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Why Hamstring Strains Occur and How to Prevent Them

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Hamstring, Hammies, Hams, or if you're feeling fancy you can use their latin names. Keep in mind there are three muscles that make up the group of muscles called the hamstrings, they are biceps femoris, semimembranosus and semitendinosus.

This group of muscles is a notorious repeat offender for injuries, across numerous sports. AFL, soccer, rugby, cricket and baseball players are all frequently falling victim to the sharp pain in the back of the thigh that can mean anything from missing a few games to ending a career.

There have been a number of superstars with their futures in doubt due to the injury, just to name a few; Michael Clarke (cricket), Chris Judd (AFL), Jamie Lyon (NRL). And more recently Cale Hooker (AFL) was in doubt to play against Geelong in the last preseason game.

What puts someone at risk of a Hamstring Injury?
When all of the studies looking into risk of injury are combined we get a good overall picture of the elements that increase the risk that someone's hamstring will be injured.

As we noted with the ACL injuries (ACL injuries in females), there are a number of factors that contribute to an injury. Some of these we can influence and others are out of our hands.

The two big factors we cannot change that influence your risk of injury are age and previous history of hamstring injury (or previous ACL/knee injury)1.

Though if you haven't had a hamstring injury before, perhaps now is the best time to see a Bodywise Health Physiotherapist for a personalised preventative program.

The good news is there are a number of risk factors that we can improve on. These include muscle strength ratios, strength characteristics of the hamstrings and player endurance1.

Are there different types of Hamstring injuries?
The location of the tear can have a significant impact on the recovery process, especially the time and rehabilitation required to get back on the field.

When considering the location of a muscle tear it is important to appreciate the whole unit. The whole unit includes the bony attachments (both ends), the tendons (a flexible cord on either end of the muscle that transmits the force of the muscle contraction to the bones) and the muscle belly - the power generator. There is also an important transition of muscle to tendon towards either end. These different locations all heal at different rates and sometimes require different rehabilitation strategies.

The extent of the tear arguably will have an impact on the recovery process. Studies looking at imaging results have not consistently shown a clear correlation between the findings on scans like an MRI and the time to return to sport (RTS). Having said that, one can respect that a more substantial sized tear would require longer to repair the damaged tissue, but there are a number of factors that weigh in when considering returning to sport.

If you have been injured, a physiotherapist at Bodywise Health will be able to assess your hamstring and determine what type of injury you have or if further investigations are required.

What can be done to prevent an injury?
This is the most important section. If you have never had a hamstring injury before you want to be proactive in reducing your risk. If you have been unfortunate enough to have sustained an injury previously, you should be working hard to reduce your other risk factors.

There have been many studies looking at reducing the risk of injury. And the great news is there are many things that can be done to reduce your risk.

Your training program should include anaerobic interval training, sports specific training drills and lengthening exercises. Stretching especially while the muscle is fatigued, has also been shown to reduce injury risk. So a proper cool down is important2!

There are also specific exercises that have been shown to reduce the risk of a hamstring injury.

What can be done if I am injured?
Just as was seen in the preventative efforts, lengthening exercises have been shown to have a faster RTS time3. Additionally, agility and trunk strengthening offered slightly quicker RTS and lower re-injury rates, when compared to just strengthening/stretching3.

It was noted that more frequent stretching can still improve the range of movement faster, as well as allowing a faster RTS, suggesting that a home exercise program conducted frequently will be helpful. NSAIDs were not found to be helpful for recovery, PRP injections were also found not to offer benefit in RTS times3.

Sports focused exercises were also found to reduce the number of hamstring injuries sustained by AFL players4.

Unfortunately many of even the elite clubs are failing to adopt the 'evidence based' hamstring injury prevention measures. One study looking at elite soccer clubs in Europe had as many as 83.3% of clubs not following guidelines5.

So if you play a sport that involves running or kicking, get ahead of the competition and see a Bodywise Health Physiotherapist for an assessment and a preventative program. If you've sustained a hamstring injury either recently or a while ago, reduce the risk of re-injury by getting a preventive program.

For a complimentary injury assessment and advice, please call Bodywise Health on 1 300 BODYWISE (263 994).

Until next time stay Bodywise,

Michael Hall
Director Bodywise Health

References
1. T. Pizzari, Risk factors for hamstring injury: An updated systematic review and meta-analysis, Journal of Science and Medicine in Sport, Volume 19, Supplement, December 2015, Page e9, ISSN 1440-2440, http://dx.doi.org/10.1016/j.jsams.2015.12.401
(http://www.sciencedirect.com/science/article/pii/S1440244015006465)

2. Verrall GM, Slavotinek JP, Barnes PG The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules football players British Journal of Sports Medicine 2005;39:363-368.

3. Pas HI, Reurink G, Tol JL, et al Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis Br J Sports Med 2015;49:1197-1205.

4. Proske, U., Morgan, D., Brockett, C. and Percival, P. (2004), IDENTIFYING ATHLETES AT RISK OF HAMSTRING STRAINS AND HOW TO PROTECT THEM. Clinical and Experimental Pharmacology and Physiology, 31: 546-550. doi:10.1111/j.1440-1681.2004.04028.x

5. Bahr R, Thorborg K, Ekstrand J Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey Br J Sports Med Published Online First: 20 May 2015. doi: 10.1136/bjsports-2015-094826

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Why female athletes are more prone to knee injuries and what you can do about it

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What a wonderful start to the Women's Australian Rules Football season. It's been fortunate that the injury toll has been keep largely in check. There have been a few exceptions, namely:

  1. Natalie Plane from Carlton with her high-grade ankle sprain
  2. Meg Downie from Melbourne with a hamstring rupture
  3. Stephanie De Bortoli also from Melbourne with an Achilles tendon tear
  4. Brianna Green, a Fremantle player fractured her collarbone


There have been two major knee injuries reported to have occurred during the season so far. Sophie Armitstead with a meniscal tear of the same knee she's previously had an ACL reconstructed and Kim Mickle who ruptured her ACL.

But what is this 'ACL'?
The Anterior Cruciate Ligament is a rope-like structure that supports your knee from the inside. In some ways, it is the last structure that prevents your thigh bone and leg bone separating during not only high force activities but also day to day activities, like walking down stairs. In addition to the structural support offered, it is also considered to give information to the brain about how you are moving from the stretch and pull it undergoes as you move. Ideally, the joint and ligament is protected by strong muscles around the joint that can absorb most the force.

What puts the ACL at risk?
Somethings are out of our control, like the weather. There have been some weather conditions, that lead to a dry field, that have been seen to increase the risk of an ACL injury1.

Regrettably being older or having a previous knee injury also increases the risk of an ACL injury.

A higher grade of football was noted to contribute to an increased risk, but these players were also generally older and had previous injuries.

Gender is also a very interesting element of ACL risk. It has been found that females have an increased risk of ACL ruptures in several sports. These sports include wrestling (4 times the risk, compared to males), basketball (over 3 times the risk, compared to males), soccer (around 2.5 times the risk, compared to males), rugby (nearly 2 times the risk, compared to males) and lacrosse (only slightly higher risk)2. That study was done before the Women's AFL took off, so it did not include females playing AFL as a comparison. It was also interesting to see that AFL had similar ACL injury rates to soccer and basketball.

Fortunately, there are somethings that we can do to help reduce the risk. Increased weight and the associated higher Body Mass Index (BMI) have also been reported as putting the ACL at more risk of a rupture1. So, eating healthy and maintaining a good balance of regular physical activity has yet another advantage!

What should I do?
Most ACL injuries in AFL matches occur without contact. This would suggest that there are elements that could be worked on to reduce the risk of an ACL rupture.

Fortunately, research has backed this up3. Specific movement strategies and muscle groups have been identified as areas that players can work on to effectively reduce their risk of rupturing their ACL3.

If you are an AFL player or play one of the sports mentioned above, it would be worthwhile booking an appointment with a Bodywise Health Physiotherapist to assess your strength and movement patterns.

This allows the physiotherapist to prescribe an individualised exercise program aimed at reducing your risk of an ACL rupture and the expensive surgery and rehabilitation that goes along with it.

For further information on how you can prevent knee injuries or for a FREE assessment, please call 1 300 BODYWISE (263 994).

Until next time, stay happy and be Bodywise,

Michael Hall
Director
Bodywise Health

References

  1. Orchard, John et al. "Intrinsic And Extrinsic Risk Factors For Anterior Cruciate Ligament Injury In Australian Footballers". The American Journal of Sports Medicine 29.2 (2001): 196-200. Web. 3 Mar. 2017.
  2. Prodromos, Chadwick C. et al. "A Meta-Analysis Of The Incidence Of Anterior Cruciate Ligament Tears As A Function Of Gender, Sport, And A Knee Injury-Reduction Regimen". Arthroscopy: The Journal of Arthroscopic & Related Surgery 23.12 (2007): 1320-1325.e6. Web.
  3. Cochrane, Jodie L. et al. "Characteristics Of Anterior Cruciate Ligament Injuries In Australian Football". Journal of Science and Medicine in Sport 10.2 (2007): 96-104. Web.
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Concerned about your child’s backpack?

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With children returning to school in the next couple of weeks, helping them make the right start to the year is critical. It can help them avoid all the negative effects that go hand in hand with pain; loss fitness, decreased confidence and social withdrawal.

And with the incidence of back pain in adolescence approaching that of adults1, the muscle and bone problems associated with backpack use have become an increasing concern with school children2.
A study by Simmons College (Boston) professor Dr. Shelly Goodgold, has found that more than half of children in the study regularly carried more than the recommended 15 % of their body weight in their school pack packs.

The U.S. Consumer Product Safety Commission estimated that more than 3,300 children aged 5-14 years, were treated in emergency rooms for injuries related to backpacks in 1998; these numbers do not include students who went to their family doctor or health professional.

A study by Auburn University researchers (Anniston, Alabama, Pascoe et al.) stated that the most common symptom reported from backpack use is “rucksack palsy”. This condition results when pressure put on the nerve as it passes into the shoulder causes numbness in the hands, muscle wasting and in extreme cases nerve damage (Journal Ergonomics Vol. 40 Pg. 6 1997).

58% of orthopaedic health professionals polled in the USA reported treating children with back pain attributable to carrying backpacks. So if your child is complaining of neck, back, shoulder or arm pain, the cause might be an ill-fitting backpack. And despite the advent of tablets, notebooks and smart phones, it seems that if anything, school bags have become heavier, not lighter. 

Children are especially at risk of injury from backpacks as carrying too much weight in a backpack or an improper fit, can put undue strain in young muscles and bones that have not full developed.backpack2Here’s what can happen. As an overloaded backpack pulls the body backwards, your child may try to re-balance the body by bending forwards at the waist.

How much is too much?
Recent university studies indicate that if a backpack weighs more than 15% of a person’s body weight, it causes adverse effects on the neck as well as upper, middle and lower back which over time will lead to pain and physical problems.  In other words, it is recommended that the weight of the backpack should be no more than 15% of a person’s body weight.For a 50 kilogram child, that’s 7.5 kilograms.

Your child’s still developing muscle and bone systems can handle 15% without much chance of injury or permanent structural change. This weight can be carried without major postural changes occurring.
However an overloaded or incorrectly fitted backpack can cause the wearer to lean forward in an effort to compensate for the additional weight on their back.

Why you should be concerned

  1. There are two main reasons to be concerned about the weight of your child’s backpack.
  2. Holding this abnormal posture for long periods of time, can lead to a weakening of the neck, mid-back, low back and abdominal muscles.

As these muscles are developing, the risk is that they develop abnormally, setting up an abnormal posture for life. The top straps of the backpack which can compress the sensitive nerves and blood vessels as they pass from the neck through the shoulder area and into the arm.

This compression can lead to pain, tingling, numbness and even weakness in the arms and is called “rucksack palsy”.

What you can do
There are 3 things that you can do to ensure that your child is not at risk of injury from an unsafe back pack.
1. Select the correct backpack
2. Load the backpack properly
3. Adjust and wear the backpack correctly

Selecting a Backpack
1. The backpack should be no wider than the torso and not much longer than shoulder to hip.
2. Well-padded straps will distribute the load over a greater area, protecting the sensitive nerves and blood vessels as they pass beneath.
Some bag straps have adjustable air bladders and wait straps for a true custom fit.

Loading a Backpack

The guiding rule is that your child’s backpack should not weigh more than 15% of their body weight. Pack only what is needed for that day and stack the heaviest items closest to the back.

Wearing a Backpack
1. Adjust the straps for a snug fit.
2. Fit the backpack to the upper part of the back as a loose, low bag is more likely to compress the nerves and blood vessels of the neck and arm as well as strain the middle and lower back.
3. Never wear a backpack slung over one shoulder; not only can it compress nerves and blood vessels, but can also cause leaning to one side which may lead to twisting of the spine (scoliosis).

How to detect if there is a problem 
JJposture-webResearch has indicated that the use of computer photography is a valid and effect tool in detecting adverse postural changes that may occur with the wearing of a backpack.3

Bodywise Health has now acquired this technology so that you can identify quickly and easily if you or your child has a postural problem.

Once identified, simple techniques, exercises and strategies can then be implemented to correct joint stiffness, muscle imbalances and faulty postures and movement habits so that physical and health related postural problems can be avoided.

Prevention as the best cure
As with all health problems, the best cure is prevention or at least correction of a problem at the earliest possible instance.Getting a quick posture and / or backpack fitting check is an ideal way to stop problems before they start.

If you are concerned about your child’s posture; if you do worry about the weight of their backpack and you would like to correct the stresses on their body so that they don’t cause physical problems for the rest of their lives, the physiotherapists at Bodywise Health have the technology, knowledge, experience and skill to be able enable your child not only to make a great start to the year, but to enjoy life long better posture, better health and greater happiness.

If you would like further information or an appointment, please call 1 300 Bodywise (263 994).

Wishing you and your family the best of health,

Michael Hall
Director
Bodywise Health

P.S. For the next 2 weeks, Bodywise Health is offering FREE Posture and Backpack checks to you or your children. To get you FREE Posture and Backpack check, just mention this blog at the time of booking your appointment.

References
1. Skagg, D, Early S, D’Ambra P et al. (2006) Journal of Orthopaedics: 26: 3: 358-363.
2. Troussier B et al. (1994): Back pain in school children: A study among 1178 pupils. Scandinavian Journal of Rehabilitation Medicine 26: 143-145
3. Chansirinukor W. et al. (2001): Effects of backpacks on students: Measurement of cervical and shoulder posture. Australian Journal of Physiotherapy 47: 110-116.
4. Siambanes D et al. (2004): Influence of School Back Packs on Adolescent Back Pain. Journal of Pediatric Orthopaedics 24:2:211-217.

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The Truth About Back Surgery

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Back pain – it can rip your life away from you making your every position, movement and activity excruciatingly painful beyond your imagination. You can’t sleep. Dressing yourself is difficult if not impossible and going to the toilet can be agonizing. The constancy of your pain can wear you down to the point where your whole world is consumed by “the pain”.

If that’s not enough the confusing array of information, advice and treatment options offered by often well-meaning people can often compound your sense of disillusionment and powerlessness.

Everyone you speak to has a different opinion or magic cure. Friends will often tell you about their “guru” therapist that you must see. Therapists will give you many and varied diagnoses and treatments all promising to “fix” your problem. Doctors may send you for X-rays, CT scans and MRI scans but often the long words of these technical reports heightens your fears that something is seriously wrong and that hope of a cure for your pain is fading.

And then under the advice of your treating health professional you undergo any number of different treatments including nerve blocks, epidurals, radiofrequency neurotomies, prolotherapy and intradiskal electrothermal therapy, unbeknown to you, that most of these treatments offer at best between 30-60% of short term pain relief. 1,2,3,4

Is it no wonder that Australia is following America’s lead with spinal surgery increasing at 10% a year?5 In America, experts estimate that nearly 600,000 people opt for back operations each year. Yet, a new study in the journal Spine shows that in many cases that even surgery can backfire, leaving patients in more pain.

Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine.

Unfortunately, for most patients with bad backs, there is no easy solution, no magic bullet. Pain management experts — and some surgeons — say that patients need to scale back their expectations. With the right treatments, pain can be eased, but a complete cure is unlikely.

27 million adults with back problems

A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, 27 million adults reported back problems with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physiotherapy, pain management, chiropractor visits, and other non-invasive therapies, the majority pays for spine surgeries.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there has been an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned.

For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. The indications for spinal surgery include:

• Nerve root compression resulting in persistent toileting problems, leg pain or numbness, tingling and muscle weakness;
• Persistent pain due to instability of a single intervertebral segment.

“But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Despite the fact that over 250,000 lower back fusions are performed every year in the USA, there is no evidence to support this operation for discogenic back pain.6,7

Burton and others recommend that patients get a second opinion when back surgery is recommended for the treatment of back pain without neurological symptoms, such as sciatica, especially if other treatments haven’t been suggested first.

“We are very successful at improving leg symptoms," says Dr. William Welch, vice chairman of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital. “We are less successful at treating back pain.”

Source of pain is often hard to pinpoint

The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain.

Even when the surgery is a success, it rarely dispels 100 percent of back pain, Welch says. And while many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating, says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. “It’s a case of, if you have a hammer, everything looks like a nail,” she explains.

In general, the best results come about through a combination of approaches, Cope says. Each strategy may reduce pain by just 10 or 20 percent, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 or 80 percent.

Proven strategies for treating lower back pain involve:
• Taking the load off the pain sensitive tissues and structures by getting into the most pain free positions as possible;
• Reducing inflammation with cold packs or medication;
• Protecting against re-injury with the use of tape or bracing;
• Promoting healing by reducing tissue tension with “hands on” techniques along with easy pain free, mobility exercises and heat treatment;
• Targeted stretching and strengthening exercises to correct muscle imbalances and joint alignment;
• Correction of posture, functional movement patterns (habits) and sporting techniques to prevent irritation of body structures and tissues;
• Core stabilisation exercises to build a strong, stable platform upon which whole body strengthening can be built;
• Functional strengthening to build your body’s capacity to cope with daily physical demands.

It is important that you understand that healing any tissue takes about 6 weeks and involves and a well-recognised progression through phases of healing. For example, the Bleeding Phase can last from 6-24 hours, Inflammatory Phase 2-5 days, Proliferation / Regrowth (framework) Phase 5 to 14 days, the Remodelling Phase 2 to 6 weeks and the Maturation Phase from 6 weeks to up to 12 months and beyond.

It therefore makes sense that if each of these phases are optimised, physically, nutritionally and psychologically and the actual causes of your back pain are corrected, then healing should not just be possible, but inevitable.

It is often quoted that it takes about 4 weeks to strengthen your muscles and at least 4 weeks to correct your posture or movement habit. So whilst not a quick fix, understanding that if you follow an evidenced based rehabilitation system that has been proven deliver results over time, you too can also achieve sustained improvement, through a progressive rehabilitation and conditioning program that will prevent re-injury and optimise your physical capacity.

If you are interested in learning about a 7 step plan that thousands of people have experienced relief through, call 1 300 BODYWISE (263 994) for a FREE Assessment and Recovery Action Plan. This plan will detail the specific steps that you need to take to on your road to recovery. Wishing you the best of health.

Yours sincerely,

Michael Hall
Physiotherapist
Director Bodywise Health

P.S. If you are in pain and you want relief, don’t put off getting effective treatment any longer.
Call 1300 BODYWISE (263 994) for a FREE, No Obligation back assessment and advice. You have absolutely nothing to lose except your pain and a healthier, happier life to gain.

References
1. Dreyfuss P. Hallbrook B, Pauza K et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygoapophysial joint pain. Spine (Phila Pa 1976)2000 25(10):1270-7.
2. Van Kleef M, Barendse GA, Kessels A et al. Randomised trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976) 1999:24(18):1937-42.
3. Yin W, Willard F, Carreiro J et al. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976) 2003;28(20):2419-25.
4. Pauza KJ, Howell S, Dreyfuss P et al. A randomised placebo controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine j 2004:4(1):27-35.
5. IA Harris, ATT Dao. Trends of spinal fusion surgery in Australia: 1997 to 2006 - ANZ journal of surgery, 2009 - Wiley Online Library
6. Carragee EJ. The surgical treatment of disc degeneration: is the race not too swift? Spine J 2005:5(6):587-8.
7. Deyo RA, Nachemson A, Miirza SK, Spinal fusion surgery – the case for restraint. N Engl J MED 2004:350(7):722-6

 

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