Watching and enjoying a Gaelic football game at the weekend I witnessed the all too common occurence of the hamstring injury. Unfortunately the player had to stop play and immediately began his rehabilitation with his soon to be close acquantence, the ice pack.It has been a while now since I hung up my boots but I clearly remember the sickening feeling of tightness in the hamstring at the start of every season. Would this be another injury interupted season spent stretching on the floor, collecting balls behind the goals at training sessions and and lying face down on the physiotherapists table? Or my personal favourite, listening to the coach tell me how in their day there was no such thing as a hamstring injury.
So what has changed over the last 20 years in regards to hamstring injuries in Gaelic Games and by obvious extension all field sports including football, rugby and Australian Rules. Hamstring injures still represent the single biggest injury cited for missing games in Gaelic games and Australian rules,
The make up of our muscles hasn’t changed nor has the healing process. What has changed is our knowledge and ability to facilitate recovery, identify and reduce risk factors and the importance we place on pre season conditioning.
We know that the location of the hamstring tear can determine the average time out of sport, with a tear in the upper hamstrings at the musculo-tendo junction requiring more time away from competition than a a tear in the belly of the hamstring. We better understand the relationships between both flexibility and strength of the hamstrings and the risk to injury. We also understand how best to facilitate increases in flexibility and strength of the injured hamstring.
We know that the majority of hamstring inuries occur in the stretch-contract cycle of the game i.e. during kicking or accelerating / decelerating. During this stage the hamstring is working eccentrically.We know therefore that eccentric strengthening of the hamstrings should play an important part in pre season conditioning and rehabilitation post injury. We also know that hamstring injuries occur more in the final quarter of games and training suggesting that strength and flexibility conditioning of the hamstrings should help reduce injury.
We also know there are multiple factors hypothesised to contribute to the risk of hamstring injury. These include inadequate warm-up, fatigue, previous injury, knee muscle weakness or strength imbalance, increasing age, poor movement discrimination, poor flexibility, increased lumbar lordosis and poor running technique. We hope that by addressing these and others with each individual we can help reduce the risk of injury.
Recent research suggests that strengthening the hamstrings pre season and especially post injury plays an important part in the reduction of injury. Currently the most efficient form of hamstring strengthening is thought to be eccentric exercises. Eccentric training should be prescribed by a physiotherapist or suitably qualified member of the team’s medical team and is worlds removed from simply sitting in the gym preforming hamstring curls (the only function of which may be to tighten your hamstrings.) One form of eccentric training used is the nordic hamstring raise.
Our understanding of the predisposing factors to hamstring injuries and what constitutes best treatment practice continues to evolve. The challenge as with all injuries is to keep up to date with current research and best practice, hopefully reducing the occurrence of injury and the length of rehabilitation time.