Hamstring health, performance and injury prevention

With new COVID lockdowns in place for Greater Sydney and community sport taking a 2 week break, we often see these types of unscheduled breaks lead to injuries when sport resumes.

Planning ahead and implementing some strategies for injury prevention will help you navigate the lockdown break and keep you on the pitch for longer.

Hamstring injuries are common amongst professional footballers and Sunday afternoon superstars alike.

Some research into hamstring injuries has demonstrated that if the hamstring musculature is strong and flexible as opposed to weak and short then it significantly decreases the risk of hamstring injury throughout the course of a season (Timmins et al. 2016 and Bourne et al. 2018). 

The Quadrant of Doom

Below is an infographic from YLM Sports Science that clearly demonstrates the relationship between strength, flexibility and injury risk. The other way to frame this is in terms of capacity. The greater the strength and movement capacity then the less likely things are to go wrong. 

The other benefit from all of the below is that by incorporating this it will not decrease injury risk but also improve performance!

Knowing this is all well and good but we also want to practically act on this. How do we build things up from a loading, flexibility and strength point of view. Below is another great infographic from YLM Sports Science that shows specific ways to address all these areas.

In summary to build strong, functional and flexible hamstrings then it is worth looking at an exercise program that includes hip and knee dominant exercises that is gradually overloaded to create adaptation. It is also worth adding some running and sprint work into the program as this is shown to have a protective effect and also some loaded flexibility work to strengthen the hamstrings in lengthened positions (Oakley et al.2018).

Take Home points for hamstring performance and health:

• Strong and long hamstrings are the goal

• Use knee and hip dominant strengthening exercises

• Incorporate sprint work

• Work on flexibility

• Progressively overload

• Stay consistent

References:

1. Timmins RG, Bourne MN, Shield AJ, et al. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study. Br J Sports Med 2016;50:1524-1535. https://bjsm.bmj.com/content/50/24/1524

2. Bourne, Matthew N., Timmins, Ryan, Opar, David A., Pizzari, Tania, Ruddy, Joshua, Sims, Casey, WIlliams, Morgan, & Shield, Anthony (2018) An evidence-based framework for strengthening exercises to prevent hamstring injury. Sports Medicine, 48(2), pp. 251-267. https://link.springer.com/article/10.1007/s40279-017-0796-xhttps://ylmsportscience.com/

3. 2017/11/26/hamstring-strain-injury-escape-the-quadrant-of-doom/

4. https://ylmsportscience.com/2017/05/06/holistic-hamstring-health-not-just-the-nordic-hamstring-exercise/

5. Oakley AJ, Jennings J, Bishop CJ. Holistic hamstring health: not just the Nordic hamstring exercise. Br J Sports Med 2018;52:816-817. https://bjsm.bmj.com/content/52/13/816

CALF STRENGTH FOR RUNNING - FLOW PHYSIO CO SUTHERLAND

Joel from Flow Physio Co Sutherland chats to us about an easy way to assess calf strength.

TRANSCRIPT:

Hey guys. I've recently been seeing a lot of soccer players and runners, and people from other sports who've been coming in with some calf and shin issues.

So I wanted to give you guys a quick little test to have a look at your calf strength, and a way to work on it as well.

So the first one to do is to get into a single leg standing position. Use a wall for balance. And just do some calf raises. Up on to your toes and back down.

So you want to get some nice control there as you're going up and down.

Then test side to side, see how many you can get before you hit fatigue on each side. If it's nice and even, that's really good.

The goal for you would be able to get about 30 repetitions or more.

Second one we want to do, is have a look at doing the same thing but with the knee bent. So coming into this squat position. Same thing, going up and down. So that's a bit more challenging, in this muscle we don't work on so much, but it's called your soleus muscle and it's really important for running.

So have a look at that as well, and have a look at your capacity there. Now, again, if they're not even side to side, or you're not getting that 30 repetitions on each side, that's something to work on.

So you want to work on that exercise, basically going to the point where you're almost getting fatigued, give yourself a couple of minutes rest, and then go again, and do the same thing. You better challenge that muscle to be able to load it a bit and get a bit stronger.

STRENGTH TRAINING FOR DECREASING INJURY RISK - FLOW KNOWS

Craig from Flow Physio Co Sutherland talks to us about a recent study that looked at the effects of strength training on injury risk. Read on for more.

Strength training programs as a whole reduced the likelihood of injury by 66% (Lauersen et al 2018)

A recent meta-analysis of 6 studies with a combined total of 7739 participants aged from 12-40 published in the BJSM looked at strengthening intervention on injury risk.

It was found that strength training programs as a whole reduced the likelihood of injury by 66% with 95% certainty!

It was also found that the longer programs provided the most favourable results.

The programs had an average of 8 months with zero adverse effects reported.

Strength training appears to have a direct preventative effect for injuries of the hamstrings, ACL and anterior knee pain.

Take Home Messages:

• This study obviously indicates the benefits of implementing a strengthening program for all athletes and weekend warriors regardless of age or sport

• Consistency over time provides the greatest benefits

• Strength training is safe

• Appropriate dosage and progression is important

Reference: Lauersen JB, Andersen TE, Andersen LB. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis Br J Sports Med 2018;52:1557-1563.

Full Text

Knee pain while exercising?

With the temperature heating up and daylight savings in full swing most people are shedding the extra layers of clothing and some are hoping to also shed a few extra kilograms.

Gym and bootcamp numbers are increasing and it looks as though everyone is now coming out of hibernation. Unfortunately, as a consequence of this we see more people present to the clinic with common complaints related to their new exercise regimes.

What is patellofemoral pain?

One of the most common presentations we see is patellofemoral pain, that is pain arising from the kneecap and its articulation with the femur or thigh bone.

It often presents with the gradual onset of pain and will commonly be aggravated by squatting and lunging motions along with stair-climbing and running, it often settles with rest however, can often cause a dull ache when sitting for extended periods which is known as movie goer’s sign.

What causes it?

We often see people present with an increased load, they have often commenced or increased squatting, lunging and running which can cause aggravation of the patellofemoral joint.

There are a multitude of factors that play varying roles including behavioural, biomechanical/anatomical, technique, muscle imbalances, weakness or restriction.

Here we will cover a general but thorough approach to what is worth looking at in the treatment of patellofemoral pain.

Alignment and control

This is about looking upstream and downstream, the patellofemoral joint does not like a rotary component which can be caused by poor lumbopelvic control (what the core/hip is doing) upstream or poor foot biomechanics (what the foot is up to) downstream.

Technique

How do the movements look unweighted, weighted and when fatigued?

Load management

There is usually a load related component so it is always worth looking at how much you are doing currently vs what you were doing previously and furthermore how to plan the load to ensure it improves. Gradual loading is the best loading (3).

Strength

How strong are the glutes and quad muscles as these 2 groups of muscles are shown to be very important when it comes to patellofemoral pain (1-3). Additionally, how strong are the calves, groin, core and hamstrings? If everything is stronger than even better! There is a significant reduction in injury risk with increased strength (4-5).

Range of motion

Are there restrictions elsewhere in the biomechanical chain causing the knees to compensate?

Is there a previous ROM limitation at the ankle due to a previous injury causing the knee to compensate? Is there limitations/tightness in the hamstring or calf? Is there significantly limited thoracic extension causing you to fall forward placing excess strain on the knees during squatting or overhead movements? Is the foot rolling outwards to make up for restricted ankle ROM (1-3)?

How best to approach it?

Unfortunately, patellofemoral pain is often a very niggly condition and a large number of people experience ongoing issues even with some form of treatment (6). As patellofemoral pain is such a multi-faceted condition it requires a very thorough approach to specifically address all the potential contributing components. It will take time but it is important to be consistent, thorough and methodical in the approach to get best results.

General areas to address:

• Alignment and control

• Lumbopelvic control

• Foot mechanics

• Technique

• Load management

• Strength

• Range of motion

References

1. Barton CJ, Lack S, Hemmings S, et al. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med 2015;49:923-934.

2. Crossley KM, Callaghan MJ, Linschoten RV. Patellofemoral pain. Br J Sports Med 2016;50:247-250.

3. https://www.mickhughes.physio/single-post/2016/06/21/Patellofemoral-Joint-Pain

4. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British journal of sports medicine. 2014 Jun;48(11):871-7. PubMed PMID: 24100287. Epub 2013/10/09. Eng.

5. https://www.mickhughes.physio/single-post/2016/12/26/8-Simple-Ways-to-Avoid-New-Years-Resolution-Induced-Injury

6. Thomas MJ, Wood L, Selfe J, Peat G. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC musculoskeletal disorders. 2010;11:201. PubMed PMID: 20828401. Pubmed Central PMCID: PMC2944218. Epub 2010/09/11. Eng.