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growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

Growing Pains

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?

Injury Prevention Strategies

Risk Factor #1

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.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

 

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.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

Calves:

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.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

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.growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

 

 

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).

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

 

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.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

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.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

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.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

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.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

POSTURAL CONTROL:

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).

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

 

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.

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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.

 

Weighted Deadlifts:

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.

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lower body injuries prevention Oakville Mississauga

Your Guide to Lower Body Injuries

1. ACL Injury

What is it? The anterior cruciate ligament is one of the strongest ligaments in your knee that provides stability, and prevents excessive forward and rotational movement. During injury it can be stretched, partial torn or fully torn.
Why does it happen? These injuries are caused by abnormal movement patterns during sidestepping or landing tasks with increased knee valgus motion and/or increased internal tibial rotation.
How do you prevent it? Focus on strengthening the core muscles, hip abductors and hip external rotators in order to prevent excessive knee valgus and/or internal tibial rotation. For example, loop a band around your stance leg (above the knee) and tie it to a stationary object so that the resistance of the band pulls the leg inward. Try to maintain that stance leg in neutral alignment (don’t let the knee cave in). Slowly lower yourself into a single leg squat position. Only go as far as you can with proper control of the leg. Repeat 10-15 repetitions for 2 sets.

2. Ankle Sprain

What is it? The ankle is made up of a series of ligaments that connect the bones and provide stability. Injury to the ankle can stretch or tear one or several of these ligaments.
Why does it happen? 50% of soccer related ankle injuries occur during contact with another player; otherwise it occurs during twisting, tackling or kicking. Have you already sprained your ankle? If so, you are 5x more likely to sprain it again.
How do you prevent it? Work on balance and proprioceptive exercises. Step/lunge onto a bosu (or pillow) from different angles. Repeat 10-15 repetitions per leg. As it gets easier you can progress to bounding onto the bosu and holding for control.

3. Achilles Tendonitis

What is it? Inflammation of the Achilles tendon, which attaches the calf muscles (the gastrocnemius and the soleus) to the heel bone.
Why does it happen? It is highly vulnerable to injury given the high amounts of tension put on it during sports. It can also be injured due to improper warm-up, muscle imbalances or poor footwear.
How do you prevent it? Strengthen your calves. Balance on a step and rise up onto your toes, then slowly lower yourself back down. Repeat 10-15 times for 2 sets. As it gets easier you can progress to doing one leg at a time.

4. Adductor Strain

What is it? The adductors are a group of muscles in the inner thigh that work together to stabilize the pelvis and move the hip. Injury usually involves a strain to one or more of these muscles.
Why does it happen? Kicking, changing direction and reaching put a large eccentric force on the adductor muscles, which puts them at risk for injury. Adductor strains are usually due to overuse and muscle imbalance.
How do you prevent it? Perform the Copenhagen adduction exercise. In a side plank position, rest on your elbow, raise your top leg and rest it on a bench. Your lower leg starts at the ground and you raise it towards your top leg. Slowly repeat 6-15 reps per side for 3 sets.

5. Hamstring Injury

What is it? The hamstrings are a group of 3 muscles at the back of your leg that help with hip and knee movements. Injury can involve a strain to the muscle or a full tear.
Why does it happen? Injury usually happens due to the high loads placed on the hamstrings during kicking and sprinting.
How do you prevent it? The Nordic hamstring exercise is one of the most widely used exercises to prevent hamstring injuries. Start from a kneeling position. Use a partner to hold your ankles or hook your feet under something heavy. Engage your core and hamstrings and slowly move forward towards the ground. Keep your hands ready to assume a push-up position. When your hands reach the ground push yourself back up. Try to go slow on the way down with control. Repeat 6-10 times for 2 sets.

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.

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Sports Physio Plyometrics Oakville Soccer 2018 Sheddon Physioyherapy Clinic Oakville Mississauga

Jump your Game to the Next Level

To excel in any sport, athletes need to focus on strength and conditioning off field in order to enhance specific athletic parameters, which will benefit them in their sport/position. Fitness parameters such as strength, endurance, balance and flexibility are common in most training programs.  Athletes can also benefit from plyometric exercises, which involve quick actions like jumping, hopping, and bounding. These exercises are essential for developing power, speed, agility and prevention of injuries. WHAT are plyometric exercises? WHY should you do them? And HOW can you integrate them into your training?

WHAT are plyometric exercises?

Think about all the great natural movements you did as a kid, such as jumping onto and off of things, skipping, leaping, and hopping. These are the types of movements involved in plyometrics. More specifically, they are quick, explosive movements using maximum force repeated for short intervals.

WHY should you start doing them?

There are a number of great benefits to integrating plyometrics into your training. Research has shown that athletes who engage in plyometrics will have greater improvements in performance than players who simply focus on practice and games alone. Improvements include:

  • Increased ball striking speed;
  • Improved change of direction ability;
  • Increased acceleration;
  • Increased muscular power;
  • Increased kicking distance;
  • Improved agility;
  • Increase in joint awareness;
  • Injury prevention (especially ACL in young females)

HOW do you integrate them into your training program?

Plyometric exercises are not for beginners, as you should have a certain level of basic fitness first. Plyometrics combine strength and speed in order to develop max force over a short period of time. Therefore, the athlete needs to have a basic level of general strength and proper technique in movements such as squats prior to initiating these exercises. Below you will find some important practical considerations on where to start:

  • Most sports are multidirectional, therefore if you are looking to improve overall performance, you must include different exercises such as vertical (i.e., box jumps) and horizontal jumps (i.e., standing long jumps), as well as unilateral and bilateral drills. If you are interested in improving only certain aspects of your fitness, then the exercises should be specific to your performance goals. For example, if your goal is to increase running speed, choosing exercises such as bounding will have more gains than box jumps.
  • As with all exercises, QUALITY is key over QUANTITY. Proper technique is key for injury prevention and performance gains.
  • Follow an 8-10 week program, 2 days/week, with a 72-hour rest period in between training sessions in order to see the best gains.
  • Exercise sessions should last 10-20 minutes, and the best time is at the beginning of practice, after the initial warm up.
  • 3-4 plyometric exercises should be performed, 2-4 sets, for 6-15 reps per training session. DO NOT use extra weight. Body weight is sufficient, as added weight will NOT increase performance gains.
  • Avoid injury by ensuring the athlete is landing softly and with proper technique. Make sure whatever you are jumping onto/over is stable and not too high. Also make sure the exercise surface is safe (avoid concrete and uneven surfaces), grass or turf is safest.

At Sheddon Physiotherapy and Sports Clinic we work with  coaches and trainers to make sure that injured athletes are properly rehabbed. We also play a role in injury prevention and enhancing performance gains so athletes can bring their game to the next level. Whether you’re returning from an injury, want to prevent future injuries or just want to improve your performance, chat with a therapist at Sheddon Physiotherapy and Sports Clinic about which exercises are best for you.

Bedoya et al., (2015). Plyometric training effects on athletic performance in youth soccer athletes: A systematic review. The Journal of Strength and Conditioning. 29,8, 2351-2360.

Wang et al., (2016). Effects of Plyometric Training on Soccer Players (Review). Experimental and Theurapeutic Medicine. 550-554.

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Don’t get Sidelined With a Hamstring or Calf Injury

Injuries to the hamstring and calf muscles are common amongst athletes in sports which involve repetitive kicking, sprinting and jumping. Re-injury of these muscles is also an issue affecting many athletes long term, with roughly 30% of athletes suffering a re-injury to the hamstring, and 63% to the achilles within 2 years after initial injury. As such, risk factors and prevention strategies are essential for coaches, trainers and athletes.

Injury Background

The hamstrings and calves play a major role in walking, running, cutting and jumping. Injury to these muscles can include a strain, partial tear or full rupture. Injuries can occur acutely following an overstretch or trauma to the muscle (i.e., being kicked to the back of the leg), or can be chronic as a result of repetitive irritation.

Risk Factors

  • Repetitive overuse;
  • Training errors;
  • Abnormal biomechanics;
  • Muscle imbalances;
  • Previous injuries;
  • Decreased flexibility or over-stretching

What can you do right now to keep yourself injury free?

Due to the high prevalence of hamstring and calf injuries, combined with a devastatingly long recovery and high probability of re-injury, research has focused greatly on risk factors and rehabilitation strategies to help prevent these injuries altogether.

Rehab your Injuries

Whether it’s your knee, ankle or hamstring, you need to address the injury sooner rather than later in order to prevent long-term problems and re-injury. Studies show that even a mild sprain/strain will put you at risk for further injury within the following year, if not properly treated. The high rate of re-occurence for many injuries can be related to improper rehabilitation, tightness related to scar tissue and altered biomechanics. Improper rehab will not only increase your chance of a re-occurence of the same injury, but it can also lead to an injury to other muscles and joints. For example, an ankle injury will alter your biomechanics, which can affect your knee and hip, leading to injuries further up the lower extremity.

Work on your core

One main problem with most rehab programs is that they only isolate the injured muscle (i.e., hamstrings and/or calves). Research has shown that the core and pelvic musculature play a major role in injury prevention. A recent study compared a core stability program focusing on trunk stabilization and agility versus a traditional program of hamstring stretching and strengthening following a hamstring injury. Results showed that the core stability group returned to sport sooner and had a reoccurrence rate of only 7% during the year, compared to the traditional rehab group, which took longer to return to sport and had a reoccurrence rate of 70% during the year (Sherry and Best 2004).

Running Program

Most hamstring and calf injuries occur later in the game when fatigue sets in. Therefore, you must ensure that your conditioning program focuses on interval speed training and endurance training to improve overall conditioning.

Proper Warm-up

As with all injury prevention programs, warming up is key! Studies have shown that the FIFA 11 warm-up program has been successful in the prevention of many different injuries. Click here to learn more about the FIFA 11 program.

Strength and Conditioning

Spending some time in the gym focusing on strength and conditioning significantly decreases overall sporting injuries. Conditioning should focus on any muscle imbalances and weaknesses, as well as general and functional strengthening, speed, agility, interval training and plyometrics. Not sure where to start? Talk to one of the therapists at Sheddon Physio and they can set you up with a program.

Already Injured? What does treatment entail?

Initially one of the main focuses of treatment is decreasing the pain, which can be achieved through manual therapy, taping and bracing. Another focus is promoting healing with modalities, such as laser and ultrasound, which speed up recovery time. Exercise is also one of the best ways to promote tissue repair and decrease pain, as well as improve function and a quick return to sport following an injury. Finally, in order to get rid of the injury and prevent it from re-occurring, the cause of the injury must be addressed. Training errors, poor biomechanics and muscle imbalances need to be addressed to ensure a full and successful return to sport.

If you’re currently injured, book an appointment with one of our physiotherapists, chiropractors, athletic therapists or massage therapists in order to help get you back on the field healthy and pain-free. If you’re not currently injured, the therapists at Sheddon can get you started on an injury prevention and strengthening program by working on your specific weaknesses and imbalances to help prevent any future injuries. If you’re looking for a sports medicine clinic in the Oakville and Mississauga area that has great therapists AND will get you results quickly, contact Sheddon Physiotherapy and Sports Clinic at 905-849-4576.

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