red Ball), to help some good friends of mine in their fundraising efforts. Please let me know if you are going via the event page on facebook:

https://www.facebook.com/events/2293992394194531/?active_tab=discussion

Happy New Year & Clinics W/C 07/01/2019

Happy New Year to you all, we are looking forward to 2019 and all it may bring!

Next week I am at Leeds Beckett University examining the BSc Sports & Exercise Therapy students. Therefore I have had to change some of the clinics. I will still be in on the Saturday morning, but Amelia will holding the fort with clinics on Wednesday & Thursday in Bedale and Friday in Northallerton. Booking appointments with Amelia could not be easier via the online booking button on this page or via the Facebook page. Simply select Amelia from the “team” drop down box and her availability will come up (see below).

Exercise Prescription vs Manual Therapy

Exercise prescription versus manual therapy, or do they work hand in hand? The aim of a sports therapist, or indeed any practitioner, is to rehabilitate an injury and help maintain and improve performance. This is done through the use of manual therapy and exercise prescription, but there is no hard and fast rule on how much manual therapy should be done versus exercise prescription. This article will explore current literature and aim to give insight into the basis for clinical decision making when it comes to methods of treatment.

Exe vs Man Th Blog1Manual therapy includes massage, joint mobilization and joint manipulation; it aims to reduce pain and increase mobility of joints. Exercise prescription can be used in a reactive or proactive way, it will aim to improve the flexibility, stability, strength, endurance and power.

Chronic low back pain (CLBP) was prevalent in the research, one study by Aure et al. (2003) suggests that 60% to 80% of the western population will experience low back pain at some stage. The study had 49 participants, one group received manual therapy with the addition of 11 exercises for the spine, abdomen, lower limbs, spinal segments and the pelvic girdle. Another group performed general exercise therapy for 45 minutes; the programmes were individually designed. Results, with a one-year follow up, showed that there were significant improvements in both groups but the manual therapy group showed better results.Ex vs Man Th Blog 2 A contrasting study by Geisser et al. (2003) found that CLBP was improved following manual therapy alongside a specific exercise program but it did not improve perceived function, stating that other psychological factors need to be addressed. Both studies were randomised control trials which are seen as the gold standard for research. However, neither study effectively blinded participants or therapists which is likely to influence the results.

Moving away from CLBP, a study by Hoeksma et al. (2004) looked at the use of manual therapy versus exercise therapy in osteoarthritis of the hip. The graph below (Figure 1) details the effect of manual therapy versus exercise therapy, it shows that manual therapy had better results on range of joint motion from flexion to extension. This result is unsurprising as the manual therapy group included manipulation and ‘vigorous stretching’ while the exercise therapy group included exercises to improve muscle function and joint motion.  Diercks et al. (2004) found the opposite in a contrasting study looking at manual therapy for frozen shoulder versus exercise therapy.

Exe vs Man Th Figure 1

Figure 1 – Results on range of motion from flexion to extension (Hoeksma et al, 2004)

The manual therapy group (physical therapy) received passive stretching and manual mobilisation and the exercise therapy group (supervised neglect) received exercises within pain limitations. Results (Figure 2) showed that the exercise therapy group had better outcomes up to 24 months after injury. This is depicted by the graph below, which shows the difference in treatment over a 24 month period; the exercise therapy group was more successful in this case.

Exe vs Man Th Figure 2

Figure 2 – Results of both groups (Deircks et al, 2004)

 

Hoving et al. (2002) conducted an alternative study, investigating the use of manual therapy, exercise therapy and care by the GP for neck pain. Neck pain is common in the general population and this study found that the success rates after 7 weeks for manual therapy, exercise therapy and care by the GP were 68.3%, 50.8% and 35.9% respectively. Although it would appear that manual therapy was the most successful, patients were allowed to continue exercises at home throughout the trial and continue taking medication which makes it difficult to control the outcome measures in isolation. Figure 3 shows that manual therapy was most successful. However, the outcome measures (perceived recovery, severity of physical dysfunction score, average pain intensity score and neck disability index score) are subjective measures relying on the patients to report how they feel. This is an unreliable way to measure due to a potential lack of understanding, dishonesty or outside influence from the patient,

 

Exe vs Man Th Figure 3

Figure 3 – Manual therapy, neck pain and GP care (Hoving et al, 2002)

 

In conclusion, from a brief look at the literature it is clear that manual therapy and exercise prescription work in varying degrees depending on the injury. There is no one course of treatment that is best overall and the choice depends on the stage and severity of the injury. It is also important to note, when using a patient-led approach to therapy, manual therapy may be more appropriate for one person but another may prefer exercises. It is not necessarily a question of manual therapy vs exercise prescription, but instead using a patient-led approach and selecting the most appropriate course of treatment.

Amelia.

The Reformer or the Rack?

My experience with a Pilates Reformer at The Pilates Studio, Yarm.

So when Helen Smith owner of Yarm Pilates studio first described the Pilates Reformer to me, the mental image it conjured up was not exactly enticing and thoughts of medieval torture kept popping into my head:

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Medieval rack has definite similarities!

Helen, however, assured me that it was great for loads of different exercises and so we arranged a time for me to have a go. What I found surprised me, other than the similarities in size and shape, it was nothing like a medieval rack!

Under Helens guidance, we started to go through just a few of the many exercises you can do on the reformer, working the legs, trunk muscles and arms. The Reformer adds adaptable resistance to the movements (by adding / removing springs), which change the feel of many of the common Pilates exercises. I found that there were definite similarities to some gymnastics strength training exercises, such as weighted mobility drills.

Using the Reformer was an interesting experience and hopefully, we’ll get a few more sessions in to really get to grips with it. It won’t be for everyone (nothing ever is), for those who have tried Pilates, I would definitely recommend it as a way of adding a bit of a twist. Helen is a great teacher who focuses on and promotes movement rather than holding a bracing, which is great to see. I did end up in some rather strange and unflattering positions though!

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Pilates Reformer rollbacks.

The Pilates Studio, Yarm is located on Yarm High Street and offers several friendly Pilates classes with great instructors to suit all levels, as well as 1-1 Reformer sessions. My clinic is at the studio on a Thursday afternoon / evening and appointments can be made via the Book Online button.

The Yarm Clinic is Open for Business!

We are open for business from next week! As I mentioned in an earlier post, the clinic is located at The Pilates Studio, where there are great Pilates instructors and a lovely refurbished studio. You’ll find the clinic above Cafe Nero, 117 Yarm High Street (just look for the blue door) and parking is free for the first hour so it’s ideal for your appointments.

The Pilates Studio Yarm logo

I will be in Yarm on a Thursday between 15:00 and 21:00 and Josie will be there on a Tuesday from 12:00 until 19:00. If you would like to book an appointment or just have a chat about an injury or training advice feel free to get in touch (our details are below).

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New sports therapy clinic, Yarm.

I popped into the clinic to deliver the couch this morning (even managed not to scuff the paint work!) and it’s looking great, we can’t wait to get started. I had the pleasure of meeting some of the Pilates regulars in between their classes and I hope to meet a few more in the coming weeks.

Remember: You don’t have to be an athlete or injured to come into the clinic, we regularly treat occupational injuries and provide sports massage too. Why not give us a follow on Twitter and like our Facebook Page to keep up to date with what we’re up to?

Contact Details:

Ed – 07837276444, ed@edprattsportstherapy.com

Josie – 07496359697, josie.grieve@outlook.com

Preventing Hamstring Injuries

This is a brief post predominently about the Nordic Hamstring Exercise, which can be used as part of a preventative programme for hamstring injuries.  It should not be used in isolation and as in all preventative programmes the sport involved, level of participation and physiological/psychosocial requirements must be accounted for.

Hamstring injuries can be a significant problem in sports involving rapid changes in pace/direction, with between 12-16% occurrence in English and Australia professional football (Peterson and Holmich, 2005). Recurrence rates are also high (12-63%), with the first month after return to play (RTP) being the highest risk period (Brukner et al., 2014).

So not only is the rehabilitation of hamstring injuries important, but the prevention of further hamstring injuries at RTP, especially in the first month. To understand how to prevent injury we need to understand the risk factors for that injury. Peterson and Holmich (2005) nicely distinguish between the different risk factors by sub-grouping them in to non-modifiable and modifiable. The main risk factors for hamstring injury are:

Non-Modifiable:

– Age – older individuals are at greater risk.

– Black or aboriginal ethnic origin.

Modifiable:

– Muscular imbalance – low hamstring:quadriceps strength ratio.

– Muscle fatigue.

– Hamstring tightness.

– Insufficient warm-up.

– Previous injury.

In terms of preventing hamstring injuries, eccentric exercises (muscle is working as it is lengthening) have received a lot of attention over the last few years (Mjølsnes et al., 2004; Small et al.; 2009 and Brooks et al., 2006) and more recently the Nordic Hamstring Exercise. Mjølsnes et al. (2004) compared Nordic hamstrings with a concentric leg curl strengthening programme and found that greater gains were achieved with the Nordic hamstrings and also a greater improvement in the hamstrings:quadriceps strength ratio compared to the hamstring curl exercise. Subjects in this group were healthy individuals with either no history of hamstring injury or “fully recovered” from previous injury.

Nordic Hamstring Exercise

The Nordic Hamstring Exercise is performed by anchoring the lower legs and slowly leaning forward from a tall kneeling position. The individual tries to control their lean until they reach a “tipping point” when they use their arms (not face!) to break their fall. See the video below for a demonstration:

Nordic Hamstring Video:

The training protocol used in the Mjølsnes et al. study was over a 10 week period and is reproduced below:

Training protocol for Nordic hamstring exercise

Reproduced from Mjølsnes et al. (2004)

Points To Note

– The subjects in this study had no current injuries.

– The Nordic hamstring exercise is a high effort level exercise to perform.

– It can be great as part of a rehabilitation programme, but should only be used as advised by a suitably experienced and qualified therapist/trainer.

– A suitable warm-up should be performed prior to performing the exercise.

– The Nordic hamstring exercise should be used as part of a comprehensive rehabilitation/preventative programme and not in isolation.

Thanks for reading, get in touch if you have any questions.

Ed

References:

Brooks, J.H.M., Fuller, C.W., Kemp, S.P.T. and Reddin, D.B. (2006) Incidence, Risk, and Prevention of Hamstring Muscle Injuries in Professional Rugby Union. American Journal of Sports Medicine, 34:8, 1297-1306.

Brukner, P., Nealon, A., Morgan, C., Burgess, D. and Dunn, A. (2014) Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. British journal of Sports Medicine 48:11 929-938.

Mjølsnes, R., Arnason, A., Østhagen, T., Roasted, T. and Baar, R. (2004) A 10-week randomised trial comparing eccentric vs concentric hamstring strength training in well trained soccer players. Scandinavian Journal of Sports Medicine, 14:, 311-317.

Petersen, J. and Holmich, P. (2005) Evidence based prevention of hamstring injuries in sport. British Journal of Sports Medicine, 39:6, 319-323.

Small, K; McNaughton, L; Greig, M and Lovell, R. (2009) Effect of timing of eccentric hamstring strengthening exercises during soccer training: implications for muscle fatiguability. Journal of Strength and Conditioning Research, 23:4, 1077-1083.

Over Reaching or Over Training?

Its that time of year, with the Spring Marathon season just around the corner, when lots of people up their running volume and intensity in an effort to reach the training goals on their training plan.  Sometimes this can lead over training (OT) and injury.  But what (apart from the obvious) is overtraining? How do we define it? Recognise it? Manage it? In this post I aim to provide some kind of definition, differentiate between over reaching and over training and provide some info on how to manage the two conditions.

Over Reaching Vs Over Training? Non Functional Over-Reaching (NFOR) can be defined as:

“When athletes do not sufficiently respect the balance between training and recovery”

Meeusen et al. (2006)

And is different, although not easily distinguishable from over training.  The defining characteristic of which, is an reduction in the ability to perform at established levels, which may persist for weeks or months (Matos et al., 2011).  By the way these two terms are different to the regular “overload” we do in our training to get adaptations and improvements in our physical fitness.  The main difference between the two conditions appears to be recovery time. Recovery for NFOR can be measured from days to a couple of weeks, whereas OT can take weeks to months to recover from.

Who is affected?

NFOR and OT can affect both endurance and non-endurance athletes (Matos et al., 2011), but measuring the exact incidence of rates can be difficult due to the difficulty establishing set characteristics and measurable markers.  The range of the incidence of OT varies greatly, dependant on whether the measurements were over a single training season (21% in swimmers) or a whole career (60% in elite runners). It is more like to be more common in elite athletes, with high training volumes and intensities.

Signs and Symptoms of NFOR & OT

This can be split into 3 main areas: Physical, Psychological, Psychosocial.

Physical

  • The defining characteristic is a reduction in the ability to perform at established levels.
  • Reduced sleep disturbances, despite fatigue.
  • Increase in perceived effort during normal training.
  • Increased upper respiratory tract infections. Thought to be due to a depressed immune system secondary to chronic physical and emotional stress.
  • Increased frequency of injuries.
  • Muscle heaviness, during and after training.

Psychological

  • Reduced enjoyment during training.
  • Lack of confidence and feeling intimidated by opponents.
  • Frequent mood changes, especially feeling sad during competition or training.

Psychosocial

    • Multiple stressors from family/own expectations, busy/work school life.
    • Sport is often the most important factor in an athletes life and can often lead to reduced involvement in aspect of an athletes life outside their sport.

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Possible cycle of psychosocial factors during NFOR & OT

Managing NFOR & OT

      1. Rest and recover – this is the most important aspect of managing NFOR and OT, you must allow the body and mind to recover. Encourage normal sleeping patterns.
      2. Training modification – reduction in volume and intensity and change from single sport/discipline to include cross-training.
      3. Communicate – athletes try to communicate with family, friends and coaches. Coaches and parents communicate with the individual.
      4. Resumption of training should be tailored to the athlete, based on their signs and symptoms and monitored and modified accordingly.

Prevention This can be more difficult than it may first seem. The effects of overtraining can take place of a protracted period and so changes in performance and general health can be quite subtle. Mood state can influence the willingness of the athlete to recognise the symptoms of over-training and thus become worse.  The points below may help:

      • By keeping a training log and note of race results (i.e. for 10k races) it is easier to identify patterns before they develop into problems.
      • Ensuring that you are getting adequate sleep and recovery. Plan this into your training week and make rest days exactly that.
      • If you compete in one individual sport (i.e. swimming or running) try and introduce some cross training into your week.
      • Keep your training varied and fun (that should be the main reason why we exercise after all)

This was a bit of a long post for me, but I hope you’ve found it useful. Feel free to leave a comment/feedback (but probably best to not comment about my lack of artistic ability!).

Best wishes

Ed

References:
MATOS, N. F., R. J. WINSLEY, and C. A. WILLIAMS. (2011) Prevalence of Nonfunctional Overreaching/Overtraining in Young English Athletes. Medicine and Science in Sports Exercise, 43:7, 1287–1294.
MEEUSEN, R., DUCLOS, M., GLEESON, M., REITJENS, G., STEINACKER, J. and URHAUSEN, A. (2006). Prevention, diagnosis and treatment of the Overtraining Syndrome. European Journal of Sports Science 6:1, 1-14.