David, Author at Paramount Physiotherapy

Cervicogenic Headaches: Neck Pain


Cervicogenic Headaches: A Pain In The Neck!


Headaches and neck pain are quite common amongst the general population. The World Health Organisation reports that last year, almost 50% ALL ADULTS suffered a headache once or on multiple occasions.



It is quite literally a pain in the neck!



There are a few different types of headaches, however, there is a particular type that can be treated effectively through manual therapy and exercise, which is called a cervicogenic headache.



What Is Cervicogenic Headache?


Cervicogenic headache is a type of headache where the symptoms begin from the neck. 


The cause is related to the soft-tissue around the neck area. And in most cases, other factors such as emotional and physical tension can cause headaches.


When you have cervicogenic neck pain, you may feel pain in the jaw, head, forehead, back of your eyes, and/or ears. Typically, the pain is referred from the top three vertebrae in the neck.



People that suffer from this headache are mostly aged between 20 and 60 years, though anybody can have it regardless of their age. There is a greater number of teenagers experiencing these headaches due to the increased stress and study times associated with schooling.


Cervicogenic headache can occur when you slouch for long, sit in a poor posture, or work in sustained postures i.e. sitting on your computer for a prolonged period of time.


I am sure some people can relate to having a long, stressful day at work, sitting down without any breaks and the boss is busting your chops….then a raging headache starts!



Can Physio Help With Headaches?


Physiotherapy has been shown to help with headaches through the use of joint mobilisations, massage and specific neck mobility and strengthening exercises.


Symptom reduction should occur within 1-2 weeks where the intensity and duration of headache symptoms will diminish.


Why 1 to 2 Weeks?


It takes a few sessions for your muscles to decrease in tone or tension which then allows the pain sensitivity to decrease over that given time period.


Everyone’s symptoms behave differently, but everyone’s tissue healing times are the same, with full tissue recovery around 6 weeks.


So I Should Be Back Around The 6 Week Mark?


Basically, cervicogenic headaches are caused by poor posture, stiffness of joints in the upper back and neck, muscle imbalance and previous trauma. To ensure that physiotherapy helps with headaches, the upper back and neck are carefully and fully assessed.


This enables the physiotherapist to focus the treatment accurately and ensure that the symptoms don’t just get treated, but the cause of the headache are dealt with to reduce the chances of headaches in the future.


This process does take time and is not an overnight fix.



What Do Physios Specifically Do For Neck Pain?




Your physio will need to take a detailed history of all the things surrounding the time of when you first got your headache, and a history of previous injuries. Below are some of the things that will be covered specific to neck pain:


  • Any trauma: current or previous trauma, motor vehicle accidents
  • Stress: work stress or life stress
  • Prolonged postures: at work or home
  • Work ergonomics: ergonomic set-up


Then a physical assessment looks at:


  • Posture: neck posture, thoracic posture
  • Joint stiffness: decreased movement and/or increased sensitivity around the neck, head, jaw, thoracic spine
  • Muscle imbalance: assessing the strength and control of the deep neck stabilisers





Headache and neck pain treatment is individualised and based upon assessment findings. The principles of treatment are similar to acute low back pain and may include:


  • Massage
  • Dry needling and trigger point therapy
  • Joint mobilisations
  • Education: Work ergonomics, posture, pillow use
  • Stress management: physical therapies help with stress management but giving you the tools to deal with stress at home or work is vital
  • Exercise: Strengthening of the deep neck stabilisers are key to decreasing recurrence of headaches and is the cornerstone to your treatment



The Bottom Line


Physiotherapy is your new headache pill!


Physio can help with headaches when administered properly and can use different techniques for restoring movements while helping the you work on the other causative factors, to decrease the chances of you getting a headache in the future.


If you want to know a bit more about what physiotherapy is and how it can help, have a read here for further information.


David Bruzzese (MPA, AEP)

APA Musculoskeletal Physiotherapist & Accredited Exercise Physiologist

Persistent Shoulder Pain

Persistent Shoulder Pain: Avoid The Cycle



Have you had shoulder pain for a while?



You don’t remember any clear injury, but the shoulder pain just won’t go away!



At first your shoulder pain was sometimes and tolerable, now your shoulder pain is relentless and impacting your life!

Sound familiar?


Does this resonate with you? If so, read on!


The Never-Ending Pain Cycle


You’ve been stuck in this rut for a while now. The shoulder pain just won’t go away, so you go to see your doctor.


You walk out of there with advice to rest the shoulder from all activity and take a cocktail of medication.


You rest, avoid doing the things you enjoy, and the things you need to do. Frustration grows, but the pain settles. The journey has come to an end, back to normal life!


You begin some activities again that used to aggravate your shoulder, then there it is again, that familiar shoulder pain! Below is a diagram to show what is going on.



Back to the doctor. FRUSTRATED, ANGRY and FED UP. A scan gets organised.


The scan comes back, and there’s all these words: degeneration, arthritis, subacrominal bursitis, rotator cuff tendinitis, rotator cuff tear, and so on.


That’s it! That’s the reason! So, a corticosteroid injection is organised.


The needle is HUGE, the injection hurts. It’ll all be worth it though! Right? You’re told to rest for another 2-3 weeks. Your shoulder pain either:

  1.       Doesn’t change at all!
  2.       Reduces, but doesn’t go away
  3.       Returns a few weeks later
  4.       Returns a few months later


When will this end? The scan said what was wrong, didn’t it?



What Does My Shoulder MRI Mean?


Medical imaging can be a very useful tool in diagnosing certain conditions. However, sometimes they can see a little too much!


As we age our body changes. We get greys, we get wrinkles, we get changes to tissues inside the body. These changes are completely normal, and exist in lots of PAIN FREE people.


Wait! What?


Research is piling up every day of PATHOLOGY seen on imaging in PAIN FREE people, all over the body!


One particular study of the shoulder reported 70% of PAIN FREE people had mild shoulder arthritis. They also reported that 90% had mild-moderate subacromial bursitis! Read that again, 90% of PAIN FREE people with NO HISTORY of Shoulder Pain had a pathology.



What About Rotator Cuff Tears? Surely A Tear Causes Pain?


In this same study 60% had either a partial or full thickness supraspinatus tear, and that’s only one of the rotator cuff muscles!


Starting to see why the corticosteroid injection may not have worked? The pathology on imaging may not be the reason you experience pain!


So what’s the answer?



Shoulder Anatomy & Human Physiology 101


The shoulder joint is made up of two bones, the scapula (shoulder blade) and humerus (arm bone).


The shoulder joint is designed for mobility! This is hugely beneficial; it allows us to accomplish many tasks in our daily lives, sports, or jobs.



But, Having Mobility Requires Stability!


Stability of the shoulder joint is provided by two muscle groups; the rotator cuff, and the scapular muscles.


The rotator cuff is a group of muscles that provide dynamic stability of the shoulder joint. When their strength and activation is less than what your body needs for the tasks in your life, your shoulder can become prone to irritability.


The scapula position and how it moves can also influence how your shoulder joint moves and functions. Stability of the scapula is also integral to a happy and healthy shoulder joint.


Starting to make sense why rest hasn’t worked?


When our muscles and tissues have prolonged rest, their capacity reduces! If you reduce your capacity, your tolerance to load (daily activities, work, sport) also decreases.



How Do We Break The ‘Never-Ending Pain Cycle’ At Paramount Physiotherapy?


  • Restoration of scapular control
  • Regaining full range of motion for the shoulder
  • Restoration of rotator cuff strength
  • Restoration of shoulder proprioception
  • Restoration of sport specific capacity – strength & power
  • Return to work or sport


Mark Walters (APAM) 


Do Runners Still Need to Go to the Gym?



Is Exercise Really That Important!



Some people think that running can only be improved by running. But, research shows that the strength training that runners engage in at the gym has a significant effect on their performance and endurance.


It’s hard as a runner to take a break from running, for some it is their social outing, for others it is like meditation. Unfortunately, a significant percentage of runners sustain injuries every year that hinder them from continuing training.


In most cases, these injuries result from muscle imbalances, ignoring niggles thereby letting them become bigger problems, and inappropriately loading.


Strength training plays a significant role in improving correct motor patterning and running economy which leads to fewer injuries.


Injuries Are Inevitable.



When a runner is injured or uninjured, a physiotherapist will often prescribe a running specific strength training routine. Post injury the strength training is an important step in getting you back to running.


To stay injury free, a runner should make the strength session a vital component of their weekly training schedule. That’s because this routine becomes the running strength foundation.


Like we say at Paramount Physio



Really. The Gym!



Some runners don’t like the idea of spending time in a gym, but it is a worthy investment. We recommend that runners give up some time of running every week in favour of strength training in the gym.


That’s because starting a strength based routine can mark the beginning of stronger, faster and healthier running.


The strength session doesn’t necessarily need to be in the gym either; an effective home exercise program can be established.



Still Haven’t Convinced You!



Evidence has shown that incorporating weight lifting into the regular exercise routine of a runner increases VO2 max (the measure of aerobic endurance) and speed.


The brain alters the neural recruitment pattern thereby calling up the fibres of fatigue-resistant muscles so that the athlete can exert minimal energy.


Strength training also promotes hypertrophy in both the type I and type II muscle fibres (type I being most beneficial to running.)


Essentially, strength training plays the following major roles:

  • It assists in loading connective tissues and muscles thereby preventing injuries.
  • It helps an athlete run faster by enhancing neuromuscular power and coordination.
  • It improves running economy by boosting stride efficiency and coordination.


You Get It Now, Right!?



A runner should know when and how to progress. For instance, if you can’t manage 30 reps of a one-leg calf raise, you may not be ready for certain running distance.


If the muscles which provide support/power to your running are not functioning properly, compensatory patterns will be evident. In that case, strength training can be a more efficient way of increasing this capacity.


Generally, the bodyweight strength training that runners engage in at the gym exceeds strength. Nevertheless, strength training should focus on different parts of the body.


A runner should not only include lower body exercises to make their running more efficient; a balanced strength training program should include exercises for the upper body and core exercises as well. This ensures that a runner has a phenomenal mobility and overall strength while running.






  • Research indicates that strength training enhances the running economy and performance of runners


  • A strength program should be practice in conjunction with a runner’s normal running schedule


  • Strength training has numerous benefits that should prompt every runner to incorporate a few sessions per week into their routine



Tara Clifford

Physiotherapist & Clinical Pilates Instructor


How Does Clinical Pilates Help Low Back Pain?

How Does Clinical Pilates Help Low Back Pain?

Learn about Clinical Pilates and how it can be used as treatment for low pain pain.

Lower back pain is a serious health problem across the world. The most common treatments for lower back pain are exercise-based interventions.


Over the last years, Clinical Pilates has become a popular form of exercise to treat people with lower back pain. Research has also shown that Pilates have numerous potential benefits for LBP.


Lets Get Into It!



Clinical Pilates can either be completed on the mat (Mat Pilates) or specific equipment (i.e. Reformer Pilates).


There are many philosophies around how to practice Pilates, but they all revolve around the intention to incorporate exercise that improve strength, balance, posture, muscle tone, and flexibility.


These exercises are all aimed at creating better body awareness in different positions under different loads!


Pilates entails the use of back and abdominal muscles in a properly coordinated manner. These exercises are aimed at training the muscles in the lower back, pelvis, abdomen, and hips to ensure that they work harmoniously.


This enhances coordination, balance and stability whether while performing daily activities or playing sports. Most physical activities and sports depend on the good coordination between these muscles.


Research on Clinical Pilates has shown that these exercises have numerous benefits for individuals that need core stability for performance and health.


Incorporating these exercises in a rehabilitation program can facilitate a new approach in teaching exercises!


“These exercises are all aimed at creating

better body awareness in different positions under different loads!”


Back Pain Can Be Quite Confusing



Lower back pain is a musculoskeletal condition which is characterised by discomfort and pain which are experienced above the buttocks and below ribs. No specific disease is attributed to this pain.


However, people with lower back pain have significantly limited mobility of the hips and spine. The pain has also been associated with low flexibility of the back and hamstrings tightness.


Several factors contribute to LBP including:

  • Erector spine muscles force and incorrect activation (i.e. too much tension!)
  • Decreased trunk and gluteal muscle strength 
  • Strength imbalance in the trunk and gluteal muscles 
  • Poor behavioural habits such as prolonged postures, spikes in activity loads 
  • Other psychosocial factors such as increased life stresses, work stresses, beliefs and understanding of pain (this topic is complex and will be covered in it’s own post in the future) 


Major Benefits of Clinical Pilates



Enhanced Muscle Strength

Research has shown that Pilates provides an effective method of reducing disability and pain among LBP patients. That’s because Clinical Pilates utilises an approach to strengthen the entire body with a focus on maintaining good control during various movements.


When a person has lower back pain, their muscle strength is reduced due to immobility and pain. With supervision, a patient can engage in Pilates which target specific muscles while enhancing their strength safely while reducing pain along the way.


Reduced Fear of Movement

When a person has lower back pain, they move abnormally because they anticipate or feel pain. This leads to poor mobility and movement patterns which leads to further physical deconditioning.


Abdominal bracing increases while segmental spine movement is reduced due to the poor patterns. This makes the spine stiff while causing more pain.


So, it becomes a terrible cycle!


Clinical Pilates helps by reassuring the patient that they can perform movements safely without pain. Reassurance that movement can be performed without causing injury is vital in the progression for someone with back pain.


“Reassurance that movement can be performed without causing injury is vital in the progression for someone with back pain”


Improved Movement Patterns

People with lower back pain have poor habitual movement patterns due to their pain. Unfortunately, these patterns can lead to further pain due to inefficient and restrictive muscle use.


Clinical Pilates makes it possible for physiotherapists to observe these poor patterns and correct them by offering alternative ways to complete the same movement. Poor movement patterns take time to change because the brain needs time to ensure that the new pattern is not a threat and safe to perform.


The whole rehab process is based on upon this concept…learn new movement > brain assesses whether the movement is safe > brain confirms safety > less pain with that movement > make movement harder.


Improved Flexibility

A component to Clinical Pilates involves stretching and mobility which improves flexibility and available joint range of motion over time.


Reduction in stiffness, primarily in the hamstrings, hip flexors and erector spinae (back muscles) will decrease pain.


Improved Mental Outlook

For individuals who suffer from low back pain on a regular basis, it can take a toll on other aspects such as thoughts and emotions.


An individual may become anxious, depressed and feel isolated due to the inability to do regular daily activities or complete things that bring joy to their life.


With the engagement of a Pilates exercise program, there can be a mindset shift from “I can’t move without pain” to “I can now exercise for a full exercise class”. This has a huge positive flow on effect in other areas of life.


What Can We Take From The Research?



Clinical Pilates offers greater improvements in functional ability and pain among people with lower back pain.


The improvements provided by these exercises are equivalent to those of the other types/forms of exercise!


Tara Clifford

Physiotherapist & Clinical Pilates Instructor



Wells, C, Kolt, GS, Marshall, P, Hill, B and Bialocerkowski, A, 2014, Indications, benefits, and risks of Pilates exercise for people with chronic low back pain: a Delphi survey of Pilates-trained physical therapists. Phys Ther. 94(6):806-17.


Barna, S, Patti, A, Bianco, A, Paoli, A, Messina, G, MontaltoMA, Bellafiore, M, et al., 2015, Effects of Pilates Exercise Programs in People With Chronic Low Back Pain: A Systematic Review, Medicine, 94(4), p e383.


Wells, C, Kolt, GS, Marshall, P, Hill, B and Bialocerkowski, A, 2014, The Effectiveness of Pilates Exercise in People with Chronic Low Back Pain: A Systematic Review, PLoS One, 9(7): e100402.

Simple Guide to Low Back Pain



Low back pain or lumbar pain, is very common, with it affecting two-thirds of adults in their lifetime. So you are not alone!


I understand that there is a lot of info coming at you about what you should and should not do for low back pain. This article will provide information around the injury and some strategies to implement in the early stages of your journey.


What is Low Back Pain?

Lower back pain can be categorised into the following categories:

  1. Specific Spinal Pathologies (<1%)
  2. Radicular Syndromes (5-10%)
  3. Non-Specific Lower Back Pain (90-95%)

As you can see, the majority of lower back pain cases are non-specific in origin. Meaning there is no specific structure that we as health professionals can state is injured and is the cause of the back pain.


Let’s go further into Non-Specific Lower Back Pain

Non-Specific Lower Back Pain is an experience of pain typically due to the following overarching factors:

  • Traumatic back injury
  • Erratic physical loading
  • Insidious onset


Within these categories, there is a multitude of reasons that are associated with why someone has spinal pain. These include [1]:

  • Sustained or repetitive positions and postures
  • Physical deconditioning
  • Life stresses
  • Emotional factors: stress, anxiety, low mood, anger
  • Poor coping strategies
  • Poor beliefs around pain and injury
  • Poor sleep
  • Poor nutrition
  • Low or highly erratic activity levels


What are the symptoms for low back pain?

You may experience sensations from a dull ache to sharp persistent feeling locally or into the buttock.

It may stay local to the lower back region, but it is not uncommon to have referral pain into the buttock and legs.

You may struggle doing normal daily activities such as bending down, straighten your back, getting up from a chair.

Your mornings will feel stiff and sore and will take about 30 minutes to get up and moving.

DON’T FRET…. All of these are normal symptoms!


What are the recovery expectations?

The above symptoms are all part of the body’s natural healing processes. So realistically, by having these sensations means you are on your way of getting back to normal life!

It won’t be smooth sailing! The duration of healing for most soft tissue injuries will take up to 6 weeks.

Pain itself will vary from person to person, but the worst of it is usually within the first 2 weeks and it will decrease in intensity over the 6 week period.


What should you do initially?

The very first thing to do when experiencing acute low back pain is to apply hot or cold therapy (this is a contentious issue and an article in itself), which is up to you but both can be tried to know which one is most effective.

Cold Therapy – Shortly after encountering the pain, apply an ice pack on the location and this can help by reducing the inflammation and interfering signals of danger to the brain.

Heat Therapy – Right after the occurrence of the ache, place a heat pack to the back muscles affected and this can provide comfort by giving good blood flow to the injured area and by increasing mobility to areas with stiffness. Another way of doing heat therapy is by engaging to moist heat like hot bath or shower.


What are some simple exercises to do for acute low back pain?

When experiencing an acute low back pain one must bear in mind to never stop moving. Daily routine and activities should be continued for as long as it is well tolerated.


The best advice is to remain active using these simple exercises:



If still able, a 10 to 20 minute walk once or twice a day will do a world of good. Walking will not only do all the good stuff that a heat pack can do, but also tell your brain that movement is safe and okay! This is key to the whole process!


Gentle Movements 

If you feel better standing up, then do some simple movements based on that position such as a standing lumbar extension.


…or a lying lumbar extension


If sitting is a preferable position, then we can choose a movement that promotes flexion such as a lying knee-to-chest exercise.


Or you can also complete gentle knee rocks moving from side to side whilst lying on your back


 Who should you see?

Pain usually subsides for lower back pain with or without treatment.

For specific guidance, an individual assessment from a physiotherapist with a special interest in back pain, such as a musculoskeletal physiotherapist, is the best option.

Your physiotherapist should be able to categorise your back pain, rule out any serious spinal pathologies, provide a management plan that not only looks at self-management but strategies that will reduce the risk of injury in the future.



David Bruzzese (MPA, AEP)

APA Musculoskeletal Physiotherapist & Accredited Exercise Physiologist



[1] O’Sullivan, et al (2018) Cognitive functional therapy: An integrated behavioural approach for the targeted management of disabling low back pain

3 Truths Behind Hamstring Strains




1. Current evidence related to the mechanism behind a hamstring strain, the importance of particular exercises that can decrease the risk of hamstring strains


2. Exercise programming for the individual returning from hamstring injury.


3. How a hamstring rehab program can be a great hamstring strain prevention program!


What Is A Hamstring Strain?



Hamstring strains, normally classified as proximal or distal strains, mostly involve eccentric muscle action and generally occur in either a sprinting-type activity (e.g. leg deceleration in terminal swing) or stretching type activity (i.e. picking up a ball) (Tsaklis et al 2015). 


So very common in sports that involve high levels of sprinting and agility such as AFL, soccer and sprinters. 


Though a majority of function may be restored when an individual returns to play, eccentric hamstring strength has shown to be inadequate and a contributing factor to the high hamstring strain recurrence rates (Askling, Saartok & Thorstensson 2006).


Hamstring muscle group


Truth 1: Exercises Can Decrease Recurrent Strains!



Fascicle length


A muscle fascicle is a bundle of skeletal muscle which increases in length after resistance training, usually eccentric training. There is a significant correlation between short (measured by fascicle length) and weak biceps femoris with hamstring injuries.



Muscle fascicle


Prior hamstring injury and biceps femoris fascicle length is shown to have a strong relationship with each other (Alonso-Fernandez, Docampo-Blanco & Martinez-Fernandez 2017). With no previous hamstring injury, a relationship exists between shorter fascicle length and increased probability of hamstring injury (9cm associated with 38% likelihood, respectively).


With previous hamstring injury, the probability is significantly greater with a shortened fascicle length (9cm associated with 65% likelihood, respectively) (Opar 2016). Though the non-modifiable risk factor of previous hamstring injury is set, we are able to use exercise to modulate the modifiable risk factor of fascicle length.


Below is a graph demonstrating the relationship between bicep femoris fascicle length and Nordic strength. With a weak/short biceps femoris had a 40% probability of hamstring strain compared to 3% probability with a strong/long biceps femoris.


Quadrant of doom (Courtesy of In:Motion Technologies)


Truth 2: Eccentric Exercises Are Awesome!



Contraction type


Muscle contraction types have an effect on fascicle length adaptation. After a 6-week concentric or eccentric only hamstring strengthening program, both eccentric and concentric exercise adaptations occur within 2-weeks of an exercise program. With concentric training, there is a change in fascicle length by -13.3% at 6 weeks.


The shortened fascicle adaptation is maintained after the strength training stimulus is removed (-12.2% at 10-weeks). Moreover, eccentric training has a similar but opposite effect on fascicle length, fascicles lengthen (14.1% at 6-weeks and 0.8% at 10-weeks) yet all adaptations are removed once the eccentric training stimulus is removed.


This highlights the importance of continuing eccentric hamstring exercise application as a preventative measure of recurrent hamstring strains (Timmins et al 2016).


Contraction types


Truth 3: Hamstring Strength Is Not Enough





During detraining periods, as previously discussed, once the eccentric training stimulus is removed, fascicle length adaptations are lost. However, though there is a loss in fascicle length, only small losses in strength adaptations associated with eccentric training are observed (Timmins et al 2016).


This is an interesting finding, as it may demonstrate why so many athletes will return to sport with adequate strength, but may reinjure in the future. It may be related to either the lack of eccentric strength work completed during their rehab or the cessation of eccentric exercises once they return to play.


What can we do about it?



The goals of a well-rounded hamstring rehab program is to cover these areas:


1. Concentric/Eccentric Long Length

  • Hip extension based exercises that keep you locked at the knee and bending forward at the hip
  • This is really important for footy players as the requirements of the game involve bending down and picking the ball from the ground


2. Concentric/Eccentric Moderate Length

  • These are your bridging based exercises
  • We can really work at developing strength and power with these exercises


3. Eccentric Only

  • The Nordic curl (as discussed above) are the perfect example of and eccentric only exercises
  • These are quite difficult, so there are many variations that allow someone to slowly progress to a full Nordic exercise. As stated, this process can take weeks to months, depending on the individual’s hamstring capacity


4. Gluteals

  • We need the gluteals to work with the hamstrings
  • There are many exercises that can be done for glute strength. The key is to make it relevant to the sport and have a focus on control


5. Whole/Neuromuscular

  • This involves a full body movement that incorporates a mixture of trunk rotations, upper body strength and single leg exercises


6. Running Mechanics

  • A gradual running/sprinting program is vital for hamstring rehab and should be progressed over 3-6 weeks (depending on severity of this strain)


Now, if you have not covered all these areas in your previous hamstring rehab programming…it is likely that you have re-injured your hamstring at some point OR at increased risk of straining your hamstring.


Final Thoughts


What we see in the clinic quite often are athletes returning to their given sport too early after they have strained their hamstring. They usually think:


“My pain is gone, so it must be healed”


“I can lift heavy deadlifts, so my hamstring should be strong enough”


“It’s just a little sore, it should be right”


We need to ensure that we tick all the boxes before a safe return to sport and decrease the risk of re-injuring your hamstring.


If you would like me to call you to discuss your previous or current hamstring program, whether you are on the right track for preventing a future hamstring & how we may be able to offer you a solution, then please fill in the contact form below and leave your best contact number. 


If you’re sick of constantly “doing your hammy” and just want to get back to it without any worry… follow the book online link in the top right corner & we hope to help you soon!




David Bruzzese

APA Musculoskeletal Physiotherapist & Accredited Exercise Physiologist




Alonso-Fernandez, D, Docampo-Blanco, P & Martinez-Fernandez, J 2017, ‘Changes in muscle architecture of biceps femoris induced by eccentric strength training with Nordic hamstring exercise’, Scandinavian Journal of Medicine & Science in Sports, pp. 1-7.

Askling, C, Saartok, T & Thorstensson, A 2006, ‘Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level’, British Journal of Sports Medicine, vol. 40, pp. 40-44.

Timmins, RG, Ruddy, JD, Presland, J, Maniar, N, Shield, AJ, Williams, MD & Opar, DA 2016, ‘Architectural changes of the biceps femoris long head after concentric or eccentric training. Medicine & Science in Sports & Exercise, vol. 48, no. 3, pp. 499-508.

Tsaklis, P, Malliaropoulos, N, Mendiguchia, J, Korakakis, V, Tsapralis, K, Pyne, D & Malliaras, P 2015, ‘Muscle and intensity based hamstring exercise classification in elite female track and field athletes: implications for exercise selection during rehabilitation’, Journal of Sports Medicine, vol. 6, pp. 209-217.