Gluteal Tendinopathy

The buttock or gluteal muscles are extremely important in providing pelvic stability when walking. Every time you step on your right foot, your right gluteal muscles are vital in keeping your pelvis stable and preventing your left hip from dropping. The gluteal muscles insert into the outside of the hip via their tendons and these tendons can break down, particularly in middle aged athletes after twisting injuries, or in endurance athletes as a result of training load. Given the frequency with which they must act (every second stride), it is easy to understand how they can become overloaded. In order to load and strengthen the tendons:

1. Lie on your side with the affected side up.
2. Have your other leg straight out underneath you.
3. Roll over so that your ‘top-side’ elbow is touching the ground.
4. Flex your knee and hip so that your ‘top-side’ ankle is resting on the side of the ‘underside’ knee.
5. Without rolling at the waist, simply hinge from your ankle so that your ‘top-side’ knee comes up in the air and you open up your pelvis. Hold briefly at the top before returning to the starting position
6. Start with 50 reps a day and look to build to 100.

Hamstring Tendinopathy

The key exercise for treating proximal hamstring tendinopathy is an eccentric bridge. As you start this type of exercise you should have your feet on the ground with your knees flexed to about ninety degrees. As you get more confident extend you knees so your leg forms a longer lever. As you make more progress you may place your feet on a chair or a swiss ball. It is important to remember that the key component is the lowering phase of the exercise.

The important points to remember are

• Engage your core muscles
• Lift your low back and buttocks off the ground - so you become supported on your shoulders and feet
• Lift the normal leg off the ground (so you are supported by your shoulders and the painful leg only)
• Slowly lower your buttocks back to the ground over a 3 second count

Remember these exercises are supposed to be uncomfortable. You should ideally aim for more than 90 repetitions a day. Start slowly and build up to this number. You do not have to do all of the exercises in one sitting. It is more manageable to do a number of smaller sets over the course of a day.

Hamstring Injury Prevent

Hamstring injuries are one of the most common injuries seen in recreational and professional sport. They can significantly affect an athletes season partly because they take a long time time to recover and also because they have a very high rate of recurrence. Approximately one third of all athletes who sustain a hamstring injury will go on to have a second injury - many of these happen in the first week back. Very frustrating!

A recent study in the American Journal of Sports Medicine has shown that the incidence of hamstring injuries in football (soccer) players can be reduced by about 60% by adopting a simple strengthening program. The study involved more than 900 professional and semi-professional football players based in Denmark. Players were either asked to complete a hamstring strengthening program or to continue with their normal training and warm-up routine. The strengthening regime involved a single exercise a 'nordic drop' - and was completed during a normal training session. Those who completed the strengthening program had a marked reduction in the incidence of hamstring injuries. The reduction was greatest for those who had previously injured their hamstring. There was an 85% reduction in the risk of injury in this group.

The nordic drop does not require any equipment and can be quickly and easily done on the training field. The exercise generally requires a partner. To do a nordic drop:

• The athlete starts in a kneeling position, with their partner applying pressure to the athlete’s heels/lower legs holding them against the ground.
• The athlete then lowers themselves forwards using their hamstring muscles. The athlete is asked to resist the forward fall for as long as possible using their hamstrings.
• As they fall forward the athlete is asked to use their arms and hands to buffer the fall, let the chest touch the surface, and immediately get back to the starting position by pushing upwards with their hands to return to the start position.
• Prior to completing this exercise the athlete should have warmed up properly

If you have any other questions about hamstring injury prevention - or the management of an acute or chronic hamstring injury - please book in to see one of our expert clinicians.