Warm Up For Hockey

So why warm up?

The warm up is often a hurried exercises of a quick jog and a few stretches but the warm up is a very important part of the  pre-match preparation. A warm up has two main aims:

Prepare the body to play - and thus prevent injuries

Prepare the mind to play - and enhance your game.

The main benefits of a good effective warm up are:

  1. Muscles that are warm are able to contract more effectively creating more force.  They are also able to relax more easily. All areas of your game will obviously be improved when your muscles are functioning at their optimum.

  2. Joint range of movement is improved after a warm up so stiffness and restriction will be reduced.  This will not only help to prevent stresses and strains but also improve your dynamic movement.

  3. Warm up causes vasodilation which enhances the carriage of vital oxygen to the active muscles.

  4. The nervous system is primed following a warm up - so is ready for the activity about to happen.

As you can see from the above points a warm up is critical for injury prevention and sporting excellence.

So what should you do?

The basic principle of a warm up is to:

  1. Get everything generally warmed up - especially on a cold morning in January!

  2. Start slowly with slower stretches progressing to dynamic work increasing intensity and speed.

  3. Strength activation exercises.

  4. Game specific activities.

1. Get warmed up:

10 minutes of brisk walking progressing quickly to light jogging should be enough to get the body ready to exercise. 

2.Stretches and dynamic stretching

Research (Page, 2012) shows that for athletes involved in running sports, such as hockey and football, dynamic stretching may be the best method of stretching. Whilst for those involved in sports requiring flexibility such as gymnastics and dance, static stretching may be more beneficial.  Therefore the stretches suggested below are dynamic. However it is important to start these stretches slowly and build up the range.

Standing on the spot:

  • Hip Swinging - Swing the leg forward and back  and side to side. X 20 each movement 

  • Knee bends and heel raises - Bend the knees and them raise heels, lower the heels and bend the knees with arm reaches. x20

  • Knee lifts and hamstring curls - Lift each knee to chest. Then bend each knee to bring the foot to bottom. x20 each

  • Roll down  and reaches - Rest hands on the thighs and nod the head and roll the spine down to reach the toes - if you feel tension in the back allow the knees to bend slightly. Uncurl as you roll up and reach for the sky. Try to move vertebra by vertebra.  x5

  • Hip Swivels - Rotate the hips in both directions. x10 each direction

  • Cross body arm reaches -Take the right arm across the body to the left - palm up, repeat with the left arm. Then repeat with the palm down. X 10 each movement.

  • Trunk twist - Cross the arms across the body, keep the hips facing the front and rotate the trunk to the right and left. x10


See the below videos to help with the above exercises.


Start to build movement:

  • “A” skips - Skip forwards knees to chest.

  • “B” Skips - Skip forwards extending the knee.

  • Back Skips - Skip / Jog backwards. 

  • Skater skips - Hop onto 1 leg at an angle in front and to the side of you., then hop to the other leg.

  • Hamstring curl skips - Move forwards bringing alternate foot to the bottom.

  • Carioca -  Run sideways alternating one foot in front and one behind. Ensure to turn around halfway to lead with the opposite side.

I suggest doing each exercises for half the width of the pitch and repeating x 2 - 3

See the below videos to help with the above exercises.

3. Muscular activation.

Hockey requires a high level of asymmetric muscle work and a common finding in my practice with hockey players is tight hamstrings (back of the thigh) and weak glueals (Buttock muscles).

We have addressed the hamstring tightness with the dynamic stretches but activation of the gluteal muscles will improve stability and help stabilize the core.

  • 1 leg dips - stand on 1 leg ensure the hips are level and bend one knee - keeping the knee cap over the second toe, ensure to “squeeze” the buttock on the stance leg. x 20 each leg.

If you can invest in some theraband, this can really help wake up the gluteal muscles.

  • Crab walking -  Tie the band around the ankle. Position the feet in turn out and keeping knee cap over the second toe walk right and the left. - 1 minute.

  • Squat to lateral lift - Tie the band just above the knees, feet hip width apart.  Squat and push the bottom backwards. Stand tall and lift the right leg to the side. Repeat squat and leg lift to the left. X20 reps.

4. Game specific:

Now is the time to start to gear up for hockey. Stick and ball work in a small area - ¼ for  5 mins. Progress to ½ pitch for 5 mins and then to position specific drills - corners passes etc. 10 mins.

You should now be all set for a great game!

The above programme is given as a suggested warm up for those with no specific concerns and does not take into account any previous injuries.  You should not feel any pain with any of the above exercise and should seek advice from a doctor or professional if you have any symptoms or concerns.  

Victoria at ThamesPhysio would be very happy to guide you through a warm up for hockey or address any individual needs.

Reference:

P. Page: “Current concepts in muscle stretching for exercise and rehabilitation”.

Int J Sports Phys Ther. 2012 Feb; 7(1): 109–119.











 









"Cartilage Tear" in the Knee

This is a common presentation  to a physiotherapy clinic. I hope that the information below will clarify some of the confusing points.

What is the Mensicus - “The Cartilage?”

The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint - the medial and the lateral menisci.  They assist in shock absorption. The knee also has articular cartilage that lines the surface of the joint and should not be confused with the menisci.

Knee anatomy.jpg

What are the types of tears: Degenerative and Traumatic

Degenerative tears are as a result of overuse and may or may not be attributable to a specific evident.  They most commonly present between the ages of 40 - 60 years Until fairly recently, an arthroscopy with meniscal debridement was often performed for these types of injuries to smooth out the tears.  However, recent evidence shows that very many people have resolution of symptoms with physiotherapy and exercises. If however, symptoms persist an arthroscopy may still be needed. It should be noted that an arthroscopy is not always a quick fix and the improvement of thigh muscle and buttock muscle (quadriceps, hamstrings and gluteal muscles) control through exercise should be done prior to surgery, to either avoid surgery altogether or ensure a good recovery. 

Traumatic tears are, as the name suggests, usually as a result of a specific injury.  They are often described by the shape and position of the tear. They often result in locking and giving way.

MeniscalTears-pic2.png

These tears usually need a surgical repair and will require a period of joint protection and rehabilitation to ensure a good outcome.

What are the symptoms and how is the problem identified?

Pain is usually the overriding symptoms and may range from acute severe pain to a dull ache.  With the more significant tears you may also experience true locking or giving way. True locking is when the knee becomes completely stuck and cannot be moved.  This usually require urgent attention as the knee is not functional. Giving way usually occurs whilst weight bearing and rotating or changing direction. Again this does require attention as further giving way can extend the tear.

A physiotherapist can identify the presence of a tear through a thorough subjective history taking and a physical examination where they will use specific tests to identify a tear.  If there is concern about the extent of a tear or a need for surgery the physiotherapist may refer you for an MRI. An X Ray would not identify a meniscal tear.


What would physiotherapy involve for a meniscal tear?

Following an assessment your treatment will be planned to treat the various problems that may exist but could include:

  • Joint mobilisation for restoration of full range of movement .

  • Soft tissue massage for reduction of swelling and movement improvement.

  • Acupuncture, Ultrasound and Interferential for reduction of inflammation and pain control.

  • Exercises for strength, balance and range of movement.

If you feel you would like to discuss your knee problems or have an assessment, please do be in touch with Victoria at ThamesPhysio Ltd.

How Much Activity Should I Be Getting?

The UK chief medical officers have today released new guidelines on physical activity based on the latest research.  (Published 7th September 2019). The guidelines are summarised into age groups.

Children and Young People (5 to 18 years)

  • Children should participate in at  least 60 minutes per day of moderate to vigorous exercise every day.

  • Children should develop and maintain muscle tone and strength.

  • Chldren should minimise sedentary pastimes and intersperse inactivity with physical activity.

Adults (19 to 64 years)

  • For good physical and mental health, adults should aim to be physically active every day.

  • Adults should participate in activities to develop or maintain strength in the major muscle groups. Muscle strengthening activities should be done on at least two days a week.

  • Each week, adults should accumulate at least 150 minutes of moderate intensity activity (such as brisk walking or cycling); or 75 minutes of vigorous intensity activity (such as running); or an even shorter duration of very vigorous intensity activity (such as sprinting or stair climbing); or a combination of moderate, vigorous and very vigorous intensity activity.

  • Adults should aim to minimise sedentary lifestyles.

Older Adults (65 years and over)

  • Older adults should participate in daily physical activity.

  • Older adults should maintain or improve their physical function by undertaking activities aimed at improving or maintaining muscle strength, balance and flexibility on at least two days a week. 

  • Each week older adults should aim to accumulate 150 minutes of moderate intensity aerobic activity, building up gradually from current levels. Those who are already regularly active can achieve these benefits through 75 minutes of vigorous intensity activity, or a combination of moderate and vigorous activity, to achieve greater benefits. 

  • Weight-bearing activities should be included to maintain bone health.

  • Older adults should aim to minimise sedentary lifestyles, or at least with standing, as this has distinct health benefits for older people. 


If you are finding that aches, pains or stiffness are preventing you from achieving the goals set out above please do contact Victoria at ThamesPhysio for an assessment to see if we can address these problems and get you back on the road to full fitness.


Muscle Loss with Ageing

The loss of muscle as we age is sadly a normal part of the ageing process it is called Sarcopenia. Sarcopenia literally means “lack of flesh.”  It occurs when the break down of muscle “catabolism” exceeds the laying down of muscle “anabolism.” It is expected that one after the age of 30, you begin to lose as much as 3% to 5% per decade.  However, the rate of muscle loss happens most around the age of 75 years. Less muscle means greater weakness and less mobility, both of which may increase your risk of falls and fractures.

Four factors have been identified that increase sarcopenia:

  1. Inactivity.

  2. Poor diet

  3. Inflammation

  4. Hormonal Changes

Inactivity

This is particularly prominent with immobility due to illness or injury but a slow decline in physical activity will also have an impact.  The immobility increases the muscle loss. The muscle loss then makes activity more difficult resulting in a reduction of activity and further muscle loss 0- a vicious cycle to avoid.

The Answer -  Maintain an active lifestyle - The old expression of “Use it or Lose it” is true.  This does not have to be sport and formal gym going but could be gardening, shopping or housework.  However the three most important types of exercise to fight sarcopenia are:

Resistance Work - This promotes the release of chemicals to build muscles (anabolism).  The introduction of a graduated exercise program including resisted exercise can really help.

Walking - A gentle weight bearing and muscle building activity.

Fitness Training - To improve aerobic aerobic capacity.

Poor diet

A poor diet insufficient in calories, and in particular protein, the building block for muscle,will result in weight loss and further muscle loss.  A loss of appetite is common with ageing and, without meaning to, a reduced calorie intake it can occur.  

The Answer - Aim for a balanced healthy diet with sufficient protein and calorie intake.  Discussing your diet with your GP or a dietitian can prove very useful if you have concerns.

Inflammation

Links have been found between chronic inflammation and sarcopenia.  Inflammation promotes the catabolic processes (breaking down of muscle) and decreases the anabolic processes (building up of muscle).   The inflammation may be as a result of a systemic condition or a musculoskeletal problem such as arthritis.  

The Answer - Your GP should be able to manage any systemic inflammatory problems and a physiotherapist can help reduce inflammatory reactions to musculoskeletal problems.

Hormonal changes

The normal falls in testosterone and oestrogen levels due to the ageing process are proven to be a major contributor to sarcopenia.  There is unfortunately nothing one can do to prevent this normal hormonal drop. However, if you are demonstrating sarcopenia at a younger age,  hormone replacement therapy can be considered. This would be something to discuss with your GP.

In Conclusion.

The loss of muscle bulk is part of the normal ageing process and if left unchecked can play a significant role in loss of mobility and independence.  However, some simple changes to lifestyle can not only decrease the rate of muscle loss can actually rebuild the muscle. If you would like to discuss any part of this paper or plan a graduated exercise programme please give Victoria a call.