Manchester Therapy Centre

16/10/2025

📃📌 Hamstring Injuries: Why They Happen, What Works, and The Hidden Keys to Prevention

▪️ Hamstring injuries are a massive challenge in sports, known for their high incidence and recurrence rates.
▪️ They account for about 10% of all injuries in field-based sports, with recurrence rates ranging widely from 15% to 70%.
▪️ Despite decades of intervention strategies, such as resistance training, the prevalence remains stubbornly high, demanding a deeper look into both injury mechanisms and prevention strategies.

⚙️ The Mechanism of Hamstring Injury

▪️ Most hamstring injuries (over 80%) occur during high-speed running.
▪️ The most vulnerable phase is the late swing phase, where the hamstrings act eccentrically.

⬜ 1. The Vulnerable Position:
During late swing, the hamstrings must produce large eccentric forces while operating at long muscle lengths to decelerate the leg.
Animal studies confirm that muscle injuries often happen when high strains occur at long muscle lengths.

⬜ 2. The Primary Victim:
The biceps femoris long head (BFlh) is the muscle most commonly affected.
Musculoskeletal modeling suggests the BFlh muscle–tendon unit (MTU) length peaks significantly longer (at 112% of upright standing length) compared to other hamstring muscles during this phase, placing significantly more strain on it.

⬜ 3. The Core Problem:
Injuries in this phase typically result from insufficient or delayed neural activation, or an inability to produce the necessary force to resist active overstretching.

▪️ Two major risk factors are consistently identified: low eccentric strength and short muscle fascicle lengths.
▪️ Athletes with short resting fascicle lengths (

12/10/2025

3 key sprinting phases and how to train them! 🏃💨

Haugen et al. (2019) is a fantastic overview of sprinting and forms the basis of our graphic and the information in this post (reference below). It's *open access* so be sure to read the full article!

The 100m sprint is composed of 3 phases; acceleration, maximal velocity and deceleration. These have differing demands and require specific training.

For example, the acceleration phase targets the start of the sprint so is short, with high intensity and includes starting from the blocks (or similar position).

The maximal velocity phase is also high intensity but uses a 'flying start' (e.g. run 20-40m at a lower intensity before breaking into a sprint) to reach the highest possible speed. This is hard to maintain so these tend to be short sprints (e.g. 10-30m).

By contrast the deceleration phase requires sprint endurance to hold speed and form in the latter sections of a race. As a result the training tends to be slightly longer in duration and needs longer recovery times between efforts.

Strength and conditioning, plyometrics and resisted sprinting can all potentially enhance sprinting performance but it's a challenge to include them all within a programme.

Haugen et al. (2019) recommend a progressive, periodised approach that's adapted to meet the needs of the individual. The suggest varying training across the season so performance and recovery needs can be met (see graphic for examples).

Reference:
Haugen T, Seiler S, Sandbakk Ø, Tønnessen E. The Training and Development of Elite Sprint Performance: an Integration of Scientific and Best Practice Literature. Sports Med Open. 2019 Nov 21;5(1):44. doi: 10.1186/s40798-019-0221-0. PMID: 31754845; PMCID: PMC6872694.

26/09/2025

Physio led Pilates Classes Monton

Classes October to December.

Come and join us! All welcome!

Classes: Monday afternoon 1pm beginners and those recovering from illness or injury, less mobile or less able to get up and down from the floor,

Monday, 2pm beginners to intermediate Monton Methodist Church Hall, Park Road, M309GJ.

Tuesday 7.30pm

St Pauls Egerton Rd M309LR

And Thursday evening 7pm

Monton Unitarian Monton Green M308AP

These classes are suitable for everyone, so long as you can get up and down from your mat. (1pm Monday if you can’t).

Any injuries or illnesses will be catered for, we always have the option for very easy options for beginners, advancing to more intermediate work as you become fitter.

There’s never any pressure in our classes!

face to face Pilates sessions £8 per class.

remote sessions will continue too via Zoom.

You will need to bring your own mat, exercise bands or loops, a small cushion for your head and loose, warm clothing.

See you soon.

Liz

👍🏻😍👏💪🏻🔥🧘🏻‍♂️🥇

16/09/2025

Forearm muscles trick
How to remember muscles

15/09/2025

Return to running after a Tibial Bone Stress injury can be a challenge, especially with high risk stress fractures.

Here are 5 pointers from a great paper by George et al. (2024) in Sports Medicine.

14/09/2025

🦵 Leg Length Discrepancy (LLD)

📖 Definition

▪️ Leg length discrepancy (LLD) or anisomelia = condition where paired lower extremities have unequal length

🗂️ Classification of LLD

🔹 Anatomical

▪️ Structural limb length inequality (osseous shortening between trochanter femoral major → ankle mortise)
▪️ Congenital: developmental abnormalities (birth/childhood)
▪️ Acquired: trauma, fractures, orthopedic degenerative diseases, surgical disorders (e.g., joint replacement)
▪️ Radiographic study:
➡️ 90% of normal population = some variance in bony leg length
➡️ 20% = difference >9 mm

🔹 Functional

▪️ Non-structural shortening (unilateral asymmetry without osseous shortening)
▪️ Causes:
➡️ Joint contracture
➡️ Static/dynamic mechanical axis malalignment
➡️ Muscle weakness/shortening
▪️ Cannot be detected with radiography
▪️ Develops from abnormal motion at hip, knee, ankle, or foot in any plane

⚠️ Etiological Factors

True LLD

▪️ Idiopathic developmental abnormalities
▪️ Fracture
▪️ Trauma to epiphyseal endplate before skeletal maturity
▪️ Degenerative disorders
▪️ Legg-Calvé-Perthes Disease
▪️ Cancer / neoplastic changes
▪️ Infections

Functional LLD

▪️ Soft tissue shortening
▪️ Joint contractures
▪️ Ligamentous laxity
▪️ Axial malalignments
▪️ Foot biomechanics (e.g., excessive ankle pronation)

🧍 Role of LLD on Posture and Gait

📌Standing

▪️ Patient compensates to level difference in height
▪️ Longer leg vs Short leg compensation:
➡️ Foot: pronation vs supination
➡️ Ankle: dorsiflexion vs plantarflexion
➡️ Knee: flexion vs extension
➡️ Hip: flexion & internal rotation vs extension & external rotation
➡️ Innominate bone: posterior rotation vs anterior rotation
▪️ If uncompensated → anterior & posterior iliac spine on short leg lower → sacral base unleveling, scoliosis, ↑ muscle activity

📌Walking

▪️ Gait asymmetries throughout kinetic chain
▪️ ↑ vertical displacement of center of mass → ↑ energy consumption
➡️ Compensations: calcaneal eversion, knee extension, toe walking, circumduction, hip/knee flexion (steppage gait)
▪️ ↓ stance time & stride length on shorter leg
▪️ ↓ walking velocity, ↑ cadence

📌Running

▪️ Running biomechanics differ from walking
➡️ Greater vertical oscillation
➡️ No double support → weight not shared
➡️ Stance phase 30% in running vs 60% in walking
➡️ Stress on lower extremity = 3× walking
▪️ Effect of LLD may be amplified threefold

🦴 Associated Musculoskeletal Disorders

▪️ Low Back Pain
➡️ LLD affects lumbar spine via scoliosis & pelvic obliquity
➡️ Lumbosacral facet joint angles smaller on short side → possible OA risk
➡️ Literature inconclusive on causal link

▪️ Hip Pain
➡️ Longer leg predisposes to osteoarthritis
➡️ Femoral head contact area decreases with ↑ length
➡️ (+10 mm = 5% loss, +50 mm = 25% loss)
➡️ Increased hip abductor tone + GRF burden on longer leg

▪️ Stress Fractures
➡️ Tibia, metatarsals, femur of longer leg → higher incidence

▪️ Other Associations
➡️ Trochanteric bursitis
➡️ Patellar capacity/joint incongruences
➡️ Myofascial pain syndrome of peroneus longus

🔍 Differential Diagnosis

▪️ Pelvis shift
▪️ Low back pain (LBP)
▪️ Idiopathic scoliosis
▪️ Iliotibial band syndrome
▪️ Foot pronation
▪️ Stress fractures (lower extremity)

🩻 Examination & Outcome Measures

▪️ Radiography = most accurate method
➡️ Best for differentiating anatomical vs functional
➡️ Limitations: contractures, magnification error, time/cost

▪️ CT scan
➡️ No greater accuracy vs radiography
➡️ Higher cost, not routinely justified

📌Direct Methods

▪️ Tape measure between fixed landmarks (ASIS → medial/lateral malleolus)
▪️ Errors possible due to iliac asymmetries, joint contractures, long-axis deviations, umbilicus asymmetry
▪️ Tips:
➡️ Take mean of 2–3 measures
➡️ Compare measures across clinicians

📌Indirect Methods

▪️ Palpation of iliac crests or ASIS in standing
▪️ Use of blocks/book pages under shorter limb until pelvis is level
▪️ Best clinical method = palpation + block correction
▪️ Consider pelvic rotations outside frontal plane

📌PALM (Palpation Meter)

▪️ Valid, reliable, cost-effective alternative to radiography
▪️ Measures pelvic height difference with inclinometer

📌Block Method

▪️ Patient stands with equal weight, knees extended
▪️ Wooden boards placed under short leg until pelvis level
▪️ Reliability depends on clinician skill

🦵 LLD After Total Hip Arthroplasty

📌Clinical Signs

▪️ Pain from imbalance in hip/knee/spine muscles
▪️ Pain & fatigue in longer leg quadriceps/hamstrings (flexed knee syndrome)
▪️ Instability/dislocation due to component orientation

📌Post-op Apparent LLD

▪️ Causes: periarticular muscle spasm, lumbosacral scoliosis, pelvic obliquity
▪️ Leads to tilted pelvis despite equal measured lengths
▪️ Treatment: reassurance, physical therapy, temporary shoe lift
▪️ Most cases resolve within 6 months

🛠️ Medical Management

▪️ Decision depends on magnitude & symptoms
▪️ Categories:
➡️ Mild (0–30 mm): usually no surgery unless symptomatic
➡️ Moderate (30–60 mm): case-by-case, possibly surgical
➡️ Severe (>60 mm): surgical correction indicated

🩺 Surgical Intervention

▪️ Epiphyseal growth blockade (in adolescents/children – stops growth in longer leg)
▪️ Bone resection shortening (in skeletally mature patients)
▪️ Limb lengthening (LLD >40–50 mm)
➡️ Cortical osteotomy + external fixation for gradual distraction

🏋️ Physical Therapy Management

📌Non-Surgical Interventions

▪️ Muscle stretching (TFL, adductors, hamstrings, piriformis, iliopsoas, others as needed)
▪️ Shoe lifts:
➡️ Inserts (10–20 mm correction)
➡️ Sole build-up (30–60 mm correction)
➡️ Gradual implementation in small increments

📌LLD, Shoe Lifts & Low Back Pain

▪️ Shoe lifts reduce LBP when correlated with LLD
▪️ Correction should be gradual
▪️ Shoe inserts effective in ≤10 mm LLD
▪️ Combine with back exercises
▪️ Quadratus lumborum endurance reduced on side of short leg (small study – more research needed)

05/09/2025

👉 We all know why we really do it:
✔️ Helping people get back to what they love
✔️ Building real connections
✔️ Seeing patients succeed (and celebrating the little wins along the way)

Because let’s be honest, that’s the real payoff.

28/08/2025

New study finds that the stubborn brain refuses to forget lost limbs. https://theconversation.com/scientists-have-been-wrong-about-phantom-limbs-for-decades-new-study-263547?utm_term=Autofeed&utm_medium=Social&utm_source=Facebook =1756368915

23/08/2025

What are the latest guidelines for Achilles Tendinopathy?

Chimenti et al. (2024) published an extensive update of the Clinical Practice Guidelines (CPG) for Achilles Tendinopathy. It’s open access so I’d recommend reading it in full (reference below).

Exercise should be a first line treatment and should be combined with education about tendinopathy, pain and load management.

Rehab should be progressive and can include all contraction types - eccentric, heavy slow resistance, isometric and plyometrics where tolerated.

Those with irritable symptoms and low load tolerance may benefit from lower-level exercises initially with education and interventions to help reduce pain.

Patient’s with high load tolerance and low irritability may be able to start with higher levels of load, for example progressing from 15RM to 6RM over approximately 12 weeks (see Beyer et al. 2015).

It should be noted that in many areas there was minimal evidence or contradictory findings. In some areas, such as stretching, no evidence update was provided so previous recommendations from the 2018 CPG were retained.

Shockwave therapy was not included in this review as it was considered outside of typical scope of practice. However, Iontophoresis was included and recommended with moderate evidence (grade B) despite it not being used widely in practice.

🗣️What do you think? Anything you’d add or change?

Reference:
Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision - 2024. J Orthop Sports Phys Ther. 2024 Dec;54(12):CPG1-CPG32. doi: 10.2519/jospt.2024.0302. PMID: 39611662.

20/08/2025

20/08/2025

17/08/2025

Rotating your running shoes can cut your injury risk by 39%. Find out how many pairs you should own—and what happens if you don’t make the switch.