HAMSTRING STRAINS/ MECHANISM, MANAGEMENT, AND RETURN TO SPORT SPTS: CSM 2017
SATURDAY, FEBRUARY 18, 2017
11:00 AM – 1:00 PM
SPEAKERS: Daniel Hass, PT, DPT, SCS; Carol Mack, PT, DPT, SCS, CSCS; Anthony Trem, PT, DPT, SCS; James Voos, MD
DISCLOSURES: NONE
COURSE DESCRIPTION
Hamstring muscle injuries are common in sprinting events and other sports that involve high-speed running. Rehabilitation
and management is challenging, as healing is typically slow and literature has shown injury recurrence rates ranging from
12% to 63%. Subsequent injuries are often more severe than the first. This session will discuss injury mechanisms of acute
hamstring injuries and describe biomechanics of sprinting as related to injury risk and rehabilitation. Physical therapy and
medical management from acute injury through return to competition will be presented. Emphasis will also be placed on
sport specific progressions for sprinting, football, and soccer. The role of the core and pelvic muscles as related to injury and
rehabilitation will also be examined.
OBJECTIVES
AT THE CONCLUSION OF THIS SESSION, THE PARTICIPANT WILL BE ABLE TO:
1. ANALYZE BIOMECHANICS OF SPRINTING AS RELATED TO HAMSTRING INJURY AND REHABILITATION
2. APPLY THE ROLE OF CORE AND PELVIC MUSCLE CONTROL TO REHABILITATION PROGRESSIONS FOR HAMSTRING INJURY
3. DEVELOP STRATEGIES FOR MANAGEMENT OF HAMSTRING INJURIES FROM ACUTE INJURY THROUGH RETURN TO
COMPETITION
4. UTILIZE RETURN TO SPORT PROGRESSIONS FOR SPRINTING, FOOTBALL, AND SOCCER.
SESSION OUTLINE
SPRINTING MECHANICS AND RELATION TO HAMSTRING INJURY
Running Progression
A. Jogging: 2.0 m/s (4.5 MPH)
B. Slow-pace running: 3.5 m/s (7.8 MPH)
C. Medium-pace running: 5.0 m/s (11.2 MPH)
D. Fast-pace running: 7.0 m/s (15.7 MPH)
E. Sprinting: 8.0 m/s+ (17.9 MPH)
F. Usain Bolt Speed: 12.26 m/s (27.44 MPH)
II. Running to Sprinting
A. Stance phase decreases from 41% to 24% from jogging (4.5 MPH) to sprinting (18 MPH+)
III. Strategies to Increase Speed
A. Push on the ground more forcefully
B. Push on ground more frequently
I.
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
C. Combination of the two
Initial Strategy
A. 4.5 to 7.8 MPH
1. 63% increase in stride length
2. only a 4% increase in step frequency
B. Main muscles involved
1. Gastroc/soleus responsible for 49-62% of GRF in anterior/posterior direction
V. Increasing Speed Strategies
A. 7.82 to 11.2 MPH
1. 30% increase in step length
2. 11% increase in cadence
B. 11.2 to 15.7 MPH
1. 18% increase in step length
2. 18% increase in cadence
C. 15.7 to 18 MPH
1. 2% increase in step length
2. 25% increase in cadence
VI. Muscular Strategies during Stance Phase – Peak Forces
VII. Why The Shift?
A. Inability to push on the ground more forcefully
B. Activation levels of gastroc-soleus continue to rise, however, the relative amount of contribution to the GRF of this
muscle group decreases
C. This is due to less ground contact time and the force-velocity curve
VIII. Force-Velocity Curve
A. Ability to push on ground becomes less effective at higher speeds
B. Cadence increases significantly whereas step length does not
IX. Sprinting > ~17 MPH
A. Because the athlete is unable to push on the ground more forcefully, he/she must increase cadence to increase
velocity
B. This results in a strategy shifting to emphasize the hip during swing phase of the sprint cycle
X. Muscular Strategies - Swing
A. Iliopsoas during initial swing and gluteus maximus/hamstrings during second half of swing to decelerate hip
B. Very large external hip flexor and knee extensor torques must be opposed by the hamstring
XI. Muscular Strategies during Swing Phase – Peak Forces
XII. Sprinting > ~17 MPH
A. No difference in velocity of swing leg between amateur and professional sprinters
B. If force is limited as speed increases, and swing leg velocity is similar, how do world class sprinters reach higher
speeds?
XIII. Rate of Force Development (RFD)
A. World class sprinters have the ability to generate greater force in shorter times
B. RFD = change in force/change in time
1. Coordination of NM system to generate force in short amount of time
XIV. Sport-Specific Considerations
IV.
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
Track athlete
1. Pure sprinters, hurdlers, long jump, triple jump, high jump, pole vault
B. Field/Court athlete
1. Basketball, soccer, baseball, football, field hockey, lacrosse
XV. Sport-Specific Considerations
A. Major difference is type of skill which will effect your end-stage rehabilitation
B. Track = closed skill
C. Field/court = Open skill, requiring reactive agility, change in direction, and varying types of sprints
XVI. Sprinting – Closed Skill
A. Acceleration
B. Max speed
C. Deceleration
XVII. Accelerating vs. Sprinting
A. Steady state: muscles function like springs storing energy with each step, no net change in mechanical energy
B. Acceleration: Legs are like motors generating power to increase kinetic energy of the body
XVIII. How important is sprinting to the field/court athlete?
A. Often thought that because sprints are short, minimal emphasis should be placed on sprinting
B. However, most field/court athletes achieve max velocity in 30 to 45 meters (opposed to track athletes ~60 m)
C. Athletes can reach up to 90% max speed in as little as 15 meters, especially since most start from a walk/jog
XIX. Field Athlete Considerations
A. Usually walking/jogging prior to sprint
B. Head looking for ball, defender, etc
C. Usually not straight line – must cut toward goal/hoop and avoid defenders
XX. Sport specific analysis
A. What distances are run?
B. What directions does movement occur?
C. Typical starting methods?
D. Typical movement combinations?
E. What stimuli trigger movement?
F. How does speed relate to sport-specific skills?
XXI. Mobility Requirements
A. Key Mobility Requirements
1. Drive/Acceleration
a) Full hip flexion as trunk is flexed
2. Late Stance to early swing - Hip Extension
3. Mid-Swing - Knee Flexion (heel to buttock)
4. Late-Swing = Combo 90 degrees hip flexion with full knee extension
B. Hamstring Injuries
1. Up to 74% of all muscle strains in Track and Field
2. Very common during sprinting in soccer, football, rugby
3. Most commonly occur during late swing phase of sprinting
a) Eccentrically controlling hip flexion/knee extension
XXII. Hamstring Injuries
A.
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
Late swing phase of sprinting: average of 7.4% (SM), 8.1 % (ST), and 9.5% (BF) greater lengths compared to an
upright configuration.
B. Peak forces in hamstring almost double from 15 to 20 MPH
C. Hamstring injury in elite sprinters was associated with weakness during eccentric action of the hamstrings.
XXIII. Evidence for eccentric training for hamstrings
A. Well established that a pre-season eccentric hamstring training program can reduce hamstring injury compared to
control
1. Askling et al. 2003 – 3/15 (experimental) vs. 10/15 sustained a hamstring injury
2. Aranson et al. 2008 – 65% decrease in hamstring injuries over 3 years in soccer teams that utilized Nordic
Hamstring compared to teams that did not
3. Petersen et al. 2011 – Level 1 RCT of 942 soccer players randomized to eccentric group or control group
a) 52 (control) vs. 15 (eccentric) hamstring injuries
XXIV. What about hamstring flexibility?
A. Arnason found that the addition of hamstring flexibility training did NOT decrease hamstring injury rates (p=.22)
1. 7 teams performed stretching and 7 did not
2. Problem with stretching: statically stretching a muscle does nothing for the length-tension relationship of the
hamstrings
XXV. What about hamstring flexibility?
A. Potier et al: eccentric training program not only increased hamstring strength, but also increased fascicle length by
34% and knee extension flexibility at 90/90 by 5 degrees
B. Supported by Systematic Review of 6 RCTs in BJSM 2012
XXVI. Sprinting Progression
A. Starts out slow at 50% intensity – emphasize form drills and identify any abnormalities
B. Emphasize Technique:
1. High knee
2. High knee A’s (marching and skipping)
3. Wall drive
4. Butt kicks
5. Cycling
6. Fall forward
XXVII. Technical Aspects
A. Initial contact: Positive shin angle with foot behind center of mass to maximizing pushing forces, not weaker
pulling forces
B. Deceleration: Absorb force through triple flexion of ankle, hip, knee with rearward lean – athletic position before
change in direction
C. Swing phase: knee to buttock to shorten lever arm to keep cadence quick
A.
MEDICAL MANAGEMENT OF HAMSTRING INJURY
ROLE OF TRUNK/PELVIC MUSCULATURE IN HAMSTRING INJURY AND REHABILITATION
I.
Lumbopelvic control necessary for optimal function of hamstrings.
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
A. Proximal stability
B. Possible decrease in strain? (Bennell 1999, Sherry 2004)
II. Iliopsoas contraction in early swing phase- anterior pelvic tilt; couples with hamstring stretch of contralateral limb
(simultaneously in late swing) (Heiderscheit 2010)
III. Progressive agility and trunk stabilization exercises (PATS): quicker return to sport, less injury recurrence vs isolated
hamstring stretching/strengthening (Sherry and Best 2004)
A. HamSprint program (running technique, coordination; hamstring function) improved lower limb control in
movements similar to late-swing phase of running (Cameron 2009)
IV. Dispelling the myth to “tighten the core”
A. “Belly button to spine,” “hollow your belly,” “pull navel away from waistband”, etc….
B. Often causes posterior pelvic tilt/flattening of lumbar spines.
C. Transverse Abdominis and pelvic floor poorly activated in this position.
1. Reduces Core muscle work/forces compensation with other trunk muscles
V. Core stability = balance of pressure and muscular force
A. Intra-abdominal pressure exchange
1. Diaphragm/breath drives the movement
2. Transverse abdominis; pelvic floor: linked and responsive to diaphragm in exchange of pressure (Hodges 1985;
Hodges 2007)
VI. Muscular force: “Core” = 4 muscles: designed to automatically activate to stabilize the center before a movement.
A. Diaphragm
B. Transversus abdominis
C. Pelvic floor
D. Multifidus.
VII. How to “strengthen the core”
A. Train stability with inhalation and exhalation
1. Planks for breath cycles versus time
VIII. Core exercises are DIFFERENT than trunk exercises.
A. Trunk exercises = abs, back, butt
1. Strong relationship with the core
2. Proper activation of trunk relies on strong core foundation.
3. To make trunk exercises true “core” exercises- progression must move from inside-out.
a) Core first, then engagement of other trunk muscles
IX. Unstable surfaces (stability ball, BOSU) do not optimize core activation
A. Compensation happens
X. Train pelvic floor
PT MANAGEMENT OF HAMSTRING INJURIES IN FOOTBALL
PT MANAGEMENT OF HAMSTRING INJURIES IN SOCCER
I.
Incidence among NCAA sports (Dalton 2015):
A. Men's football 35.3%
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
B. Men's soccer 9.9%
C. Women's soccer 8.3%
II. Two types of acute sprains (Askling 2012)
A. Injury with high speed running
1. Often involves long head biceps femoris
B. Stretching of the muscle at extreme joint position
a) High kicking, slide tackling, sagittal split
b) Often involves free proximal tendon of semimembranosus
C. “Significantly greater extent of injury” when dominant leg involved in Elite mens soccer (Swedish first league)
(Svensson 2016)
III. Mens professional soccer (UEFA): Training-related hamstring injury rates increased since 2001; 4% annually (Ekstrand
2016)
A. Match-related injury rates stable
B. Factors in recovery:
1. Types of injury with longer RTP:
a) Slow stretch
b) Central tendon disruption of biceps femoris
c) Close proximity to ischial tuberosity
d) Increased ROM deficit with hip flexed at 90°
e) Time to first consult >1 week
f) Increased pain on visual analog scale
g) >1 day for painfree ambulation after injury
IV. Outcomes
A. Recurrence
1. Higher risk of recurrence with…
a) Biceps femoris injury (Hallen 2014)
b) Active knee extension deficit
c) Number of previous hamstring injuries
d) Isometric knee flexion force deficit at 15o
e) Localized discomfort on palpation just after RTP (De Vos 2014)
2. Second injury usually more severe- time away from sport typically doubles (Brooks 2006, Koulouris 2007)
3. Amateur soccer: previous strain strongest risk factor for recurrent (Engebretsen 2010)
B. Long term deficits
1. Strength
a) Eccentric hamstring strength reduced- even after RTP (Brughelli 2010, Lee 2009, Opar 2013, Sanfilippo
2013, Sole 2012)
(1) Factor in high recurrence rate?
(2) Due to prolonged neuromuscular inhibition after injury?
(a) Inhibition occurs due to pain after injury
(b) Limits hamstring exposure to eccentric stimuli at long muscle lengths during rehab (Fyfe 2013);
i) Impairs recovery:
(1) Chronic eccentric hamstring weakness
(2) Selective hamstring atrophy (Slider 2008)
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
(3) Shifts in the torque joint-angle relationship (Brockett 2004)
(4) Shorter biceps fascicle length, increased pennation angle, reduced eccentric strength in
previously injured hamstrings. (Timmins 2014, 2015)
b) Opar et al- previously injured hamstrings had lower rate of torque development (RTD), early contractile
impulse (IMP) during slow max eccentric contraction
(1) Compared with uninjured limb.
(2) Lower myoelectrical activity confined to the biceps femoris long head.
2. Function
a) Soccer players at return from injury: lower sprint speed, horizontal power (Mendiguchia 2014)
(1) Improved with 2 months of full training with team
V. Soccer-specific rehab progression:
A. Based on type of injury
B. Return to sprinting:
1. High-load eccentric contractions at slow to moderate angular velocity (Guex and Millet)
a) Keep hip in large flexion position (80°); focus on knee joint
(1) Elongation stress than occurs at terminal swing phase
2. Emphasize strength plus timing of contraction
3. Incremental progression of running speed; supplement conditioning as able
a) Aerobic/anaerobic fitness
b) Must rebuild soccer-specific fitness to decrease recurrence risk
C. Eccentrics
1. Early exposure
2. Nordics
a) Caution- biceps femoris activity decreases with fatigue (1 set x 5 reps in amateur soccer players) (Marshall
2015)
b) Lower incidence of hamstring strains Icelandic/Norwegian soccer teams in season (Arnason 2008)
(1) Danish soccer athletes: 52 injuries in control group; 15 intervention (Petersen 2011)
c) Recommend performance after training vs before to decrease injury risk (Lovell 2016)
(1) Greater eccentric hamstring fatigue following the observed before training in amateur players
(2) Hamstring EMG declines; decreased eccentric hamstring peak torque during soccer-specific exercise.
3. Lengthened state eccentrics:
D. Neuromuscular/Biomechanical assessment and correction
1. Lumbopelvic control
2. Asymmetry L vs R leg
3. Previous injury history
4. Functional strength/control
VI. Return to sport criteria:
A. Task Breakdown:
1. Match profile:
a) Sprint every 90 seconds
(1) Total sprint distance 1,025 +/- 150m
b) 150-250 “brief intense actions” per player each match
c) 111 “on the ball activities” per game
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
(1) Performed in explosive manner
(2) Near-maximal power production
d) Average oxygen uptake (elite): 70% of VO2max (Bangsbo 2006)
(1) VO2max strongest predictor of high intensity running in women’s collegiate soccer (McCormack 2014)
2. Position-specific:
a) Wing midfield; central midfield: greater total distance covered per match
(1) Wing midfield, forwards, fullbacks: greater max running speed
b) Recovery:
(1) At least 72 hours to achieve pre-match values for physical performance
(2) Ekstrand- “underperforming” players 2002 WC played mean of 12.5 matches during 10 weeks prior
(a) Players who performed “above expectations” played 9
(b) Dupont: 6.2-fold higher injury rate with players in 2 matches/week vs 1 match/week
B. RTP Progression
1. Rebuild aerobic fitness first (“base”)
2. Rebuild technical skills: footskills
a) Can be initiated early
3. Rebuild capacity for intermittent, high-intensity endurance
a) Criteria to initiate sprinting
b) Mixed Intensity Interval Endurance Drill
(1) 6-minute cycle of intervals
(2) 30 sec submax jog
(a) 30 sec 90-100% max effort
(b) 60 sec submax jog
(c) 60 sec 80-90% max effort
(d) 90 sec submax jog
(e) 90 sec of 70=80% max effort
(f) Increase by one cycle each week
(g) Add cones to train change of direction as needed
i) Clark JE. The use of an 8-week mixed intensity interval endurance-training program
improves the aerobic fitness of female soccer players. J Strength Cond Res 24(7):1773-1781
ii) Ferrari Bravo D, Impellizzeri FM, Rampinini E, Castagna C, Bishop D, Wisloff U. Sprint vs
Interval Training in Football. Int J Sports Med 2008; 29:668-674.
c) Repeated sprint training
(1) Ability to recover, reproduce performance in subsequent sprints
(2) Shuttle Sprint Drill
(a) Ferrari Bravo D, Impellizzeri FM, Rampinini E, Castagna C, Bishop D, Wisloff U. Sprint vs Interval
Training in Football. Int J Sports Med 2008; 29:668-674.
(3) Develops repeated sprint ability
(4) 3 sets of 2 shuttle sprints of 20-m at 50-75% speed
(a) 180o direction change every 10m
(b) 20 sec passive recovery between sprints
(c) 4 min passive recovery between sets
(5) Increase to 3 sets of 6 sprints
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
C.
(6) Increase to 80-90% full speed
(7) Increase to 3 sets of 2 shuttle sprints of 40-m at 50-75% speed
Fitness testing for RTP:
a) Return to baseline
(1) Repeated Shuttle-Sprint Ability (RSSA) (Impellizzeri 2008, Rampinini 2007)
(2) Yo-Yo Intermittent Recovery Test (YYIR; “Beep Test”) (Krustrup 2006)
(a) Measures “intermittent, high-intensity endurance”
b) Baseline strength, function
QUESTION AND ANSWER
REFERENCES
• Fournier-Farley C, Lamontagne M, Gendron P, Gagnon DH. Determinants of Return to Play After the Nonoperative
Management of Hamstring Injuries in Athletes: A Systematic Review. Am J Sports Med. 2015 Dec 15. pii:
0363546515617472. [Epub ahead of print]
• Barreira P, Drust B, Robinson MA, Vanrenterghem J. Asymmetry after hamstring injury in English Premier League: issue
resolved, or perhaps not? Int J Sports Med. 2015 Jun;36(6):455-9. doi: 10.1055/s-0034-1398493. Epub 2015 Feb 20.
• Marshall PW, Lovell R, Knox MF, Brennan SL, Siegler JC. Hamstring Fatigue and Muscle Activation Changes During Six
Sets of Nordic Hamstring Exercise in Amateur Soccer Players. J Strength Cond Res. 2015 Nov;29(11):3124-33. doi:
10.1519/JSC.0000000000000966.
• Schmitt, Brandon, Tyler Tim, and Malachy McHugh. "Hamstring injury rehabilitation and prevention of reinjury using
lengthened state eccentric training: a new concept." International journal of sports physical therapy 7.3 (2012): 333.
• Brukner P, Nealon A, Morgan C, Burgess D, Dunn A. Recurrent hamstring muscle injury: applying the limited evidence in
the professional football setting with a seven-point programme. Br J Sports Med. 2014 Jun;48(11):929-38. doi: 10.1136/
bjsports-2012-091400. Epub 2013 Jan 15.Sugiura, Yusaku, et al. "Strength deficits identified with concentric action of the
hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters." J Orthop
Sports Phys Ther 38.8 (2008): 457-464.
• Andersen, Thor Einar, et al. "Video analysis of injuries and incidents in Norwegian professional football." British
journal of sports medicine 38.5 (2004): 626-631.
• Askling, Carl, Jon Karlsson, and Alf Thorstensson. "Hamstring injury occurrence in elite soccer players after preseason
strength training with eccentric overload." Scandinavian journal of medicine & science in sports
13.4 (2003): 244-250.
• Arnason, A., et al. "Prevention of hamstring strains in elite soccer: an intervention study." Scandinavian journal
of medicine & science in sports 18.1 (2008): 40-48.
• Chumanov, Elizabeth S., et al. "Hamstrings are most susceptible to injury during the late swing phase of sprinting."
British journal of sports medicine (2011): bjsports90176.
• Debaere, S., Jonkers, I., & Delecluse, C. (2013). The contribution of step characteristics to sprint running performance in
high-level male and female athletes. The Journal of Strength & Conditioning Research, 27(1),
116-124.
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
• D'Souza, D. "Track and field athletics injuries--a one-year survey." British journal of sports medicine 28.3
(1994): 197-202.
• Dorn, T. W., Schache, A. G., & Pandy, M. G. (2012). Muscular strategy shift in human running: dependence of running
speed on hip and ankle muscle performance. The Journal of experimental biology, 215(11), 1944-1956.
• Elliott, Marcus CCW, et al. "Hamstring muscle strains in professional football players a 10-year review." The
American journal of sports medicine 39.4 (2011): 843-850.
• Hamner, S. R., & Delp, S. L. (2013). Muscle contributions to fore-aft and vertical body mass center accelerations over a
range of running speeds. Journal of biomechanics, 46(4), 780-787.
• Jeffreys, Ian, ed. Developing Speed. Human Kinetics, 2013.
• Lai, A., Schache, A. G., Lin, Y. C., & Pandy, M. G. (2014). Tendon elastic strain energy in the human ankle plantar-flexors
and its role with increased running speed. The Journal of experimental biology, 217(17), 3159-3168.
• Lee, Sabrina SM, and Stephen J. Piazza. "Built for speed: musculoskeletal structure and sprinting ability." Journal of
Experimental Biology 212.22 (2009): 3700-3707.
• Malliaropoulos, Nikolaos, et al. "Posterior thigh muscle injuries in elite track and field athletes." The American
journal of sports medicine 38.9 (2010): 1813-1819.
• Miller, Ross H., Brian R. Umberger, and Graham E. Caldwell. "Limitations to maximum sprinting speed imposed by
muscle mechanical properties." Journal of biomechanics 45.6 (2012): 1092-1097.
• Mjolsnes, Roald, et al. "A 10-week randomized trial comparing eccentric vs. concentric hamstring strength training in
well-trained soccer players." Scandinavian journal of medicine & science in sports 14.5 (2004):
311-317.
• Morin, J. B., Edouard, P., & Samozino, P. (2011). Technical ability of force application as a determinant factor of sprint
performance. Medicine and science in sports and exercise, 43(9), 1680-1688.
• Morin, J. B., Bourdin, M., Edouard, P., Peyrot, N., Samozino, P., & Lacour, J. R. (2012). Mechanical determinants of 100-m
sprint running performance. European journal of applied physiology, 112(11), 3921-3930.
• Nagahara, R., Naito, H., Morin, J. B., & Zushi, K. (2014). Association of Acceleration with Spatiotemporal Variables in
Maximal Sprinting. International journal of sports medicine, (EFirst).
• Nagahara, Ryu, et al. "Kinematics of transition during human accelerated sprinting." Biology open (2014):
BIO20148284.
• Opar, David A., et al. "Acute hamstring strain injury in track-and-field athletes: A 3-year observational study at the
Penn Relay Carnival." Scandinavian journal of medicine & science in sports (2014).
• Orchard, John, and Huge Seward. "Epidemiology of injuries in the Australian Football League, seasons 1997–2000."
British journal of sports medicine 36.1 (2002): 39-44.
• O'Sullivan, Kieran, Sean McAuliffe, and Neasa DeBurca. "The effects of eccentric training on lower limb flexibility: a
systematic review." British journal of sports medicine (2012): bjsports-2011.
• Petersen, Jesper, et al. "Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men’s Soccer A ClusterRandomized Controlled Trial." The American journal of sports medicine 39.11 (2011): 2296-2303.
• Potier, Tara G., Caroline M. Alexander, and Olivier R. Seynnes. "Effects of eccentric strength training on biceps femoris
muscle architecture and knee joint range of movement." European journal of applied physiology 105.6
(2009): 939-944.
• Schache, A. G., Dorn, T. W., Williams, G. P., Brown, N. A., & Pandy, M. G. (2014). Lower-limb muscular strategies for
increasing running speed. journal of orthopaedic & sports physical therapy, 44(10), 813-824.
• Schache, A. G., Blanch, P. D., Dorn, T. W., Brown, N. A., Rosemond, D., & Pandy, M. G. (2011). Effect of running speed on
lower limb joint kinetics. Medicine and science in sports and exercise, 43(7), 1260-1271.
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
• Sugiura, Yusaku, et al. "Strength deficits identified with concentric action of the hip extensors and eccentric action of the
hamstrings predispose to hamstring injury in elite sprinters." journal of orthopaedic & sports physical
therapy 38.8 (2008): 457-464.
• Thelen, DARRYL G., et al. "Hamstring muscle kinematics during treadmill sprinting." Med Sci Sports Exerc 37.1
(2005): 108-114.
• Weyand, Peter G., et al. "Faster top running speeds are achieved with greater ground forces not more rapid leg
movements." Journal of applied physiology 89.5 (2000): 1991-1999.
• Weyand, P. G., Sandell, R. F., Prime, D. N., & Bundle, M. W. (2010). The biological limits to running speed are imposed
from the ground up. Journal of applied physiology, 108(4), 950-961.
• Yeung, Simon S., Annabella MY Suen, and Ella W. Yeung. "A prospective cohort study of hamstring injuries in competitive
sprinters: preseason muscle imbalance as a possible risk factor." British journal of sports medicine 43.8
(2009): 589-594.
• Brukner P. Hamstring injuries: prevention and treatment-an update. Br J Sports Med. 2015 Oct;49(19):1241-4. doi:
10.1136/bjsports-2014-094427. Epub 2015 Jun 23.
• Hodges PW1, Gandevia SC. J Appl Physiol (1985). 2000 Sep;89(3):967-76.Changes in intra-abdominal pressure during
postural and respiratory activation of the human diaphragm.
• Neurourol Urodyn. 2007;26(3):362-71. Postural and respiratory functions of the pelvic floor muscles. Hodges PW1,
Sapsford R, Pengel LH.
• Mori, Rl, Bergsman AE, Holmes MJ, Yates BJ. 2001. “Role of the medial medullary reticular formation in relaying
vestibular signals to the diaphragm and abdominal muscles.” Brain Research. May 25: 902 (1): 82-91.
• Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, and Jull GA. 2001. “Co-activation of the abdominal
and pelvic floor muscles during voluntary exercises.” Neurourology And Urodynamics 20, no. 1: 31-42.
• Sherry MA, Best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop
Sports Phys Ther 2004;34:116–25. doi:10.2519/jospt.2004.34.3.116
• Amy Silder, Marc A. Sherry, Jennifer Sanfilippo, Michael J. Tuite, Scott J. Hetzel, Bryan C. Heiderscheit. (2013) Clinical
and Morphological Changes Following 2 Rehabilitation Programs for Acute Hamstring Strain Injuries: A Randomized
Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy 43:5, 284-299. Online publication date: 1-May-2013.
• Cameron ML, Adams RD, Maher CG, Misson D. Effect of the HamSprint Drills training programme on lower limb
neuromuscular control in Australian football players. J Sci Med Sport. 2009;12:24–30. http://dx.doi.org/10.1016/
j.jsams.2007.09.003 [CrossRef] [Medline]
•Marshall PW, Lovell R, Knox MF, Brennan SL, Siegler JC. Hamstring Fatigue and Muscle Activation Changes During Six
Sets of Nordic Hamstring Exercise in Amateur Soccer Players. J Strength Cond Res. 2015 Nov;29(11):3124-33. doi:
10.1519/JSC.0000000000000966.
• Brukner P, Nealon A, Morgan C, Burgess D, Dunn A. Recurrent hamstring muscle injury: applying the limited evidence in
the professional football setting with a seven-point programme. Br J Sports Med. 2014 Jun;48(11):929-38. doi: 10.1136/
bjsports-2012-091400. Epub 2013 Jan 15.
•Epidemiology of Hamstring Strains in 25 NCAA Sports in the 2009-2010 to 2013-2014 Academic Years. http://
www.ncbi.nlm.nih.gov/pubmed/26330571
•Arnason, A., et al. Prevention of hamstring strains in elite soccer: an intervention study. Scandinavian journal of
medicine & science in sports 18.1 (2008): 40-48.
•Petersen, Jesper, et al. Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men’s Soccer A ClusterRandomized Controlled Trial. The American journal of sports medicine 39.11 (2011): 2296-2303.
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.
• Svensson K, Alricsson M, Eckerman M, Magounakis T, Werner S. The correlation between the imaging characteristics of
hamstring injury and time required before returning to sports: a literature review. J Exerc Rehabil. 2016 Jun
30;12(3):134-42. doi: 10.12965/jer.1632558.279. Review.
• Svensson K, Eckerman M, Alricsson M, Magounakis T, Werner S. Muscle injuries of the dominant or non-dominant leg in
male football players at elite level. Knee Surg Sports Traumatol Arthrosc. 2016 Jun 23. [Epub ahead of print]PMID:
27338959
• Lovell R, Siegler JC, Knox M, Brennan S, Marshall PW. Acute neuromuscular and performance responses to Nordic
hamstring exercises completed before or after football training. J Sports Sci. 2016 Jun 6:1-9. [Epub ahead of print]
• Ekstrand J, Waldén M, Hägglund M. Hamstring injuries have increased by 4% annually in men's professional
football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med. 2016 Jun;
50(12):731-7. doi: 10.1136/bjsports-2015-095359.w
This is a preliminary handout. Full handout will be posted on SPTS website on the CSM handout page on
the day of the lecture.