Fearghal Kerin - T-Junction Hamstring Management

Episode 191: In this episode of the Inform Performance Podcast, Andy McDonald is joined by Dr Fearghal Kerin. Fearghal is a chartered physiotherapist with extensive experience in elite sports. He has worked across Irish sports, including as Rehabilitation Physiotherapist at Leinster Rugby for nine seasons, before transitioning to Chelsea Football Club in the English Premier League, where he held the same position. At Chelsea, he worked with international athletes including Premier League, Champions League and World Cup winners. In this episode Andy and Fearghal discuss the management of T-Junction hamstring Injuries. 

Topics Discussed:

• Evolving Perspectives on Strength and Injury Prevention
   
• Understanding T-Junction Hamstring Injuries
   
• Diagnostic Challenges and Testing for T-Junctions
   
• Establishing a Competency-Based Pathway
   
• Understanding Loading and Injury Prevention
   
• Revising Traditional Approaches to Hamstring Injuries
   
• The Importance of Execution in Rehabilitation
   
• Exploring the Role of Ankle and Hip Mechanics
   
• Identifying Contributing Factors to Hamstring Injuries
   
• Innovations in Rotational Testing and Rehabilitation 

Key Points

• T-junction hamstring injuries are complex and often misdiagnosed due to their variable anatomical presentation. They occur at the confluence of the short and long heads of the biceps femoris, with the location varying significantly among individuals. This variability complicates palpation and diagnosis, often leading to underreporting in imaging studies like MRI, which may require supplementation with ultrasound for dynamic assessment.

• These injuries are characterized by a high recurrence rate, with studies indicating up to 60% re-injury within a few years. The challenge lies in their deceptive recovery; athletes often feel better quickly, leading to premature return to play and subsequent breakdowns. This pattern underscores the need for cautious rehabilitation and extended recovery timelines to prevent re-injury.

• The dual innervation and potential neural involvement in T-junction injuries add another layer of complexity. These injuries often present with a neural component, such as trunk extension or rotation issues, which can complicate the clinical picture and require a multifaceted approach to treatment and rehabilitation.

• Diagnostic clarity is crucial, yet challenging, with T-junction injuries. They are often underdiagnosed due to their subtle presentation on standard imaging techniques. A comprehensive diagnostic approach, including dynamic ultrasound, can help identify the specific components of the T-junction involved and guide targeted rehabilitation strategies.

• Rehabilitation of T-junction injuries should focus on rotational testing and loading, as these injuries frequently involve rotational mechanisms. A structured rehabilitation program that includes anti-rotation, concentric, eccentric, and dynamic rotational exercises can help address the specific demands of the injury and prepare the athlete for return to sport.

• Early loading decisions must be carefully managed to avoid exacerbating the injury. While traditional approaches may emphasize knee or hip dominance, a more nuanced strategy that considers the specific loading needs and adaptations required for T-junction injuries is essential. This may involve a combination of isometric, concentric, and eccentric loading tailored to the individual's needs.

• The role of the biceps femoris long head is critical in T-junction injuries. Dysfunction in this muscle can lead to compensatory hypertrophy of the medial hamstrings or contribute to recurrent injuries. Rehabilitation should focus on isolating and strengthening the biceps femoris long head to restore balance and function.

• Broader anatomical considerations, such as hip and ankle function, play a significant role in the management of T-junction injuries. Addressing deficits in hip strength and motor control, as well as ankle stability and range of motion, can help reduce the risk of recurrence and improve overall rehabilitation outcomes.

• The integration of running mechanics into rehabilitation is essential, as poor mechanics can increase the risk of injury. Training should focus on improving the physical capabilities that influence running mechanics, such as hip strength and control, to enhance performance and reduce injury risk.

• A comprehensive rehabilitation program for T-junction injuries should include a competency-based pathway that incorporates imaging, strength testing, and rotational assessments. This approach ensures that athletes progress through a structured rehabilitation process that addresses all aspects of the injury and prepares them for a safe return to sport.

Where you can find Fearghal:

• LinkedIn
• X (Twitter)
• Instagram

Sponsors

VALD Performance, makers of the Nordbord, Forceframe, ForeDecks and HumanTrak. VALD Performance systems are built with the high-performance practitioner in mind, translating traditionally lab-based technologies into engaging, quick, easy-to-use tools for daily testing, monitoring and training

Hytro: The world’s leading Blood Flow Restriction (BFR) wearable, designed to accelerate recovery and maximise athletic potential using Hytro BFR for Professional Sport.