Don’t be hamstrung by hamstring injuries

The rugby season is rapidly approaching… training is back in full swing… the club is finally showing a few signs of life again; felt a little like a ghost town during the off-season… and the best part? (Insert sarcasm here) I trade sunny Saturday afternoon’s lazing poolside for sweaty footballers, strapping tape and deep heat.

In most professional sports these days a lot of time and money is invested into ‘injury prevention programs’. Players are screened individually with data used to create personalised gym programs  tailored to suit each athletes specific strength and mobility needs…. All this in attempt to try and keep players on the field week in week out.

Many traumatic injuries are unavoidable but there is research to show that some overuse and muscular injuries can be prevented by incorporating certain conditioning exercises into both pre-season programs and maintenance training during the season.

A big focus in all codes of rugby and also football (or soccer as I like to call it) has been preventing hamstring strains and tears. Easily one of the most common injuries that can sideline players for weeks and furthermore when correct rehabilitation doesn’t take place the chance of re-occurrence can further delay return to play.

To develop an effective ‘prevention’ program we need to address the reasons why hamstrings seem to be so vulnerable to injury. A few that come to mind here that I personally as a physio would address in an athlete would be:

1. Fatigue / overtraining: Coaches & strength trainers can be guilty of pushing athletes into larger volumes of training than they may be capable of. It takes a good 6-8 months to work into a high volume training routine and in order to place such demands on the body an individual also needs to consider lifestyle and nutritional factors. This is especially important when it comes to many semi-professional athletes who work in a sedentary job for 6-8 hours a day. These individuals will be more prone to stiffness through the lumbar spine and shortening of the hip flexor muscles both of which can increase the risk of suffering a hamstring related pathology.

hamstring2. Lack of eccentric strength: Eccentric strength refers to the strength capabilities that the muscle holds as it is lengthening. In sports requiring high acceleration and sprinting this is essential as the muscle needs to be conditioned to produce rapid contractions and handle extreme ground reaction forces. In my experience this is often a component of a legs training program that is overlooked. A few good exercises include

  • Hamstring curls – perform the curl with both legs then lower the weight with a single leg over a 3-4 second period facilitating control as the muscle is lengthening.
  • Single leg hamstring bridges on a swiss ball, or single leg deadlift with emphasis on control of the speed of the movement and balance. Want a real challenge? Do this on a bosu ball you hammys will be burning for days.
  • A more advanced exercise is the Nordic Strengthening program. Research indicates this is best performed as a 5-10 week pre-season program with a day between sessions initially to allow for delayed onset muscle soreness. Start with 2 sets of 5 and increase as tolerated each week. By week 6 the athlete should be performing 3 sets of 10 reps.nordic

3. Structural imbalances: strengthening should not be restricted to the hamstrings but rather should incorporate a combination of exercises that assist with developing neuromuscular control in surrounding muscles. The glutes or BUTT muscles contribute to 50% of hip extension movement; if your glutes are weak the hamstrings can become overloaded and susceptible to injury. Hamstring / glute bridging as discussed earlier is a good exercise for this. Lunges, step ups and deadlifts can also be good to re-integrate hamstring and glute strength. We must also remember that the hamstrings are predominantly ‘fast twitch’ fibres that respond better to high intensity training. High speed exercises and agility drills should be included in a pre-season training program to ensure sport specific conditioning takes place.

4. Improper warm up: There is no evidence in any literature anywhere that supports static hamstring stretching as an effective exercise. Sure by all means go ahead and do it BUT athletes must must must partake in an active warm up including dynamic stretching combined with a variety of functional drills that prepare the hamstrings for the stresses they will encounter in sprinting and multi-directional movement.

5.History of pervious hamstring injury OR lower back pathology: as the team physio I would say this is my DOMAIN. Previous hamstring injury can leave a build up of scar tissue and adhesions resulting in excessive tightness. ART (Active Release Technique) combined with trigger point massage and dry needling is a pretty effective way of restoring optimal muscle length and correct function. In cases of chronic hamstring tightness and persistent injury the lumbar spine should always be assessed, and again this is particularly important in sedentary office workers. They sit in a position of prolonged flexion all day, causing certain muscles (namely the hip flexors) to become short and tight. This places undue stress on the lumbar spine especially during the action of running and sprinting and can easily pre-dispose an athlete to hamstring related injury.

Apologies that was A LOT to take in…. and that is a super condensed version of what is probably one of the most extensively researched topics in sports medicine. The take home message here is that pre-season training is very important to build a good base of strength and also to facilitate the development of neuromuscular control in the lower limb chain. A gym program should include a variety of closed chain exercises, eccentric strength work and core stability training combined with a higher intensity speed program to target the ‘fast twitch’ fibres within the hamstring and condition them for the demands of sprinting, rapid acceleration/deceleration and sudden directional changes.

Fail to prepare, prepare to fail.

Happy Australia Day (for yesterday) and hope you all have a fabulous Monday off work!! 🙂

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