Call 07 3102 3337

Call 07 3102 3337

reception@praxisphysio.com.au

Call 07 3102 3337
Book Online
Hamstring Strain Injuries: Lessons from Personal Experience and the Latest Research

Hamstring Strain Injuries: Lessons from Personal Experience and the Latest Research

by | May 29, 2023 | Gym and Strength, Return to Sport, Running Injuries

Recently, in an effort to keep the ballooning effects of the all-you-can-eat buffet at bay during my Cricket Australia Indian tour, I ramped up my high-intensity running load. Things were going splendidly — four days of high-intensity running under my belt — until day five, when 90% of the way through a very intense interval session, I tore my hamstring.

I felt the tell-tale sensation so many of my patients describe: a sharp tearing and retraction sensation in my outer thigh while sprinting. I had to pull up immediately and iced the injury straight away. You’ll be happy to hear that I’ve since fully recovered. No longer ‘gun shy’ at my top speeds (which, admittedly, are not that fast!), my strength has vastly improved, and I’m back running at full capacity.

Having treated countless hamstring injuries through my long involvement in recreational, semi-elite, and elite sport — especially with Cricket Australia teams and the Aspley Hornets NEAFL squad — this experience gave me even deeper appreciation for how tricky these injuries can be. Hamstring strains are one of the most common injuries in running athletes, responsible for significant downtime and lost performance. Hamstring injuries have remained the most prevalent injury in professional AFL for the past 21 consecutive seasons (Orchard et al., 2013), with the average 2012 injury costing clubs over $40,000 per player!

Understanding Hamstring Injury Mechanisms

Most hamstring tears occur during the late-swing phase of running, where the hamstring undergoes rapid lengthening while producing high forces (Danielsson et al., 2020). Key risk factors include:

  • High eccentric loading demands.

  • Poor neuromuscular control.

  • Muscle imbalances (particularly hamstrings vs quadriceps).

  • Fatigue — as evidenced by my own injury, occurring late in a demanding session!

Importantly, the long head of biceps femoris is the most commonly injured muscle, partly due to its higher proportion of fast-twitch fibers and its anatomical position under stretch during running (Martin et al., 2022).

Fatigue, poor trunk/pelvic control, and sudden spikes in high-speed running are emerging as significant contributors to hamstring strain risk, particularly in field and court sports (Martin et al., 2022).

Preventing Hamstring Injuries

The good news is, hamstring injuries can often be prevented with smart training. Strengthening the hamstrings through eccentric exercises like Nordic hamstring curls and single-leg Romanian deadlifts has been shown to reduce injury rates significantly (Al Attar et al., 2017; Martin et al., 2022).

Effective prevention programs should also include:

  • Agility and trunk stabilization exercises — not just strength work (Martin et al., 2022).

  • Warm-up routines with dynamic stretching and sport-specific drills.

  • Monitoring high-speed running loads to avoid sudden spikes in intensity.

Addressing muscle imbalances is key too. Maintaining a healthy strength ratio between the quadriceps and hamstrings — and ensuring good trunk and gluteal control — promotes optimal biomechanics and reduces injury risk (Martin et al., 2022).

Recovering Well After a Hamstring Injury

A proper recovery should include:

  • Early management: Controlling swelling and pain with ice and appropriate activity modification.

  • Progressive eccentric strengthening: Integrated carefully to build resilience.

  • Functional rehabilitation: Sprinting drills, agility work, and sport-specific movements are crucial before returning to full play (Martin et al., 2022).

Interestingly, studies show athletes who follow programs that include eccentric training and trunk stability work have lower reinjury rates than those who just focus on basic strength and stretching (de Visser et al., 2012; Martin et al., 2022).

Return-to-play decisions should be made carefully. Factors like strength symmetry, absence of pain, and readiness for high-speed running should all be considered to reduce the risk of reinjury, which can be as high as 30% otherwise (Martin et al., 2022).

Final Thoughts

Even as a physio, my personal hamstring tear was a stark reminder that fatigue, progressive loading, and structured rehab are vital ingredients for both prevention and recovery. Whether you’re a weekend warrior, a professional cricketer, or just trying to beat the buffet, hamstring health is crucial.

If you’d like help strengthening your hamstrings, managing an existing injury, or optimising your running and performance, feel free to reach out. I (and my hamstrings) would be happy to help!

Till next time, Praxis what you Preach!

Backed by evidence. Trusted by athletes. Here for every body.

References

  • Al Attar, W.S.A., et al. (2017). The effectiveness of injury prevention programs in reducing the incidence of hamstring injuries in soccer players: a systematic review and meta-analysis. Journal of Physiotherapy, 63(1), 11–17.

  • Danielsson, B., et al. (2020). Mechanisms of hamstring strain injury: current concepts. Sports Medicine, 50(4), 669–682.

  • Martin, R.L., et al. (2022). Hamstring strain injury in athletes: Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy, 52(3), CPG1–CPG44.

  • Orchard, J.W., et al. (2013). AFL Injury Report 2012.

Understanding Sever’s Disease: A Common Foot Condition in Active Growing Children

Understanding Sever’s Disease: A Common Foot Condition in Active Growing Children

by | May 16, 2023 | Ankle and Foot, Return to Sport, Running Injuries

Sever’s disease, also known as calcaneal apophysitis, is a prevalent foot condition that primarily affects growing children. While not a true “disease,” it is an overuse injury that causes pain and discomfort in the heel.

Sever’s disease occurs when the growth plate in the heel, known as the calcaneal apophysis, becomes inflamed and painful due to repetitive stress and tension. This condition typically affects children between the ages of 8 and 15 who are actively involved in sports or activities that involve running or jumping. During a growth spurt, the heel bone can grow faster than the surrounding tendons and muscles, leading to strain and irritation during loading.

Symptoms and Diagnosis

The primary symptom of Sever’s disease is heel pain, usually felt at the back or bottom of the heel. The pain is typically aggravated during physical activities such as running and jumping and may improve with rest. The pain is often described as aching or throbbing and is usually located at the back of the heel or bottom of the foot. A physical examination by a Praxis Physio, combined with a review of the presenting history and symptoms, is usually sufficient to diagnose the condition. In some cases, an X-ray or MRI may be recommended to rule out other possible causes of heel pain.

Treatment and Management

The treatment for Sever’s disease focuses on relieving pain and reducing inflammation. Initially, the R.I.C.E. (rest, ice, compression, elevation) method is often recommended to manage symptoms. As many parents know, rest is easier said than done so avoiding or modifying activities that aggravate the pain is crucial. Your physio will be able to aid in planning the week’s loading to ensure symptoms are kept at bay. In some cases, heel pads or shoe inserts can provide additional cushioning and support. Exercises that stretch and strengthen the calf muscles and Achilles tendon to improve load tolerance are also provided by your physiotherapist as shown in the video above. Pain relief medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), may be prescribed in severe cases.

Prevention and Prognosis

Preventing Sever’s disease involves maintaining a balance between activity and rest. Encouraging children to warm up properly before physical activities can help reduce the risk. Additionally, the rehabilitation between bouts of physical activity will also allow for the easing of symptoms. The prognosis for Sever’s disease is excellent, with most cases resolving as the growth plate closes. Once the bones and muscles have finished growing, the symptoms typically disappear.

In summary, Sever’s disease is a common condition that affects growing children, primarily those engaged in sports or activities involving repetitive stress on the heel such as running. Recognising the symptoms, seeking early diagnosis, and implementing appropriate treatment and preventive measures are key to managing this temporary condition and ensuring a smooth recovery for children experiencing Sever’s disease. To ensure your child is back playing sports quickly, book in with the friendly and professional physios at Praxis today!

References

James, A. M., Williams, C. M., & Haines, T. P. (2016). Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial. British journal of sports medicine, 50(20), 1268–1275. https://doi.org/10.1136/bjsports-2015-094986

Scharfbillig, R. W., Jones, S., & Scutter, S. D. (2008). Sever’s Disease: What Does the Literature Really Tell Us? Journal of the American Podiatric Medical Association, 98(3), 212–223. doi:10.7547/0980212

Weert, H. C., van Dijk, C. N., & Struijs, P. A. (2016). Treatment of Calcaneal Apophysitis: Wait and See Versus Orthotic Device Versus Physical Therapy: A Pragmatic Therapeutic Randomized Clinical Trial. Journal of pediatric orthopedics, 36(2), 152–157. https://doi.org/10.1097/BPO.0000000000000417

Fact or Fiction Friday – Lower back Pain and MRI’s

Fact or Fiction Friday – Lower back Pain and MRI’s

by | Nov 8, 2022 | Lower Back, Pain

I need to get an MRI to help with the management of my lower back pain

Answer – FICTION

In a recent narrative review, Wang and colleagues (2018) concluded that MRI imaging in the early stages of lower back pain can have detrimental effects including more pain, less improvement, higher risk of surgery and worse overall health status. In fact, one study reported that patients that received an MRI within the first month had an 8x greater risk for surgery and 5x more medical costs!

If you do NOT present with severe neurological deficits, signs of a serious or specific underlying condition or have persistent pain >6 weeks which is unresponsive to conservative treatment then there likely isn’t a need for further investigation!

To get help with your long standing back pain or even that acute flare up, give us a call on (07) 3102 3337 or book online  so we can sort you out.

#praxiswhatyoupreach #praxisphysio #factorfictionfriday #physioeducation #preventprepareperform #pain #backpain #lowerbackpain #MRI #patienteducation

Wang Y, et al. Informed appropriate imaging for low back pain management: A narrative review. Journal of Orthopaedic Translation. 2018.

Stingers AKA Neural traction injuries

Stingers AKA Neural traction injuries

by | Dec 17, 2019 | Nerve Pain, Pain, Shoulder, Sports Injury

SUMMARY:

  • Stingers are essentially a tractioning of the neural system
  • This can cause pain, movement and sensation changes
  • Chronic traction to the nervous system can have a cumulative effect on nerve function
  • The more damage to the nerve, the more serious the outcome
  • We shouldn’t be as dismissive of “stingers”, particularly if they are recurrent
  • Physiotherapy has a role to play

STINGERS:

Stingers have been the catch cry of many contact sports over the years. Often dismissed as ‘just a stinger’, trauma to the nervous system should probably be taken a little more seriously, as we delve into detail today.

Stingers are most commonly experienced in contact sports whereby the shoulder of a players is forcefully depressed, as experienced with a tackle in NRL or union. A large range of motion over a short period of time can result in a ‘traction’ of the Brachial Plexus (a network of nerves formed from exiting branches of the spinal cord in the neck that transverse to the shoulder and arm). Thus network of nerves sends signals from your spinal cord to your shoulder, arm and hand and thereby providing feeling and movement to these regions.

BACKGROUND:

To understand a stinger injury, a clear understanding of nerves and nerve related injuries is required. A nerve is an enclosed, cable-like bundle of nerve fibres called axons, in the peripheral nervous system. A nerve provides a common pathway for the electrochemical nerve impulses that provide a number of functions, including getting our muscles to move!

Seddon and Sunderland present a five-grade classification scale for nerve related injuries[1-4]. Figure 1 illustrates the physiological changes that occur through each grade of injury. Essentially it outlines the greater amount of disruption to the anatomy of the nerve.

The more damage to the nerve, the more serious the outcome. Table 1 outlines the three different grades of stinger injuries.[4, 5] The most common stinger is a grade 1 injury, which represents a neurapraxia, or nerve stretch injury, without axonal disruption.[4] In an acute setting, this can result in motor and sensory loss/changes, which usually resolve within minutes.[1, 4] Grade 2 and 3 involve a higher degree of nerve injury, usually involving a crush, transection or compression mechanism.[1]

Chronic traction to the nervous system can have a cumulative effect on nerve function. This is termed “chronic stinger syndrome” and represents a distinct entity from acute stingers that may reflect long- standing structural changes of the subaxial spinal canal and chronic irritation/degeneration of the exiting nerve root complex.[4, 6]. This sounds complex but essentially means

Mid Potion Achilles Tendinopathy Location

A Clinical Example from Zac

“During a Gridiron match, a player was injured whilst making a tackle. I reviewed the player on field and he was unable to utilise his right upper limb (full paralysis) from shoulder down to his hand. The player was removed from the field immediately to be further assessed and monitored. A complete neurovascular assessment was performed, assessing motor function/strength, sensation, reflexes, and vascular status, as well was the cervical spine. Motor and sensation changes were the only deficits noted and were reviewed frequently. After roughly five minutes, the player demonstrated full upper limb motor strength and sensation, with nil lingering symptoms. In collaboration with the patient, it was decided he would return to match play immediately. The patient was monitored throughout the game and reported no further symptoms.”

Figure 2 shows a proposed decision tree when managing stinger injuries.[4] This clinical example outline above fits the Grade 1 Mild category as he was able to return to competition with nil lingering symptoms. Despite the lack of symptoms during the game, it is recommended the patient be reviewed again both after the game and weekly for two weeks to ensure a full resolution of symptoms.[4, 7]

The role for neural mobilisation?

Current non-surgical management involves rest, pain control and resistance training[4]. Though not explored within the literature, neural mobilization may have an important role in patients with persistent symptoms, such as Grade 1 moderate to severe, and more recurrent neuropraxias. Though not assessed in this specific population, there is evidence for neural tissue management being superior to minimal intervention for pain relief and reduction of disability in nerve related chronic musculoskeletal pain.[8] It is biologically plausible that recurrent neuropraxias may respond in a similar way, utilising neural mobilisation (tensioning or sliding) and mobilisation of surrounding structures.

Management of persistent Grade 1 injuries may differ slightly, specifically if the suspected mechanism of injury was through traction rather than compression. The nerve structures may have a heightened sensitivity to tensioning based techniques due to the similar mechanism of injury and may respond better acutely to sliding techniques which limit the strain on the nerve and focus on excursion. Tensioning techniques may be important in the sub-acute phase by loading the patient’s nervous system (i.e. increased strain) in preparation for return to function (i.e. tackling with acute traction on the brachial plexus).

In summary, perhaps we shouldn’t be as dismissive of “stingers”, particularly if they are recurrent for you! If you have any questions or would like to see one of our physios regarding your injury, feel free to contact us on (07) 3102 3337 or book online on our website

Till next time, Praxis what you Preach

Team Praxis

Prevent | Prepare | Perform

REFERENCES:

Menorca, R.M.G., T.S. Fussell, and J.C. Elfar, Nerve physiology: mechanisms of injury and recovery. Hand clinics, 2013. 29(3): p. 317-330.

Tsao B, B.N., Bethoux F, Murray B, Trauma of the Nervous System, Peripheral Nerve Trauma. 6th ed. In: Daroff: Bradley’s Neurology in Clinical Practice. 2012.

Sunderland, S., A classification of peripheral nerve injuries producing loss of function. Brain, 1951. 74(4): p. 491-516.

Ahearn, B.M., H.M. Starr, and J.G. Seiler, Traumatic Brachial Plexopathy in Athletes: Current Concepts for Diagnosis and Management of Stingers. J Am Acad Orthop Surg, 2019.

Feinberg, J.H., Burners and stingers. Phys Med Rehabil Clin N Am, 2000. 11(4): p. 771-84.

Presciutti, S.M., et al., Mean subaxial space available for the cord index as a novel method of measuring cervical spine geometry to predict the chronic stinger syndrome in American football players. J Neurosurg Spine, 2009. 11(3): p. 264-71.

Aldridge, J.W., et al., Nerve entrapment in athletes. Clin Sports Med, 2001. 20(1): p. 95-122.

Su, Y. and E.C. Lim, Does Evidence Support the Use of Neural Tissue Management to Reduce Pain and Disability in Nerve-related Chronic Musculoskeletal Pain?: A Systematic Review With Meta-Analysis. Clin J Pain, 2016. 32(11): p. 991-1004.

Shin Splints | Physio Guide to Medial Tibial Stress Syndrome

Shin Splints | Physio Guide to Medial Tibial Stress Syndrome

by | Nov 27, 2019 | Ankle and Foot, Return to Sport, Running Injuries, Sports Injury

SUMMARY

  • Shin splints are essentially an overuse injury
  • Numerous factors contribute to symptoms but mainly involving the poor control of force through the lower limbs
  • Important to stop symptoms to avoid developing stress fractures, which require lengthier time away from activity
  • Corrective strengthening exercises, relative rest, and workload management all seem to be treatment mainstays
  • Physiotherapy has a significant role to play in getting back to running and sport
Mid Potion Achilles Tendinopathy Location

SHIN SPLINTS

Shin splints, or as it’s referred to as in the literature, medial tibial stress syndrome (MTSS), is a common injury seen in the recreationally active and army populations. Symptoms typically consist of an aching pain to the lower medial (inside) part of the shin, that can be sharp when running or when inflamed. There can also be some pain and stiffness when you first walk around in the morning, or when you first start your activity.

Risk Factors:

Over 100 potential intrinsic risk factors of MTSS were identified in a recent systematic review [1] involving 21 different studies. Of those risk factors, nine were identified as having a moderate to strong occurrence in clinical practice. Out of these nine, the risk factors that result in the greater loads on the body (such as body mass index) or poorer acceptance of load with running were the most important.

A number of range of motion parameters were also identified. For example, larger plantar flexion range of motion (the movement of pointing your foot down) was identified. It has been hypothesized that the increased plantar flexion results in a greater likelihood of the individual landing on their forefoot rather than their rearfoot while running, possibly increasing the strain on the rear inside leg (posteromedial tibia). Forces on the inside of the shin bone explain the why pain may be present in that area.

Treatment:

Most people tend to simply rest which may decrease symptoms in the short-term, but it doesn’t address the direct cause! The condition is very commonly seen in recreational runners and not as much in your higher-level athletes. Why is this? It’s quite simple! As mentioned in our previous running blogs, the adherence to well-planned running workloads is what separates recreational runners from the competitive or non-injured. Planned training leads to adequate adaptation of the body to the demands placed upon it.

One of areas patients with shin splints focus on is poor “foot posture”. It is very common to hear the same old story, “I have shin splints because my feet are flat, I need orthotics to correct that”. The biggest problem with that approach is that not a lot of people realise that the reason that they are flat footed is not necessarily because of a defect in their feet! It may be because they have strength and control of their hips which is in turn is causing over pronation or flattening of their feet.

The diagram below demonstrates that perfectly!

As the hips cannot stay level during running, this may cause the knees to fall inwards and in turn causes pronation or flattening of the foot. Then, voila! You have increased tractional stress on the medial aspect of the tibia/shin bone. Yes, there is some evidence that poor foot posture can cause the problem, but only in combination with extrinsic risk factors such as over-training and rapid increases in workload.

Poor hip control and strength is also a precursor for many other musculoskeletal conditions such as lower back, hip, knee and Achilles pain. So if we could reduce the risk of these outcomes occurring in the future, why wouldn’t we try!

It is possible that MTSS is a condition where the simple treatment of rest is enough to reduce symptoms. Until proven otherwise, relative rest remains the number one treatment option for reducing your symptoms. However, If addressed early, MTSS can be managed with the combination of targeted strength routines, running workloads, manual therapy and ensuring adequate recovery time between training sessions.

If you are experiencing shin splints or are looking to prevent such injuries from reoccurring, please feel free to book online or give us a call (07) 3102 3337. You’ll receive an in depth assessment and treatment plan to help you achieve your goals and run better for longer!

Till next time, Praxis what you preach.

The Praxis Team.

PREVENT | PREPARE | PERFORM

Images:

The above images are owned by the “Trainer Academy (https://traineracademy.org/) ” and used in this article with thanks.

References:

[1] Winkelmann, Z., Anderson, D., Games, K., & Eberman, L. (2016). Risk factors for medial tibial stress syndrome in active individuals: An evidence-based review. Journal of Athletic Training, 51(12), 1049-1052. 10.4085/1062-6050-51.12.13