The Hamstring in Function
Another weekend of Premiership action and another hamstring injury, Spurs’ Kyle Walker pulled up during the game with Man City.
But why are hamstring strains so common, especially in football?
An FA review in 2004 showed that hamstring strains made up 12% of football injuries, with a higher percentage in the top division.
Footballers are particularly vulnerable to these injuries due to the high speeds of running and change of direction involved, especially at the highest level. There is also an issue of volume, in terms of the top players playing 2-3 times weekly which may not provide enough recovery time.
The hamstrings are particularly vulnerable as they are bi-articular muscles (Devlin 2000) and involved with movement in all 3 planes. They also have a greater percentage of fast twitch fibres (Hawkins 1999) compared with other lower limb muscles, so are responsible for power production through stance phase in running.
So how can we reduce the number of hamstring strains? I believe the answer is to functionally train the hamstrings in all 3 planes of movement, rather than traditional sagittal plane motion and strengthening. We need to look at the frontal and transverse planes of motion around the knee and the hip in an upright position incorporating balance and control of motion.
Another area that is not given enough attention is the speed at which we perform the exercises. Most high speed hamstring strains occur just prior to foot contact in sprinting (Askling 2008), which involves huge eccentric load to the hamstring in all planes. For this client group performing rehab/prehab exercises at a high speed is necessary for optimum function and prevention of reoccurrence.
We also need to look at the link between the anterior abdominals and the hamstrings in function. During the gait cycle the abdominals and hamstrings of the front leg work synergistically in the sagittal plane to control anterior pelvic tilt. If the abdominals cannot lengthen or control the lengthening with the anterior pelvic tilt this will create further eccentric load on the already loaded front leg hamstring.
The current concepts on hamstring training and prevention advocate the Nordic hamstring eccentric program. This 10 week program has proven to be very effective in prevention of hamstring injuries (Thorborg 2010) especially those with previous injuries. However, this is limited to only working on the sagittal plane mechanics of the hamstring and does not take into account the affect of the feet on hamstring function!
For further information on the functional thought process see
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Mark Leyland MCSP FAFS
– Askling, C 2008. Hamstring Muscle Strain. Thesis for Doctoral Degree (PhD). Karolinska Institute
– Devlin, L 2000. Recurrent posterior thigh symptoms detrimental to performance in rugby union: Predisposing factors. Sports Medicine 29: 273-287
– Hawkins, RD, Fuller, CW. A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med 33: 196-203
– Gray 2004. FVDS 3.5. The Hamstring. Gray Institute
– Price et al 2004. FA Medical Research Programme. An audit of injuries in academy football. BrJ Sports Med 38: 466-471
– Thorborg, K 2012. Why hamstring eccentrics are hamstring essentials. Br J Sports Med; 46:463-465
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