Author Archives: richardtregarthen

About richardtregarthen

I am a remedial and sports therapist

Montane Lakeland 100 & 50, July 2013

Well, that was something a bit special I think you’d all agree!  What an event!!  The weather was fantastic, the atmosphere was a bit special and then the rain arrived at 10pm – bit of a shame and it changed the atmosphere a bit; the focus changed from dehydration to dehydration and hypothermia which was a shame and the crowd moved inside, but the vibe was still there and each and every competitor received a rapturous welcome as soon as they were in the building!

We were kept really busy trying to loosen off some extremely tired muscles, so we adapted ourselves to soothe the aching limbs and bring people back round to planet earth.  We were overwhelmed by the effort all the competitors had put in and it was a real pleasure to see everyone leave our tent feeling better and able to shuffle to their showers/beds a little more easily than when they’d fallen onto our treatment couches.  Some of the tales of pushing on through extremely traumatised injuries were almost beyond comprehension, but fortunately all will be recoverable with the right post-race rehab.  Concerns were raised at people with stress fractures who were unsure about what to do, so we did have to have a few sterner words with those guys to make sure they did the right thing for themselves – you know who you are!  Please get yourselves repaired…

We wanted to get more pictures taken, but as we were rushed off our feet, the camera got put away unfortunately.  Anyway, here are a few from behind the scenes and it was great working with Gary Wilkinson and John Warburton to the very small hours – who says you can’t pull a 19 hour Sports Therapy shift…?

We look forward to seeing you out at the remaining events, so we hope your training goes well and get in touch with us if you need advice on injury management – better to nip any problems in the bud wouldn’t you agree?!?!


Proximal Hamstring Tendinopathy ” A pain in the backside”

To the vast majority of the population, the image of a hamstring tear will be a Sprinter pulling up in a race looking like they’ve been shot. To me, a common hamstring condition is an endurance athlete, runner, cyclist or triathlete, saying to me that they’ve got “a pain right in my ar*e” and “I’m struggling to increase my speeds as I know it’s going to go”.

It’s really important to run a full diagnostic with the evidence presented and pinpoint the cause, but invariably, the description given will lead you right to the spot, basically proximal hamstring and often right at the Ischial Tuberosity (your seat bone).

To understand what’s where, there are 3 hamstring muscles of the posterior thigh: Semitendinosus (ST), Semimembranosus (SM) and Biceps Femoris (BF) with it’s long and short heads. Proximally, while the short head of BF attaches to the femur, all the other hamstring muscles share a common point of origin on the ischial tuberosity (seat bones) of the pelvis, all covered by the gluteal muscles.  Distally, ST and SM both attach to the medial tibia while BF attaches distally close to the fibular head, lateral to the knee.


However, the hamstrings, being a two-joint muscle group (crossing hip and knee), when we run there are other considerations to take into account, especially during stance phase. During this phase the foot is anchored to the ground by our body weight creating what’s called a “closed chain environment”. As the hamstrings contract with Glute Max to create hip extension propelling us forwards, they also create an extension moment at the knee… rather than just knee flexion.

The Injury Itself!
The common origin point of the hamstring muscles at the ischial tuberosity of the pelvis is basically the site of injury when diagnosing Proximal Hamstring Tendinopathy. The injury is classified as a tendinopathy rather than a tendonitis, as it has a more degenerative nature rather than being an inflammatory condition.

Sufferers will complain of pain local to the ischial tuberosity when running, especially when accelerating and sustained faster paced running as mentioned before. The pain will most likely be an intense ache in nature, rather than sharp or stabbing. Due to the anatomical proximity to the common hamstring origin, the sciatic nerve can sometimes be affected (Therapist will check Glute Med and Piriformis), which can cause referred pain into the posterior thigh. Once aggravated, sitting on solid surfaces can also be uncomfortable, as can direct palpation and pressing onto the ischial tuberosity manually.

Differential diagnoses for similar symptoms can include piriformis syndrome, pelvic stress fractures and low back injuries. Thus, a proper assessment from a musculoskeletal physiotherapist or similar sports injury professional is important. Often an MRI scan will be used to support diagnosis once and for all, but this can be avoided with accurate diagnosis – depends entirely on the choice of the individual!

Treatment and Rehab:
Soft Tissue Treatment, Manual Therapy & Stretching:
Hands-on treatments providing soft tissue mobilisations to break up scar tissue and adhesions can be useful, as can transverse frictions to the affected tendon. Care should however be taken not to apply direct pressure to the ischial tuberosity itself. This sort of soft tissue work is complementary to a gradual introduction to regular hamstring stretching.

If upon assessment, pelvic malalignment (anterior innominate rotation in particular) is identified, manual manipulation to restore alignment of the pelvic bones is often useful in restoring proper hamstring function. The question of course must always be asked – where does the imbalance come from that caused the pelvic malalignment…?

Specific Hamstring Strengthening
It is suggested that the progression of targeted hamstring exercises should go as follows:
Double leg, non-weight-baring isometric exercises:
Bridge Holds
Single leg isometric (closed chain) and isotonic (open chain) exercises:
Single Leg Bridge Holds
Single Leg Hamstring Catch
Eccentric hamstring loading exercises:
Swiss Ball Hamsring Curls
Single Leg Swiss Ball Hamstring Curls

It goes without saying that these progressions depend on the pain free completion of each stage.

(“Finally, you might say”) Core Strength & Pelvic Posture Correction!

Hands-on treatments, stretching and progressive strengthening are all important parts of the any good rehabilitation plan for Proximal Hamstring Tendinopathy. However, in my experience, I find the following core strengthening element to be the key to a successful outcome.

In my experience of working with triathletes/athletes/runners who suffer from proximal hamstring tendinopathy, or recurrent hamstring strains, almost all were displaying poor ability to control their pelvic position throughout the performance of functional movements for their sport.

In virtually all cases, it seems that the recurring theme is that they fall into an anterior pelvic tilt/innominate rotation during exercise; this will put the hamstring in a position where they are chronically held under tension, or put a different way, the soft tissue is now technically inelastic and unable to contract and extend from a neutral (and stable) position.

Re-educating proper pelvic position throughout movement, and working to correct imbalances which predispose an athlete to poor pelvic posture should be treated with equal importance, because if not, increased precedence over elements of the rehab programme such as eccentric hamstring strengthening protocols are potentially exacerbating the problem. It’s absolutely vital to check for quad flexibility or a dominance (unwilling to release), and tight hip flexors.

It’s very simple to prescribe a raft of general exercises that will help build stability, but equally as important, you have to treat and deal with the individual in front of you so that the balance between anterior and posterior muscle groups must be achieved first so that all you are strengthening on a “stable” platform rather than over-exerting already (technically) weakened muscles.

Get in touch with us if you want to talk further and we’d also like to hear about the topics that interest you that you’d like us to put on the website!

Train well and look forward to seeing you soon (preferrably uninjured!)

The STNW team.

Sports Therapy, Science Testing and Bike Fitting clinic now OPEN!

It’s been an incredibly busy few months what with getting everything ready at the Endurance Store in Appley Bridge and also supporting the Epic Events in the sun-kissed Lake District, but we’re now incredibly happy to announce that we’ve got our dedicated facility OPEN!

Before we go on, about us being OPEN 6 days a week, Monday to Saturday, how about we make you an introductory offer of £20 for your first Sports Massage treatment?  The only proviso being that you’ll need to bring a stick to bite down on once Jacqui (who works in the Store) gets a hold of your legs!  Richard’s a bit nicer…he brings his own sticks.

We don’t want to be boring here, but we’ve now got a great team of Sports Therapists, Performance Analysists and Coaches who have been brought together with the sole purpose of understanding how you currently train, compete and perform so that we can help you look for and find the ways that will help you maximise your performance on your efforts.  If it makes it easier, we’ve broken down our Services into the following:

Sports Therapy – Injury Rehab, Soft Tissue Improvement, Sports Massage, Postural Analysis, Personal Training and Event Support

Science Testing – Metabolic Testing, Nutrition Analysis, Performance Feedback, Coaching, Training Plans

Performance – Bike Fitting, Personalised Coaching, Training Schedules, Core Fitness, Winter Spin Classes

We are always present in support of Epic Events at the weekend’s, so feel free to come along and have a chat, discuss whether you’d like to know more about our services (a bike fitting session could be the answer to many an issue), and it’s also our intention to give you a free rub down (BYO bite stick)!  We will also usually be present at the Tuesday evening Duathlon and Open Water Wednesday’s at the 3 Sister’s Lake (email us if you can’t make it and have a question).  In all seriousness though, we understand the rigours, stresses and strains that a tri event (or double or single for that matter), place on the human body, so we are here to get to the cause of the problems and give you accurate feedback as to what’s happening and then help you out.

All our details are in the “Contact” section, so even if you’re not injured, why not take up the £20 offer and see if we can get you feeling in top shape by ironing some well used soft tissue fibre’s from your heavy training schedules, especially now the business end of the season is here.

We look forward to seeing you all soon!  Train hard, train smart and it will be a pleasure to sort your body’s out.

The Sports Therapy North West Team

p.s. Don’t forget your bite-stick…