Osgood Schlatters (OS), Larsen-Johansson (LJ) and Severs disease are common adolescent conditions that affect young rapidly growing athletes. These injuries occur where the muscle tendons attach to the bone. During a growth spurt the bones, muscles and tendons are all growing at different rates. If the muscles are tight they put extra stress on the bone resulting in inflammation and pain. In the case of OS and LJ the pain is felt at the knee, where Severs affects the heel. Many athletes are specializing in sport earlier and are engaging in year round training, how can you make sure your young athletes can continue to train during this stage of development without suffering from growing pains?
The bones are growing faster than the muscles can adapt in terms of flexibility. Which puts a lot of stress on the muscle-tendon junctions, bone-tendon junctions, ligaments and growth cartilage.
Prevention strategy: Implement a regular stretching program focusing on the hamstrings, quadriceps, and calves, which have all been shown to be excessively tight during the adolescent growth spurt. Stretching should take place when the body is warm, i.e., at the end of your workout. Stretches need to be held for at least 30 seconds to be effective x 3 sets.
Hamstrings: Raise one foot onto a bench, lean forward bending from the hips and keeping your back straight. You should feel a stretch at the back of your leg.
Quadriceps: Stand on one leg (holding onto to something for support if needed). Bend your opposite knee and bring your heel towards your buttock as you hold your foot with your hand. You should feel a stretch in the front of the leg.
1. Gastrocs: Stand in front of a wall/bench and bring one leg back ensuring your toes are facing forward. Keep your heels on the ground and lean forward keeping the back leg straight. You should feel a stretch in the back leg.
2. Soleus: From the same position as above bring your back foot forward. Make sure both heels stay on the ground and bend through your knees. You should feel a stretch in the back leg.
Risk Factor #2
“Adolescent Awkardness:” the athlete is growing at different rates and there is now an imbalance in strength and coordination.
Prevention strategy: Exercises focusing on glute strengthening, core stability and neuromuscular control. Stability and strength of the pelvis and spine help with proper mechanics and loading of the lower extremity in running, kicking, and changing directions. Perform the exercises below 2x/week for 10 repetitions and 3 sets.
GLUTE STRENGTHENING: Start position for exercises below. Start in an athletic stance, both knees/hips slightly bent with your chest and head up. A band is wrapped around your knees or ankles. Your knees should be in line with your 2nd toe. Make sure your knees are not caving in (see bad/good form below).
1. Mini walks with a band: Start in an athletic stance. From this position take a step outwards and then feet back together again. Repeat 5-8 steps in one direction and then back in the other direction.
Single leg balance (with or without a band): Start in an athletic stance with a band around your knees for added difficulty. Keep one leg bent and raise the other leg out in a 45 degree angle. Hold for 5 seconds and return to start position and repeat on the other side.
CORE STRENGTH: Plank (with/without a ball pass): Start in a plank position from your elbows or hands, making sure your back stays flat and core stays tight. Hold for 30 seconds. For added difficulty hold the position while rolling the ball to a partner or wall.
Side plank: Place one hand on the ground, extend your legs out so you are in one straight line. The only thing touching the ground is your hand and the outside of one foot. Make sure your hips don’t sag towards the ground. Lift the top leg up for added difficulty. Hold for 20-30 sec and switch to the other side.
Y balance exercise: You can use tape to draw a Y on the floor (or imagine a Y on the floor) while you are doing this exercise. Stand on 1 leg with the support knee slightly bent, while reaching out in three different directions with the opposite leg. Position 1 is in front, position 2 is out to the side and back, and position 3 is back and across to the opposite side. Perform each position once and repeat the cycle for 3-5 sets. Ensure your form is good, and your stance knee is staying in line with your 2nd toe (not caving in).
Risk Factor #3
Congested training schedule with very little rest
Prevention strategy: Modify your exercises and training if you are suffering from an injury. I.e., Single leg landing, jumping and sharp cutting drills puts a lot of stress on the knee and heel and will aggravate these injuries. Modify or eliminate these exercises as needed.
If you are the parent, coach, or trainer of a young growing athlete be proactive and chat with one of the therapists at Sheddon on injury prevention strategies.
For more info, contact Sheddon Physiotherapy and Sports Clinic at 905-849-4576.
Lets face it, we all like to think that we’re still as strong, fast and agile as we were in our prime. Unfortunately, aging will get us all. Our endurance, strength, balance and flexibility aren’t what they used to be. Injuries happen more often and take way longer to recover from. To top it all off, lots of us need to make a living, raise a family and maintain a household. Where is the time for working out? Many older athletes would rather spend their time playing the sports they love than pushing weights around a boring gym. Unfortunately, if you’re only playing soccer (or any other sport) 1-2x a week, and spend the rest of your time behind a desk on your tush, chances are you’re a ticking time bomb for injury. Spending most of your week sedentary will make your muscles weak, stiff and poorly conditioned for any sport. You don’t have to be a gym rat to see benefits; you just need to maximize your time at the gym and do the RIGHT exercises. Hitting the gym will not only improve your health and fitness, but it will also increase your success and performance on the field.
Where to Start and What to do?
Soccer requires endurance, strength, power and agility. Therefore, your workouts should focus on improving all of these areas. Strength training doesn’t need to be done everyday. If you’re short on time, make sure you’re doing a full body workout 2x/week. ***IMPORTANT*** Every athlete is different. Talk to a therapist at Sheddon Physiotherapy and Sports Clinic if you have specific injuries or health concerns before starting an exercise program. The program described below is for a currently healthy, injury free individual. You don’t need any fancy equipment or a gym membership to perform these exercises. Remember, changes don’t happen overnight; it takes 6-8 weeks to see true strength and conditioning changes.
Unless otherwise stated all exercises will be completed for: 3 Sets 10-12 Reps 60 seconds Rest
If you’re short on time, go through each exercise as a circuit and repeat the whole circuit 3x with no rest in between exercises.
Back lunge to high knee:
Stand with your feet hip-distance apart, step back into a lunge bending at both knees and then bring the back leg into a high knee position. Ensure your stabilizing knee does not cave in. Repeat 10 on one leg before switching to the other side. Progression: add a weight in each hand, medicine ball, kettle bell, band around your ankle etc.
WHY? Improves strength, stability & balance
Start in an athletic stance with both knees slightly bent and feet together. Take a step sideways and then bring your feet together again. Repeat 10 steps in one direction and then ten steps back. Place band around knees to start and progress to ankles and feet. Placing the band around the feet will be the hardest but has the greatest activation of the glut med and max muscles.
WHY? Strengthens the glutes, a weak link in many athletes. Strong gluts will result in a more stable knee with decreased risk for injury.
Nordic Hamstring Curls
Can be completed with a partner holding your legs or hooking your feet under something heavy. Lower yourself forward, keeping your back and hips straight. Once you cannot go any further push yourself back into start position.
WHY? Eccentric hamstring exercises have been shown to significantly decrease the risk of hamstring injury.
Tie a theraband around your ankle, start with your leg away from your body, stand upright and engage the core. Slowly bring the leg towards your other leg and slowly bring it back out.
Why? Kicking, changing direction and reaching in soccer puts a large eccentric force on the adductor muscles, which puts them at risk for injury.
Side plank with leg raise
Lie on your side with your right elbow on the ground. Your bottom leg should be bent and your top leg straight. Raise your body off the ground so that your elbow and knee are the only parts in contact with the ground. Hold this position and slowly lift your top leg up and down. Repeat 10x / leg.
WHY? Core strength and pelvic stability is crucial for soccer players for changing directions, kicking and sprinting on the field
Bring your feet slightly wider than shoulder width apart, imagine a chair behind you (or actually put a chair for better form). Squat down and touch the chair and lift yourself back upright. Add a weight in front of your body for added difficulty.
WHY? Squats help build strength and power in all the leg muscles.
Start from your knees if from your feet is too difficult
WHY? A stronger upper body will help with throw-ins and pushing through defenders
1 Arm Row
Keep your feet hip width apart, slightly bend both your knees, engage your core and rest one hand on a chair or bench for added support. Holding a weight in one hand bring your arm back bending your elbow.
WHY? A stronger upper body will help with throw-ins and pushing through defenders
How to Progress
If you want to take it up a notch you can add in high-intensity interval training to provide a more sport specific/game like situation (i.e., after every strength exercise add a 30 sec AMRAP, “as many reps as possible”) of drills like squat jumps, burpees, box jumps, sprinting, etc. ALWAYS REMEMBER QUALITY OVER QUANTITY. 5 perfect squats is far more beneficial than 20 mediocre squats. You can also add in simple ladder footwork/agility drills. These drills will help with changing direction, tracking the ball, and being quick on the field. Extra Goalie Exercises: Lateral Bounds are great for developing goalies strength and speed for quick side-to-side movements in the net. In addition, vertical jumping is essential for goalies looking to get a little higher reach in net.
If you’re looking for a sports medicine clinic in the Oakville and Mississauga area to treat your current injuries or help put together a program to prevent future injuries, contact Sheddon Physiotherapy and Sports Clinic at 905-849-4576.
The Most Effective Hamstring Injury Prevention Program
Hamstring injuries have been reported as one of the most common injuries across a variety of sports that involve repetitive kicking and/or high speed running, such as soccer, track and field, football, and rugby. Re-injury rates are also an issue affecting many athletes long term, with roughly 30% of athletes suffering a re-injury to the hamstring within the first year. In order to prevent hamstring injuries it is important to understand WHY they occur, and to develop a prevention program which targets these risk factors.
The hamstrings are a group of 3 muscles, the biceps femoris, the semitendinosus, and the semimembranosus. Their main purpose is to bring the hip back and bend the knee. The majority of injuries to the hamstrings are strains to the biceps femoris long head muscle. Injury occurs mainly during sprinting, as the muscles contract eccentrically to decelerate the leg.
What are the Risk Factors?
Age Unfortunately, the older you get, the higher your chance for hamstring injury. The age when the risk starts to significantly increase is 25 years old, with research suggesting a 30% increase in risk annually thereafter.
Decreased flexibility Tight hamstrings aren’t the only problem; tight hip flexors and/or quads are also problematic.
Muscle Imbalance/weakness Muscle imbalance within the lumbopelvic region and/or weakness in the hamstrings;
Previous injury Previous injury to the hamstring, groin and/or knee.
The Most Effective Hamstring Prevention Program
Eccentric Strengthening Program The majority of hamstring injuries occur during sprinting when the muscle is working eccentrically. As such, eccentric strengthening programs have been shown to decrease the risk of hamstring injury by 65-70%. The most popular and widely studied exercise for hamstring injury prevention is The Nordic Hamstring Exercise. We strongly encourage all athletes to add this exercise to their strengthening regime. However, it shouldn’t be the only hamstring exercise you do. While it has been shown to decrease the risk of hamstring injury significantly, it only activates part of the hamstring muscles (specifically the semitendinosus and short head of the biceps femoris). 80% of hamstring injuries occur to the long head of the biceps femoris, which is better activated with a hip extension exercise such as deadlifts. The most effective hamstring injury prevention program should focus on targeting all the hamstring muscles with both knee and hip dominant movements. Below you will find 2 different exercises: the nordic hamstring exercise and straight leg weighted deadlifts. We recommend doing both for the greatest benefit. See a progressive 12 week schedule below:
Frequency 2x/week x 12 weeks. Week 1-3: 3 sets of 5-6 reps Week 4-6: 4 sets of 6-7 reps Week 7-9: 4 sets of 8-9 reps Week 10-12: 4 sets of 10-12 reps
Nordic Hamstring Exercise: Can be completed with a partner holding your legs or hooking feet under something heavy. Lower yourself forward, keeping your back and hips straight. Once you cannot go any further push yourself back into start position.
Work on your core While strengthening the hamstrings is important, you can’t forget about everything else that helps support, align and coordinate the hips. If there is an imbalance around the hip such as tight hip flexors, weak glutes, etc., the hamstrings will be more susceptible to injury. In addition, exercise programs that focus on trunk stabilization and agility vs. a traditional program of ONLY hamstring stretching and strengthening post injury results in a quicker return to sport and significantly much lower reoccurrence rate (7% vs. 70%).
Running Program Most hamstring injuries occur during sprinting, especially later in the game when fatigue sets in. Therefore, strengthening and isolating the hamstrings in the gym is essential, but you must also include interval speed training to improve coordination, large hip/knee joint torques, and explosive strength. Weekly sprint workouts have been shown to prevent hamstring injuries. Like all training loads, ensure the sprinting load (distance, reps and speed) is progressed gradually.
Where to go from here?
If you currently are suffering from a hamstring injury it is best to book an appointment with a therapist and get on an individualized rehab plan. If you are currently injury free and would like to stay that way, then add the above hamstring exercises to your current strengthening program following the 12-week plan. If you want more bang for your buck, then add some core and hip stability exercises as well. If you still have questions or want more guidance on injury prevention book an appointment with one of the Sheddon Physiotherapy and Sports Medicine therapists at 905-849-4576.
Heiderscheit et al., (2010). Hamstring strain injuries: Recommendations for Diagnosis, Rehabilitation and Injury Prevention. Journal of Sports Physical Therapy. 67-81. Liu et al., (2012). Injury rate, mechanism, and risk factors of hamstring strain injuriesin sports. A review of the literature. Journal of Sport and Health Science. 92-101. Prior et al., (2009). An evidence based approach to hamstring strain injury. A systematic review of the literature. Sports Health. 154-164.
For more info, contact Sheddon Physiotherapy and Sports Clinic at 905-849-4576.
Sheddon Physiotherapy and Sports Clinic (SPSC) has been a member of the Oakville community for over 10 years and strongly believes in being involved within the Oakville community and giving back to those who have supported us throughout the years, as well as helping those who are less fortunate. Overall the next few weeks, Sheddon Physiotherapy and Sports Medicine will be collecting donations for its Christmas Food and Toy Drive.
Food donations are in support of the Oakville Fare Share Food Bank and will be collected until the new year.
Items needed: instant coffee, peanut butter, cookies + crackers, diapers (size 6 only), breakfast cereals, canned fruit, soups, powder laundry soap, side dishes (grains), etc.
Toys will be collected until December 18th, 2018 in Support of the Oakville FireFighters Toy Drive
The mission of the Oakville Firefighters Toy Drive is to ensure every local child has an opportunity to unwrap a gift of their own over the holidays. All donations are distributed directly to local families, institutions and community agencies supporting children and youth in Oakville and Halton Region.
All donations are greatly appreciated, however the area of greatest need are gifts for boys and girls ages 11-15 (ie., gift cards, backpacks, clothing (winter hats and gloves), hair accessories, cosmetics and movie passes).
In addition, Physiotherapist Dana Clark will be donating his treatment time Friday December 14th from 6:20am-1pm. In lieu of payment for his treatment time he will be accepting donated toys/gifts for the Sheddon Toy Drive.