Throughout our #ReturntoPlay blog series we’ve been looking at evidence-based ways to reduce injury risk when going back to sport following the lockdown.

So what are we talking about this week?

For this final entry we’re looking at what’s out there on how to reduce your risk of concussion. Unfortunately, there’s no sign of collision sports (like rugby) or combat sports (like judo) restarting any time soon, but it’s best to get ahead of the game with our simple tips so you’re in the best condition possible when you get your boots back on & return to the pitch, or put your gi on & return to the mat!

What can I do about it?

The good news is that we know keeping a strong neck helps to reduce your risk of suffering from concussion (Collins et al., 2014; Eckner et al., 2018). You should start with these simple isometric (not moving) exercises and progress to isotonic (with movement) exercises when you feel ready.

Let’s start by completing these 3 super simple exercises daily…

Forward press 

Try to nod your head down & resisting this movement with your palm.
Hold this for 5 seconds then relax.

Side press 

Press your head to the side into your hand. Repeat on the other side.
Hold this for 5 seconds then relax. 

Backward press 

Try to tilt your head back & look up, resist this movement with your hands.
Hold this for 5 seconds then relax. 

What if I’m concussed? How do I know?

As sports physiotherapists, if we suggest a player is concussed when playing sport we would look for any signs or symptoms, check the player is orientated in time & place and can remember the game clearly. We would also ask 5 simple questions which someone without concussion would know easily, but someone concussed might struggle with.

Here is the list of symptoms we look for in concussion.

If you have any, or a combination of these symptoms following an accident or hitting your head– contact your GP, or Jersey Sports Medicine or if you are very concerned or your condition is worsening then attend A&E. Once your doctor has diagnosed concussion then we can help you through the return to play process.

Remember- you don’t need to hit your head or be knocked out in order to have a concussion, it can also happen from a whiplash type injury where the head is jolted backwards & forwards or where your head quickly decelerates for example a rugby tackle or landing from a fall.

Will I recover from my concussion?

We can help you through the recovery process. This is a step-by-step process which starts with gentle exercise and normally lasts around 1-2 weeks, then once you’re back to playing your sport and feeling good, you don’t need to worry about it.

During this process people with concussion often tell us they just ‘don’t feel themselves’, it can be common to feel uneasy, anxious or down, this is normal & will improve!

What’s important is that you get informed advice on how to return to your life and sport safely to avoid prolonging the process, suffering from a second concussion or risking a bodily injury like an ankle sprain.

The bottom line is concussion is common, can be managed easily with the right advice and you can reduce your risk of suffering from it by building a strong neck!

Blog Post by…
Fiona Robertson 
BSc(Hons) Physiotherapy MCSP

Throughout our Return to Play blog series we have explored evidence–based ways to prevent injury in specific body parts, such as avoiding ACL injury or groin strain. If you’re just looking to keep your joints strong and avoid aches and pains then this is the blog for you! 

There is an age old myth that running is bad for you- some say it wears out your knees and hips or is bad for your back. The good news is there’s new evidence to say that not only is running not bad for your knees- but it can actually improve damage to the joint.

This study took middle aged non–runners took an MRI scan of their knees, they then completed a four month training program, ran a marathon then MRI scanned their knees again. Of the participants who had a degree of damage to their knee joints before the training program… following the marathon many of them were improved! In addition, most of their BMI’s had reduced and there was no change to their meniscal cartilage damage.

Another study which looked at the presence of arthritis in both hips and knee joints in active marathon runners showed less hip and knee arthritis in the runners than the general population- woohoo!

So the message seems to be…
-> if you are already running; then take confidence that you are keeping your joints healthy,
-> if you are not running because you’re afraid of damaging your joints; now you have seen the evidence- why not give it a go?

We recommend starting with a gradual program like Couch to 5k. This programme is gradual enough to avoid injury in most cases, but if you struggle with it then give us a shout. Or if you want to get involved in running in a really fun environment then see our ultra-marathon-smashing, incredibly inspirational friend James Manners at Traction Running & Fitness for some incredible run coaching! He’ll have you fighting fit in no time.

For all runners we recommend strength training once or twice a week, see our suggestions for getting started in the infographic below. Paul & I had a discussion on our top tips for runners (old & new) and answered common questions on a recent Facebook live – check it out!

Blog Post by…
Fiona Robertson 
BSc(Hons) Physiotherapy MCSP

Doing a few stretches is enough to warm up before my football game, isn’t it? 

Sorry to be the bearer of bad news- unfortunately not!! 

The purpose of a warm–up is to prepare your body for the demands of the sport ahead- get your heart pumping harder, breathing quicker, muscles warmed up & get your head in the game! The other important purpose- the one that we physiotherapists care most about- is that warm-ups should prevent injury!!

In order to do this we need to do different movements which replicate the challenges of the game ahead. We have been looking at loads of different evidence-based ideas to prevent injury, check the other blogs out here.

Where do I start? 

A clever bunch of international researchers have devised an excellent warm-up protocol which has been proven to reduce the risk of injury significantly. This protocol is called the Fifa 11+ and it is a 20 minute programme with 3 different stages- compiling of running drills, strength and balance exercises. The only thing you have to think about is making sure your knee is aligned with your foot- see the diagram at the bottom of the poster.

All you must do is complete the warm-up twice weekly and it can reduce injury rates up to a massive 40% – how great are those odds? 

It has been shown to reduce risk of many different injuries, including knee, ankle and hamstring injuries- though most impressively it is very effective in reducing risk of the dreaded ACL injury. 

Here’s a poster of the exercises to complete- Part 2 is split into 3 categories so there’s an option for everyone’s ability. 

Who should do the warm–up? 

Everyone who plays team sports– football, netball, rugby, hockey, volleyball… 

Anyone who plays individual sports which incorporate changing direction- tennis, squash, badminton… 

Even if you don’t take part in team sports these exercises will still help you to improve strength, balance & co-ordination. Most of all they will help you to stay in good condition & stave off injury!

I don’t have 20 minutes before football training! 

No problem- there is a cool study (Whalan et al., 2019) in which half did the full Fifa 11+ warm-up before training, and the other half did the running exercises before training and completed the strength exercises after training. The good news is there was no difference between the 2 groups so you can do whatever’s most convenient for you- and we love convenience! 😀 
 

Sound pretty good? 

It’s awesome! Get your whole team on it- or ask your coach if they can introduce it to your training night. Effective warm-ups mean less injuries-> which means your A-team can keep playing all season long-> which means more fun and more wins! We all love taking part, but winning is best, so get started with the Fifa 11+ now!

Blog Post by…
Fiona Robertson 
BSc(Hons) Physiotherapy MCSP

So now your hamstrings are in great shape from our previous blog post lets work round to the inner thigh/groin, to a group of essential muscles called the adductors. 

Adduction 

NOUN
physiology
adduction (noun) 

The movement of a limb or other part towards the midline of the body or towards another part.
The opposite of abduction. 

Groin strain is relatively common injury, though fortunately there is some compelling evidence on how to prevent it with a simple exercise completed as part of your warm up or gym routine. 

This Scandinavian study found a 40% reduction in groin injury from following the exercise protocol in male players. Unfortunately there is no research looking into the same protocol for females or adolescents though we can assume a certain amount of the benefit will be the same for different groups.

If at any point during or following the exercises you experience pain in your groin, please regress by one level for a few weeks then try again. 

So where do I start? 

We would suggest starting with level 1 exercises… 

Lying on your side with your top leg resting in front of you
Slowly lift your bottom leg off the ground as high as it can go then lower it back down.
Repeat on both sides. 

When you feel strong with that exercise, progress to level 2… 

In a side plank position with a partner holding your top knee with both hands (or you can use the straps of a suspension trainer or bench in the gym).
Pushing down with the top leg to bridge your body up and bring your bottom leg to meet the top one.
Slowly lower back down & repeat on both sides. 

Then when you feel great doing that version, progress to level 3! 

In a side plank position with a partner holding your knee and ankle (or using the straps of the suspension trainer or bench in the gym).
Pushing down with the top leg to bridge your body up and bring your bottom leg to meet the top one.
Slowly lower back down & repeat on both sides. 

Phew! We said the exercises were simple but they certainly aren’t easy!

With each exercise start with 3-5 repetitions on each side & build up to 12-15 repetitions on each side, 1 to 3 times per week. If you want to get really technical you can follow the sets and repetitions from the study

Don’t hesitate to get in touch if you’ve sustained an injury or want some advice.

This is especially important if you’ve had more than one episode or longstanding groin pain as it can develop into a chronic issue if ignored- but we can help!

Happy exercising!

Blog Post by…
Fiona Robertson 
BSc(Hons) Physiotherapy MCSP

First up in our Return to Play series is the hamstrings

Here’s Will Highfield aka the Jersey Gorilla to show you where they are… 

You may have heard of the hamstrings being mentioned in relation to football- and this is not surprising– as they are the most common injury.  They are disruptive and costly to teams and frustrating for injured players. Hamstring injury is not just for footballers and can affect anyone, especially active people. If you injure your hamstring you may notice a painful pop in the back of your thigh, or it can just feel tight in the back of the leg when you’re running or bending down.

So how can I keep my hamstrings in good condition? 

If your hamstrings feel good right now, but you want to make them stronger & keep them happy– great!! You can skip ahead to the exercise plan. 

If your hamstrings feel a bit tight (especially if it’s only on one side) it shouldn’t be ignored as it may be a sign of a strain. Rest can help but it can also cause weakness which can lead to re-injury. It’s best to get proper advice- just ring us if you’re not sure! 

Prevention is better than cure! Unfortunately, if you’ve strained your hamstrings before, you’re more likely to hurt them again- so avoiding injury in the first place is always the best option.

Make a plan

Have a training plan or routine which allows for recovery in between training.  

You’re more likely to injure your hamstrings sprinting. This can commonly happen if you turn up to running or sports training with the tank half full, because you did a heavy legs session the day before. Weekend warriors– great effort but cramming your training into 2 days then doing nothing for the other 5 isn’t a great plan. See if you can spread it out a bit throughout the week by cycling to work or fitting in a run at lunchtime.

Nordic hamstring curls 

We love these! A simple exercise that gives you great bang for your buck.
Add 3 sets of 6 of these to your plan once per week and you’ll notice the difference- and the burn!!

Start here using resistance bands or an exercise ball for support… 

OR

Then after a 6-12 weeks of these ones (or when your legs feel strong doing the supported version) progress to the hardcore option! The slower you move and longer you hold the position without dropping to the floor, the harder the exercise is. 

These exercises are tough so so only attempt if your hammies are feeling strong!

Sprinting– and we mean full speed sprinting at 100%! 

Nordic curls are great, but the best formula is to combine them with sprint training. Sprinting is great for preventing hamstring injury and may even improve your running speed- so it’s win win!! This is most important if you play a sport which requires you to reach top speed at any point. 

We recommend doing a few short sprints twice per week on fresh legs, maybe fit it into the warm-up before football training or as intervals during a training run. 

Our suggestion is…
   – head down to your local football pitch or mark out roughly 50 & 100 metres on the road
   – do a warm-up of a few 100m laps at a gentle jog (50% of your maximum speed)
   – then do a few 100m laps at a slightly quicker pace (60% of your max speed)
   – then do a few 50m laps at a quicker pace again (70% of your max speed)
*You might want to stop here if you’ve not run in a while & repeat this session a few times over a few weeks before progressing*
If you’re feeling good and have lots of energy at this point…
   – repeat 4 x 50m laps where you build the pace until you’re running at top speed
The aim is to get a few 50m top speed sprints in your legs twice per week and keep this up throughout the season/year.

Make it a habit & stave off those pesky injuries!! 

So there you have it- the easy peasy guide to super happy hammies! 

Blog Post by…
Fiona Robertson 
BSc(Hons) Physiotherapy MCSP

Help! Sports training in starting back and I’m out of shape!

Planned to get in the shape of your life during lockdown but spent most of your time on Zoom quizzes instead?

Some sports have restarted but if you’re not back to training yet then listen up- over the coming weeks we will discuss evidence–based i.e. actual science (not bro science) recommendations about the best way to return to sport, reduce injury and make the most of the sporting season. 

We will look into how you can keep your hamstrings in top condition, how to bulletproof your groin, how to keep your knee joints happy, how to prevent the dreaded ACL injury and even how strengthening your neck helps to prevent head injury/concussion! 

Feeling a bit deconditioned? 

If you’re used to training at high intensity and have been taking a bit of a break over lockdown then it’s a good idea to prepare your body before getting back to sport full steam ahead. Hopefully you’ve kept up some activity- even small amounts relative to your normal training volume can cut your losses significantly. 

So I won’t have to start from zero again? 

There is a lot of research over the past ten years looking into just that; and the good news is that not only does it take quite a few months to lose muscle strength and fitness back to untrained levels… but we know that when you start training again you can make up what you lost in half the time. 

We recommend taking at least 6 weeks to reintroduce your body to sport- starting with low to medium intensity training for a few weeks then gradually increasing the intensity and progressing towards sport specific movements (like changing direction & sprinting for footballers, or lunging for badminton players) 

Also if you have any previous injuries then you’ll need to pay extra attention to these as you return to training, we’ll discuss how in the coming blog posts. 

Great- when can I start!? 

Now! With news coming out all the time of more sports returning then it’s a good idea to get ahead of the curve and start training as soon as possible. Start with conditioning and check back here for more great ideas… here’s a sneak peek at things to come… 

Blog Post by…
Fiona Robertson 
BSc (Hons) Physiotherapy MCSP