Hamstring strain injury (HSI) is the most prevalent injury in football (soccer), representing 12% of all injuries in high-level players. 1 A professional team can expect 5 to 6 HSIs per season, 2 and these injuries typically have persistent symptoms 3 and high recurrence rates. 2 Players “off
João Breno Ribeiro-Alvares, Maurício Pinto Dornelles, Carolina Gassen Fritsch, Felipe Xavier de Lima-e-Silva, Thales Menezes Medeiros, Lucas Severo-Silveira, Vanessa Bernardes Marques and Bruno Manfredini Baroni
Timothy F. Tyler, Brandon M. Schmitt, Stephen J. Nicholas and Malachy P. McHugh
Hamstring-strain injuries have a high recurrence rate.
To determine if a protocol emphasizing eccentric strength training with the hamstrings in a lengthened position resulted in a low recurrence rate.
Longitudinal cohort study.
Sports-medicine physical therapy clinic.
Fifty athletes with hamstring-strain injury (age 36 ± 16 y; 30 men, 20 women; 3 G1, 43 G2, 4 G3; 25 recurrent injuries) followed a 3-phase rehabilitation protocol emphasizing eccentric strengthening with the hamstrings in a lengthened position.
Main Outcome Measures:
Injury recurrence; isometric hamstring strength at 80°, 60°, 40°, and 20° knee flexion in sitting with the thigh flexed to 40° above the horizontal and the seat back at 90° to the horizontal (strength tested before return to sport).
Four of the 50 athletes sustained reinjuries between 3 and 12 mo after return to sport (8% recurrence rate). The other 42 athletes had not sustained a reinjury at an average of 24 ± 12 mo after return to sport. Eight noncompliant athletes did not complete the rehabilitation and returned to sport before initiating eccentric strengthening in the lengthened state. All 4 reinjuries occurred in these noncompliant athletes. At time of return to sport, compliant athletes had full restoration of strength while noncompliant athletes had significant hamstring weakness, which was progressively worse at longer muscle lengths (compliance × side × angle P = .006; involved vs noninvolved at 20°, compliant 7% stronger, noncompliant 43% weaker).
Compliance with rehabilitation emphasizing eccentric strengthening with the hamstrings in a lengthened position resulted in no reinjuries.
Diulian Muniz Medeiros, César Marchiori and Bruno Manfredini Baroni
. doi: 10.1034/j.1600-0838.2003.00312.x 27. Opar DA , Williams MD , Shield AJ . Hamstring strain injuries: factors that lead to injury and re-injury . Sport Med . 2012 ; 42 ( 3 ): 209 – 226 . doi: 10.2165/11594800-000000000-00000 28. Larruskain J , Celorrio D , Barrio I , et
Sergio Jiménez-Rubio, Archit Navandar, Jesús Rivilla-García, Víctor Paredes-Hernández and Miguel-Ángel Gómez-Ruano
can help interpret the actual physical exertion of the player and give meaningful information about the adequacy of workloads in training and competition. Different authors have validated RTP criteria following hamstring strain injuries, 21 but no one has used performance parameters from competition
Sergio Jiménez-Rubio, Archit Navandar, Jesús Rivilla-García and Victor Paredes-Hernández
complex contributed to 37% of all noncontact injuries, with a recurrence rate between 13% and 17%. 3 On an average, when a player suffers a hamstring strain injury, he/she missed 18 days and 3 to 3.5 matches, 4 with the number of days of layoff increasing based on injury severity. 5 Sprinting and
Tobias Alt, Igor Komnik, Jannik Severin, Yannick T. Nodler, Rita Benker, Axel J. Knicker, Gert-Peter Brüggemann and Heiko K. Strüder
Purpose: Concentric hip and eccentric knee joint mechanics affect sprint performance. Although the biarticular hamstrings combine these capacities, empirical links between swing phase mechanics and corresponding isokinetic outcome parameters are deficient. This explorative study aimed (1) to explain the variance of sprint velocity, (2) to compare maximal sprints with isokinetic tests, (3) to associate swing phase mechanics with isokinetic parameters, and (4) to quantify the relation between knee and hip joint swing phase mechanics. Methods: A total of 22 sprinters (age = 22 y, height = 1.81 m, weight = 77 kg) performed sprints and eccentric knee flexor and concentric knee extensor tests. All exercises were captured by 10 (sprints) and 4 (isokinetics) cameras. Lower-limb muscle balance was assessed by the dynamic control ratio at the equilibrium point. Results: The sprint velocity (9.79 [0.49] m/s) was best predicted by the maximal knee extension velocity, hip mean power (both swing phase parameters), and isokinetic peak moment of concentric quadriceps exercise (R 2 = 60%). The moment of the dynamic control ratio at the equilibrium point (R 2 = 39%) was the isokinetic parameter with the highest predictive power itself. Knee and hip joint mechanics affected each other during sprinting. They were significantly associated with isokinetic parameters of eccentric hamstring tests, as well as moments and angles of the dynamic control ratio at the equilibrium point, but restrictedly with concentric quadriceps exercise. The maximal sprints imposed considerably higher loads than isokinetic tests (eg, 13-fold eccentric knee joint peak power). Conclusions: Fast sprinters demonstrated distinctive knee and hip mechanics in the late swing phase, as well as strong eccentric hamstrings, with a clear association to the musculoarticular requirements of the swing phase in sprinting. The transferability of isokinetic knee strength data to sprinting is limited inter alia due to different hip joint configurations. However, isokinetic tests quantify specific sprint-related muscular prerequisites and constitute a useful diagnostic tool due to their predicting value to sprint performance.
Jennifer W. Cuchna, Lauren Welsch, Taylor Meier, Chyrsten L. Regelski and Bonnie Van Lunen
Are Nordic hamstring exercises more effective than standardized training in reducing hamstring strain injury rates in competitive soccer players over the course of at least one season?
Clinical Bottom Line:
The evidence supports the use of Nordic hamstring exercises to reduce hamstring injury incidence rates over a competitive soccer season. Therefore, progressive Nordic hamstring exercises should be included within some aspect of a practice to prevent the occurrence of hamstring injuries.
Simone Ciacci, Rocco Di Michele, Silvia Fantozzi and Franco Merni
Kinematic asymmetry is believed to be associated with elevated risk for muscle injury, but little is known about the links between hamstring injuries and asymmetry of sprinting mechanics.
To evaluate the value of kinematic analysis of sprinting for the detection of injury-related asymmetry in athletes with a history of hamstring strain.
Six sub-elite male sprinters, including two who sustained a hamstring strain injury.
Absolute differences between left and right symmetry indices and symmetry angles were both calculated for ground contact time and selected angular displacements. Measurements were acquired at foot strike, during the stance phase, and at toe-off.
At toe-off, injured athletes exhibited greater knee flexion and less hip extension for the injured extremity compared to the uninjured extremity. Symmetry indices for these variables markedly exceeded an established 15% threshold for clinically relevant asymmetry. Each of the uninjured athletes exhibited a high degree of symmetry for all parameters, with mean values for symmetry indices significantly lower than the 15% threshold (P < 0.05).
Kinematic analysis of sprinting asymmetry appears to be valuable for identification of elevated risk for hamstring injury.
Paul W.M. Marshall, Ric Lovell and Jason C. Siegler
Passive muscle tension is increased after damaging eccentric exercise. Hamstring-strain injury is associated with damaging eccentric muscle actions, but no research has examined changes in hamstring passive muscle tension throughout a simulated sport activity. The authors measured hamstring passive tension throughout a 90-min simulated soccer match (SAFT90), including the warm-up period and every 15 min throughout the 90-min simulation.
Passive hamstring tension of 15 amateur male soccer players was measured using the instrumented straight-leg-raise test. Absolute torque (Nm) and slope (Nm/°) of the recorded torque-angular position curve were used for data analysis, in addition to total leg range of motion (ROM). Players performed a 15-min prematch warm-up, then performed the SAFT90 including a 15-min halftime rest period.
Reductions in passive stiffness of 20–50° of passive hip flexion of 22.1−29.2% (P < .05) were observed after the warm-up period. During the SAFT90, passive tension increased in the latter 20% of the range of motion of 10.1−10.9% (P < .05) concomitant to a 4.5% increase in total hamstring ROM (P = .0009).
The findings of this study imply that hamstring passive tension is reduced after an active warm-up that includes dynamic stretching but does not increase in a pattern suggestive of eccentric induced muscle damage during soccer-specific intermittent exercise. Hamstring ROM and passive tension increases are best explained by improved stretch tolerance.
Paul Comfort, Amy Regan, Lee Herrington, Chris Thomas, John McMahon and Paul Jones
Regular performance (~2×/wk) of Nordic curls has been shown to increase hamstring strength and reduce the risk of hamstring strain injury, although no consensus on ankle position has been provided.
To compare the effects of performing Nordic curls, with the ankle in a dorsiflexed (DF) or plantar-flexed (PF) position, on muscle activity of the biceps femoris (BF) and medial gastrocnemius (MG).
15 male college athletes (age 22.6 ± 2.1 y, height 1.78 ± 0.06 m, body mass 88.75 ± 8.95 kg).
A repeated-measures design was used, with participants performing 2 sets of 3 repetitions of both variations of Nordic curls, while muscle activity was assessed via surface electromyography (EMG) of the BF and MG. Comparisons of muscle activity were made by examining the normalized EMG data as the percentage of their maximum voluntary isometric contraction.
Paired-samples t test revealed no significant difference in normalized muscle activity of the BF (124.5% ± 6.2% vs 128.1 ± 5.0%, P > .05, Cohen d = 0.64, power = .996) or MG (82.1% ± 3.9% vs 83.5 ± 4.8%, P > .05, Cohen d = 0.32, power = .947) during the Nordic curls in a PF or DF position, respectively.
Ankle position does not influence muscle activity during the Nordic curl; however, performance of Nordic curls with the ankle in a DF position may be preferential, as this replicates the ankle position during terminal leg swing during running, which tends to be the point at which hamstring strains have been reported.