1

Clint Haggard, MA, ATC, SCAT, NREMT_B

Head Football Athletic Trainer

University of South Carolina

Agenda

� Anatomy

� Rate of Injury

� Injury Presentation

� Injury Considerations

� Risk Factors

� Rehabilitation

� Prevention

Anatomy Anatomy

Rate of Injury

� UEFA over 7 seasons (Ekstrand, 2009)

� 525 hamstring strains = 11.7%

� Avg of 7 hamstring strains per season on a 25 player squad

� Hong Kong Football Association, 1 season (Wai-Yuk Lee, 2014)

� 12% incidence rate

� Out of all recurrent injuries, 26% were hamstring strains

� 28% of hamstring strains were moderate or severe (>7 days time loss) = avg 9.4d time loss

� MLS inaugural season, 1996 (Morgan, 2001)

� 9% of total injuries were hamstring strains

� 42% of all muscle strains

Injury Presentation

� High speed running � Rapid acceleration / deceleration

� Susceptible during powerful eccentric contraction� Late in the swing phase – most common

stage of injury occurrence

� Running injuries involve biceps femoris most often

� Semimembranosus injured in kicking or dancing

(Heiderscheit, 2010)

2

Injury Considerations

� 1/3 of hamstring injuries will recur (Orchard, 2002)

� Highest risk within the first 2 wks of return to sport

� Some factors require a longer rehab period (Heiderscheit, 2010)

� Proximal free tendon injury

� Close to the ischial tuberosity

� Increased size of injured area

� Intramuscular tendon injuries present as more severe but typically have a quicker return to play (Heiderscheit, 2010)

Possible Risk Factors

� Weakness and imbalance

� Body mechanics

� Fatigue

� Lack of flexibility

� Inadequate warm-up

� Sport specific activities

� Psychosocial factors

� Running technique

� Hydration??

(Hoskins, 2004)

Rehabilitation

� Goals

� Protect scar development

� Minimize atrophy

� Protection

� Avoid excessive active or passive

lengthening of hamstrings

� Criteria for progression

� Normal walk with no pain

� Very low speed jog with no pain

� Pain free isometric contraction against submax resistance at 90

Phase 1

Heiderscheit BC, Sherry MA, Silder A, Chumanov ES,

Thelen DG. Hamstring strain injuries: Recommendations for

diagnosis, rehabilitation and injury prevention. J Orthop

Sports Phys Ther. February 2010; 40(2): 67-81. doi:

10.2519/jospt.2010.3047.

Rehabilitation

� Stationary bike x 10min

� Side step x 10m, 3 x 1min

� Grapevine x 10m, 3 x 1min

� Fast feet stepping, 2 x 1min

Phase 1

Rehabilitation

� Prone body bridge, 5 x 10s

� Side body bridge, 5 x 10s

� Supine bent knee bridge, 10 x 5s

� Single limb balance progression, 4 x 20s

Phase 1

Rehabilitation

� Goals

� Regain pain-free HS strength

� Develop neuromuscular control of trunk and pelvis

� Protection

� Avoid end-range lengthening of hamstrings while

weakness is present

� Criteria for progression

� Full strength without pain during manual strength test at 90

� Pain-free forward and backward jog, moderate intensity

Phase 2

3

Rehabilitation

� Stationary bike x 10min

� Side shuffle x 10m, 3 x 1min

○ Moderate to high intensity

� Grapevine jog x 10m, 3 x 1min

○ Moderate to high intensity

� Boxer shuffle x 10m, 2 x 1min

○ Low to moderate intensity

� Rotating body bridge, 5s hold, 2 x 10

Phase 2

Rehabilitation

� Supine bent knee bridge with walkouts, 3 x 10

� SL balance windmill touches, 4 x 8 reps per arm

� Lunge walk with trunk rotation and T-lift, 2 x 10 steps each

� SL balance with forward trunk lean and opposite hip extension, 5 x 10s

Phase 2

Rehabilitation

� Goals

� No pain or tightness during all activities

� Normal concentric and eccentric HS strength throughout

full ROM and speeds

� Improve neuromuscular control of trunk and pelvis

� Integrate postural control into sport-specific movements

� Protection

� Avoid full intensity if pain/tightness/stiffness is present

� Criteria for return to sport

� Full strength without pain

� Full ROM without pain

� Replication of sport specific movements near max speed without pain

Phase 3

Rehabilitation

� Stationary bike x 10min

� Side shuffle x 30m, 3 x 1min

○ Moderate to high intensity

� Grapevine jog x 30m, 3 x 1min

○ Moderate to high intensity

� Boxer shuffle x 10m, 2 x 1min

○ Moderate to high intensity

� A and B skips, 2 x 1min○ Start at low knee height

� Forward-backward accelerations, 3 x 1min ○ 5m � 10m � 20m

Phase 3

Rehabilitation

� Rotating body bridge with dumbbells, 5s hold, 2 x 10

� Supine SL chair bridge, 3 x 15, slow to fast speed

� Single limb balance windmill touches with dumbbells, 4 x 8 reps per arm

� Lunge walk with trunk rotation and T-lift with dumbbells, 2 x 10 steps ea

� Sport-specific drills

Phase 3

Prevention

� Flexibility?� Eccentric strengthening in routine

training

� Nordic hamstring exercise

� SL physioball extensions

� ROLL OUT, BALL OUT!!!

4

Prevention

� Neuromuscular control exercises for lower extremities and lumbopelvic regions (Cameron, 2007)

� High knee marching

� Quick support running drills

� Forward falling running drills

� Explosive starts

References

Alternating One-Leg Eccentric SB Glute-Ham Curls [Video]. YouTube https://www.youtube.com/watch?v=jWT_uFyRxms.

Published Sep 16, 2014. Accessed May 5, 2015.

Cameron ML, Adams RD, Maher CG, Mission D. Effect of the HamSprint Drills training programme on lower limb neuromuscular

control in Australian football players. J Sci Med Sport. 2007;12:24-30. doi:10.1016/j.jsams.2007.09.003.

Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J

Sports Med. 2011;45:553-558. doi:10.1136/bjsm.2009.060582.

Fast Feet: Cardio Exercise-Fat & Calorie Burning, Get Ripped, Sculpt & Tone, Weight Loss [Video]. YouTube

https://www.youtube.com/watch?v=iUo7R9jDAT8. Published Dec 22, 2011. Accessed May 5, 2015.

Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: Recommendations for diagnosis,

rehabilitation and injury prevention. J Orthop Sports Phys Ther. February 2010;40(2):67-81. doi:10.2519/jospt.2010.3047.

Hoskins W, Pollard H. The management of hamstring injury – part 1: Issues in diagnosis. Man Ther. May 2005;10(2):96-107.

Lee JWY, Mok KM, Chan HCK, Yung PSH, Chan KM. A prospective epidemiological study of injury incidence and injury patterns

in a Hong Kong male professional football league during the competitive season. Sports Med Arthrosc Rehabil Ther Technol.

October 2014;1(4):119-125. doi:10.1016/j.asmart.2014.08.002.

Morgan BE, Oberlander MA. An examination of injuries in major league soccer. The inaugural season. Am J Sports Med. Jul-Aug

2001;29(4):426-30.

Nordic Hamstring (Finnen) [Video]. YouTube https://www.youtube.com/watch?v=lg4ucCsuWGw. Published on Mar 6, 2013.

Accessed May 5, 2015.

Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports

Med. 2002;36:39–44. doi: 10.1136/bjsm.36.1.39.

Sherry MA, Best TM, Silder A, Thelen DG, Heiderscheit BC. Hamstring strains: Basic science and clinical research applications for

preventing the recurrent injury. Strength Cond J. June 2011;33(3):56-71. doi: 10.1519/SSC.0b013e31821e2f71.

Soccer Warm up – Side Shuffle [Video]. YouTube https://www.youtube.com/watch?v=I9x3sHxpoBE. Published Jan 31, 2010.

Accessed May 5, 2015.

Thank You!!