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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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How to Recognize a Concussion?

Concussions make up roughly 22% of all soccer related injuries. Despite public awareness and athlete education surrounding concussions, roughly 50% of athletes do NOT report their concussions and return to sport while still symptomatic. These athletes either see no harm in playing with a concussion, believe it will make them look weak, or truly do not realize that they have sustained a concussion. In reality, a concussion should be taken seriously. Playing any sport with a concussion will prolong recovery, and if the athlete were to sustain a second impact, there is the potential for additional and more complicated injuries to the brain, which could even be fatal. This article is meant to educate coaches, athletes, trainers, and parents on how to recognize and manage concussions more effectively.

Concussion Recognition

Recognizing a concussion is the most important step in the management of the injury. Concussions are extremely difficult to recognize because you must rely heavily on athletes reporting their symptoms, and no two people will experience a concussion in the same way. If an athlete sustained a significant hit to the head OR body, you should suspect a concussion. REMOVE THEM FROM PLAY, and assess for symptoms. There are a number of different symptoms that people will experience, including physical symptoms (i.e., headaches, fatigue, dizziness, blurry vision, neck pain, balance issues, nausea), cognitive issues (i.e., poor concentration, memory issues, confusion) and/or emotional disturbances (i.e., irritability, sadness, emotional). If an athlete denies any symptoms, there are still some signs you need to look for:

  • Does the athlete appear to be disoriented, slow, or uncoordinated?
  • Does the athlete seem to be starring into space or appear dazed and confused?
  • Is the athlete sick and vomiting?
  • Is the athlete acting odd or out of character?
  • Did the athlete lose consciousness?
  • Is the athlete unable to respond to simple questions? Is their speech slurred?

If the athlete has any of the above signs or symptoms it is best to err on the side of caution and have a medical practitioner assess and diagnose properly. Early concussion recognition and intervention has been shown to significantly decrease recovery time and improve long-term outcomes. At Sheddon Physiotherapy and Sports Medicine all of our therapists are trained in concussion management and we strive to assess athletes with suspected concussions as quickly as possible.

Importance of a Concussion Baseline Test

A concussion impacts how the brain functions; therefore an MRI and other brain scans will NOT detect a concussion. Furthermore, there is no single clinical test that can be done to know when an athlete has sustained or fully recovered from a concussion. Occasionally, athletes sustain a hit and have a vague concussion presentation, whereby they deny symptoms, but parents feel that something seems off. In unclear cases like these, a preseason concussion baseline test comes in handy since it tests different areas of the brain that could potentially be affected by a concussion. Post injury test results need to be compared to pre-injury values in order to know if/when an athlete is at their normal pre-concussion baseline values. If an athlete does not achieve their pre-concussion baseline value in one or more components of the test, then a concussion is diagnosed. The baseline test is also essential for return to play decision-making. Research has shown that if sport clearance is based solely on symptom resolution, which occurs much sooner than brain recovery, athletes may be at risk for returning to sport too quickly. As such, the best way to ensure that you return to sport safely following a concussion is to get baseline tested BEFORE a concussion even occurs.

Concussion baseline testing is currently recommended in the National Concussion Guidelines for all athletes. This guideline was developed by chief medical experts of the Canadian Paraylmpic Committee, Own the Podium, and the network of high performance sport institute across the country. At Sheddon Phyiotherapy and Sports Medicine, we offer the most comprehensive and research proven concussion baseline testing of any sports medicine clinic in the Mississauga and Oakville area. Teams and athletes across the GTA have trusted in our baseline testing for many years. To date, we have completed over a thousand baseline tests and successfully treated well over 800 concussions.

All of the therapists at Sheddon Physiotherapy and Sports Clinic have undergone extensive training with the Complete Concussion Management program in order to be educated with the most recent research-proven concussion management strategies. CASM and the Canadian Concussion Collaborative strongly promote a multidisciplinary approach to concussion management, which extends beyond the family doctor to include health care professionals with developed skills and expertise in concussions. If you have experienced a concussion and are still suffering from symptoms, contact one of the therapists at SPSC in order to assess and treat them immediately. If you have not suffered a concussion, but play a high-risk sport, contact SPSC regarding our baseline testing at 905-849-4576.

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sport medicine clinic oakville mississauga

SPSC: A Sports Medicine Clinic for ALL Athletes

In every profession there are individuals and companies that are passionate about what they do, while others just seem to go through the motions. When you’re searching for a Sports Medicine Clinic you need to do a bit of research and find one that offers it all.  They do exist; great therapists, flexible hours, expertise, and a commitment to work with you in order to get you better. Sheddon Physiotherapy and Sports Clinic takes pride in offering patients the best care they deserve. How is Sheddon Physiotherapy and Sports Clinic different from every other physiotherapy clinic in Oakville/Mississauga?

Expertise/Level of Therapists

At SPSC, our mission is to offer the most up-to-date treatments by some of the best therapists in the Halton region. All of our therapists have completed extensive post-graduate education across a variety of specialties, including concussion rehabilitation, acupuncture and several other manual therapy courses. All of us at SPSC are committed to providing the most effective treatment possible.

Multi-disciplinary Team

SPSC offers expertise in Physiotherapy, Chiropractic, Athletic Therapy, Massage Therapy, Pedorthists and Sports Medicine Physicians. Having all these disciplines under one roof makes it more convenient for patients, and easier for therapists, to collaborate and communicate together in order to provide a more thorough approach to your rehabilitation. Having a Sports Medicine Physician on site is also a huge bonus, as they work with our therapists to help manage patients, guide rehabilitation and facilitate referrals to specialists, diagnostic testing, etc.

Focus on Sports Injuries and Athletes

Treating athletes is a whole different ballgame. At SPSC, we have been treating athletes of all ages and levels, including clientele from a variety of major sports teams and organizations, such as the TFC, NHL, OHL, national level swimmers, runners and Olympic athletes for over 10 years. We understand the demands and needs of athletes and strive to get them back to their sport as quickly and as safely as possible.

Team-Based Therapy

Sheddon Physiotherapy and Sports Clinic works with teams and individual athletes throughout their entire season, coordinating with coaches, trainers, as well as strength and conditioning specialists to ensure that everyone working with the athlete is on the same page. During preseason our therapists play an important role evaluating strength, flexibility, stability and balance to identify limitations, asymmetries and inefficient movement patterns, which may lead to injury during the season. Early identification of weaknesses, tightness, poor stability or inefficient patterns could help prevent future injuries, as each athlete is given an individualized exercise program to target their weaknesses. During the competitive season, SPSC plays a vital role in managing and rehabilitating any athlete who sustains an injury and guiding their safe return to sport. Our therapists stay in communication with the coaches and training staff to ensure that they are aware of the athletes progress and limitations.

Concussion Management

Concussion management programs have become a major focus in sports medicine clinics, due to increased public awareness and recognition of concussions. Our therapists at SPSC have undergone extensive training with the Complete Concussion Management program in order to be educated with the most up-to-date concussion management strategies. In addition, we have successfully treated hundreds of sport-related concussions and have a network of specialists, including sports medicine physicians, vestibular physiotherapists, chiropractors and athletic therapists. We also offer the most comprehensive and research proven concussion baseline testing of any sports medicine clinic in the Mississauga and Oakville area. If you want to organize a time for your team or group of athletes to come in and get their concussion baseline tests completed, we do offer significantly discounted rates for teams and/or groups.

If you are 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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volleyball athlete injury prevention

Train Smarter for Injury Prevention

Athletes of all ages and skill levels are being pressured with more and more commitments regarding training, practices, games and tournaments. Back in the day, extra skill development, strength and conditioning, and mental skill training were reserved for “elite” athletes. Nowadays, all athletes want that competitive edge. In order to improve fitness and skill development, athletes need to push their training to greater limits. If an athlete “under trains” they risk injury due to being under prepared. If an athlete “over trains”, they risk injury due to fatigue and overuse. The key is finding the “perfect” amount of training AND recovery in order to achieve the optimal training benefits, without risk of injury. Unfortunately, there is no “one size fits all” training program, as each athlete responds differently to training, based on internal and external factors. The tips below will help coaches, trainers, parents and athletes train smarter for optimal performance benefits:

1. Periodization: A poorly managed training and competition schedule can increase risk of injury, if training isn’t well planned throughout the season. For example, injuries are most likely to occur following repetitive and rapid increases in training intensity, frequency or duration, especially if the training greatly exceeds the fitness level of the athlete. While it is okay to train hard and push athletes, coaches/trainers need to be mindful of how the athletes are responding. A hard training week, resulting in athlete fatigue, should not be followed by an even harder week. Athletes need time to recover and adapt.

2. Offseason Conditioning: Ensure adequate off-season and pre-season physical/psychological training so that athletes are in top shape when the season begins.

3. Recovery: Following intense training periods and tournaments athletes will have a temporary decrease in physical performance, neuromuscular control and muscular strength that can take up to 5 days to return to baseline levels. In addition, muscular fatigue from cumulative training days will compromise coordination, decision making and joint stability, all of which can lead to acute injuries, such as ACL tears. Recovery days are key to building stronger athletes.

4. Monitoring: Athletes need to be monitored in terms of physical performance, emotional well-being, stress and fatigue. This can be easily achieved with training logs and monthly questionnaires, and training should be adjusted accordingly.

5. Injury surveillance: Overuse injuries need to be caught early in order to avoid prolonged time off sport. As such, monitor your athletes for changes in performance and compensatory patterns, since most athletes will ignore early signs of injury.

6. Emotional well-being: Psychological stress has been shown to increase muscle tension, narrow the visual field and lead to increase distractibility, all of which can increase risk of injury. Be aware of athletes’ mental state (anxiety, stress, nervousness), as it plays a huge role in injury susceptibility. Provide a supportive and strong social support network within the team, including players, coaches and trainers.

7. Healthy behaviours: Training hard in the gym and on the field is only one piece of the puzzle. Athletes need to be aware of the importance of adequate sleep and nutrition.

Sheddon Physiotherapy and Sports Clinic has a team of athletic therapists, massage therapists, chiropractors, physiotherapists and sports medicine doctors who can help get you back on the field healthy and pain-free. 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.

Soligard et al., (2016). How much is too much? International Olympic Commttee consensus statement on load in sport and risk of injury. British Journal of Sports Medicine. 50:17.

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concussion and neck injury physiotherapy sports clinic oakville mississauga

Concussion and Neck Injury

Most concussed patients will start to feel better within 10 to 14 days. However, roughly 10-15% of concussed athletes will go on to have prolonged symptoms that can last for weeks or years. These symptoms can effect an individuals daily life from school or work to doing basic activities like grocery shopping or going out to see a movie. Given how debilitating these symptoms can be, research has focused greatly on trying to find out “why” some people have long lasting symptoms.

Symptoms following a concussion can come from a number of different areas. For days or weeks after experiencing a concussion, there are metabolic and physiological changes in the brain, which have been shown to produce a variety of symptoms. However, the cervical spine, visual integration system, vestibular system and/or psychological factors can all be affected following a concussion and lead to a variety of similar symptoms.

The cervical spine is particularly vulnerable following a concussion, given the whiplash mechanism, which usually occurs with concussions. Studies have shown the range of linear acceleration needed to sustain a concussion is between 70-120 G’s, whereas a mild neck strain only takes 4.5 G’s. Therefore, it could be hypothesized that the majority of concussions will also have some degree of cervical spine injury, which may involve the soft tissue and/or joints of the neck. These resulting symptoms are very similar to concussions, including:

  • Headaches;
  • Dizziness;
  • Vision changes;
  • Vertigo;
  • Irritability/mood disturbances;
  • Cognitive changes (i.e., concentration/memory issues)

Current research has shown that following a concussion, physiotherapy focusing on cervical and/or vestibular rehabilitation significantly helps in the recovery of concussion symptoms. Treatment for cervical injury includes soft tissue release, mobilizations and exercises to strengthen the deep neck flexors, as well as proprioceptive exercises for the neck region. For more information regarding assessment and treatment of the visual system, click here, and for the vestibular system, click here.

At Sheddon Physiotherapy and Sports Clinic, our post-concussion assessment carefully examines the cervical spine, vestibular system and visual system, as well as a full neurological exam. Based on the patient’s findings, the appropriate therapy and exercises are given in order to reduce the symptoms. The key to a speedy recovery post-concussion is to have a thorough assessment of all the different systems in order to see which are dysfunctional and leading to symptoms. If these areas are treated early on in the injury, it may help prevent long-term symptoms.

Leddy et al., (2014). Brain or strain? Symptoms alone do not distinguish physiological concussion from cervical/vestibular injury. Clinical Journal of Sports Medicine. 0:1-6.

Marshall et al., (2015). The role of the cervical spine in post-concussion syndrome. The Physician and Sports Medicine. 1-11.

 

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