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
John Grace
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Hey John,
Great article. I too have looked at that paper on eccentric loading and have also written a blog post about the potential benefit of this type of loading for injury prevention.
My frustration with the literature is that the control groups and sample sizes can be really small.
In this paper the control group had a 2/3 injury rate, that seems incredibly high compared to the general athletic population. And of course a 10/15 to 3/15 sounds like a great improvement.
I definitely think eccentric loading and nordic curls are great for athletes with a history of hamstring strain but I worry that some studies are sometimes skewed and that other factors can come into play.
Regards,
Chris
Chris, thanks for reading.
I agree that some research is limited in the sense you’re referring to, but what is said for a sample size of a relative few, may be able to give us a little insight on how to attack this issue.
Proper weight training in soccer is generally one of the more underutilized tools. Of course, other factors surely do come into play (genetic predispositions, age, joint laxity, nutrition, games played, etc). Out of all of these factors that have the potential to increase likelihood of injury, I think strength training and sprint training are tools that are certainly in our control to utilize (if used correctly) to help reduce the likelihood of injury.
John
The other study that may be of interest, if you haven’t seen it already is on the effectiveness of warm-up strategies here.
The study showed some exciting results for the 11+ warm-up regime particularly for soccer players. Sadly, the results didn’t indicate a statically significant reduction in hamstring injury, however it did show improvement for injury reduction in other areas.
I apologize for the late reply here.
I think you bring up a good point in the warm-up being an effective tool to reduce likelihood of injuries in training and on game. It’s a great starting point, but I think there needs to more substance to an effective injury prevention protocol.
Research suggests that injuries (in matches) increase as minutes played increases. While there’s no doubt that a proper warm-up is needed (in games and training), the research shows that a lack of fitness is much more of a determinant of injuries in games.
Improving an athlete’s aerobic base and strength can play a big role in preventing late game injuries.