Physio Charlie

I was one of the physio's attending the Special Olympics this week.  See below for photos:

http://www.facebook.com/album.php?aid=93367&id=108443...

I treated various sprains and cramps and used my taping techniques on several athletes.

By the way this is my new Facebook webpage for Physio Charlie.

I have a new website!!

http://physiocharlie.vpweb.co.uk

http://www.sportex.net/newsite/common/mainframe.asp?txtOr...

http://www.sportex.net

Conditioning the hamstrings: training considerations for performance and injury prevention
by Dr Duncan N. French, Published in sportEX dynamics, Issue: 15, Pages: 18-22

"The hamstrings themselves are most active during the late swing phase, through early to mid-stance phase of the running gait cycle. They act to decelerate the forward momentum of the leg and reverse the swing action via active hip extension. During the late swing phase, the bicep femoris experiences a great degree of mechanical stretch, thereby becoming susceptible to specific injuries related to the lengthening of the musculotendon unit. In listening to athletes who have experienced hamstring strains many report that their injury occurred as a result of acting to decelerate their body or working their limbs through an exaggerated range of motion as they emphasised their stride length during a sprinting action. The majority of hamstring strains occur during the eccentric actions of the blocking and plant phases of running gait, with most occurring during the plant phase as muscles move into a lengthened position whilst also experiencing high tensile loads. Training of the hamstrings to manage these forces should therefore be a critical part of any athletes preparatory activities".

References

1.  Santana JC. Hamstrings of Steel: Preventing the Pull, Part I - Isolated Versus Integrated Function. Strength and Conditioning Journal 2000; 22(6):35 - 36

2.  Brandon R and Cleather D. Training the hamstrings for high speed running ? Part II. Professional Strength and Conditioning 2007;7

3.  Lieber RL. Skeletal muscle structure, function, and plasticity. Lippincott, Williams and Wilkins 2002. ISBN 0781730619

4.  Gambetta V and Benton D. A systematic approach to hamstring prevention and rehabilitation. www.gambetta.com/resources

5.  Boyle M. Functional Training for Sports. Human Kinetics 2003. ISBN 073604681X.

 One of the Juniors did an IST on principles of training:

Overload principle

For any fitness component to improve, it must be overloaded.

This principle states that training programs should stress the individual’s physiological mechanisms enough to cause an improvement.

To obtain optimal improvement and prevent injury, overload must be individualized and progressive” (Hodge, Sleivert, McKenzie, 1996).



The frequency of training:

The Frequency of exercise is a fine balance between providing just enough stress for the body to adapt to and allow enough time for healing and adaptation to occur.

- How many sessions per week that you do?

The intensity (how hard you work):

The Intensity of exercise is the amount of effort that should be invested in a training programme or any one session.

Effort – running fast or slow or using high resistance/low resistance.

Resistance – body resistance, weight training.


Speed of contraction - Muscle fibre type used.

Fibre Type Type I fibres
(Slow Twitch) Type II a fibres
Fast Twitch Oxidative Glycolytic Type II b fibres
Fast Twitch Glycolytic Type II x fibres
(Spangenburg & Booth , 2003)
Contraction time Slow Moderately Fast Very fast Fast
Size of motor neuron Small Medium Very large Large
Resistance to fatigue High Fairly high Low Intermediate
Activity Used for Aerobic Long-term anaerobic Short-term anaerobic Short-term anaerobic
Maximum duration of use Hours 1-3 minutes 0-10secs 0-30secs
Force production Low Medium Very high High
Mitochondrial density High High Low Medium
Capillary density High Intermediate Low Low
Oxidative capacity High High Low Intermediate
Glycolytic capacity Low High High High
Major storage fuel Triglycerides Creatine phosphate, glycogen Creatine phosphate, glycogen Creatine phosphate, glycogen
Example of use Marathon 400 metres sprint. 100-metre sprint, getting up from chair. 200-metre sprint.


Ratio of both types of muscle fibres varies in each individual and each muscle:
• Ratio is thought to be genetically determined.
• Both types of fibres can improve their metabolic capabilities through specific strength and endurance training.
• Sprinters and weight lifters have a large percentage of fast-twitch fibres.
• Marathon runners generally have a higher percentage of slow twitch fibres.
• Muscles that primarily maintain posture against gravity require more endurance and generally have a higher percentage of slow-twitch fibres (Fitts & Widrick, 1996)
• Muscles that produce powerful, rapid, explosive strength movements tend to have a greater percentage of fast-twitch fibres.


Metabolic pathways utilized.

The body has two main energy systems (aerobic and anaerobic energy system).

There are two types of anaerobic systems:

(1)The ATP-PC system (Alactic)
The ATP-PC system is found in both muscle fibre types, it doesn’t require oxygen and doesn’t produce oxygen. It is used for dynamic quick actions e.g. a tennis serve, sitting up.

(2)The anaerobic gycolysis (Lactic) from degradation of glucose/glycogen.
The anaerobic glycolysis (Lactic) system doesn't require oxygen but does produce lactic acid and is normally used for activities that last between 10 seconds and a minute.

Aerobic energy system

Energy taken during the breakdown of food manufactures Adenosine triphosphate
(ATP). The energy required for exercise can be obtained by burning food stores
with oxygen (obtained by breathing). This aerobic system works by the breakdown of carbohydrate, fatty acids and some amino acids. This system uses slow twitch fibres and as it requires oxygen it can run for longer

The type of training:

The type of training dictates what kind of exercise you should choose to achieve the appropriate training response.

Take in to consideration the components of fitness:

Health Related components: Those factors that are related to how well the systems of your body work
Cardiovascular Fitness: The ability of the circulatory system (heart and blood vessels) to supply oxygen to working muscles during exercise.
Body Composition: The relative percentage of body fat compared to lean body mass (muscle, bone, water, etc).
Flexibility: The range of movement possible at various joints.
Muscular strength: The amount of force that can be produced by a single contraction of a muscle.
Muscular endurance: The ability of a muscle group to continue muscle movement over a length of time.

Skill Related Components: Those aspects of fitness that form the basis for successful sports participation.
Speed: The ability to move quickly from one point to another.
Agility: The ability of the body to change direction quickly.
Balance: The ability to maintain an upright posture while still or moving.
Coordination: Integration with hand and/or foot movements with the input of the senses.
Reaction Time: Amount of time it takes to get moving.
Power: The ability to do strength work at an explosive pace.


The time of training:

The time of element of training refers to the duration of the exercise - long you exercise for.

Duration
-Time exercising
-Recovery between bouts or work intervals
-Number of reps
-Number of exercises and sets

Progression Principle

This is a continuation of the overload principle. As the bodies physiological mechanisms adapt to your training, there is a need for the training to be advanced, otherwise you will remain at a training plateau and not respond to further training efforts.

This progression has to be gradual in nature however, so as to prevent you becoming injured by over-exerting yourself (over-training), and possibly de-motivated to further training because you are not achieving the training targets

- Over training

If over training occurs, there is not sufficient recovery time between workouts; progress is hampered. However, an exerciser may be slightly over trained and make progress, just not as much as if they were not over trained (Stone et al, 1991).

Specific General
Acute -Muscle worked to exhaustion
-Traumatic orthopaedic injury -Body exhausted after bout
-Glycogen depleted
-Sympathetic response elevated

Chronic -Muscle becomes weaker over time
-Orthopaedic overuse injury -Body becomes weaker over time
-Glycogen depleted over time
Parasympathetic response


Signs of over training (Stone et al, 1991)
Sympathetic Parasympathetic
Increased resting heart rate
Increased resting blood pressure
Decreased maximal power output
Decreased sports performance
Decreased maximal blood lactate concentrations
Slower recovery after exercise
Weight loss
Decreased appetite
Decreased desire to exercise
Increased irritability and depression
Increased incidence of injury
Increased incidence of infection Decreased resting heart rate
Faster return of heart rate to resting value after exercise
Decreased sports performance
Decreased blood lactate concentrations during sub-maximal and maximal exercise
Unemotional behaviour


Reversibility Principle

A basic principle of training that refers to the gradual loss of beneficial training effects when the intensity, duration, or frequency of training is reduced. Training effects produced over a short term are usually lost more quickly than those produced over a longer term, and strength losses tend to be faster than mobility losses. (American College of Sports Medicine, 2005)

Specificity Principle

The specific nature of a training load produces its own specific response and adaptations.

Training specifically for the movement pattern, speed, joint position, speed, and type of contraction produces improvement specifically in those movement parameters (Kreighbaum et al, 1996).

Variance Principle

This training principle states that maximum benefits are obtained when a training programme includes a variety of training methods.
This will help to maintain interest and motivation.
It will also ensure that loads you work against are varied – reduces the chances of injury or exhaustion.


Strength training – working to improve either muscular strength or muscular endurance.


Strength training is the use of resistance to muscular contraction to build the strength, anaerobic endurance and size of skeletal muscles.

Rep - short for repetition

Set - a set consists of several repetitions performed one after another with no break between them with the number of reps per set and sets per exercise depending on the goal of the individual (Davis et al, 2000).


Variable Training goal
Strength Power Hypertrophy Endurance
Load (% of 1RM) 80-100 70-100 60-80 40-60
Reps per set 1-5 1-5 8-15 25-60
Sets per exercise 4-7 3-5 4-8 2-4
Rest between sets (mins) 2-6 2-6 2-5 1-2
Duration (seconds per set) 5-10 4-8 20-60 80-150
Speed per rep (% of max) 60-100 90-100 60-90 60-80
Training sessions per week 3-6 3-6 5-7 8-14

Table taken from Siff, M.C. (2003).


Note: Not always safe to test one rep max as it can cause injury. It is best to calculate from standard markers.

1 Rep Max Percentages
Reps %1RM
1 100
2 95
3 90
4 88
5 86
6 83
7 80
8 78
9 76
10 75
11 72
12 70


• Sets of one to five repetitions primarily develop strength, with less impact on muscle size and none on endurance.
• Sets of six to twelve repetitions develop a balance of strength, muscle size and endurance.
• Sets of thirteen to twenty repetitions develop endurance, with some increases to muscle size and limited impact on strength. (Feigenbaum & Pollock, 1997).
• Sets of more than twenty repetitions are considered to be focused on aerobic exercise. They do still use the anaerobic system, but usually at a rate through which it can consistently remove the lactic acid generated from it (Feigenbaum & Pollock, 1997).

Advanced techniques in strength and weight training
Set structure

Pyramid sets - In a pyramid the weight is first increased, and then decreased over a series of sets. A full pyramid typically includes five sets of approximately 12, 10, 8, 10 and 12 reps.

Combined sets

Super Sets - Performing an exercise set immediately after a different exercise set. Nearly no rest is taken between exercises (sets), only that which is taken to get in position for the second exercise.

Beyond failure sets

Negative reps - Negatives are performed with much heavier weights. Assistants lift the weight, and then the weight trainer attempts to resist its downward progress through an eccentric contraction.

Other techniques

Super slow - Super slow repetitions are performed with lighter weights. The lifting and lowering phases of each repetition take 10 seconds or more.


Aerobic Training

Se t the goal or focus – weight loss or cardiovascular fitness.

You need to work within certain heart rate zones in order to make efficient grounds with your weight loss or cardio-vascular fitness regime.

Begin by calculating your target heart rate.

220 - age

Then calculate 50-60% for fat burn or 70-80% for cardiovascular fitness.

NOTE: Exclusive use of heart rate (HR) to prescribe exercise intensity may lead to errors in estimating relative exercise intensities, particularly when the maximum heart rate is predicted (PMHR) from age (220 - Age) instead of a direct measurement. An age predicted prescription of 60% HRR may be as low as 70% and as high as 80% of the actual HR max (Dishman 1994).


Duration

• The American College of Sports Medicine recommends 20 to 60 minutes of continuous aerobic activity.

• Time constrains of the individual must be considered.

• Depending upon individual fitness goals exercise sessions may be of moderate duration (20 to 30 minutes) excluding time spent warming up and cooling down.

• Initial programs may last 12 to 15 minutes and progress toward 20 minutes.

• Severely unfit individuals may need to perform multiple sessions of short duration (~10 minutes).

• Duration should increase as adaptation to training occurs without evidence of undue fatigue or injury (ACSM 1995).

Frequency

• Scheduling constrains of the individual must be considered.

• The American College of Sports Medicine recommends aerobic activity to be performed 3 to 5 session times a week.

• It is recommended that individuals beginning an exercise program should perform aerobic exercise 3 days per week on non-consecutive days.

• Severely deconditioned individual may need to perform multiple sessions of short duration (~10 minutes) (ACSM 1995).

• Individuals just beginning weight-bearing exercise (e.g. walking, etc.) may be advised to wait 48 hours between bouts to prevent overuse injuries.

• If exercising on consecutive days, alternating between two modes of exercise (e.g.: walking one day, cycling next day, swimming the day after) can be suggested, particularly for those who are overweight or those who have had certain orthopaedic injuries in the past.


Advanced Techniques

Continuous training means the person training is using 60%-70% of their energy for a long period of time. Also known as cross training.

Fartlek, which means "speed play" in Swedish, is a form of conditioning which puts stress mainly on the aerobic energy system due to the continuous nature of the exercise. The difference between this type of training and continuous training is that the intensity or speed of the exercise varies, meaning that aerobic and anaerobic systems can be put under stress. Most fartlek sessions last a minimum of 45 minutes and can vary from aerobic walking to anaerobic sprinting. Fartlek training is generally associated with running, but can include almost any kind of exercise. Also known as interval training.



References

Kreighbaum E., Katharine, BM (1996). Biomechanics; A Qualitative Approach for Studying Human Movement, Allyn & Bacon,

Hodge K, Sleivert G, McKenzie A (eds) (1996) Smart Training for Peak Performance–A Complete Sport Training Guide for Athletes. Aukland: Reed, Birkenhead.

McArdle WD, Katch FI, Katch VL (2001) Exercise Physiology: Energy, Nutrition, and Human Performance, Fifth edition, Chicago: Lippincott Williams and Wilkins.

Reaburn P and Jenkins D (1996) Training for Speed and Endurance. Australia: Southward Press.

(Fitts & Widrick, 1996) Muscle mechanics: adaptations with exercise training. Exercise and Sport Sciences Reviews (ESSR), 24, 427 - 473.

Spangenburg & Booth , (2003) Molecular regulation of individual skeletal muscle fibre types. Acta Physiol Scand. Aug;178(4):413-24.

American College of Sports Medicine, (2005) ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription,

Stone, M.H., Keith, R.E., Kearney, J.T., Fleck, S.J., Wilson, G.D. and Triplett, N.T. (1991) Overtraining: A Review of the Signs, Symptoms and Possible Causes. The Journal of Applied Sports Science Research 5:35-50,

Siff, M.C. (2003). Super-training. 6th Ed. Super-training Institute.


Feigenbaum, M.S.; Pollock, M.L. (1997). "Strength Training. Rationale for Current Guidelines for Adult Fitness Programs". Physician and Sportsmedicine

Davis, B, Bull R, Roscoe, J, Roscoe, D, ( 2000). Physical Education & the Study of Sport 4th edition

Dishman RK (1994). Prescribing exercise intensity for healthy adults using perceived exertion. Medicine & Science in Sports & Exercise. 26: 1087-1094.


American College of Sports Medicine, (1995) Principles of Exercise Prescription, William & Wilkins, 5.

Guided walks in Leicestershire booklet

http://www.charnwood.gov.uk/uploads/guidedwalksbooklet200...

http://www.resus.org.uk/pages/guide.htm#postrs

http://www.resus.org.uk/siteindx.htm

http://www.rcseng.ac.uk/rcseng/content/education/courses/...

This report published in 2001 was produced and made available on the Web by the British Medical Association (BMA). Aimed at doctors and other health professionals, it provides advice to those who may provide medical assistance at sports events, drawing attention to legal implications and issues that should be considered. The six page report is available online in plain text or can be downloaded in PDF format using Adobe Acrobat software.

http://www.bma.org.uk/ap.nsf/Content/sportingevents/

I attended the above match on 2/12/06 as team physio.  There were a few injuries, nothing serious.  Ax 1 knee MCL injury pre match.

I did the Physio for Syston again last Sun.  There was a reinjured ACL injury and a suspected # nose.