Which type of hamstring strain do you have?

When it comes to assessing hamstring strains you will find it no longer looks at grades 1-3, now you will find you are put into 1 of 2 groups.

Type 1 – This injury occurs at high speed, for example when running. Pain and disability are high in the very early stages but the length of recovery quite short. You will find you can start to jog quite early on in rehabilitation. It is usually found to be the outer hamstring (long head of biceps femoris)

Type 2 – This injury is related to over stretching the hamstring like doing a high kick or sliding tackle. The injury may not be very disabling or painful and for this reason has a high risk of re injury. This injury takes longer to recover from than a type 1. It is usually found to be the inner hamstring (semimembranosus).

Both injuries take a slightly different rehabilitation approach. You also have to take into account the site of pain, the closer it is to your ischial tuberosity (known as the sitting bone) the longer it will take to heal.

Although it is hard to give a time frame for injury recovery as everyone is different, we can start to give more information about recovery in relation to the mechanism of injury and site of injury. One study found on average it took 23 days to recover from a type 1 and 43 days to recover from a type 2. The study also looked at specific rehabilitation programs and this will be discussed in our next newsletter sent out at the end of May.

Tension Headache? Sports Massage Can Help

Constant headaches can make it difficult to perform well at work and often ruin any chance of relaxing after. Here at Pro-Am we have found that deep tissue massage often provides a fast solution.

What are tension headaches?

Tension headaches are often caused by stress and can be exacerbated by dehydration. Tension headaches are characterised by feeling tight or sore at the back of the head (base of the skull) and can refer over the top of the head to the sinuses at the front. You can sometimes find pain is felt in the temple areas and behind the eyes, these symptoms can be related to jaw clenching.

The above symptoms are usually associated with a stiff neck and shoulders making things feel worse! A stiff neck can be caused by work stress or prolonged postures.

What can you do about your tension headaches?

To start it is usually best to book in for a sports massage. Here at Pro-Am we use a variety of techniques to treat the neck and shoulders, jaw and temples to find out where your headaches are stemming from. We can then talk through possible triggers like prolonged posture, jaw clenching and stress management techniques like simple breathing exercises. Our clients tend to be busy people and we advise measures that can ease headaches at work and prevent recurrence. A few simple practices might mean that your next massage can be more about relaxation and less about relieving pain.

Get on top of your headaches now by booking in 01723 363332

Myofascial Release Part 2

At the weekend I finally got round to completing my part 2 Myofascial Release with John Annan (PhysioUK course). It was jam packed full of practical techniques aimed at the pelvis, front of the neck and temporomandibular joint (jaw). All of which will help me treat many lower back and neck problems.

I will write up a summary of the course and go into explaining the temporomandibular joint more in our April Newsletter.

Our March newsletter will be out soon explaining the risk factors of Achilles tendinopathy for runners.



Plantar Fasciitis in Runners

Correctly referred to as Plantar Fasciopathy (FP) or Plantar Heel Pain due to there been an absence of inflammatory cells in this condition. This is an overuse condition of the plantar fascia at its attachment to the calcaneous (heel bone).

PF is a common condition amongst runners and can be often challenging and frustrating for both injury therapist and runner. The plantar fascia plays an important role in normal foot biomechanics, offering static support and dynamic shock absorption during the foot’s contact phases of running. The plantar fascia may be overloaded at the push off phase when the toes are dorsiflexed (pulled up towards the shin) and the calf muscles are the main contributors to propulsion

The development of PF appears to be linked with increased load on the plantar fascia. This can be due to a number of things like increased mileage, poor or worn down trainers, muscle weakness and poor motor control. However some recent research suggests we may be able to change how we run to help combat this injury?

Although we may associate PF with increasing mileage too quickly a study by Nielson et al 2013 suggests we also need to consider rapidly increased running pace. Other injuries that maybe affected by this speed change include Achilles tendinopathy and calf injuries. It was found that marathon runners were at less risk of PF compared to runners running shorter distances, suggesting PF is more easily developed at shorter distances.

This leads us to the next study which asks ‘is it possible to alter the loading on the plantar fascia?’ A study by Wellenkoiter 2014 suggests a 5% increase in cadence (steps taken) may benefit. For me this flags up a few questions, how do you increase your cadence and does this go against the above paragraph by increasing cadence, does this increase you speed? Are you sacrificing stride length to increase cadence? Is this about reducing foot contact time and how does this affect how much force you push off with, which in turn gives you your propulsion forward?

Another study by Crowell 2011 found running with a softer/quieter footfall reduced vertical loading rate which can be linked to PF. I would love to see how you would explain and get your average runner to try and land more quietly without them looking like they are prancing around.

The findings from the studies above do sound like positive solutions for runners suffering from PF but for your average runner they may be hard to practically implement. Running style and technique are very hard to change. There is also no evidence it will improve pain or function in PF.

This next study suggests a more practical and effective way to treat PF. Rathleff et al 2014 looked at high load strength training compared to a standard plantar specific stretching program in the treatment of PF. The stretch group were told to sit with the affected leg over the other and grasp the base of toes and pull them up to wards the shin for 10 seconds repeat for 10 reps and perform 3 times a day. The high load strength group performed a heel raise off a step with a towel under the toes to mimic the high load phase on the plantar fascia. Each rep would take 3 seconds going up, hold for 2 seconds in the up position and lower back down taking 3 seconds. Every other day they would perform 3 sets of 12 reps and throughout the weeks they would progressively add weight by using a back pack loaded with books (set and reps were adjusted accordingly). At 3 months the high load group were showing better results but at 6-12 months there were no differences in outcome. If you were to choose between two treatments that have similar long term effects but one will give a quicker reduction in pain, it makes sense to prescribe the one with the quickest reduction in pain.


Each person seen with PF needs to have their own treatment approach to suit them, if they have brought in speed work too soon, it may have been the trigger. If they have a slow cadence and/or land very heavily then getting to them to speed up their cadence and land lighter may help. Implementing a progressive loading program to strengthen the plantar fascia and structures around (calf, hips, core.) to cope with load may play a more effective approach.

Tips for runners with plantar fasciitis from the study by Rathleff et al 2014

  1. It is important to complete the exercises instructed to you by your injury therapist. It is more likely that your heel pain will decrease if you comply.
  2. You should not run before your heel pain has been pain free for 4 weeks and you can walk 10k without pain during or the morning after. (pain scale 3-4 /10 acceptable, 5 and above not acceptable)
  3. If you need to wear flat shoes (dress shoes) use heel gel inserts in both shoes.
  4. It is important to keep your exercises going even if your pain might have gone, this will decrease risk of recurrence
  5. Use the pain scale guidance. Some pain 3-4/10 is acceptable but let us know if pain suddenly gets worse after the exercises and lasts for more than 24 hours.
  6. Make sure you are performing your exercise correctly
  7. It is important to try and avoid activities which cause your heel pain to flare up. When you want to start up with these exercises again you should be careful and slowly progress. Refer to number 2 which can be used to help you understand when you are ready run again.


Studies referenced

Rathleff et al 2014. High load strength training improves outcome in patients with plantar fasciitis: a randomised controlled trial with 12 month follow- up. Scand J Med Sci Spor. doi 10.1111/sms12313

Nielson et al 2013. Classifying running related injuries based upon etiology, with emphasis on volume and pace. Int J Sports Phys Ther Apr; 8 (2);172.9

Wellenkotter et al 2014. The effects of running cadence manipulation on plantar loading in healthy runners. Int J Sports Med. Aug;35(9);779-84

Crowell et al 2011. Gait retraining to reduce lower extremity loading in runners. Clin Biomech (Bristol, Avon). Jan;26(1);78-83




Top running tips from the experienced for the beginner

I am currently getting our battle hardened veteran runners at our local club to give their top 3 tips for beginner runners. The plan is to draw a conclusion of what the top 3 tips are, as well as share some of the tips which you may not think of to create a helpful flyer for beginner runners.

Here is one of our contributers with his tips


I started my running career at the age of 38, at the same time as my 15 year old son switched from football and boxing.  We had both had some experience of running, but not very much. Amateur boxers and lower league footballers were not the most earnest trainers, and indeed back in 1978, some smoked cigarettes, and most drank too much!

 My first running club was at Waldneil, in the former West Germany.  It was the home of Dr Van Aaken who was the founder of Long Slow Distance, (LSD), and so this is what I started out with.

 Here is a brief description of his theory etc;

Dr. Ernst Van Aaken who developed a specific long, slow distance approach to running based on endurance training consisting mainly of long distance training plus interval and speed training with a unique twist as he stressed a very conservative ratio of long distance running to speed training (he applied his approach to distances ranging from the 5k to the marathon).

Dr. Van Aaken believed the interval method (commonly practiced today) stressed too much speed and high intensity work.  While it may sound like Dr. Van Aaken’s method is similar to Authur Lydiard’s method, there are actually some clear differences.  While Dr. Van Aaken agreed with interval principles and speed training in general, he believed that too much high speed intervals blocked endurance rather than building it and that the continual practicing of high speed, beyond racing speed, was uneconomical and led to a decrease in reserves.  He stressed that the bulk of running should be done at a heart rate of about 130 beats per minute and that doing too much running at 140-200 beats per minute placed too heavy a strain on the cardio-vascular system to allow proper adaption.

It is interesting given recent stories of stress on the heart, than a heart rate of 130 was recommended for the bulk of running.

 Van Aaken’s method certainly suited me, and I swiftly progressed from running 1.5 miles, (the Army Fitness Test Distance), to a marathon in 5 months, and two months later a sub 3 hour marathon. My speedwork consisted mainly of occasional races, sometimes even a half marathon, but I would not recommend this, and some training runs with runners who were slightly faster.  At the time, I wore well padded shoes and only slightly less padded ones for racing.  I went years without any running injuries.

I would advocate lots of easy paced running and some Parkruns for speed.

So that makes:-

Tip one – Make most training sessions easy paced running

Tip two – Don’t over train on speed intervals

Tip three – Wear good cushioned shoes for training and you can go lighter for racing.

I am still gathering information, so any Scarborough Athletics Club members who want to give their top 3 tips please send them via one of our website form, Facebook Page (link below) or write them down and hand them to me at club. The deadline is Wednesday 12th and hopefully the flyer should be ready a few weeks after.


Should you exercise through pain?

As a Sports Therapist this is a common question I get asked.

‘Should I exercise through pain?’

First of all if you have persistent pain whilst exercising, please get it checked out.

My response  to this question is usually ‘it depends, pain is complex’ clients are left frustrated by me leaving the answer open ended. It is important for the client to understand pain but it can take time to explain. I tend to stick to 3 short rules.

  • During your session use a pain scale 1-10 (1 no pain 10 pain as bad as it could be) do not go into or beyond 6/10.

0-2 Safe 2-5 Acceptable 5-10 high risk

  • Recovery, if you have 3/10 pain the next morning that is okay you can do your next session, if you have 3/10 pain in 1-2 days you can do your next session with caution reduce intensity or volume, if you still have pain above 3/10 3-5 days after, then you have done too much, rest, and cross train. Your next session should involve less volume or less intensity when pain has reduced to an acceptable level.
  • If you have to miss 2 weeks of exercise or pain is not reducing in fact is getting worse: rest, cross train and seek out an injury expert.

The above maybe all you want to know but here is some more in depth information:

Pain is a complex thing, I have done a lot of reading on it and here are my conclusions. It can really stop us in our tracks or it can just let us know we had a good training session. Peoples perception of pain varies greatly, what is sharp for one person may just be dull for another. Our bodies response to a pain stimulus is also not very accurate, using an example of making toast, it can not tell whether you have burnt the toast or burnt the whole house down. It just sends the signal and sometimes, over reacts. We can say pain and tissue damage are very poorly correlated. Just because you feel pain does not necessarily mean you have damaged something. An example would be a single episode of cramp.

Can you change your pain?

See if slowing down, reducing intensity, and/or changing type of exercise (high impact to low impact) eases your pain. Are there certain movements which ease your pain, performing these regularly but staying away from painful actions can off load the injury site and help it recover. Sometimes a change of footwear is needed. If trainers are getting old or have started to lose their support due to getting soaked through it can trigger many lower limb injuries. Check for technical errors or if you have implemented some changes intensity/volume/technique/equipment have these triggered the pain?

Sometimes when you can modify your pain it is good to test your limits. I have seen many clients where actual fear of injury recurrence can increase perception of pain. Test it out gradually on your next sessions, do not go straight back into the same volume or intensity, build it back up. Your injury site has to get back to a level of been able to cope with the impact, fitness and stress of your exercise. Exercise in itself can help stimulate healing. An injury specialist can help guide you, to help get you back fully into your chosen exercise.

Physiologically what signs can we see of a serious injury?

Look for swelling, redness, heat, severe pain, giving way or locking of a joint and bony tenderness. You should not exercise through pins and needles or numbness, which are your typical symptoms of referred pain from a disc/nerve been compromised. All of the above are symptoms you should not exercise through. These are symptoms to get checked out.

When should I definitely NOT exercise?

If there is any suggestion of a stress fracture, then exercise especially impact exercise (running, zumba, gymnastics ect.) should be avoided until advised it is safe to do so. You may be able to use swimming or cycling for very light exercise but only if they give the go ahead. Acute injuries or the acute stage of an injury (1-2 wks) active rest is recommended. If a tendon has become swollen and very painful (reactive) exercise will likely aggravate it further. If a tendon injury has been around for a while and you mainly get pain after or the next day but it goes away in a few days, exercise is okay. If you have been training really hard, you may have over trained and rest can be the best option for both recovery and injury. Do not push through chest pain or abdominal pain.

Try to follow the above information if you are having pain exercising and if ever in doubt get it checked out. Never put up with pain thinking it will go away, it may just get worse.

 The text above is for guidance purposes only. If you are in pain whilst exercising then seek out a specialist in this area.

Patellofemoral Pain Syndrome

When you come to your appointment at Pro-Am the therapists first part of the assessment is asking as much information about your injury as possible.  The answers you give are important to guide the rest of the assessment. Sometimes a diagnosis can be given just from the subjective history you give and then we use a physical assessment to back up the diagnosis.

Here are some simple question our therapist will ask you when you are suffering from pain around the front of the knee.

Q1 Do you have pain sitting with your knees flexed?

Q2 Do you have pain standing?

Q3 Do you have pain going up or down the stairs, or both?

Q4 Have pain or swelling been key features?

Q5 What is your view on crepitus? (pops, clunks and grinding)

Answers to these questions will really help guide the therapists assessment and get to the cause of your injury.

Are you are runner struggling with tightness?

One of the most common problems I see in the clinic is runners with tight rigid muscles. It is suprising how many runners can not do a full depth squat. Most runners will have tried ice baths, stretching, foam rolling and massage with little effect.

Part of my job is understanding how the body responds and adapts to exercise in order to help runners maintain and improve performance. Yes a lot of my work is deep tissue work but we also have to look at the whole picture; why is this muscle feeling sore? why is your posture not aligned? No one treatment will work on its own.

Most runners will say “I know I don’t stretch enough as what I should” If something feels tight it makes sense for you to stretch it right? If your feeling tight and you stretch, how long do the effects last for? do you have to keep stretching? Foam rolling is increasing in popularity but does rolling around in agony help? In my experience these offer only short term relief.

So what can you do?

Training exposes the muscles to load which can fatigue the muscles and they become tight. Increases in training and or intensity can overload the muscles if not done gradually. The solution would be to STRENGTHEN the muscles to cope with the demands.

Tightness/stiffness is how the body protects itself and can be one of the first signs of over training or injury. Pro-Am can help to reduce tightness in muscles with deep tissue work but also combine it with a functional strength exercise program.




Neck and Shoulders Feeling Tight?

Neck and shoulder pain? tight or painful chest? stressed at work or home? does your pain keep returning or getting worse? Breathing patterns can contribute to or even be the cause of your chronic muscular pain. Here is some information you will find helpful to start finding relief.

Breathing is intertwined with our bodies emotional responses and stress levels, how? the diaphragm’s connection to the brain. We have to breath to survive, we do not have to think about breathing it just happens but it can also be controlled.

How does breathing relate to painful shoulders? when we are stressed our brain sends an alarm signal that alerts us to danger. however this works like a fire alarm. It does not know whether you have burnt your toast or if the house is on fire. It simply sends an alarm.

Your reaction to this alarm has 3 reactions Fight, Flight or Freeze. Within the work environment you can not start a fight or run a way from it unless you want to lose your job. You just hope that the deadlines and work volume will somehow go away without devouring you? This is the freeze response and is usually accompanied with breath holding. Breath holding is a natural primitive survival instinct and is an automatic response to stress and pain.  It is something we do not usually notice ourselves doing unless we are extremely body aware.

When we freeze our breathing becomes shallow, our ribs move less and our muscles become tense. If we were in a real life threatening situation we would be playing dead. With this response repeated day after day it can lead to our muscles feeling stiff and hard, leading to chronic pain and dysfunction.

If not acknowledged and dealt with stress can cause many health problems, sore muscles are just the first step. It can lead to you feeling tired and run down, frequently getting ill and headaches. All warning signs that your body needs some kindly attention.

So what can you do?

You begin your journey by having awareness of your breath. It is advised that you do seek out a therapist to make sure you do not have any underlying mechanical reasons for your neck and shoulder pain. Breath holding maybe in response to protecting an injury site.

Muscular pain caused by work related stress is very treatable. With the assistance of a therapist you can become more aware of your breathing pattern and put ‘you’ in driving seat to combating your pain.

Here at Pro-Am we can help you to understand the mechanisms of the stress response and help improve your breathing pattern which will help keep your shoulders, ribs and chest mobilised.




Sciatica Causing You Problems?

Is Sciatica causing you pain? How can we help ease your sciatic pain?

What is Sciatica?

Sciatica describes a set of symptoms that can include lower back pain, pain in the glutes (buttocks), pain shooting down the leg and numbness and tingling in parts of the leg and foot. It is often just experienced down one side of the body and can interfere with activities of daily living and sleep.

What Causes Sciatica?

Sciatica is an irritation of the sciatic nerve, there are many causes and in order for treatment to be successful the right cause needs to be found. Common causes are tight muscles in the lower back or glutes, and disc or facet joint irritation .

Less common sciatic symptoms can be caused by spinal stenosis (a narrowing of the spinal canal) or a growth or infection.

What is piriformis syndrome?

Piriformis syndrome describes a case where the muscle known as the piriformis compresses the sciatic nerve due to its position deep in the glutes. This can be caused by poor posture when lifting, poor prolonged postures (office based, driving) or physical activity  overuse. If referral pain is present is usually stays above the knee sometimes into the calf but rarely, if referral pain travels into the ankle or foot is is most likely related to the disc. Sometimes piriformis syndrome can mimic a hamstring strain.


Can Sports Therapy provide effective Sciatica treatment?

In cases where muscle tightness and stiffness is causing impingement of the sciatic nerve, then yes. If your injury is caused by the disc becoming irritated or facet joint irritation without  damage, then yes. You have to remember that muscles control joint position and when tight can alter posture and create compression on the sciatic nerve. Even with a herniated disc we can advice you on exercises to help get you back to full fitness and how to prevent flare ups.

Early treatment intervention can prevent chronic muscle tightness from establishing itself. However even in cases where chronic tightness is already presenting itself sports therapy can still be an effective treatment intervention.

Often sciatica creates a pain cycle, once the nerve has been irritated by tight muscles, the body further contracts around the sensation of pain to protect itself. This exacerbates the original tightness. A Sports Therapist can manually locate, ease and soften tight muscles and provide relief of pressure and relief of pain. We educate about good movement patterns and use muscle energy techniques to change the bodies pain cycle allowing movements to become pain free.

If there are any underlying issues that created the primary irritation of the sciatic nerve sports therapy can work in support of other treatment modalities. Just inform the therapist if you already have a diagnosis of sciatica so they have the full details and can design a treatment plan to suit your needs.

How else  might we support you through your sciatica care?

We can show you how to do exercises to ease and mobilise stiff muscles and joints. At Pro-Am we believe starting with a good breathing pattern and good body awareness enhances the efficacy of the exercises given. We like to make you involved in improving on and maintaining the benefits our treatments provide.

Please note that this blog post is for information purposes only.If you think you may be suffering with sciatica please seek out an injury professional or see your doctor.