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You know, it’s not the things that you would imagine are the things that you take from a day like the 7th
Spetember 2014. All Ireland day. The pinnacle. The ultimate aim for any professional working in Irish sport, any GAA person and especially any Tipperary fanatic ….. and I am lucky enough to be in a position to tick all three of those boxes simultaneously.
It’s a tricky line to tread really. As a professional and a member of the backroom team you need to be calm, objective and removed from the barrage of emotions that such a day will throw at you. A huge task in itself. But a colossal task when there’s a screaming lunatic of a Tipperary hurling supporter just underneath the surface only too keen to voice his opinions and display his unchecked reactions to the unfoldings of the day. Thankfully, over the years, I have learned to use the supporter within to energise me, keep me in the moment and push me to go the extra mile for the cause.
Don’t get me wrong, I look forward to the day that I can unleash that supporter again but I realise that it will be a different supporter to the one that was consumed by the professional 7 years ago. I will be a supporter who is more informed, more measured in distributing opinion, more aware of the fact that I do not have the full facts or knowledge of the internal goings-on within the dressing room walls and that I do not have an inkling of the level of sacrifice that each person within that dressing room makes from kitman to captain.
I do fear that my experience of the past 7 years will render me unable to blissfully disengage and enjoy a live game as I did before. I’m afraid I will not be able to attend without scrutinising the injury status of players of both teams, monitoring player fatigue, watching off the ball movement, checking that players are getting adequate water, watching sideline dynamics and observing injury management. I hope that I will be able to return to the passionate, appreciative, ‘child at Christmas’ supporter of the game that Donal Og has rediscovered after his 5 Munster, 2 All Irelands and 2 All Stars that was evident in his radio commentary of the last few minutes of the game.
I suppose All Ireland day is the same for no one. The experience is dependent on the individual and the circumstances. I have seen the devastation it can reap on the losers and the unbridled joy it can bestow on the victors. I have also seen the lonliness it imposes on those on foreign shores as they struggle with a whole other spectrum of emotions. I have seen the most timid of people become monsters in their seats and old men put father time in reverse to become boys again. The power of an All Ireland day is hard to explain and to fathom.
One of our strength and conditioning coaches is a Polish man named Lukas. Lukas has been involved for two years. He has attended training 5 times each week with the lads, every game and is an amazing professional at what he does. Lukas was new to hurling two years ago. I have watched his relationship with hurling develop and I have watched and shared his devestation at our championship exit to Kilkenny in Nowlan Park in 2013. Lukas came to me after the All Ireland in 2014 and simply said ‘I thought I knew this game, now I get it’. That spoke volumes to me.
The part of the day I enjoy most on All Ireland day is meeting the lads in Portlaoise and our bus trip to the hotel for prematch preparations. This may be a little strange but it is the only part of the day that I can really relax. My gear is on the bus and I am completely organised. I am aware of what I need to do from the minute the bus stops at the hotel but until then I can do nothing. I sit at the window and watch the supporters as we pass with their waves and taunts depending on the colours they are wearing but it’s generally all good natured. I watch people in Dublin going about their usual Sunday routines still taking time to wave to the bus or beep their horns even though I know none of them will be at the game. The fact that they reach out is great. They know what an All Ireland is.
My abiding memory of the 2014 All Ireland will be something I saw on my drive to Portlaoise to meet the lads and the bus. Just past the Borris-in-Ossary exit I saw a father and a son standing on the bridge. The son was holding a Tipperary flag that was as big as himself and the father was holding the son. The little lad was waving furiously at the steady stream of cars that were passing under his feet. Maybe it hit me because of the stage of life that I am at, but it hit me hard. They were not going to the game but they were doing their bit. They knew what an All Ireland was.
They got it.
Predicting Injury; Functional Movement Screening
Although us physiotherapists are pretty good at treating injuries, our main goal is to prevent them happening in the first place. Physiotherapists the world over are using the Functional Movement Screen (FMS) as a predictor of injury in all levels of sport! And if it's good enough for elite athletes it's good enough for me! The functional movement screen is a tool used to identify injury susceptibility. It is an individual screen, particularly used in pre-season, to help identify players with poor movement patterns and asymmetries, which are associated with an increased risk of injury.
As we all know too well, participation in sport exposes individuals to a risk of injury. According to the GAA Development Conference 2013
, 2 out of 3 GAA players get injured per season (67% footballers, 71% hurlers). And the GAA folk are not the only ones falling apart, 16-26% of novice runners experience at least one running related injury in the first 2 months of training, and 1 in 4 rugby players are injured per season. That's a lot of injuries!!!!
As always prevention is better than cure, and identifying those at risk of injury pre-season limits time lost to injury and increases overall player satisfaction. The FMS allows physiotherapists to identify such players before injury strikes!
The screen consists of 7 global body movements, including;
- Deep squat
- Hurdle step
- In-line lunge
- Shoulder mobility
- Active straight leg raise
- Trunk stability push up
- Rotary stability
These movements are thought to be the foundation of more complex movements required in sport. The screen identifies dysfunctional movement patterns, asymmetries from left to right and general mobility and stability. Each movement is scored from 0-3, as shown in the table below:
The maximum score is 21, however the average score in healthy, but untrained populations, ranges from 14.14 ± 2.85 points to 15.7 ± 1.9 points. 1
. A score of less than 14 suggests a greater risk of injury. 3
If you would like to read further about current research into the effectiveness of FMS to predict injury, please follow this
link to a very comprehensive review of current literature, a summary of which is below,
“In summary, at least 18 studies have assessed whether the FMS score can predict the incidence of injury. Of these 18 studies, 11 have assessed the relative risk of individuals with an FMS score of ≤14 points being injured in comparison with individuals with an FMS score of >14 points. Out of these 11 studies, 4 found that the FMS could not predict injury risk. In the remaining 7 studies, the relative risk was between 1.65 – 11.67 times, which suggests that the FMS may well differentiate between individuals who are at a greater or lesser risk of injury.”
Following completion of the FMS, any identified weaknesses or asymmetries can then be addressed through an individualised training plan. Current research shows that neuromuscular training can improve FMS scores, and thus decrease the risk of injury.
If you would like to book an individual/team Functional Movement Screen or would like to discuss the screen with one of our physiotherapists, please contact the clinic on 067 42837
Strength training for runners…..what’s the evidence?
Strength training for runners…..what's the evidence?? It would seem logical to me as a runner, and as a chartered Physiotherapist, that strength training would minimise injury and enhance performance, however the science is lacking. And these days it's all about the science! The following two papers lend support to the role to strengthening in terms of injury prevention and performance enhancement.
In 2013 Lauersen et al
carried out a meta analysis, entitled “The effectiveness of exercise interventions to prevent sports injuries”. Meta analyses are considered a bench mark of evidence based practice, as they compare and contrast existing research in the area and offer an up to date consensus. Here, the authors reviewed 25 studies in total, and concluded that “strength training decreased sports injuries to less than 1/3 and overuse injuries could be almost halved”. These are astonishing results. If there were pills out there that boasted such benefits we’d all be popping them, so.. why are we ignoring strength training. I do acknowledge that the study was not specifically about running and the exercises were varied, however it cannot be dismissed.
Recent support for performance gains, was provided in this 2014 study
, which looked at “The Effect of Strength Training on Performance in Endurance Athletes”. The authors concluded that current research supports the addition of strength training in terms of improved economy, muscle power and performance. However, the authors do suggest that methods of assessing strength as well as the appropriate selection of strength exercises, for example which exercises, the load needed etc., need to be further investigated. It's a good start though!
So it seems strengthening may have its place…but why?
There are a number of reasons strength training may be beneficial, including increased strength, tissue adaptation, coordination and increased neuromuscular efficiency. You can generally tell by looking at someone's running style whether they are new to the sport or years pounding the roads. Just like everything in life, the more we practice, the better we get, the more fluid and seamless it all appears to the outside world. The reason this happens is neuromuscular efficiency and coordination. However running alone is not going to cut the mustard! A very interesting paper
was published this year showing that “leg strength declined in older adults despite habitual endurance exercise”. I'd like to point out here that the study looked at runners aged over 48. Don't be offended, 48 is still young…it did say OLDER not OLD adults!!The authors concluded that “resistance training be an integral component of a fitness program, and that running alone was not sufficient to prevent the loss in muscle strength”.
But how can you get faster and improve performance through bulking up? It is not about building bulk, it's is about creating adaptation and functional strength. Strength training should be as running specific as possible. The phases of running need to be broken down and analysed, to determine the biomechanics and muscle recruitment patterns. The goal of strength training should be to address and improve control, stabilisation, strength and proprioception. Core, leg and proprioception work are essential, as well as functional drills. Specificity is key to feeding forward into an athlete's running technique. Here
is some further reading from a coaches point of view, with some excellent insight into running technique and strengthening.
Finally just to touch upon muscle physiology. Another reason why strength training may improve your performance is its capacity to change muscle composition. A 2011 study
entitled the “Effects of resistance training on endurance capacity and muscle fiber composition in young top-level cyclists”, showed that a 16 week strength and endurance programme resulted in a reduced number of type IIx fibres and a concurrent increase in type IIa fibres. Type IIa are thought to be more fatigue resistant and so would have an important effect on endurance . . . In summary; runners like to get up and go. No warm up, no stretch, no thinking..just head off and enjoy the ride. But do you want to improve your running economy, aerobic ability, coordination, overall performance and injury resilience? If the answer is yes then strengthening should now become part of your approach to running. No matter how recreational your running is, science supports strengthening. Specificity will yield greater results but generic exercise, for the major muscle groups involved in running, will not see you too far wrong.
Foot strike….fore foot, mid foot, heel strike, does it really matter?
I’ve been spending a lot of time online recently, reading about foot strike in runners….I realise this makes me sound quite sad! But there is so much information out there, with some fantastic online contributions from experts in the area. So to offer a little summary of what the current consensus is, I've decided to write this week’s blog on foot strike…watch out exciting stuff ahead!
To simplify things, it is widely believed, and marketed, that traditional shoes are associated with heel striking and barefoot/minimalist shoes are associated with mid/forefoot striking. And again to generalise, the belief is that heel striking is bad and mid/forefoot is good. A sweeping statement indeed! However it is more accurate to say that different strike patterns load different tissues, and it cannot be generalised or simplified to stating that one is either “good” or ”bad”. Each strike pattern carries a higher risk of certain injuries.
Let's start with heel striking. The current thinking among runners is that traditional running shoes promote a heel strike due to their chunky heel. And in the past 10 years traditional shoes and heel striking have become something of a “dirty topic”. Who dares heel strike these days?? Well… It is estimated that approximately 75% of runners do. Heel striking is not wrong, however is thought to be associated with a greater risk of anterior compartment syndrome, tibial stress fractures and knee pain. That does not mean all heel strikers suffer from these though.
As for mid/forefoot, you would be forgiven for thinking that the whole world is running like this due to the hype around both, however the reality is very different. Forefoot is somewhat of a buzz word in running, perhaps becoming less popular these days as runners struggle to transition and they realise that it carries it's own risk of injuries. Forefoot striking is associated with an increased risk of metatarsal stress fractures, calf pain and Achilles' tendon injury. But again not all forefoot strikers will suffer these.
Really the truth is there is no perfect running technique, no "one size fits all”. I'll use a quick example to finish this off. Take a runner who has a history of Achilles' tendon pain, but hasn't bothered him in a few years. He reads all the magazines and online blogs of fellow runners and decides that forefoot running is the way to go. However as you now know forefoot striking is associated with increased loading in the calf muscles, and so when he commences forefoot training his pain is aggravated. In this case changing this runner’s style to forefoot may be detrimental!
In summary no landing pattern is ideal, no “one fits all” running style is suitable. There is a place for all types of foot strikes and the coaching of each may be very beneficial to some but perhaps detrimental to others. No matter what, if changing your technique, transitioning is key, and this takes time and patience.
Ne-nagh ne-nagh…here comes the POLICE!! (Acute injury management)
If you're about to embark on a running adventure this weekend then it may be a good idea to keep POLICE
in mind! You can leave your handcuffs at home, we’re talking about the management of acute injuries! The acronym POLICE stands for Protect, Optimally Load, Ice, Elevate and Compress
. Used in the acute stage of injury, these will help reduce pain and speed up recovery. Useful to remember if you pick up an injury when there's no chartered physiotherapist about.
Protection may involve the use of crutches, slings, bandages etc. These protect the area from further damage and allow healing. Protection is useful initially, and is essentially part of the optimal loading stage.
The previous acronym for the management of acute injuries was PRICE, where the R stood for rest. However certain injuries do not benefit from complete rest, and so the R was replaced with OL (optimal loading) to conveniently make another word..POLICE! Which is perfect as it fits in with my ne-nagh ne-nagh gag nicely!
Rest was thought for a long time to be essential in the early management of injury, and although useful initially, continued rest may cause muscle weakness, joint stiffness and longer healing times. For example in the case of an acute ankle sprain gentle movements of the ankle joint can be useful to reduce swelling and pain, where rest would prevent this. Also recent studies have shown that optimal loading plays an important role in stimulating bone, tendons, ligaments and muscles to repair. What constitutes optimal load, is tricky to define. Generically speaking it would be weight bearing/loading with minimal pain. Sometimes the optimal load may be no load at all and rest may be called for. This is very much dependent on the extent and severity of your injury.
There is a lot of controversy in physio-land regarding ice and it's use, how long for? how often? hot cold? bag of peas vs ice bath? Etc
As a general rule;
- Ice for 10-20mins, no longer
- Protect the skin while icing, place a damp towel between the ice and your skin.
- Repeat approximately 3 times per day for the first 5days
Compression can be very useful in minimising and reducing swelling. A bandage or compression sleeve, which you can get in the pharmacy or here at the clinic, are handy ways of managing swelling and pain. When using compression ensure it is not too tight, and that blood flow is not impeded to the extremities. Wear throughout the day and remove at night.
Elevation is a simple, yet effective tool for reducing swelling and alleviating pain, and the perfect excuse for sitting down and putting your feet up…literally!
In short, if you pick up an injury think POLICE. It is a very useful tool to adopt if you sustain an acute injury, however it doesn't replace medical assessment and treatment. If you are concerned about your injury, seek medical advice immediately or contact the clinic on 067 42837 or visit us online at www.sportplus.ie
How hard should I push it?
It’s vitally important when doing aerobic exercise (running, walking, cycling, etc.) to know how much is too much and especially so when you are older. The mind may be willing but what the body can cope with is a different story. It’s this factor that has been shown to be one of the primary factors which prevents older adults from participating in exercise. The aim of this blog is to teach you how to monitor the intensity of your aerobic training and explain to you the different ways of doing this.
The most accurate method of monitoring exercise intensity is through monitoring heart rate. Heart rate is measured in beats per minute This can be done by taking your own pulse at your wrist or at the side of your neck. It can be tricky to take your pulse properly if you are not trained to do so. Count the number of beats in 10 seconds and multiply it by 6 to get beats per minute. Thankfully measuring heart rate is much more easily done these days thanks to technology. Heart rate monitors are readily available in pharmacies or sports shops and can be worn around the chest, as a wrist watch or even as an app on your phone.
To use heart rate properly as a monitor of aerobic intensity you need to know what your maximum heart rate is and from this you can calculate your ideal exercising heart rate. Maximum heart is calculated by subtracting your age from 220. For frail elderly people and beginners you should keep your exercising heart rate at 40-60% of your maximum. Healthy individuals should aim for 50-75% of their maximum. It’s also worth keeping a record of your resting heart rate over time. As you get fitter you will notice that your resting heart rate will decrease.
The second way of monitoring aerobic exercise intensity is by monitoring your level of comfort while exercising on a 0-10 scale. This is called a perceived exertion scale. This might sound very abstract but it has been shown in research to be very accurate. I’ve printed a copy of the scale below. It’s definitely worth memorising if you are doing aerobic exercise and it really highlights the important message of ‘listen to your body’. You need to be in tune with how you are feeling while exercising, monitoring your own breathing, sweating and comfort levels and not monitoring yourself against the people you are exercising with.
10 Maximal Near exhaustion 100%
||% Max Heart Rate
||Nothing at all
||No perceptible sign
||Feeling of motion
||Warm on a cold day
Slight sweat on a warm day
||Sweating but can talk easily
||Heavy sweating. Difficulty talking.
The simplest was of monitoring you exercise intensity is by using the talk test. This simply means that if you can talk while you are exercising you are in a safe zone. Once you speech starts to break, slow or become uncomfortable you need to pull back. If you can sing while you exercise you are not working hard enough!
It is important to state that you must see you GP prior to undertaking aerobic exercise if you are an older adult or if you have not done any exercise in a long time. Your GP will screen you and make sure you are safe to begin aerobic exercise. If you have any concerns about aches, pains or old injuries please give us a call at Sportsplus Physiotherapy Clinic (067 42837) and we will screen you to ensure you do not do any further injury while exercising.
Strengthening in Relation to the Older Adult.
As people get older things slow down on several levels. If left unchecked the rate of decline can be quite steep. This can result in diminished ability to perform functional tasks and an increased rate of falls. Research has shown that a major factor associated with the risk of falls is strength. A misconception exists that older people cannot make strength gains. Loss of strength in older people is called sarcopenia. Resistance exercise can slow the loss of muscle strength in older adults but the vast majority of older adults do not engage in this form of exercise as they are afraid that they will cause themselves injury and they are not fully aware of the potential benefits.
Strengthening exercises for the older adult has been shown to result in strengthening muscles, maintaining bone density, improving balance, improving mobility, improving coordination, improving mood and improving sleeping pattern. As if that wasn’t enough of a reason to do strengthening exercises this form of activity has been shown to improve symptoms of diabetes, arthritis, osteoporosis, back pain, obesity and depression.
If you are an older adult and you think you would like to embark on a programme of strengthening exercise your first stop has to be with your GP. You need to explain what you want to do and get your GP to do a full physical on you to make sure that there is no medical reason that you should not start some strengthening work. Your next stop should be with your chartered physiotherapist to screen you and identify what areas you need to prioritise in terms of strengthening. It is important that your chartered physiotherapist and your GP are in communication to ensure that any potential problems are identified before they happen and to make sure you are safe.
Your chartered physiotherapist is trained in identifying your weaknesses and advising you on how to safely begin and methodically work through progressions of exercises over an appropriate time frame to maximise your potential gains. The progressions of resistance training as regards the older adult begin in the water. This allows you to work with percentages of body weight and against the resistance of the water. Then you move to body weight exercise in various positions using base of support, centre of gravity and equipment variations to offer you different intensities of work and to allow you to work different muscle groups. The final progression is to use external resistance in the form of weights, cables and resistance bands to further work the muscles and to result in overall strengthening.
For someone not accustomed to strength training it is best to begin with a program that exercises all the major muscle groups in the same session. 2-3 sessions each week is recommended with 24-48 hours between each session to allow full recovery. Recovery is vital because with strength training what you are doing is pushing the muscle beyond what it is used to and cause some microdamage within the muscle. This stimulates it to recover stronger than it was previously in anticipation of the same load again. If you exercise before you are fully recovered you will not make any gains as you are just damaging the muscle.
The intensity, frequency and type of training you embark on must be tailored to your specific needs and goals so the best step is to give us a call in Nenagh on 067 42837 and we can talk you through what you need to do. We plan to begin classes in the near future to teach you about the benefits and the basics of strength training for older adults so let us know if this is something you would be interested in. All questions, feedback and ideas are appreciated.
Active Retired Blog – the benefits of staying fit as we get older.
For our July series of blogs we are going to switch themes again. Our aim each month is to give you a taste of what physiotherapy, and our clinic in particular, has to offer different client groups. Our blog series for July will focus on the older individual. This is especially important in Ireland at present as statistics show that our population is aging. 11% of our population is over 65 now and by 2041 it is predicted that this will have doubled to 22%. Trends show that over the same period the number of people over 85 years old will have quadrupled. It follows that the incidence of chronic illness will rise dramatically and hence the cost of care for this section of society will follow suit.
The benefits of staying fit and healthy for this demographic are long established. Older people who walk outdoors at least four times each week for a minimum of 15 minutes have a 50% lower risk of mortality than those who walk less frequently. Moderate to high levels of physical activity in the 50+ age group leads to a 50-56% reduction in the odds of having depressive symptoms. It has been proven that engaging in physical activity reduces the risk of cardiovascular disease, preserves functional ability, improves psychological health and improves brain function.
So now that we know exercise benefits older adults we need to look at what is actually happening in this population group. Recent research by the Centre for Aging and Research in Ireland has show that physical activity declines with age. Adults aged 75+ years are on average 2.5 times more likely than 60-64 year olds to be insufficiently active. Women are less likely to be sufficiently physically active , almost 2 times less active than men of the same age group. People who have physical, psychological or mental health disorders are the groups most likely to report inactivity. Older adults who do stay active say that participation in sports such as cycling, swimming, golfing, aerobics, dance and jogging as their preferred exercise, so it is important that a transition from team sports to individual sports is available for middle-aged to older adults.
A valid question at this stage is why do levels of physical activity decrease with age? A Northern Ireland research paper in 2010 showed that the main reason for this is that older age groups have a perception that they are not able, they have safety concerns and they don’t have access to activities specifically designed for them. A study in Scotland in 2004 showed lack of interest to be the most important deterrent and this was thought to be due to a lack of understanding of the benefits of physical exercise.
The next question is how much exercise should older adults do? National guidelines on physical activity recommend that older adults engage in 150 minutes of moderately intense activity each week to achieve both physical and cognitive health benefits. Healthy Ireland has a target of increasing by 20% the proportion of the population undertaking regular physical activity by 2025.
Now you know why you should exercise. In the next few blogs for July we will go into more detail as to what older adults should be doing as regards exercise, the specific benefits of different forms of exercise and how to do it safely.
When can I return to exercise after childbirth?
Here is our final blog in this Women’s Health series with Eimear Lynch. It is a huge area of physiotherapy and one which we will certainly return to at a later date. The purpose of this series was to give you a taste of what physiotherapy has to offer ladies with these issues. Below Eimear outlines three simple tests to help you gauge whether you are ready to begin exercising again after child birth.
Post pregnancy exercise....am I ready? Everyone knows the importance of exercise in pregnancy and there's no better group of women to keep fit than those with bumps. However the most frequent question I get asked is what can I do now that my baby is born, and the bump is gone? Women are eager to tone up their tummies and lose the little bit of weight gained in pregnancy, but are often nervous about returning sport. Below are a few tips to help you assess your readiness for return to activity.
1. Curl Up Test Lie on your back with your knees bent. Slowly lift your head and shoulders off the floor keeping your chin tucked in. Using your fingers feel for the borders of the muscles along the middle of your tummy. Is there a ‘soft’ gap or separation of these muscles?
Online Tummy Check video at http://www.youtube.com/user/TheBumpRoom
2. Leg lift test Lie on your back with legs out straight. Lift one leg off the floor a few inches and lower. Repeat on opposite side. Note during the test; • Does either leg feel heavier or harder to lift? • Is there any pain when lifting either leg? • Is there any visible bulging of the tummy when lifting either leg?
3. Pelvic floor test •Feel your pelvic floor (at the opening of your vagina). Is there descent or bulging out when you cough? . Is there any leakage when you cough or sneeze?
If you have answered yes to any of the above, then contact the clinic and make an appointment with Eimear, or if you want to speak to Eimear privately then you can contact her on 0863576823.
As always use a little common sense, build your fitness and strength up gradually to help you return to full activity. You've had a long off season, so have patience and take your time building back up to your pre pregnancy fitness or sport. P.s. Changing nappies is not considered a sport...but I often think it should be!