Hamstring Injury Prevention

Injuries are bound to happen. It’s the nature of sport. You push your body until your body pushes back. In sport, the hamstring muscles undergo major forces during sprinting, jumping, kicking, etc. Soccer is no exception to this.  Many studies have targeted this issue and have tried to pin point how to reduce injury rate and injury recurrence in elite soccer athletes. Much of this research has looked at strength training, specifically developing eccentric hamstring strength, as a means to do this.

This study looks at the relationship between muscle injury and unilateral strength deficiencies. Could normalization of strength imbalances reduce the incidence of hamstring injuries?

Methods: A standardized concentric and eccentric isokinetic assessment was used to identify soccer players with strength imbalances. Subjects were classified among 4 subsets according to the imbalance management content. Recording subsequent hamstring injuries allowed us to define injury frequencies and relative risks between groups.

Results: Of 687 players isokinetically tested in preseason, a complete follow-up was obtained in 462 players, for whom 35 hamstring injuries were recorded. The rate of muscle injury was significantly increased in subjects with untreated strength imbalances in comparison with players showing no imbalance in preseason (relative risk = 4.66; 95% confidence interval: 2.01–10.8). The risk of injury remained significantly higher in players with strength imbalances who had subsequent compensating training but no final isokinetic control test than in players without imbalances (relative risk = 2.89; 95% confidence interval: 1.00–8.32). Conversely, normalizing the isokinetic parameters reduced the risk factor for injury to that observed in players without imbalances (relative risk = 1.43; 95% confidence interval: 0.44–4.71).

Conclusion: The outcomes showed that isokinetic intervention gives rise to the preseason detection of strength imbalances, a factor that increases the risk of hamstring injury. Restoring a normal strength profile decreases the muscle injury incidence.

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Another study emphasized eccentric overloading in the preseason of 30 professional soccer players in Sweden. One group received the specific hamstring training for 1-2 times a week for 10 weeks. The other group did not receive any specific hamstring training.

The results showed that the occurrence of hamstring strain injuries was clearly lower in the training group (3/15) than in the control group (10/15). In addition, there were significant increases in strength and speed in the training group.

That’s a 20% injury rate in the strength training group compared to a 67% injury rate in the non-strength training group. The specific strength training group also increased strength and speed. This is essentially killing two birds with one stone.

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The 5 top men’s soccer divisions in Denmark were also analyzed. The intervention group completed Nordic hamstring lowers in a defined set a rep protocol as a means to develop eccentric hamstring strength. In this study, a hamstring injury was defined as any acute physical complaint in the region of the posterior thigh sustained during a match or training.

50 teams with 942 players completed the study. At the end of the season, there had been 15 hamstring injuries (12 new, 3 recurrent) in the eccentric hamstring exercise group and 52 injuries (32 new, 20 recurrent) in the control group.

On top of this staggering number initial injuries, the rate of recurrence is 25% to 62.5% for the eccentric hamstring group to the control group, respectively. Even if a hamstring injury occurs concurrently with strength training, there is a huge reduction in risk of reinjury.

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Body weight exercises, like Nordic hamstring lowers, can provide a stimulus to strengthen the hamstrings, but there is a point where body weight exercises can become relatively easy. Implementing a holistic approach, using body weight and weighted exercises like deep squats, lunges, step-ups, can help provide the stress needed for the adaptation of the musculature to occur, in turn, reducing injury.

References:

1. Croisier, Jean-Louis; Sebastien Ganteaume, Johnny Binet, Marc Genty, Jean-Marcel Ferret. Strength Imbalances and Prevention of Hamstring Injury in Professional Soccer Players. The American Journal of Sports Medicine. vol. 36 no. 8 1469-1475

2. Askling, C., Karlsson, J. and Thorstensson, A. (2003), Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scandinavian Journal of Medicine & Science in Sports, 13: 244–250.

3. Schache A. Eccentric Hamstring Muscle Training Can Prevent Hamstring Injuries in Soccer Players. Journal of Physiotherapy. 2012;58(1):58

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John Grace is a coach at Athletic Lab Sports Performance Training Center in Cary, NC - USA. John has his CSCS, USAW Level 1 certification, USATF Level 1 certification and has worked as an assistant fitness coach for the Vancouver Whitecaps of the MLS.