The high incidence of hamstring injuries in all the football domains is common knowledge. And there has been intense study and focus on reducing their numbers, however in Europe the numbers continue to increase, although in Australia the numbers are reducing.
Anyone want to give a guess at the reason for the difference between Australia and Europe?
Why are hamstring injuries such an ongoing problem?
High incidences of recurrent hamstring injury(12-34%) implicate inadequate rehabilitation and/or premature Return to play as a reason, both potentially the result of underestimating the injury (Brooks, 2006; Orchard and Seward, 2002).
So how should we manage hamstring injuries?
The Return to Play program should be aligned to the different healing stages of muscle (Jarvinen et al. 2005;2014), incorporate the findings from the clinical examination and individualised to the player and injury situation, while considering the risk factors associated with hamstring injuries (Van Beijsterveldt et al. 2013; Bahr and Holme, 2003; Opar et al. 2012; Mendugichia and Brughelli, 2011).
Major Factors that can be controlled are load, lumbopelvic strength, hamstring strength, flexibility, neural tension and running mechanics (Gabbe et al. 2005).
Lumbopelvic stability (Core strengthening) programs are an established part of HMI rehabilitation
The connections of the hamstrings to the pelvis and in particular Biceps Femoris, imply hamstring function is dependent on pelvis posture and kinematics (Higashihara et al. 2015).
Rehabilitation focusing on lumbopelvic control has been shown to reduce hamstring reinjury rates, compared to a stretching and strengthening program (Sherry and Best, 2004).
There has been much research on the role of strength in injury prevention and rehabilitation
Eccentric hamstring strength programs with good compliance have been shown to reduce first time and recurrent HMI in amateur and professional athletes (Petersen et al. 2011; Tyler et al. 2017; Askling et al. 2013; Brooks, 2006). Nordics have particular strong evidence behind them, but the importance of hip extensors in producing force production during sprinting (Edouard et al. 2018), implies the need for rehabilitation exercises to include hip dominant exercises.
As the majority of hamstring injuries occur during high speed running (Brooks, 2006) running practice during rehabilitation and throughout training practice is vital for safe return to play and injury prevention. Achieving the same rate of high speed running in training and rehabilitation, that you achieve during match play is key for safe return to play and to protect against recurrent injury.
Altered neural tension has been found in rugby players with a history of repetitive hamstring injuries, this is the reduced ability of the sciatic nerve to slide and glide thereby limiting the ability of the hamstring to stretch and activate.
This is what the Aussies do best! High accumulated loads and peaks in load are associated with increased injury risk. Progressive increases in chronic workload protect against injury (Bowen et al. 2017).
Sligo Physio Space has extensive experience in managing hamstring injuries in Australian rules, soccer, GAA, rugby and gymnastics. So if you have an issue with your hamstring Get in touch for a comprehensive assessment and management plan. Also check out my video of some simple flexibility work for your hamstrings.