Hamstring injuries are the most common injury in football and AFL, and we can help our patients strengthen their hamstrings while significantly reducing their risk of injury with the right exercise program. What are the best exercises to use to strengthen and lengthen the hamstrings, and to prevent hamstring injury?

In this Physio Edge podcast with Dr David Opar, we discuss hamstring injury prevention, which athletes will benefit, which exercises to use, the most important aspects of each exercise and how to incorporate these with your athletes. You will discover:

• What does the latest research around hamstring exercises and injury reveal?
• Which players are most at risk of hamstring injury?
• How can we prevent hamstring injuries?
• How does hamstring muscle architecture adapt to training, and how does this relate to your exercise selection or prescription?
• How can we increase hamstring muscle fascicle length?
• How can we tailor our patients hamstring program based on whether they are preseason, in-season, uninjured or previously injured?
• Which exercises are important in hamstring rehabilitation and prehabilitation?
• How can you start and progress a hamstring injury prevention program?
• How quickly do patients lose their hamstring gains, and how much maintenance do they need to perform?
• What happens to hamstring muscle strength and flexibility following injury?
• What neuromuscular inhibition happens following hamstring injuries, and how can we address this in our rehab?

There has been a lot of great research performed recently on hamstring injuries, and to share this and help you with your hamstring injury patients, we have invited Dr David Opar to present at the upcoming Sports Injuries virtual conference in December 2017. You can access six free preconference sports injury presentations by CLICKING HERE.

Links

• Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino
• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership
• ACU open access hamstring journal repository
• Dr David Opar on Twitter
• Dr Anthony Shield
• Dr Morgan Williams
• Dr Matthew Bourne
• Nicol van Dyk
• Rod Whiteley
• Nirav Maniar
• Jack Hickey
• Ryan Timmins
• Dr Steve Duhig

Articles associated with this episode:

• Bourne et al. 2017. Impact of exercise selection on hamstring muscle activation.
• Opar et al. 2015. Eccentric hamstring strength and hamstring injury risk in Australian footballers.
• Petersen et al. 2011. Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men’s Soccer.
• Timmins et al. 2015. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study.
• Timmins et al. 2016. Architectural Changes of the Biceps Femoris Long Head after Concentric or Eccentric Training.
• van Dyk et al. 2016. Hamstring and Quadriceps Isokinetic Strength Deficits Are Weak Risk Factors for Hamstring Strain Injuries: A 4-Year Cohort Study.

Athletes with groin pain will commonly play with pain until the end of the season, and rest during the off-season in the hopes this will aid in their recovery. Unfortunately this offseason rest period rarely results in recovery, and athletes head into the preseason with long-standing groin pain and an extended recovery period.

In this episode of the Physio Edge podcast with Dr Adam Weir , you will discover how to treat adductor related groin pain (ARGP) and complex patient presentations with multiple areas of pathology or pain.

This podcast follows on from the Physio Edge podcast episode 69, where Dr Adam Weir and I discussed in detail how to assess and diagnose adductor related groin pain, identify or exclude differential diagnosis including stress fractures, hip joint involvement, inguinal related groin pain and nerve entrapment.

You will explore:

• Treatment of acute adductor strains
• Long term adductor related groin pain (ARGP)
• Is rest during the off season helpful or harmful for groin pain
• What pain level is ok during rehab exercises
• How can you describe ARGP to decrease patient fear
• Is ARGP a tendinopathy or different pathology?
• How to answer your patients when they ask how long until they can return to training (RTT) or return to play (RTP)?
• What is and how can you incorporate the Copenhagen Adductor exercise?
• Is there a role for passive treatment?
• Is hand held dynamometry useful during recovery?
• Treatment for adductor related groin pain (ARGP)
• Starting treatment
• Exercise progressions
• What criteria can you utilise for treatment progressions?
• What criteria can you use prior to allowing your patients to return to running, change of direction and RTP
• How to progress running and change of direction training
• Adductor to abductor strength ratios your athletes can achieve prior to RTP

Complex presentations

• How can you make a diagnosis and tailor your rehab when a patient has multiple areas of pain and positive tests eg ARGP plus Psoas related groin pain or Inguinal related groin pain?

• How your treatment program may evolve as your patient progresses through their rehab

Dr Adam Weir will be presenting at the upcoming Sports Injuries virtual conference on the assessment and treatment of Inguinal related groin pain. You can access his free preconference presentation, along with other free sports injury assessment and treatment videos AT THIS LINK

Links associated with this episode:

• Get your access to free Sports Injuries presentations
• Download your free podcast handout
• Dr Adam Weir on Twitter - @adamweirsports
• Aspetar – Sports groin pain centre
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook
• Adductor protocol on Mobile devices
• Adductor protocol videos on Youtube

Articles associated with this episode:

• Branci et al. 2014. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls.

• Drew et al. 2017. Experimental pain in the groin may refer into the lower abdomen: implications to clinical assessment.

• Drew. 2017. PhD Thesis - Beyond the pathoanatomical explanation of long-standing groin pain in athletes

• Mosler et al. 2015. Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis.

• Weir et al. 2015. Doha agreement meeting on terminology and definitions in groin pain in athletes.

• Whittaker et al. 2015. Risk factors for groin injury in sport: an updated systematic review.

Adductor related groin pain is the most common diagnosis for athletes with groin pain. In this episode of the Physio Edge podcast you will discover how to assess and diagnose adductor related groin pain, identify or exclude differential diagnosis including stress fractures, hip joint involvement, inguinal related groin pain and nerve entrapment.

Dr Adam Weir is a Sports Physician with a PhD on groin pain, the lead author for the Doha agreement meeting on terminology and definitions in groin pain in athletes, who currently shares his time between the Aspetar sports groin pain centre and the Erasmus University Hospital Academic Centre for Groin Injuries in Holland. Adam will take you through exactly how to perform an assessment around the hip and groin, how to interpret your findings and how to explain your diagnosis to your patients. You will explore:

• The common presentation and symptoms of someone with adductor related groin pain
• Structures that are commonly involved
• Aggravating and easing activities
• Area of pain, and new research highlighting unexpected pain referral areas from the adductor tendons
• Differential diagnosis
• Bone stress injuries around the hip and pubic bone
• Genitofemoral nerve entrapments - symptoms, diagnosis and treatment
• Red flags
• Acute versus chronic presentations
• Adductor related versus pubic related groin pain
• How to perform an assessment, including screening tests
• Tests you need to incorporate into your assessment
• Identifying and diagnosing all the structures contributing to a patient's symptoms
• What is the value of imaging and when should it be performed?

Links associated with this episode:

• Get your access to free Sports Injuries presentations
• Download your free podcast handout
• Dr Adam Weir on Twitter - @adamweirsports
• Aspetar – Sports groin pain centre
• Erasmus University Hospital Academic Centre for Groin Injuries
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook

Articles associated with this episode:

• Branci et al. 2014. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls.

• Drew et al. 2017. Experimental pain in the groin may refer into the lower abdomen: implications to clinical assessment.

• Drew. 2017. PhD Thesis - Beyond the pathoanatomical explanation of long-standing groin pain in athletes

• Mosler et al. 2015. Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis.

• Weir et al. 2015. Doha agreement meeting on terminology and definitions in groin pain in athletes.

• Whittaker et al. 2015. Risk factors for groin injury in sport: an updated systematic review.

There are a range of tendinopathy presentations, from easily diagnosed with a local area of pain and clear pain response to tissue overload; through to patients with trickier presentations and multiple contributors to pain e.g. long term proximal hamstring or gluteal tendinopathy with a lumbar spine radiculopathy.

How can you diagnose and treat patients with complex tendinopathy presentations? How does the latest research around tendinopathy help us? I explore these issues and more with Dr Peter Malliaras in episode 68 of the Physio Edge podcast. We also explore:

• Do tendinopathy patients always present with a small area of pain, or can they have pain in larger, more diffuse areas?
• How will you identify tendinopathy or other structures that may be contributing to your patients symptoms?
• Clues in your patients' history to help you identify and differentiate tendinopathies, lumbar and SIJ referral
• Symptoms and how your treatment will differ in patients with paratenon and fat pad involvement
• How can you measure your patients load tolerance?
• What categories of tendinopathy patients can you use to help differentiate your treatment?
• How can you rehabilitate patients with tendinopathy?
• What role does biomechanics have?
• What advice can you provide to your patients about load management, symptoms and flareups?
• When is it ok for your patients to continue or return to running?
• What strength tests should your patients be able to complete before returning to running?
• If your patients are not tolerating running, which aspects should you modify first - frequency, intensity, type or duration?
• When are isometrics useful in your treatment?
• When can you start isotonic and plyometric exercises?
• How can you incorporate tendon neuroplastic training (TNT)?

Links associated with this episode

• Download your podcast handout
• Dr Peter Malliaras on Twitter
• Tendinopathy rehab blog with Dr Peter Malliaras
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook

Other episodes of interest:

• PE 046 - Proximal hamstring tendinopathy with Tom Goom
• PE 042 – Treatment of plantaris and Achilles tendinopaty with Seth O’Neil
• PE 023 – Lower limb tendinopathies with Dr Pete Malliaras

Articles associated with this episode:

• Coombes et at. 2016. Isometric exercise above but not below an individuals pain threshold influences pain perception in people with lateral epicondylalgia

• Rio et al. 2015. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy

• Silbernagel et al. 2007a. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled trial.

• Silbernagel et al. 2007. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy.