Old Bawn Clinic articles & publications

HOW TO AVOID INJURY ON THE SLOPES WITH TOP SPORTS PHYSIO ALAN KELLY

There was a time not so long ago when skiing was the preserve of the rich and famous. The only time mere mortals got to see it was looking at film stars in glossy magazines skiing down the slopes in Aspen.' So says top sports physiotherapist Alan Kelly, (or AK). 'But not so now with the onset of cheap travel, skiing is now open to just about anyone and with the winter ski season approaching the clinic will start to fill up with a whole collection of skiing injuries. Most of these will affect the unfit, recreational skier - the man or woman who looks at the brochure and says "let's go for it."

Falls account for 70% of all ski injuries, with medial knee and ligament strains being common. "These usually happen when beginners twist their knee while falling. Damage to the cruciate ligament can also happen to skiers who fall backwards while their leg is extended forward. Fractures also occur in violent falls and collisions.' Upper limb injuries account for the rest o( the injuries - with thumb sprains being common.

THE APRES SKI FACTOR
Alan Kelly has also noticed that most ski injuries occur on day three of the holiday. Three days on the slopes and a few late nights' apres ski and your concentration just won't be the same,' says Alan. 'And with poor concentration injuries are more likely.'

The ways to avoid injuries begins weeks before you even hit the slopes. 'Apart from moderating your alcohol intake and getting plenty of rest you should also take part in a good pre ski conditioning programme.' says Alan. 'The training must focus oh building muscular endurance, to help avoid fatigue and maintain technique. But am exercise programme should be functionally related to skiing to get the most benefit.' This means the exercise programme should rehearse any moves you will be making on the slopes.

Alan also suggests working out in a good gym. 'Most gyms have pre-ski exercise programmes. lust make sure the training focuses on building muscular endurance to help avoid fatigue and maintain technique. Studies show that all the major muscles work hard during skiing turns. Tummy and back muscles are working especially hard to maintain your forward position on the skis - so theses muscles must be in good shape.'
Alan has several other tips: take ski lessons if you have never skied before, pace yourself, get your ski instructor to show you how to fall correctly, check all your equipment before you go our and consider each ski day as being equivalent to two heavy sessions in the gym

Alan Kelly, is one of Ireland's leading sports physiotherapists. known to friends as ‘The Great AK’ he has worked with some of ireland’s top athletes. names such as DJ Carey, Kieran Mcgeeney, Peter Canavan, Padraig Harrington and Ronan O’Gara, to name but a few that have benefited from AK’s healing touch.

With over 20 years in practice, Alan writes exclusively for the player and gives a unique insight into one of the most common injuries in GAA players and tips on prevention and treatment of the dreaded hamstring injury.

We all know the feeling - you have just bent down to pick up that ball, looked up, and you’ve seen the gap; shoulders back, turbo on and as you accelerate through you are suddenly vercome by agonising severe pain in the back of the leg. You sometimes think you have been shot from behind. there is immediate loss of function as you pull up sharply. The muscle is in spasm and is extremely tender. You beckon to the sideline for assistance and as you are assisted off the pitch, the coach can often be heard murmuring "oh no, not another hamstring."

In a recent study carried out on Gaelic football injuries, the hamstring accounted for 25 per cent of all soft tissue injuries, so now it might be time to think that the hamstrings are much more than big slabs of meat at the back of your thighs. they actually consist of a functionally, very important group of muscles. The hamstrings are unique in the fact that they span over two joints, the hip and the knee. they also have to perform a multiplicity of tasks in the sprint, gait cycle. When running, the hamstring is required to forcefully contract both eccentrically and concentrically, shortening and lengthening, extending the hip and fl exing the knee.

This puts the muscle under an extreme amount of load especially when the muscle is fully lengthened. When the hamstring muscle becomes tight the resting length of the muscle shortens and this is when it is most vulnerable. Although no exercise can guarantee an injury-free existence, hamstring training is very important as a precautionary attempt to minimise injuries. the smallest tear in a hamstring can set a player back three to fi ve weeks so it is very important in your pre-season work to ramp up your leg power and flexibility to reduce your chances of injury.

HAMSTRING MUSCLE TEARS ARE BELIEVED TO RESULT FROM A COMBINATION OF FACTORS Intensity of training and matches Inadequate strength of the affected muscle Muscle strength imbalances (ratio of hamstring to quadriceps front thigh muscle strength). When the quadriceps overpowers the hamstring it can cause a severe muscle tear. Inflexibility of the affected muscle. A strong pre-stretched muscle has a much better chance than a weak inflexible one. Inadequate and improper warm-up. A player must fully understand the needs and demands of the game and what the muscle is expected to do. Poor core stability and functional strength which can lead to extra work for the hamstrings. Previous injury not properly rehabilitated. 1 2 3 4 5 6 7 TREATMENT The immediate treatment of the acute hamstring muscle tear is still the old reliable rest, ice, compression and elevation. You must apply your ice packs to the tender area straight away. Elevate the injured limb where possible and apply a compression bandage over the site as soon as the initial ice application is completed.

Over the last number of years in my clinic, I have dealt with numerous players from club to senior intercounty who have been mismanaged, misdiagnosed and mistreated. The player is always vulnerable and time can be critical. How many players have come across the eager masseur or sports therapist who has massaged and stretched the injured muscle in the acute stage (i.e. 24 to 72 hours) and has done as much damage as the player would if he went back out to run or play again?

The rules regarding treatment are still the same. Firstly, do no harm and secondly, as with any injury, the correct diagnosis is vitally important. How can you treat what you don’t know? More, importantly still, is a detailed and accurate history to try and prevent recurrence.

Irrespective of what treatment protocol is used, one of the most important factors for healing and treatment is the relationship between the player and his therapist. The human element cannot be overstated. Healing takes place the moment the player or patient fully believes and trusts the practitioner. As my good friend and colleague Mr Gerard Hartman would say “Belief creates a flow of healing.” The mind is such a powerful force in terms of healing that while we must never fool a patient, we may use persuasiveness as an ingredient in treatment.

REHABILITATION Signing off a players’ rehabilitation is a major decision so best to get it right. Often, rehabilitation programmes stop when the player is able to run. However, in sports rehabilitation it is also important that besides being physically able to return to full activities, the palyer must also be psychologically prepared.

The activities undertaken should include everything the player is likely to do on his return to full unrestricted training and playing. This includes kicking, twisting, turning and all other movements associated with the game.

Again, it is so important that the therapist has complete knowledge of the demands that are likely to be placed on the player when he returns to play so that the activities can be introduced that would place more stress upon the injured part than would occur during normal programmes.

How many players injure their hamstring only to re-injure the same hamstring at a later stage, so band aid therapy has no place in modern treatment protocols.

A holistic approach must be taken. Flexibility of structures that affect the biomechanics of the hamstring should be considered as very relevant. Just like simple engineering, structure will always govern function. n You can contact Alan Kelly at the Old Bawn Clinic, Ph: 01-4513207

HOW TO AVOID INJURY ON THE SLOPES WITH TOP SPORTS PHYSIO ALAN KELLY

There was a time not so long ago when skiing was the preserve of the rich and famous. The only time mere mortals got to see it was looking at film stars in glossy magazines skiing down the slopes in Aspen.' So says top sports physiotherapist Alan Kelly, (or AK). 'But not so now with the onset of cheap travel, skiing is now open to just about anyone and with the winter ski season approaching the clinic will start to fill up with a whole collection of skiing injuries. Most of these will affect the unfit, recreational skier - the man or woman who looks at the brochure and says "let's go for it."

Falls account for 70% of all ski injuries, with medial knee and ligament strains being common. "These usually happen when beginners twist their knee while falling. Damage to the cruciate ligament can also happen to skiers who fall backwards while their leg is extended forward. Fractures also occur in violent falls and collisions.' Upper limb injuries account for the rest o( the injuries - with thumb sprains being common.

THE APRES SKI FACTOR
Alan Kelly has also noticed that most ski injuries occur on day three of the holiday. Three days on the slopes and a few late nights' apres ski and your concentration just won't be the same,' says Alan. 'And with poor concentration injuries are more likely.'

The ways to avoid injuries begins weeks before you even hit the slopes. 'Apart from moderating your alcohol intake and getting plenty of rest you should also take part in a good pre ski conditioning programme.' says Alan. 'The training must focus oh building muscular endurance, to help avoid fatigue and maintain technique. But am exercise programme should be functionally related to skiing to get the most benefit.' This means the exercise programme should rehearse any moves you will be making on the slopes.

Alan also suggests working out in a good gym. 'Most gyms have pre-ski exercise programmes. lust make sure the training focuses on building muscular endurance to help avoid fatigue and maintain technique. Studies show that all the major muscles work hard during skiing turns. Tummy and back muscles are working especially hard to maintain your forward position on the skis - so theses muscles must be in good shape.'
Alan has several other tips: take ski lessons if you have never skied before, pace yourself, get your ski instructor to show you how to fall correctly, check all your equipment before you go our and consider each ski day as being equivalent to two heavy sessions in the gym

A tangle of legs, a seemingly Innocuous tumble and a horror moment frozen in time by a photographer's lens.

"I heard a crack, I didn't know from where. But I knew it was the leg. The initial pain was very bad. After that, I don't remember most of it," Beano recalls.

For those watching on TV, instant replays revealed the worst. McDonald's lower right leg had snapped. The following day's newspapers would offer graphic confirmation.

McMenamin, horrified, started waving frantically for medical assistance. Gerry McEntee, the former Meath footballer and leading surgeon, acted almost as swiftly, he texted Laois selector Declan O'Loughlin to assure him the Mater Hospital would be on standby for their stricken star forward.

Beano was in the Mater inside 25 minutes. A fractured tibia and fibula was diagnosed. He was booked into theatre the next day. Nine months on, you have been granted the privilege of sitting in with Beano on one of his regular trips to the Old Bawn Clinic.

There, physical therapist Alan Kelly aka "the great AK" has been nursing his broken body back into championship shape since late January. In some ways, Beano's plight has been magnified by that captivating Sportsfile photo. His private hell made public property. You ask if the photo upsets him.

"I don't mind looking at it. It happened and hopefully it will never happen again," he states, matter-of-factly.

"But I can remember the following morning. I hadn't seen the photo and I was being brought into theatre. Whoever was pushing me from behind, he hadn't said a word and then he said "well, did you see the picture?"

"And I said 'no' and he said "wait', just as he was coming back, the nurse said Jeez, don't show that to him! 'I knew it was bad, but I didn't realise (how bad) until I saw the picture."

Mr Ashley Poynton performed the surgery. The leg wasn't put in plaster; instead, a nail bar was placed along the tibia to hold the broken shin bone in place while two screws were inserted near the knee and another near the ankle.

The crutches were cast aside on September 14. "He told me to use the crutches as little as possible, so I didn't use them at all after that" the model patient reveals.

In early winter he rejoined his laois colleagues for upper-body weight training. But the long road back to fitness was only just beginning...

THOROUGHBRED CROCK
Brian McDonald is one of a rare breed of GAA stars who are instantly recognisable by their first name (think DJ, Paid!) or in his case a nickname "Beano" - that has long overtaken his real one. Hard to believe he will only turn 25 on June 7; he has been making headlines for almost a decade.

Laois may have produced the original Boy Wonder (Tommy Murphy) and the latest (Donie Brennan) but Beano was the nineties wonderkind. He appeared in three consecutive All-Ireland minor finals, winning in'96 and '97, losing in '98. He was scoring for fun and coveted by all. He made his senior championship debut on his 18th birthday, coming off the bench and scoring a late point as they beat Westmeath. "When I was 18 I was Laois minor. U21 and senior," he recalls.

He didn't think about burnout back then because he was too busy playing ball. For myriad club and county teams, and pretty soon college in UCD. Alan Kelly recalls Beano's first visit to his clinic on January 28 last. He was like a battered old car in need of a "complete service." His right leg. thankfully healing, was only part of the problem.

"The only regret I'd have with Beano is that someone, anyone, didn't get him a couple of years earlier to correct all his lower limb biomechanics. He was over-trained and over­played to death. He wouldn't be the first one, and he certainly won't be the last. It's endemic," he sighs.

Kelly is something of a sports injury guru to the stars. He has stuck his strong healing hands into DJ Carey, Peter Canavan, Dessic Farrell, Keiran McGeeney and several of his Armagh teammates, a host of Tipp hurlers and many more besides. He has treated millionaire pros like Padraig Harrington and is alarmed by the spiralling commitment asked of so-called amateurs.

The cost can be counted in a glute of wear-and-tear injuries, especially at county level. Gilmore'a groin is so common, you'd swear it was infectious. Beano McDonald was already suffering his own groin problems before he broke his right leg. It had bothered him all summer. Renowned for his ability to turn on the proverbial six-pence, any twisting was liable to cause a dart of pain. He was also prone to lower back trouble. And several years earlier, in 2000, he had broken his left fibula. The war wounds were catching up on him.

BACK TO THE MATER
On December 21 last he was back in the Mater for groin surgery under Gerry McEntee, who performed an abductor tenotomy. The tendon is very, very tight. He cuts to release it," Kelly explains. Beano was given a six-week programme. But by late January another ongoing groin syndrome osteoitis pubis was causing problems and McEntee referred his patient to Kelly. It was now time for some serious handiwork. "The rehab has to be very sports-specific, it has to be aggressive and determined. If it's not, he's not going to get better." Kelly outlines. He got to work on the lower leg where, as the bone repairs, it tends to ossify or thicken. This had to be broken down, slowly but surely. The groin was more problematic, and even more painful.

"Some of the sessions here were nothing short of brutal, weren't they?" Kelly recalls.
"Unreal!" Beano admits. "I had to put the air-conditioning on at least two occasions!" Kelly quips. "But we got there, and pain-free now."

Initially, Beano was making the 75-minute Tallaght trip three times a week. He recalls some particularly painful sessions around February/March, when he almost unleashed a few instinctive uppercuts on his "tormentor".

Even during our visit (when the worst is over) we overheard the occasional "Sorry Beano" and "Oh Jesus!" from his grimacing patient as Kelly worked on the groin, and later to relieve some inflammation of the sacroiliac joint, where the spine and pelvis connect.

There have been in minor hitches along the way. Initially, when he went back jogging as part of his groin rehab, he still had a bad limp in his right leg. The limp disappeared but then the four-inch screws in his knee started to cause trouble. These were removed under local anaesthetic (a "sore enough" procedure) in early March.

Within a week he was back running again, but the osteoitis pubis came back "as bad as ever" at some stage in March. Other problems were tackled as part of a complete patient Overview. Beano had very flat feet and a slight leg length discrepancy. That needed to be corrected by a very good podiatrist. He did a complete biomechanical gait and stride analysis with him," Kelly outlines. Beano was fitted with customised orthotics which, apart from offering cushion and support, act like "a rudder in your shoe. They will track you in the right biomechanical groove."

Armagh footballing superstar Diarmuid Marsden has been on a pilgrimage to the foothills of the Dublin Mountains in search of the cure that will rejuvenate his season. Marsden, the man widely regarded as leading the race for the footballer of the year award has his had season overshadowed by injury.

But he has beaten a path to the Old Bawn in Tallaght where he is the latest in a long line of athletes to respond to the healing hands of Dublin Alan Kelly.

Known by his patients as "The Great AK" it's a name built by the hands that are making all the difference to a growing wave of Irish sports stars.
For the past 12 years, Kelly has been working quietly away, building up a network within the sports community here.

A life member of Thomas Davis GAA club, much of his work has been in the injury-filled world of rugby, where he is into his tenth year with Old Wesley. He also worked from 1994 to 1998 as physio with the Leinster inter-pro team for their European Cup campaigns.

Attention

But it has been his association with top GAA stars like Marsden - who was on RTE radio this week singing his praises - that has really drawn attention to a man who has a client list that reads like an All Star team.
Nicky English has credited Kelly with helping extend his playing career by fending off injuries. And indeed, so impressed was he that he made him part of his set-up with the Tipp team this year as they won the League and brought Clare to a replay in the Championship.

Kilkenny's DJ Carey is another devoted follower and regular visitor. His current treatment list includes such household GAA names as Michael Duignan, Noel Connolly, Brian Lacey, Peter Barry and Brian McEvoy.
His treatment room is packed with autographed pictures of a whole range of stars who have left mementos of their thanks.

Top tennis player Scott Barron and Ciaran McDonagh, national senior long jump record holder and described in a recent Irish Runner article as "the best white long jumper in the world" are also among those who have included him in their preparations. Modern technology has given rise to a wide range of machines to aid physio treatment. But Kelly remains unswayed, keeping ultimate faith in the power of his hands to come up with the cure.

"The secret is having access to accurate diagnosis" he claims. And it is the ability to quickly get to the root of a player's problem that has singled him out for special praise. A close friend of Limerick and London based physio legend Gerald Hartmann; Kelly also has close links with the newly opened Tallaght Hospital and top surgeon Arthur Tanner to help establish a quick and accurate picture of the problem involved.

After that Kelly admits he is a task master and it is his skill at raising the spirits of injured players which he believes is of as much benefit as his work on the injured muscles. “You have got to be able to help in every way. This physical and mental fitness is intrinsically linked and you can’t fix one without the other” he explains. “A player who comes in here is injured is obviously going to be down and worrying about missing a competition or losing their place. It’s important that you raise their spirits. “It means building up a level of trust with the athlete which is invaluable” he adds.

Injury is an accepted part of sport now – something Kelly believes is down to the extra amount of games played, and the greater intensity and pressure that is involved. “The guys playing now are bigger, stronger and faster than athletes of 20 years ago and injury is depending on the intensity and duration of the activity” he says. Kelly is forever mindful of the need to show respect to the huge number of physios and doctors who are working with teams around the country.

But while he may not say it, you only have to look at his expanding list of top class clients to be convinced that there is definitely something special to his treatment and approach to healing injury.
A lover of all sports, the 46 year old admits to having a soft spot for footballers and hurlers.“The GAA guys deserve much more credit. They are amateurs playing in front of huge crowds but who have to find time of work, family, training and physio all in a day. “I think guys like DJ Carey really have to be admired” he says.

Greece can boast Alexander the Great, Russian Peter the Great and Turkey can go one better with Suleman the Magnificent, but Tallaght can be very proud to boast a great of its own.  The Great AK is the name bestowed upon life-long Tallaght resident Alan Kelly by the numerous sports stars the physio has treated.

Kelly has always had a passion for sports and competed for years, but his passion and gift for physiotherapy overcame the love or playing and he decided to concentrate on his physiotherapy career.  And what a decision it turned out to be, it’s certainly one which Ireland’s sporting elite are glad he made.

Kelly is now one of Ireland’s leading sports physiotherapists, working with some of Ireland’s best-known athletes such as DJ Carey, Kieran McGeeney and Padraig Harrington, to name but a few.

Originally a Thomas Davis man, Kelly never moved far away from home and set up his clinic on the Old Bawn Road and remained at the Tallaght locations since 1987.

And the clinic has become more and more of a success and a big part of many sporting achievements including numerous All Ireland Championship-winning campaigns.

Upon entering his Old Bawn set up the first thing you noticed, as a result of the numerous pictures on the wall, is the vast array of stars the man has helped to heal.

There are countless pictures of GAA players who have previously suffered terrible injuries but, after being treated by Kelly, have returned to play and be successful.

One of the biggest and most graphic injuries we have seen would be when Brian “Beano” McDonald broke his leg playing for Laois against Tyrone in the All Ireland Quarter final in 2004.  That television image and the newspaper pictures of his hand reaching down to his leg with agony clearly etched on his face brought sympathy flooding in from all parts of the country.  His standing in the game as a player of the highest sportsmanship and having displayed such skill since his underage years had made Beano a household name and such was the extent of his injury that it was feared he would never grace a football field again.

However, after months of medical care he went to Kelly in Old Bawn and with intensive physiotherapy, he was back playing in 2005.  Kelly explained to The Tallaght Voice: “It’s hard when you see young people coming in with sports injuries, both Brian [Beano] and Diarmud Marsden’s injury have been the most difficult.  It’s not only the injury you have to worry about, the person’s confidence has hit a new low, so I try and convince them to be positive or else there is no point in trying to solve the problem.

“Rehabilitation is a major factor when it comes to treating an injury.  If you do everything by the book, and do not rush things gradually everything will fall into place. Some people feel that there should be instant success when having physiotherapy – this is not the case.  It could take months/years – it all depends on how bad the injury is,” he added.

Kelly feels that if people are patient everything should hopefully improve.

Sports injuries these days are second to nothing, pulled hamstrings, ankle, shoulder problems are just some of the many injuries that young sports competitors are suffering after training or playing games.  And Kelly feels that some of the injuries occur as a result of over training or the intensity of the training or if a previous injury hasn’t been treated properly.

Last year’s Dublin Hurling Champions and local side Ballyboden St. Enda’s were one of Kelly’s many benefactors.  And although the majority of his clients in the sporting world would be GAA inter-county players, Kelly states: “I have treated rugby players like Ronan O’Gara and Brian O’Driscoll in the past, but those lads can relax on a Monday morning after a game.  GAA players can’t, they all have to work and pay bills so in the long run it is harder for the GAA players to recover, at the end of the day they are amateur players.”

Having seen the efforts those amateurs players put in a at firsthand, and with the new GAA Schemes coming into place, Kelly feels that the players should get more benefits.

The GPA are doing a great job for the players and at the end of the day, they provide entertainment for us, why shouldn’t they get some sort of reward” he continued. This year the Tallaght great has taken on somewhat of a new challenge and setup a clinic in IT Tallaght, further cementing his position in the area.

“The clinic runs one day a week and so far it has been a great success,” Kelly, who works closely with Tim O’Connor – Head of Sport in IT Tallagh and Gerry Anderson, explained. With a lot of sports within IT Tallaght it makes sense that a local person opened a clinic and in Kelly they got one of the country’s best.

The charismatic Tallaght man has also started lecturing on physiotherapy in Setanta College, which is a blended learning institute that offers managers, coaches, players, teachers and sports science graduates the opportunity to pursue practical coaching courses via the internet learning process.

The appointment of Kelly to the post further increases his Stock especially when you consider lecturing with him are such people as Jim Kilty (former Irish Athletics coach) and Dr. Liam Hennessy (Director of Fitness for the IRFU).

But for now it is  alook ot the year ahead and with the GAA Championship falling into place over the next week or so, no doubt there will be injuries so the healing hands of the Great AK will be needed.