Hamstrings Injuries

With the AFL and soccer season right around the corner, I thought we would take a deep dive into the most common injury in both AFL and soccer - hamstring strains. 

Anatomy: 

The Hamstring muscle is a group of 3 muscles that are found on the backside of your thigh. They originate from the hip bone and run to attach just underneath the knee. Consequently, they are a more complicated muscle as they run over and therefore influence both the knee and hip joints.

Frequency of injury : 

Research has found that at an AFL community football level, over 80% of hamstring injuries occurred in running or sprinting actions and 19% of injuries occurred during the kicking motion (Gabbe, 2005). 

In regards to soccer, hamstring injuries are also the most common soccer related injury - accounting for 37% of all soccer muscle injuries (van der Horst, Wouter Smits, Petersen, Goedhart, & Backx, 2014).

Mechanism of Injury 

The hamstring muscle is most likely to be injured in a lengthened state. With regards to the gait cycle, this is most likely to occur in the late stance phase and late swing phase of gait (Wood).  

Going through the following videos, we can see the common mechanics of how the AFL footballers injured their hamstrings. The injuries occurred as the footballers were running at maximum speeds whilst incorporating a bend or twist in their back - this puts greater length and force through their hamstring and therefore increases its chance of injury.

Grading of injuries: 

There are 3 types of grading for hamstring strains. 

• Grade I: mild strain injury with minimum tear of the musculotendinous unit and minor loss of strength

• Grade II: moderate strain injury with a partial tear of the musculotendinous unit and a significant loss of strength that results in significant functional limitations

• Grade III: severe strain injury with a complete rupture of the musculotendinous unit and is associated with severe functional disability (Liu, Garrett, Moorman, & Yu, 2012). 
  

Average time loss due to injury: 

The averaged time losses for different grades of hamstring muscle strain injuries in European professional soccer are (Ekstrand et al., 2011): 

• Grade I: 17 ± 10 days 

• Grade II: 22 ± 11 days 

• Grade III: 73 ± 60 days 

Nordic exercises:  

A very popular exercise for hamstring strains is the nordic exercise. There have been studies to show that incorporating nordic exercises can be an effective way to increase hamstring eccentric strength (Mjolsnes, Arnason, osthagen, Raastad, & Bahr, 2004). Another study also found adopting nordic exercises helped reduce hamstring injury rates by 65 to 70% in a group of male professional soccer players (van der Horst, Wouter Smits, Petersen, Goedhart, & Backx, 2014). Click here to watch.

Whilst most of the research has been for soccer originally, the effects are thought to be not as effective when compared to AFL due to the differences in physical demands in each sport. These differences include differences in hamstring length in kicking motion due to differences in ball drop and trunk angle as well as the requirement for AFL to pick up the ball on the run. As such, the nordic exercises should be included with caution in regards to preventative programs for AFL specifically (Milanese & Eston, 2019). 

More AFL specific exercises for Hamstring strain: 

See the exercises below with an explanation on how the little tweaks can make a big difference, all to try to mimic real life AFL scenarios. 

• Exercise 1: single leg deadlift off a step. 

Using a step will increase the depth of your hip flexion eccentric load. As we know hamstrings injuries usually occur when the tissue is lengthened, adding a step will promote more strength through range in the hamstring muscle. In this exercise, really try to get more depth by reaching the weight as far towards the ground as possible. 

AFL Task: This hip depth is vital for AFL football as it mimics the required hip flexion range you need to kick a football.  Click here to watch.

• Exercise 2: Eccentric load with rotation drivers 

As we saw from the injury videos above, the hamstring was injured usually when the trunk was bent over and there was a twisting action through the torso.In this exercise, flex through your hamstring. At the bottom of range - add a twist right and left to place a greater rotational load through the hamstrings to mimic AFL scenarios. 

AFL Task: This exercise mimics picking up a ground ball whilst trying to evade an oncoming tackler. Click here to watch.

• Exercise 3: Eccentric Load with reaches in front  

Standing off a step, reach down and out with the weight and feel the hamstrings work. Try and work all different angles in front of you so mimic reaching out from 9 o'clock to 3 o'clock on the clock face. As you do the exercise, try to gradually increase the depth, weight or distance of your upper body to increase the load through the hamstring. 

AFL Task: trying to lunge for tackle or lunge to mark the ball - this exercise tries to mimic the position in which many of the hamstring injuries occur as seen in the injury videos above. Click here to watch.

• Exercise 4: Adding speed and unpredictability to your training 

As research has found that the speed of the hamstring lengthening can affect the severity of the injury it is important to train for the unpredictable nature of the hamstring contraction. For this exercise, stand off a step and get a partner to throw tennis balls to you. This will force the hamstring muscles to lengthen at a much quicker rate. Click here to watch.

How good it is that football and soccer are back!

Whilst having general hamstring and lower limb strength is important, the small tweaks in each exercise make them much more specific to your sports or task, and therefore more effective in trying to prevent injuries. If you are wanting to elevate your sports performance to the next level get in touch, we’d love to help you reach those goals by providing a more supportive and tailored program for you and your sport.  

References: 

• Ekstrand, J., Healy, J. C., Waldén, M., Lee, J. C., English, B., & Hägglund, M. (2011). Hamstring muscle injuries in professional football: The correlation of MRI findings with return to play. British Journal of Sports Medicine, 46(2), 112-117. doi:10.1136/bjsports-2011-090155

• Gabbe, B. J. (2005). Risk factors for hamstring injuries in community level Australian football. British Journal of Sports Medicine, 39(2), 106-110. doi:10.1136/bjsm.2003.011197

• Liu, H., Garrett, W. E., Moorman, C. T., & Yu, B. (2012). Injury rate, mechanism, and risk factors of hamstring strain injuries in sports: A review of the literature. Journal of Sport and Health Science, 1(2), 92-101. doi:10.1016/j.jshs.2012.07.003

• Milanese, S., & Eston, R. (2019). Hamstring injuries and Australian rules football: Over-reliance on Nordic hamstring exercises as a preventive measure? Open Access Journal of Sports Medicine, Volume 10, 99-105. doi:10.2147/oajsm.s212008

• Mjolsnes, R., Arnason, A., Osthagen, T., Raastad, T., & Bahr, R. (2004). A 10-week randomized trial comparing eccentric vs. concentric hamstring strength training in well-trained soccer players. Scandinavian Journal of Medicine and Science in Sports, 14(5), 311-317. doi:10.1046/j.1600-0838.2003.367.x

• Van der Horst, N., Wouter Smits, D., Petersen, J., Goedhart, E., & Backx, F. (2014). The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: A randomized controlled trial. British Journal of Sports Medicine, 48(7). doi:10.1136/bjsports-2014-093494.135

• Wood, G. A. (n.d.). Biomechanical limitations to sprint running. Medicine and Sport Science, 58-71. doi:10.1159/000414398