Hamstring Injuries in Football

Watching easter weekends Premiership football got me rather fustrated, seeing two Sunderland players dropping to the ground clutching their hamstring. Stoke's Matthew Etherington also suffered the same injury Tuesday evening against Tottenham and Carlos Tevez missed the big Manchester derby FA Cup semi final with a hamstring injury. This is sadly a common occurrence, even at the highest level of the game. However, many of these injuries can be prevented.



I used to be quick to point the blame at the player's training regime, however experience has taught me that it's not as simple as poor training methods or work load management, we don't always know the full story. Fatigue has a large role to play in these injuries. There are various methods of monitoring athlete's fatigue levels, which can then be a good indicator for injury risk. Fatigued athlete = Higher risk of injury. Simple. However Strength and Conditioning coaches often face an uphill battle, you try telling Alex Ferguson that Wayne Rooney shouldn't play against Chelsea this weekend as his data levels indicate high fatigue. The money involved with the game sadly means a player's welfare isn't always number one priority.

The risk of a hamstring injury is heightened in any change of direction sport as they require constant acceleration, deceleration and maximal sprinting. Studies have found in elite professional football, as much as 17% of all injuries involve the hamstrings. Up to 31% of hamstring injuries reoccur within the first year with over half (54.5%) of these recurrences happening within two weeks of return (i.e. Danny Wellbeck). They can be difficult to rehabilitate and because of this, careful planning and smart training is needed during rehab to reduce the chance of recurrence.

Why do they happen?

Hamstring injuries generally occur during two actions; explosive high speed running (Sunderland's Asamoah Gyan) and extreme Range of Motion (ROM) during stretching movements. Injury can also be associated to:

• Strength inbalance between the quadricep and hamstring
• Lack of flexibility
• Inadequate warm up
• Fatigue (probably more common in the Premiership)
• Ability to decelerate (slow down)

They can occur during maximal sprinting due to the hamstring's role in decelerating hip flexion and knee extension.


Sunderland's Asamoah Gyan pulls up.

How can I get better?

Obviously resting is important but it's not the only thing that you should do. Incorporating a progressive training programme that involves strength and flexibility work is important. Your aim should be to:

Avoid:

• Any reduction in flexibility
• Muscle wastage (atrophy)
• Collection of scar tissue

Improve:

• Range of Motion
• Eccentric strength

Example Training Progression

Phase 1 - Basic Strengthening - Focus on hamstring specific exercises such as Romanian Deadlift and hamstring complex exercises (stability ball roles) whilst continuing to increase ROM through stretching.
Perform stretches 3-5 times a week, holding for 30-45secs and repeat up to 4 times.


Hamstring complex

Phase 2 - Low velocity eccentric strengthening - Begin to introduce exercises such as Nordic lowers and split squats, while continuing to develop concentric strength and ROM.


Nordic lowers

Phase 3 - High velocity eccentric strengthening - High velocity plyometric and sport specific exercises to increase hamstring torgue at high speed. Squat jumps, bounding and depth jumps. Strength and ROM should continue to be improved.

Phase 4 - Sport specific - Multidirectional activites should be introduced, such as lateral hurdle hops, double and single leg zig-zag bounding and hopping.