Hamstring Injury Prevention: A How to Guide This Sporting Season

Hamstring injuries are one of the most common sporting injuries and they have a high rate of recurrence. Sports involving high speed running or extensive hamstring lengthening activities such as kicking are more at risk of injury. They can take weeks to reach full recovery and the time missed playing sport can be detrimental to individual and team performance. Being aware of risk factors for hamstring injuries and using research based evidence to aid in injury prevention can help make this next sporting season a success.

A wise person once said that prevention is better then a cure.  By being aware of the risk factors that contribute to hamstring injuries, the athlete can start to minimise the risks that can be modified. Risk factors include age, past history of injury, hamstring strength, fatigue and player position (with speed positions being more likely to injure). Although you can’t control how old you are or if you have previously injured your hamstring, you can improve hamstring strength!

So what is the best way to improve your hamstring strength? The most evidence-based approach to reducing hamstring injuries from occurring in the first place and reducing recurrence is performing eccentric strengthening exercises. In one study, they discovered that if soccer players did an exercise called the Nordic Hamstring Curl in pre-season training, and then maintained the exercise as part of their training during the competitive season, they were able to reduce new hamstring injuries by up to 60% and recurrent injuries by 86%.

The Nordic Hamstring Exercise Protocol is an eccentric exercise program that loads the hamstring muscle while it lengthens. This exercise is performed with a partner securing the feet to the ground. The athlete then falls forward from the knees, resisting the fall for as long as possible with the hamstrings. As the athlete’s upper body approaches the ground, the hands must be turned out to buffer the fall, letting the chest touch the ground. Upon completion of one repetition, the athlete must return to the starting position by thrusting themselves back up using their hands.

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Ideally, the strengthening program should begin 10 weeks prior to the start of the season. When the season begins frequency should be reduced to 1-2 times per week. The exercises should be completed in a non-fatigued state after an appropriate warm-up.The table below outlines the ideal weekly progressions for the exercises.

Week Sessions/week Sets Reps
1 1 2 5
2 2 2 6
3 3 3 6-8
4 3 3 8-10
5-10 3 3 12,10,8
11 and beyond 1-2 3 12,10,8

It is important to note that the Nordic Exercise Protocol has been researched mainly on soccer and AFL players, but the research can apply to similar sports. Balance and proprioception exercises, flexibility training and soft tissue therapy can also be implemented in prevention programs. 

If you are currently struggling with a hamstring injury it is important that you consult your physiotherapist first before beginning an intense prevention program (as above), as appropriate rehabilitation exercises must be done first. If you need help getting started or have a hamstring injury that needs attention call to book an appointment today on 9543 1888. 

References

Bourne MN, Williams MD, Opar DA, Al Najjar A, Kerr GK, Shield AJ. Impact of exercise selection on hamstring muscle activation. British journal of sports medicine. 2016 May 13, 2016.
Brukner and Khan.(2012) Clinical Sports Medicine Forth Edition.North Ryde NSW: McGraw Hill Education Pty Ltd.     

Hughes, M. (2016). Hamstring Injuries: A Review of the Recent Literature. https://www.mickhughes.physio/single-post/2016/06/19/Hamstring-Injuries-A-Review-of-the-Recent-Literature

Sayers, A., and Sayers, B.(2008). The Nordic Eccentric Hamstring Exercise for Injury Prevention In Soccer Players. Flexibility and Rehab. Volume 30, Number 4. http://www.ctgdevelopment.net/members/images/adobe_pdf/exercises/the_nordic_eccentric_hamstring_exercise_for_injury.10.pdf

Van der Horst, N. et al.(2015) The Preventive Effect of the Nordic Hamstring Exercise on Hamstring Injuries in Amateur Soccer Players. American Journal of Sports Medicine. Volume 43, Issue 6. http://journals.sagepub.com/doi/abs/10.1177/036354651557405