In elite and recreational sport, hamstring injuries remain one of the major reasons players spend time on the sideline. In the AFL, hamstring injuries remain a particular concern, with an estimated five new hamstring injuries occurring each season per club on average. This remains the case despite the best efforts of some of the best medical professionals and fitness coaches in the industry. At the time of writing this article, 24 AFL athletes are currently on their respective club's injury list due to a hamstring injury!
The difficulty in predicting and preventing hamstring injuries lies in the fact that there are numerous risk factors at play. Some show strong, clear correlations to hamstring injury risk, while others remain a topic of debate amongst physiotherapists, sports scientists and fitness coaches. The most significant factors considered are listed below:
Previous hamstring injury. If an athlete has previously injured their hamstring, they carry a significantly increased risk of a future recurrence.
Reduced hamstring strength. This weakness makes the hamstring more vulnerable to injury when subjected to high stress situations such as during a maximal effort sprint.
Reduced hip strength. This may increase the demands on the hamstring during activity as it is forced to compensate for weakness of the surrounding hip muscles.
Impaired quadricep to hamstring strength ratio. The hamstrings and quadriceps have important roles during a sprint- part of the hamstring's role is to help slow down the lower leg as it springs up in the air before powerfully pushing back down to contact the ground for the next stride. The quadricep muscle helps spring the leg up into the air, therefore it is thought that if the hamstring is weak relative to the quadricep, more force is being produced relative to what the hamstring can handle. This puts the hamstring at risk of injury.
Inefficient running technique. Running is a skill learnt from a very young age. Contrary to what most might believe, it is a skill that should be taught with specific instruction to ensure the correct movement patterns are grooved from a young age. Unfortunately, many athletes have played throughout their junior careers with little to no coaching in how to run efficiently. This leaves many with an inefficient running style, putting more strain on muscles and joints, creating more fatigue and ultimately increasing injury risk. Although challenging, good coaching and persistence can lead to positive changes in an athletes running technique.
Inappropriate training loads. Too much or too little high intensity and/or maximum speed running during the training week leading up to games relative to an athletes ability to recover increases the risk of hamstring injury. Also relevant is the appropriate placement, timing and type of weight training, sprint training and skills training during the training week. Improper programming of these variables can put an athlete at risk of injury due to increased fatigue or muscle soreness.
Inadequate cardiovascular fitness. Reduced cardiovascular fitness means an earlier onset and greater level of fatigue during games, which increases an athlete's overall risk of injury.
Dysfunction of surrounding joints and muscles, including the hip/pelvis, lower back and foot/ankle. Joint stiffness, joint hyper-mobility (too much flexibility), muscle weakness, muscle tightness or poor posture can reduce the efficiency of the body's movement during activity. This ultimately can increase the strain on the hamstrings making them more vulnerable to injury.
Poor recovery including lack of quality sleep and poor diet. This influences the body's ability to recover from training, putting the muscles and joints at a higher risk of injury.
Why do hamstring injuries seem to be on the rise in elite AFL athletes?
Hamstring injury risk is most likely influenced by the interplay between all of the above factors, making an injury very difficult to predict and challenging to prevent! AFL athletes are being pushed to the edge physically (and psychologically) in order to gain a competitive edge. This is most likely the cause of many injuries at the elite level of sport. The more an athlete is pushed physically to the edge through increased training loads (see point number 6 above), the more each of the other above factors need to be controlled and optimised to mitigate any increased risk that may result from this extra training workload. This is the reason why elite teams invest so much time and money in player recovery and tracking and managing player workloads during games and throughout the training week! Unfortunately for some teams pushing the boundaries, injuries do occur if the balance of training load, recovery and other factors mentioned above is not correct- something that some teams will only come to realise after a spate of injuries occur.
What can you do to reduce your hamstring injury risk?
Most of the above factors can be modified to reduce your risk of suffering a hamstring injury. If you are a recreational or elite athlete reading this, consider adding in the Nordic Lower (see below) to your training program. This is one exercise which has been proven to reduce hamstring injury risk by helping to correct the risk factor highlighted in the second point above: reduced hamstring strength.
To incorporate Nordic Lowers into your training routine, try the following gradual progression:
Week 1: 2 sets of 4 reps
Week 2: 2 sets of 5 reps
Week 3: 3 sets of 4 reps
Week 4: 3 sets of 5 reps
Week 5: 3 sets of 6 reps
If you are incorporating this exercise into your program for the first time and you are in-season playing a competitive sport, be aware you may experience some hamstring muscle soreness in the days following. While this is normal, it is best to leave at least three days to recover between completing this exercise and playing your next game!
There are many other great exercises that should be incorporating into a comprehensive strength and conditioning program to reduce your risk of hamstring injury. Keep a look out for future articles where we will discuss each dot-point in more depth and give you more tips on reducing your hamstring injury risk! If you would like an assessment and injury prevention program, you can call or SMS us on 0415 889 903 or email us at admin@prosportphysio.com.au
