Category: News

‘Strength Training Exercises for Runners’

Posted on | by Mark Brady | Leave a Comment on ‘Strength Training Exercises for Runners’

The introduction of strength training to complement the work you do on the track or on the road can reduce the risks of picking up many of the injuries runners see as part and parcel of their sport.

It can also help you to become you a more efficient runner, improve your recovery from sessions and help you train harder and longer during your high training-load weeks.

By selecting exercises that target the areas most important for running, you can ensure maximum crossover to your technical training.

Below are 5 exercises that you can put together in a session to target each of those areas,

Click on the image below for full article
UPMC SSC Strength training exercises
Frans Bosch

Robustness in Running – Frans Bosch

Posted on | by Mark Brady | Leave a Comment on Robustness in Running – Frans Bosch

SSC is delighted to welcome Frans Bosch to present his work during a one day workshop “Robustness in Running”. The workshop will be of huge benefit to physiotherapists and strength and conditioning coaches who are working with athletes across sports to improve performance and reduce injury rates.

Course Content

 Motor Control and Motor Learning
 The basics of running and jumping
 Model for High-Speed Running
 Running analysis
 Exercise selection and correction

 CPD: 7 points

Since 2005 Bosch teaches at the Fontys University for Applied Sciences in Sports, mainly in the field of anatomy, biomechanics, strength training and motor learning. Bosch has given numerous presentations on training related topics all over the world and frequently works internationally as a consultant in sport and as a conference speaker on training related subjects.

Clients in recent years are the English Institute of Sports, Wales National Rugby Team, the British and Irish Lions and others. Together with Ronald Klomp, he wrote “Running, biomechanics and exercise physiology applied in practice”, published in the Netherlands in 2001 and translated in English in 2005.

In 2012 “Krachttraining en coördinatie, eenintegrati-evebenadering”  (Strength training and coordination, an integrated approach) was published in the Netherlands.

 

To book your place please contact David Carolan by email:  [email protected]

 

Mr Ray Moran UPMC Sports Surgery Clinic

Video Blog – Understanding The Anterior Cruciate Ligament (ACL) Injury

Posted on | by Mark Brady | Leave a Comment on Video Blog – Understanding The Anterior Cruciate Ligament (ACL) Injury

You wouldn’t think Arsenal striker Theo Walcott, Chicago Bulls point guard Derrick Rose, New England Patriots tight end Rob Gronkowski, Leinster winger Luke Fitzgerald, Kilkenny legend Henry Shefflin and Tiger Woods would commiserate each other if they ever met. But they’ve all fallen victim to the cruellest little injury in sports: the ruptured ACL.

In ‘Any Given Sunday’, Al Pacino, as Head Coach Tony D’Amato, says victories are gained “inch by inch”, but sometimes it comes down to only half an inch. A half-an-inch wide stretch of a ligament inside the knee is rarely even considered until something goes wrong, and then it is cursed and talked of in grave tones. “Ah, he’s done his cruciate…”

The Anterior Cruciate Ligament is a stabilising ligament in the knee that is designed to prevent excess turning of the knee joint. When the ACL is stretched beyond its stabilising function, it tears or snaps completely, leaving the athlete who was in full fight only moments before lying prone on the ground in agony. Those close by hearing a popping sound which is now synonymous in high-level sport with the end of the season for the injured player as recovery times range from six to 12 months. When Walcott went down with no one close to him in the North London Derby that made up the third round of the FA Cup last year, the Spurs fans jeered him for feigning injury, but his fellow professionals knew it was serious. It was soon after confirmed that Walcott will miss the World Cup as Arsenal announced he was out for “at least six months.”

It is a cruel blow to any player, but it is certainly not uncommon. That ‘pop’ is being heard increasingly on play fields as athletes grow stronger and faster. As the speed of movement increases on the pitch, the chances of tearing the ACL become greater. Still, also, as more is known about the injury, the possibility of prevention becomes greater. Studies have found that incidents of ACL injury are reduced by regular neuromuscular training so that movement patterns, balance and muscle strength are improved in conjunction with each other. As Eanna Falvey points out our video, a simple warm-up routine centred on jumping and landing has shown significant results in preventing ACL injuries in women’s sports where they are four to six times more common due to different use of the quadriceps and hamstrings when landing.

Though impact can sometimes cause an ACL tear, as in Tom Brady’s 2008 injury, generally, the injury will happen away from any contact. Twisting, cutting and landing at speed is usually the cause of that ‘pop’ which is why when Walcott went down yards from any Spurs player the enlightened observer knew it was serious. He’d done his cruciate.

Two or three decades ago, Walcott would very likely have ‘done’ his whole career as doctors would simply not have known what to do despite a relatively long period of research and surgery. The first surgical repair of an ACL was conducted in 1895 in Leeds by A.W. Mayo Robson who stitched back together with the ligament of a miner who had been injured in a fall. Six years later the miner was able to run and walk without limping and reported the knee as being ‘perfectly strong’. Since then the ACL has been treated in a number of different ways to varying success but the present surgery which uses the patellar tendon, which connects the bottom of the kneecap to the shinbone, as a replacement ACL is the most beneficial for athletes. Previously the same tendon had to be rerouted through the femur and tibia which was successful for getting people walking again but less successful for getting young men such as Walcott competing at World Cup level again. Now though the patellar tendon is harvested and fed through drilled holes in the femur and tibia, giving a sturdier replacement which can see full function recovered in less than a year after the necessary rehabilitation.

The surgery itself takes around an hour and a half to three hours to harvest the patellar tendon and rehome it through the knee. It is then really that the hard work begins, as the athlete must endure the rehab process of regaining the strength and muscle in the afflicted leg. In fact some findings suggest that the new ACL – the tendon vascularises to become an organic part of the knee after eight months – is stronger than previously.

It is cold comfort for Theo Walcott in a World Cup year, but he can be thankful that his ACL injury occurred in such a time of surgery and prevention strategies for future injuries.

For further information on ACL Surgery or to make an appointment with an Orthopaedic Consultant, please contact [email protected]
Operating theatre at UPMC Sports Surgery Clinic

‘In the safest pair of hands with Dr Cruciate’

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Irish Times Journalist Ian O’Riordan discusses ACL injuries with Mr Ray Moran.

Ray Moran picks up a plastic model of the knee, and holding it between both hands, makes one simple twisting movement from side to side as if breaking the neck of a little bird.

“What happens is you turn, or land, or put some tension into it, and ‘snap’, it just goes,” he says, pointing to a thin, flesh-coloured fibrous strip, which looks as if it’s been threaded up through the middle of the knee, joining the thigh bone to the shin bone. “And to some extent, it’s not fit for purpose. It’s certainly a bit miserable for the job it has to do.

“Because relative to the size of the knee, it’s not a big member. And it is still such an innocuous injury, in many cases involving a simple change of direction, with no contact whatsoever. I suppose that’s still the scary thing about it.”

It is the anterior cruciate ligament – more typically whispered as the ACL, sometimes going unmentioned for fear of a jinx, or else cursed out loud with a series of dirty expletives whenever that ‘snap’ is heard on the field of play. And for all the advances in sports science and strength and conditioning, it can still tear apart as easy and wretchedly as putting scissors to a piece of string.

Which is where Moran comes in: he wasn’t the first person in the world to perform surgical reconstruction on the ACL, but after 20 years in the business, he’s long since lost count of how many times he’s made the small surgical incision in the front of the knee, inserted the tiny arthroscopic camera, and with freshly stripped portions of tendon sliced from the hamstring and kneecap, begins to deftly rethread the cruciate, finishing it all off in less than an hour by stitching everything back into place – then sending the patient off to begin nine months rehabilitation.

Moran is telling me this in his consultant’s suite at the UPMC Sports Surgery Clinic in Santry, where, a couple of hundred times every year, he tells patients from a wide referral basis the same thing, possibly in more lurid detail, before calmly reassuring them it is all perfectly fixable. Still, it’s hard to imagine being told this for real, especially the elite player who would miss a full season as a result. But if someone has to tell you, they don’t come better qualified than Moran.

It’s been a long learning process. After returning from a fellowship in the US, Moran was working in the A&E at Beaumont, where one night a GAA player came in with a broken arm, lining up with the other casualties. “I remember thinking ‘this doesn’t make sense’, there has to be a better way”: now, the Santry Clinic – which Moran started up in 2007 – is a one-stop-shop for the full array of sporting ailments, not just those requiring surgery.

Recently they have added a running re-education system designed to improve the rehabilitation.

Yet he is their Dr Cruciate, knowing everything there is to know about that thin, flesh-coloured fibrous strip: with that Moran can also strip away the many myths from the simple realities, including the notion that ACL tears are somehow only a recent curse.

“We’ve certainly evolved from chasing the bison, or whatever it is, to feed the family,” he says. “And the sport has taken the knee a little bit by surprise, bringing in high-speed torque, and rotation. And the cruciate is a very small ligament for that job. So a player changes position, or jumps and fields a ball, and the knee buckles on him.

“But what’s new about that? Those features have always been in games. The reality “The reality is that 20 years ago there was very little recognition of the cruciate. There weren’t MRI scans. I still come across guys in their 50s and 60s who tore their cruciate 20 years ago and just didn’t realise it. They had enough cartilage on the side of the knee to get through it. But they have no cruciate ligament. In fact, a lot of those were told they had a ‘weak’ knee. Or a ‘dodgy’ knee.

But nearly all of those were actually torn cruciate, and just weren’t recognised. Some of them were actually sent back to play. That seems ludicrous now, but that was the sequence.”

Moran admits he came into the knee surgery business with a bit of a head start – not just because of his own sporting background, having played soccer himself from an early age growing up in Dublin, but also as the older brother of Kevin Moran, formerly of Dublin Gaelic football, Manchester United and Republic of Ireland fame.

“I did play a bit myself, but I was useless,” he says. “Let’s be quite clear about that. And at home, as the older brother, I had to reluctantly recognise that Kevin was actually good. So he sent me in the direction of early retirement. But some of the sporting interest came off my brother, yes, and I think it was natural enough that I went into sports practice.

“But with patients, too, coming from a sporting background, you’d be somewhat more empathetic. And that’s really lived on.

You would never put a patient at risk. But at the same time, you’re not immune to it being the beginning of a season, a big match coming up, or whatever. “Sometimes in those circumstances, you balance the judgment a little between coming back a little earlier, with maybe a little bit more risk. But not in a reckless way. There’s a grey area in the middle, where you might be able to shave a couple of weeks off the rehab programme.”

That, however, is as good as it gets: along with the notion that cruciate tears didn’t happen 20 years ago, there is no truth in the notion that someday the injury will be preventable, or even surgically repaired to the point of near-total reliability.

“No, we won’t ever prevent it. It’s about diminishing the prevalence. There is some evidence, in Norway, for example, with female netballers, that certain training programmes can diminish the prevalence. And that can be applied to all sports. There are some surgical changes as well, for high-risk cases, like using a bit of the iliotibial band, to create a new ligament.

Like a sort of bionic knee? “No, and there won’t be. We could reach the stage where a six-month return would be considered a quick-fix. And we do get some cases where if its tears off very high, or very low, it can be knitted back together. But repairing is never as good as replacing.”

There was, a few years ago, also the notion that surgical intervention mightn’t be needed at all, that the injured player could carry on through rehab alone. This is what Henry Shefflin thought, before the 2010 All-Ireland hurling final, although unfortunately, he didn’t last long.

“You always get cases when people can manage, through muscular control. But they are the exception. And you can’t build a practice on exception. The downside of not doing the surgery is the risk of further damage to the knee joint.

“And if it’s ruptured it’s usually complete. So getting rid of the problem is not an option. A guaranteed no. We could be still sitting here in 100 years and talking about cruciate injuries. Because it’s wrong to promote the idea we can eliminate the risk. That’s just fantasy.”

There are, however, other notions, such as the GAA player somehow being more at risk (Cork footballer Colm O’Neill, for example, currently recovering from a third tear in six years, and he’s not yet 25); or the notion modern football boots are somehow to blame, with their rigid blades rather than studs. Moran strips all that away, too.

“The blades were getting blamed, but if they were slipping on the foot, the level of rotation going through the knee would be diminished. If they were the old big studs, then the foot wouldn’t slip as easy, and that would have the opposite effect, increase the rotation going through the knee. So I’m not so sure about the boots.

“Now we do see an awful lot of GAA players, but that’s simply because of the numbers that play. The rates would be the same in basketball, and most of the field sports that involve any rotational episode. This is a ‘land-buckle-torque’ injury. It’s doesn’t matter how well conditioned the player is, either. Because it’s a mechanism thing.

“The increase in physicality is a concern, especially in rugby, but, by the same virtue, players are more conditioned now than ever before. It’s always a bit of a balancing act, and any field sport will bring on that reality.

“So you’re either going to play sport or you’re not. That’s not being fatalistic about it. That’s just the way it is. Anyone who thinks you can divorce that reality from the game, well, it ain’t going to happen, We can hose it down a bit, but it will be there. Injury is part of the nature of sport.”

All this talk leaves me feeling a little weak in both knees, walking carefully out of the door, thinking of that little bird breaking its neck, knowing at least I’d be close to the safest pair of hands.

For further information on ACL Surgery or to make an appointment with an Orthopaedic Consultant, please contact [email protected]

‘Ask The Experts’ Irish Runner October / November 2013

Posted on | by Mark Brady | Leave a Comment on ‘Ask The Experts’ Irish Runner October / November 2013
From strength training to stretching to foot-strike, John Foster, Physiotherapist and Neil Welch, Strength & Conditioning Coach, of the UPMC Sports Surgery Clinic offer up their professional advice.

Will strength training help my running?

Those of you who have read Alberto Salazar’s comments on Mo Farah and Galen Rupp’s training will no doubt have taken note of his mention of strength training. The answer, in short, is yes, it will. Strength training will improve your ability to produce and absorb force, enable you to maintain correct form and technique and reduce your chances of injury.
As a general rule, you are looking for as much crossover between your strength work and your running as possible. Single leg exercises such as split squats or step-ups allow increases in strength while having to use ranges of motion and movements similar to running. As for the kind of sets and reps you should be using, aim for shorter sets of 3-6. Heavier weights increase strength more effectively than longer sets of lighter weights. The most important point is to complete the movement, keeping good form with rapid movement.

Is plyometric training good for distance running?

Plyometric training covers a broad group of exercises. Basically it means exercises using some kind of a rebound; running is actually a form of plyometric exercise. We can use higher-loaded exercises to improve that rebound and make a more efficient runner. I like to group the exercises into short and long ground contact and use them depending on the sport.

For distance running, the aim is to apply force to the ground as quickly as possible, not to produce the highest force possible as in a high jump. Because of the shorter contact required, exercises like drop jumps (dropping off a low box and jumping straight off the ground as fast as possible) are good for this. Plyometric exercises should be done non-fatigued with plenty of rest and shorter sets of 3-8 focusing on movement quality. The high loads involved in this type of training mean that supervision from a strength and conditioning coach is preferred as there is a greater risk of injury.

At what age is it safe to start training in the gym?

I will get straight to the point here; there is no cut-off age for safety as regards training. A qualified strength and conditioning coach should be well able to coach pre-adolescent, adolescent and youth athletes safely. There is a myth that delayed growth should be a reason for avoiding strength training; there is no scientific evidence that this is the case. In any case, coaches will generally not be looking to start heavy strength training but will aim to improve and increase the athlete’s’movement vocabulary’ or ability to move well.

This will involve jumping, landing, pushing, pulling, squatting and lunging-based movements in multiple directions. Only once these movements have been optimised would a strength and conditioning coach, generally, seek to add weights to increase strength. This type of training will improve the young athlete’s performance and reduce injury risk, which is greater when playing sport than training in a gym.

Should I adopt a Midfoot Strike Pattern?

Over the last few years, we have seen an increasing number of runners adopt a mid-foot strike pattern. This stems from the belief that the natural way our ancestors ran when they were shoeless was on the forefoot or mid-foot. Several researchers also showed that a mid-foot strike was good for certain injuries. Recent studies, however, have since shown that the majority of habitually barefoot people still land with a heel strike unless sprinting. A midfoot strike is good in certain injury conditions and a heel strike in others. We have major success with Anterior Compartment Syndrome with changing to a midfoot strike but in others such as Achilles tendinopathy, this can often aggravate the condition. Sometimes we have even seen stress fractures develop in the foot as a result. The best advice I can give is to transition SLOWLY. While I tend to advise against an extreme heel strike, there is nothing wrong with a slight heel strike and if it isn’t broken, I don’t fix it.

Should I increase my step rate?

There is a common myth that we should aim for 180 steps per minute when running. This originated from the work of distance running coach Jack Daniels. In the 1980s he analysed the stride rates of several elite athletes and determined that most took about 180 steps per minute.
However, this figure was recorded only during racing and for some reason has been promoted for non-race situations by non-elite athletes. A small increase in step rate makes good biomechanical sense from an injury point of view, due to lower rotational and impact forces, but for the majority of us, an increase of only 5-10% is sufficient. In practice, this is much more achievable, as large increases normally result in excess fatigue and initially poor running economy. Anecdotally, some of our elite athletes report improved running economy after small cadence increases after 6-8 weeks.

Should I stretch?

My patients know I am not a big fan of stretching for the sake of stretching. If I think reduced ankle or hip mobility is causing a problem then we address this with specific mobility exercises. Stretching often causes a reduction in muscle tension, but this tension is required for joint protection and propulsion.

We know the immediate effect of stretching is a reduction in muscle strength and it is this reduction in strength that often leads to problems. Too often I see runners with overstretched, sore calf muscles continuing to stretch in the mistaken belief this will cure their ills. Overstretched tissues are a key component of many runners’ ailments and this becomes obvious on slow-motion video capture. Many of the strategies we employ are actually to stiffen the lower limbs, including step-rate modification, visualisation and runner-specific resistance training. The legs are like springs; don’t overstretch them!

 

Click here to read the full article. For further information on strength training or to make an appointment with a physiotherapist please contact [email protected] or 01 526 2030.

‘Lean On Me’ An interview with Dr Eanna Falvey

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Life is finally calming down for Ireland and Lions team doctor Eanna Falvey after the carnage in the Irish medical bay in the Six Nations and the 60 days spent as part of the mobile the juggernaut that was the 2013 Lions tour. An interview with Dr Eanna Falvey published in the August 2013 edition of Emerald Rugby.
Click here to read the article in full.

‘Problematic running injuries: shin splints and Iliotibial band syndrome’

Posted on | by Mark Brady | Leave a Comment on ‘Problematic running injuries: shin splints and Iliotibial band syndrome’

Physiotherapist Orla Crosse of the UPMC Sports Surgery Clinic explains how to deal with two of the most common and problematic running injuries: shin splints and Iliotibial band syndrome.

Two of the most common running-related injuries I see in the clinic, and indeed in my own running group, are shin splints and Iliotibal band syndrome. If you have a race or event coming up they can put a serious wall in front of you, bringing you to a painful stop each time you put on your runners. Frustration! I’ve heard it all, from ‘try golf ball massage’ to ‘change runners frequently’ and ‘regular deep tissue massage on the shin bone’. The good news, though, is that you can control many variables that cause these issues, you can change the situation. Such overuse conditions are usually affected by your running biomechanics (how you run), leg strength and flexibility. Research has shown that many common running injuries such as ITB symptoms and shin splints could have been prevented if deficits had been identified and addressed earlier. Sports physiotherapists can identify in advance whether physical limitations or deficits exist which may lead to or delay the recovery of current injuries.

Shin Splints

This term relates to pain below the knee in the front of the shins. Most of us have experienced pain along the front of our shins either during or after a run at some point.

Shin splints are caused by many issues which a chartered physiotherapist can discuss with you. Overpronation, worn shoes and inadequate stretching regime or running continuously on a deviated surface (Irish country roads!) are influential factors. True shins splints often occur because of an imbalance between the muscles at the back of your leg (calf) and the front (tibialis anterior).

Iliotibial Band Syndrome

This is an umbrella term for knee pain that can present on the outside of your knee. It is a stubborn and nagging injury and usually occurs after an amount of mileage has built up, but can also affect those new to running.

The underlying causes of pain with ITBS are varied but tend to have a few common threads between patients. Overuse and inflexibility can shorten the ITB. Also, ITB length is influenced by our leg biomechanics or ‘hip – knee – foot’ alignment. Runners who develop ITB pain may overpronate, have a leg length discrepancy, and suffer from weak hip abductor or gluteal muscles. When the ITB reaches the knee it becomes narrow and friction can occur between it and the underlying bone; this causes inflammation, thickening and pain.

Click here for the full article in which physiotherapist, Orla Crosse recommends treatments for these common running injuries.

‘We’re never going to get rid of Cruciate Problem’

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By John Fogarty
Last weekend, Wexford’s Tomás Waters and Waterford’s Martin O’Neill damaged their ACLs (anterior cruciate ligaments), the latest in a long line of inter-county players including three-time victim Colm O’Neill.
At Moran’s UPMC Sports Surgery Clinic based in Santry, a new pitch lab has been developed to investigate what can be done to avoid groin injuries.
The brainchild of Dr Andy Franklyn-Miller and Dr Eanna Falvey, it’s planned that the ACL will shortly be incorporated into the initiative.
Meanwhile, the GAA is currently looking at putting together prehabilitation programmes to cut down the number of cruciate injuries.
However, Moran warns the cruciate is such a “puny” part of the knee that it is always going to be susceptible to tears and ruptures.
“We’re never going to get rid of the problem — it’s whether we can influence it is the question.
“The ACL is vulnerable to rotational activity. Any field sport involving jumping or torque threatens it. To some extent, the ACL is not fit for purpose. An animal like the mountain lion has an ACL like a triple bundle but ours is nothing close to that.
“Sport has taken the knee by surprise with the amount of turning and cutting involved. The Aussies pride themselves on their preventative programmes but there have been several cases of injuries in the AFL this year.”
Moran reports over 60% of cruciate injuries are non-contact and states it’s not a GAA issue. He also says the American Journal of Medicine has had to cull the number of articles on ACL injuries.
He debunks the myth that a torn cruciate injury ages a knee by 20 years. “Those are throwaway remarks. The chances that a patient will end up with completely degenerative knee is actually quite small. As the patient gets older, they can move on from football to golf and the demand levels can drop.”
He also dismisses the effectiveness of ACL braces to avoid the injuries. “A lot of work has been done by the NFL but there hasn’t been documented proof it can be prevented from occurring [by a brace].
“The simplest movement could damage it. You’re talking about snapping a chicken’s neck and if it rotates beyond the control of the brace there lies the difficulty.”
Studies have shown in the AFL that the chances of a cruciate injury recurring are 15% over a five-year period. Cork’s Colm O’Neill this year underwent his third cruciate operation while Kerry’s David Moran has undergone two operations.
“We’re not claiming we can do a better job than the original,” Moran underlined. “It if happens a second time the risk of it happening again can be greater.”
Moran is excited about what information on the ACL may be derived by studies in the UPMC Sports Surgery Clinic’s new lab.
“There is a three-dimensional analysis of the turning on the hip and what way a person runs or cuts and see what impact that has on their groin.
“It’s work that hasn’t been done before and could lead to a preventative programme that may involve re-education in the manner a person runs or cuts.
“They have data compiled of over 200 patients and they’re expanding that to the ACL and seeing can they analyse aspects of running that may contribute to the injury.”

The Science behind the decision to retire from professional sport

Posted on | by Mark Brady | Leave a Comment on The Science behind the decision to retire from professional sport

Doug Howlett’s shoulder forced him out, Ronan O’Gara decided it was time for a new chapter and, tonight, Isa Nacewa will hope to end his career as gracefully as he ended so many attacking moves.

On the other side of the ledger, Brian O’Driscoll opted to carry on. Having vowed all year to ‘listen to his body’, it evidently gave him the good news.

In the end, that’s all any athlete can do, but they require someone like the UPMC Sports Surgery Clinic’s Dr Andy Franklyn-Miller to translate.

Franklyn-Miller is a consultant physician specialising in sport and exercise with a CV that includes British Athletics, the RFU and on into rugby league with the Melbourne Storm and New Zealand Black Ferns. In both codes of rugby, the demands of the modern game mean it is more important than ever to heed Franklyn-Miller’s advice and input.

MORE THAN MANY recent years, the end of this rugby and football season has been dominated by sportsmen asking themselves serious questions.

To carry on and go against some perception that age has made the body no longer fit for purpose?

Or to retire, leave well enough alone and cease to be a sportsman?

Doug Howlett’s shoulder forced him out, Ronan O’Gara decided it was time for a new chapter and, tonight, Isa Nacewa will hope to end his career as gracefully as he ended so many attacking moves.

On the other side of the ledger Brian O’Driscoll opted to carry on. Having vowed all year to ‘listen to his body’, it evidently gave him good news.

In the end, that’s all any athlete can do, but they require someone like the UPMC Sports Surgery Clinic’s Dr. Andy Franklyn-Miller to translate.

Franklyn-Miller is a consultant physician specialising in sport and exercise with a CV that includes British Athletics, the RFU and on into rugby league with the Melbourne Storm and New Zealand Black Ferns. In both codes of rugby, the demands of the modern game mean it is more important than ever to heed Franklyn-Miller’s advice and input.

Higher, faster, stronger

“The game is clearly adapting and speeds are higher. Collisions are higher. Injuries really are divided into avoidable and non-avoidable.” Says Franklyn-Miller. And it is his job to make sure the avoidable category remain avoidable. Particularly as athletes age, become less explosive and heal much more slowly.

Speaking before the Six Nations, Jamie Roberts (a student doctor at the time) speculated that players breaking into the international game at a young age today would not manage to play far beyond their 30th birthday.

However, as rugby becomes more physically demanding, an increase in the integration between coaching and sports science and medicine can help to offset the casualty rate.

“It’s really careful monitoring of the load, monitoring the recovery and then really putting all those bits together so maybe by being smart with working more on speed, muscle strength rather than heavy lifting you maintain he availability on the playing list.

“Our job as sport physicians in a professional environment is really to try and maintain that playing list for the coach at 100%.”

Absolute recovery

As he says, doing that requires a team to be smart. More haste and less speed, in effect, with more timely work rather than simply more – a changeover which many may find counter-intuitive.

“Sleep becomes more important as an athlete ages.” Says the consultant as point number one in a simplified check-list.

“Maintaining quality sleep and recovery becomes a much bigger part of the day-to-day existent than necessarily hitting the same targets in volume.

“You want to try and reduce the training volume to a level which meant that the recovery was absolute.

More sleep, reduced work-load: little wonder that Brian O’Driscoll felt driven to carry on.

Obviously, there is only so far even the best-oiled machine can be pushed. David Wallace last week told TheScore.ie that his strength and conditioning scores had never been as impressive as they were in the lead-up to the 2011 World Cup. Wallace cites the wear and tear on his joints as the factor that eventually forced him to call it a day.

“The longer anybody spends in professional sport or spends time as a full-time athlete they increase the chance of sustaining a joint injury.” Franklyn-Miller adds.

“The more joint injuries build up, the more the impact on the body is and therefore the harder it is to recover from them. The advantage of course is that a retiring athlete doesn’t have the same demand on the body.”

The good doctor is sure to issue a stern caution, however: “The real skill here with someone who has been training professionally for 10 years or more is an athlete can’t just stop.

Cardiac risk

“It’s more difficult for an endurance athlete – a cross-country skier, a rower or swimmer – but it’s the same for anybody who has been training regularly.

“What we know is that if you stop suddenly there is increased risk of cardiac abnormality or hormonal imbalance developing a diabetic type or inflammatory bowel disease or cardiac failure because you’re used to a certain level of activity. And that’s without looking at the joints.

“The immediate risk means you have to go through a period of de-training almost and manage that de-training.”

“The flip side of that is you need a loaded joint for good bone health. So the risk is if you de-load it too quickly you don’t do that and you develop some de-mineralisation or loss of bone strength just by the very fact that you’ve stopped training.”

An athlete’s gift is rare. You either use it, or you lose it.