Physio Room Blog: Mirallas set to miss Stoke trip

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Like every other Evertonian inside Goodison, my heart sank to see Mirallas pull up and grasp the back of his thigh just before half time last Sunday.  Having watched in awe Gibson’s pin point passing, the out ball, to our flying winger, I knew we were in for a tough second half once Mirallas didn’t emerge for the second half.

I think the concern is this may be a recurrent problem for Mirallas, for this season anyway.  I had hoped after the good news of Mirallas’ scan that it was a niggle that would go away.  We’ve seen it time and time again though with young fast players (not so much at Everton as we’ve not had a flying winger since Kanchelskis) being prone to suffering these hamstring strains.  Ryan Giggs springs to mind and Michael Owen is another that has been plagued by hamstring and groin injuries.  Gareth Bale thankfully was missing against us because of a hamstring injury.

Reasons the hamstrings tear

Generally speaking the hamstrings are very stretchy especially in youngsters.  They don’t tend to tear from overstretching during running unless you’re a bit older.  The thing that struck me about Mirallas on Sunday is his hamstrings didn’t ‘pull’ whilst he was running full pelt so I doubt the injury reoccurred purely from just overstretching the hamstrings.  The other reason the hamstrings tend to tighten up is to protect the knee.  Every person with a knee injury I’ve ever assessed has always had increased tightness or spasm in the hamstrings behind the knee. Mirallas gripped the back of his thigh after a jinking run from the right wing area to the left side of the Spurs penalty area.  He was running but I suspect the hamstring tightness came on as a result of the twisting and turning occurring in the knee joint.  As the knee twists, the force of the body weight through the joint is transmitted through the 4 main ligaments, which resist this force to stop the knee collapsing.  The knee ligaments are packed with nerve endings that constantly fire messages to the brain and spinal cord telling our body what position the knee is in and to contract the muscles to change the position of the joint.  Sometimes the force through the ligaments causes them stretch to a point that a pain signal is triggered.  The body perceives pain as harm so the muscles around the knee, especially the hamstrings, tighten up around the joint to protect it from harm. For Mirallas, bearing down on goal, he carried on running and that’s when the hamstring tear may have occurred as he stretched against the body’s protective tightening of the muscle.

What can be done about it?

I talked in my last blog about how the hamstring tear can be treated but Mirallas will now have to embark on rehab training to prevent this injury becoming a persistent problem.  This involves specific strength work, not just to bulk up the muscle but also to gain better control through the muscles around the knee to improve balance and fine movements and better resist twisting movements.  This however takes time and is why Mirallas might not be free of this problem just yet.

Improving proprioception

Proprioception is a fancy word given to your balance reactions.  It’s a bit more than that though.  It’s your ability to know what position your joints are in and what force is required to perform a certain movement.  An example of this is to close your eyes, point your finger out to the side then place your finger on your nose.  Providing you’re not drunk and you managed to do it, how did you know what position your arm and hand were in order to touch your nose?  How did you know not to slam your hand into your face and break your own nose?  That’s the proprioceptive reaction.

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If you transfer this to running, your proprioception is the reaction that controls the fine movements of your leg.  The better your proprioception, the better control you have of your joints and therefore the less chance you have of injury.  Another example of this is to stand on one leg and keep your balance.  Now close your eyes and keep your balance.  How long did you manage?

Your proprioception can be trained to improve.  If you spend time standing on one leg with your eyes closed, you will find the more you practice the longer you can stand without falling over.

This is low-level stuff but is your basic starting point to improving your proprioception.  For Mirallas, rehab should be progressed to involve different types of balance exercises, practicing twisting movements and fine control of the knee joints through the range of movement.  On top of this, more traditional strength sessions in the gym to bulk up the hamstrings will no doubt take place.  For now, Mirallas should recover quickly from the current hamstrings pull and Moyes said he took him off as a precaution but expect Mirallas to be in and out of the side this season because of his hamstrings.

Expected return: 1-2 weeks.  West Ham away.

By Ross @UKPhysiotherapy

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