Eliminate Hamstring Injuries

Hamstring Injury Myths

So we are going to have a look at hamstring injuries and some of the myths and some of the things I want to draw your attention to. And two, there's so much information out there, as we know, and sometimes it can be you can get lost and you can miss some of the important points about hamstring injuries and their role and the importance of them. But one of the reasons, understandably, is that there are so many different sports. Different places, different demands on hamstrings. Different training methods affect them, but I want to go through and I'm gonna leave you with takeaways I want you to consider for Team Sport again.

A hamstring injury is probably the first injury I had and I spent a lot of time over the years trying to fix myself. Thankfully I did. The first hamstring injury was a stretch one. I thought OK, everything is about getting mobility back. When it went again, I realized it was about strengthening and so that was the first exposure I had to understand, OK, it's not purely about. These results were strength components and how we Prevent this from happening and I never had another injury. Must have been for at least another ten, never another injury at all for another 12 years.

So when you're working with athletes, hamstring injuries or the band, and there they are of course, but all soft tissue injuries, very, very preventable. And again it's one of the most common injuries. It's one of the most serious, it's one of the most worrisome, but it's one of the ones that we should not have. So there are several reasons for poor understanding. One is that there are poor data. So a lot of self-reporting data, you can't believe the information that you're getting from teams. It's very hard then for scientists on this to correctly come to conclusions if the data they're getting is not quite accurate.

And that's not blaming people in teams as well, because it's difficult to collect data properly from players, from professional players, and for the audience that you're going to work with. There's a huge difficulty in gathering data over the long term because players come, go, and leave, So what has happened? The other concern is with meta-studies, which are wonderfully done. But you're combining probably some studies with brilliant data with pure data, and they can be a little bit misleading. So finding good research is essential to the conclusions that you're gonna come to.

I'll show you one or two papers, I think they're well worth looking at. And the other, the other issue is that if you've got small data. Sizes, they're not cleaned properly and you don't know what you're looking for can be misleading, but the biggest one from a team sport perspective is got nothing to do with the data, has got nothing to do with the hamstring injury. So It's got to do with the training methodology because the training methodologies, in my opinion, have a bigger impact on the outcome.

Neither good nor bad in the sense that somebody may have a very speed-oriented program, somebody else might have an endurance-oriented program, there might be changes in staff and that influence hamstring injury. When you look at all of those things, but then only analyze, for example, age and previous injury, your footwear, you're not even accounting for the biggest factors, the factors that have the biggest impact on hamstring injuries.

So really, if you're to studying to understand hamstring injuries, you need to do a lot of the work yourself. You need to use a lot of common sense. You need to be very, very critical of the information that you're getting so that you can come to the right conclusion and know what's going to work for you and your team.

That's what I want to leave you with today. I want to show you a few things that you can take and use to analyze the health and the hamstring health of your players. So, Before we get into the detail of the conclusions, I want to just show you a few things that surprised many people aren't aware of. One is the role of the hamstring, like the true role of the hamstring. When we hear of a hamstring injury, we think, oh, hamstring sprinting.

That's the only muscle that's involved in sprinting. He's not quite true. And what's the true role of the hamstring in the sprinting complex, if you will? The other critical thing is understanding the role of the other muscles and why. When we strengthen or we strengthen them or we strengthen the hamstring, what's happening in this, in this comp, in this whole complex, and again, like I said, what's the confusion around what the hamstring is? And when you look at it, you'll realize, OK, there are a lot of other factors here that come into play. So when we look at. The actual role in the activation of the hamstring, it's is initial contact, initial contact on the other side. So initial contact takes off. You'll see the hamstring is critical here, but after takeoff, its role falls.

And So what you start to see here is the hamstrings roll really, and you've got. Answering, but you also the glutinous Maximus. Your real power pocket itself is what's going to be key a takeoff and then again when the foot starts to return. But what's most interesting about this for me is missing. So when you start to look at all of the muscle groups themselves. And this is, uh, this is from Kim and Gabriel. You'll see it here. These are the hamstring muscle groups themselves, all of the different semitendinosus, semimembranosus, the long head, and the short head of the bin. But what's also really, really interesting here is for me, the Doctor Group and the Doctor Group have a huge role to play in sprinting and movement, particularly in team Sports.

Because in track, for example, it's a lot more linear, but with movement and adjustment, the adopter group becomes more important, particularly as the athletes start to change direction and the adductor group has a huge role in hip extension, which we look at a little bit later. So you're looking at the 710 tendonosis members Nosis, Longhead, and Shorthead and you can see here the initial contact take off and then again initial contact.

Now, what does this mean? What it means is that at the initial stage when the earthquake flood is coming off, there is actual activation and then the heel is coming to the ground again to decelerate. These are the two moments when the hamstring is most under stress if you will or most under focus. But if we take a closer look at the actual anatomy itself, and look at where the attachments and insertions, the key ones here, are going to be the issue. Issue tuberosity Linea Aspera OK, so this is where the origins of the hamstring are and then the insertions, then further down on the superior tibia.

But I want to focus on the origins because what you'd see here is these are the origins up underneath your backside. And that is the two key areas where most injuries tend to occur tend to be at the actual tenderness juncture, at the insertion up there, and in the belly of the hamstring. It's rare much rarer to have actual injuries down lower. So why is that? Well. That's large because that's where most of the force is going. And if you think about it, where we looked at where the hamstring is most active, it's at the takeoff and the deceleration and these are the two points where most of the injuries occur.

Then when you look at a cross-section of the hamstring, what you see here is this is the quadricep group here. OK, so the anterior compartment and the hamstring group are here. But also when you look here on the far side, what you see is the adductor group on the inside and it's quite a large muscle group itself. And it's not solely used for you know, adoption or even abduction but what you're seeing here is the hamstring group. But then actual doctors themselves play a large supporting role for the hamstrings in terms of locomotion now when we look at it. Actual hamstring injuries.

We want to look at the types, the causes, and the reasons and then at what you can do. And that's what I want to start with. Now in most cases what people will do is they'll start with one of the reasons, but I wanna look at the types first and some of what are the most common types of injury. There are 3. Common types. These two stretch types enforce type are the most common. There's a third one which is a deceleration type, and this language is. This is called Assassin.Um, work which is again.Fascinating, and I'll put a link to the thesis I remember speaking with him in London. These are the two he studied.

We spoke about this third one, which he hadn't researched, but he's done a lot of work looking at the nature of the hamstring now. He describes the stretch and the force type as a dancer and a sprinter hamstring injury. This third one we call Hammy the dancer. Hamstring injury is when there's an overstretch of their muscles so the muscle is overstretched in a team sport. Think of it as a player reaching their feet, overreaching, or sliding, so there's an actual stretch in the muscle. The sprinter one is more takeoff where there's an excessive force through it, the handbrake. Injury is on actual contact when the heel is coming down. OK, as the heel is coming down, there is an actual force or a pull through it.

Now this one's a little bit different because it's usually a result of fatigue, but when you think of all of the hamstring injuries that you've seen. They'll fall usually into one of these, probably most often the sprinter type where a guy, so we're a guy regards sprinting and they reach further hamstring after the food has come down or if they decelerate harder they land and there's a sudden shearing or pulling of the hamstring itself. That's the actual hamstring injury itself. No, asking went through all of this research, and if you look at the actual regions involved, something will start to point, something will start to appear very, very quickly. The proximal injury site is far more common overall, in fact, asking themselves that clearly shows a majority of the injuries.

Proximal means essentially at the issue of tuberosity itself. So where the insertion occurs or in the belly of the muscle, in the actual body of the muscle itself, clearly shows the majority of injuries. Now we're gonna come to that later because it becomes very, very important, but there are no studies. Showing the initial decrements and muscle strength under flexibility correlated with time back. This is very important. It's something I've seen firsthand as well, just because somebody is weak or you are sorry, just when you test their strength or flexibility after the injury, it's not a great indicator of whether or not they can come back. So if you can, you would prefer to use MRI. But don't be misled.

I've seen athletes with tremendous flexibility in the hamstring group itself only days after an injury. I've also seen athletes who've got incredible strength in the hamstring group itself. That's large because of compensation.The flexibility itself could be down to just simply mobility in the hip. So it's it can be very misleading to look at strength or flexibility as an indicator.Moreover, and sorry close to looking at studies reporting with hamstring strains were encountered not only in high-speed running but in some cases stretching and kicking movements. And so for rugby soccer players or kickers and other sports, this is where you'll see those injuries and they can be most severe because you've got a stretch and it might seem as bad, but they can take much longer to occur so.

One of the things is when you look at running, the hamstring is activated here but doesn't come into full activity beyond 20 meters when the athlete is upright and the hamstring is moving. So hamstring is used here for acceleration, but you'd never have maximum. Course going until the athlete is upright and this is where the phases matter. So as the athlete gets beyond HH, that's when the hamstring comes. So if you want to train and not put excessive stress under the influence on the hamstring when I'm seeing is keep the distances below 20 meters.In fact. A lot of aerobic or anaerobic and aerobic fitness tests I would do would never go beyond 20 meters for that reason, because I want the player to push themselves hard but I never want them to be to go beyond 20 meters and run the risk of pulling a hamstring, not in the test.

We'd certainly train for it but I wouldn't want them to get injured. Doing a test. So what does all of this mean? The actual activation? The origin? The construction? The function of the hamstring? Well.There are few things two players rarely start from a three-point stance. They rarely reach true Max speed, they're always changing direction. The adopter group comes in to compensate, and the full hamstring activation only happens 20 meters and beyond. And the stretch or dancer injury is rare in a team sport player unless they're kicking.We're reaching farts. So the two that you're going to see are the sprinter injury where there's a force or a deceleration. And that's what leads us to then how you train it.

Because what you want is want most of the movement to happen around the hip at the issue of tuberosity because that's where most of the injuries are occurring. That means that most of the force is going through that, which is where most of the activity is happening and that's where you want to be strongest. So for example, stretches or movements like reverse hyper or glued ham raises allowed the strengthening of the actual hip movement.Hip extension is critical and perhaps even here at the lower point, but this is the most important point.No.This is the pitch where I cringe. You might not cringe, but I cringe a little bit around Nordic corals. Now, first of all, there's no such thing as bad exercise per se, but my worry with the excessive amount of Nordics is having seen where the activity is, seen the construction, and seen the injury sites.

Why would you spend an excessive amount of time focused here on knee flexion? Particularly when you see, yes, the insertions are here, but this is only for example, the short head of the bicep that's being activated here. You do have isometric force, but unless you're putting a force on the hip itself, which is the difference between the Nordic for example, and the dilute. Careers The other worry as well is that if you're. Strengthening or doing an excessive amount of Nordics. What's happening here is you're changing what's known as the strength curve. So a strength curve is when we, if you, for example, even a bicep curve, there's a particular point where you're strongest and you're very, very strong and you're weak, OK. So the strength curve is the strongest point if you go back to for example.

Let's go back to here. We want the strength curve to be higher. We don't want the strength curve to move down. So in theory. You could suggest that an excessive amount of Nordics makes the hamstring weaker at the point where you need it. Now it doesn't work like that. The hamstring gets strong, it's just not getting strong where you need it to get strong. There is a danger of course with any training if you do an excessive amount of work in one. The part that is not fully recovered is that the actual part of the strength curve and musculature could be weaker. That's my little rant over about Nordics. As I said, there's no such thing as bad exercise. It's just certainly not one of the first that I would ever choose for hamstring strengthening.But reverse hyper is excellent because it's doing two things.

It's first of all allowing you to get full hamstring lengthening from the hip the whole way down and there are also strengthening the glute region itself. OK, so the hips themselves are full hip extension allowing. Coming up and you have low back strength, not as much as low back strengthening but this is probably one of the best exercises. When I say one of the best exercises I mean outside of squatting, deadlifting, good mornings, and remaining deadlifting. Talking about actually isolated semi-isolated strengthening exercises.Say for example with the GHR glute ham raise, what you're getting here is you're getting strengthening along the hamstring the whole way up right up to the issue of sugar asked you for. Again, we know most of the injuries already occur and you're allowing the athlete to get a full hip extension and full low back extension for theirs. After spinning on the lots, the whole way up here.

 First of all. Established the injury type. If an athlete gets injured what type of injury were it and the injury method? OK, how they get injured would tell you a lot about the nature of the injury. Was a stretcher a dancer or was it a sprinter-type injury the body often self-protects it causes a spasm so initially. The first indication might be if you're lucky, a little spasm. So that's the nervous system shutting down the muscle because it's either fatigued, there's a lot of force going through it that it can't compensate. So take this as a warning, OK? And it may be a result of residual fatigue, what I mean by residual fatigue. Your muscles work as agonists and antagonists and it's not simply the quad and hamstring.

The operator possibly, but if the hamstring has been overly fatigued what will happen is the nervous system will start to fatigue. It can't contract fast enough, so when you decelerate it can't relax quickly enough. The action potential cannot get to the muscle or isn't signaling to the muscle quickly enough to shut down. And what you have is Co contraction, and in that case, the quadricep will almost always win and the hamstring will fail. And that's what happens in the deceleration phase. You're decelerating, you're changing direction quads.

Hamstrings are Co contracting when the hamstring actually should be shutting down and shutting off, so you have to be careful about that. Residual fatigue can also be caused by metabolic waste still in the muscle itself. To get two main paths, stretch type and sprinter type, which we've covered now. The important thing is even if the acute symptoms in the stretch type are small, the recovery time can be long. It's a little bit of the opposite. Even if the acute symptoms are marked, the recovery time could be shorter for the sprinter type, depending on how hard. So it's important to recognize that an overstretch one might need a little bit longer. And again, we can't rely on the strength and flexibility tests as an indicator.

For how long it's going to take to recover with the third type, remember, isolated stretch and strength tests may not be sufficient measures. The leg isn't legal. You just can't simply strengthen hamstring curls or Nordic curls or isolate parts of the movement itself. Do you want to strengthen the hamstring? Through its whole proper range of motion. Take all the cute hamstring strains seriously. Underestimation is far too common, so if there's a spasm. Relax. Make sure that you allow the athlete to recover fully. You get the full treatment and be careful after four to 10 days because that's the window where the actual spasm has gone down. The protective mechanism is relaxed, but the muscle may not be. The athlete may not be fully able to participate in practice, so decrease watch.

How the athlete is moving and palpating is something that is again often underestimated. Being able to feel and palpate through a very good or good massage therapist or manual therapist is gold because of the feedback not only that they can get, but they can give and the feedback loop between them and they are. And how does it feel? How does it feel here? Where is the swelling? Where is the heat?If you have the option of an MRI, depending on the level that you're at, that'll give you a better indication and what you will find as well as if the tendon itself is included. So generally, as I said, the majority of hamstring and hamstring injuries are going to be more proximal. They're gonna be closer up to.I'm going to be closer to the issue of tuberosity itself, but if the tendon itself is inflamed or involved, that could be very serious because in some cases of course the hamstring will come away from the bone itself.

Doctors have a key role and they need to be trained, but you want to train them in the movement that they're used to. So you wouldn't use, for example, Copenhagen or isolated a doctor's movements. What you would do is you would use unilateral workers step UPS, lunges that include the adopter as part of the. One string group. No. Yes, you can isolate them, but you have to remember that if you're going to isolate the muscle itself, you're not training it along with all of the other muscles that it's going to be used with. So now you're going into an exercise with a prefix fatigue muscle, you're going into training with a pre-fatigue muscle, and in some cases. Coaches who isolate the hamstring excessively then put the player in and meaning well, but they isolate the hamstring excessively, putting the player into the sport. Would you now have if you've got arrested Quadricep, a doctor group, you've got a pre-fatigued hamstring group and then they wonder why the hamstring group itself? Feels better, and starts to get injured.

So be very very careful pre-training and don't create a vicious cycle. Training the hamstring, but fatiguing it, it gets injured. Then training is more fatiguing it. Train it in unison together. Understand the strength curve. You don't want to move the actual strength curve proximately distally, because what will happen then is the actual strength curve itself starts to shift and you're not allowing the hamstring. Strongest where it needs to be strongest again, don't create that vicious cycle again. And the hamstring function is largely hip extension. So in all of those movements, it's not knee flexion. Don't isolate it with knee flexion movements. If you want to. With knee flexion movements, you can use high Rep work, but I wouldn't use strength works specifically.If you were going to do anything, it's hip extension work as where you're going to get most buying for bulk.

Lastly, hamstring injuries may not be caused by hamstrings. It can be an imbalance in the quadricep group. It changed pattern fatigue can lead to the hamstring going. So if you've got a hamstring injury. Back to the first point, look at the mechanism of injury. Investigate that, put on as I said, put on your CSI hat, and investigate before you jump to conclusions and ask yourself why did it happen? Very often it's fatigue in the athlete and inability to adjust and it fails. And if you're fortunate, it's simply a spasm.

Which is a warning flag. The athlete might be just generally fatigued, might have been a lot of upright running, and could have been a change in actual grounder and running pattern. But it may not be the hamstring itself that is the reason the hamstring may not be weak. So don't go on a huge journey of strengthening the hamstring excessively, OK? Because an excessive amount of hamstring work can lead to fatigue, can lead to overuse. So when the athlete then goes to actually train and work again, they're more fatigued, and that causes another hamstring injury. So keep all of those in mind and eliminate hamstring injuries from your team sport.