As some of you may be aware we are hosting a Hamstring Seminar at the start of next month, and in preparation we are catching up on some of the latest research surrounding this topic. It can be an extremely confusing area as much has been done in the past 10 years, however people are still unsure of how to properly manage this injury. We are trying to get some of the best clinicians and researchers to give us an insight into their methods of assessment and management of some of the most complex topics. They will try to give us the most up to date research that they are using on their patients, hopefully helping us to stay up to date with best methods and practices.

 

So I would encourage everyone to have a read of the following few articles that have come out recently and consider how they may influence practice

 

 

  1. Hansen et al. Peak medial (but not lateral) hamstring activity is significantly lower during stance phase of running. An EMG investigation using a reduced gravity treadmill. Gait & Posture. (2017). 57 (7-10).

 

  • They discovered that increased hamstring muscle activation occurs with increased speed
  • The pre heel strike (swing phase) muscle activity peaks are higher than the post heel strike (stance phase) peaks for both the medial and lateral hamstrings.
  • The peak activation for both phases was slightly (but not statistically significantly) higher for the lateral hamstrings throughout the gait cycle whereas the medial hamstring peak was approximately 20% lower during stance (large effect size).
  • The reduction in peak activity of the medial hamstrings during swing phase suggests that there could be a relatively higher load being borne during running by the lateral hamstrings as the medial hamstrings are effectively afforded a slight “rest” during the swing phase.

 

We know that Nordics preferentially target the semitendinosus muscle (still has a large effect on muscle activation of the  BFlh). Maybe the role in Nordics is by increasing the load capacity of the semitendinosus?

 

 

  1.   Bourne et al. Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention. BJSM. (2016). 0 (1-9).

 

  • This study compared a 10 week programme between Hip Extension at 45 degrees, Nordic Hamstring Exercise and a control on measures of Bicep Femoris Fascicle length, muscle volume, architectural cross-sectional area (ACSA) and strength.
  • Some of the main findings:
    • BFLH volume increased significantly more in the HE than the NHE, however no significant changes were noted between the NHE and HE on semitendinosus muscle volume
    • The percentage change in BFLH ACSA was greater in the HE training group than in the NHE.
    • Participants increased their fascicle lengths from ∼10.6 cm prior to training, to 12.8 and 12.0 cm in the NHE and HE groups, respectively, which would likely result in large reductions in hamstring injury risk.
    • This study shows, for the first time, that the limited excursion of the hamstrings during the NHE does not prevent the exercise from increasing BFLH fascicle length. Indeed, the exercise resulted in greater fascicle lengthening than the HE, although the current study lacked the statistical power to distinguish between the two.  
    • Both exercises resulted in significant strength increases, which were similarly evident in the NHE and HE strength tests.

 

This study expands our understanding of other exercises often used in the rehabilitation and performance setting. The next step would be to do an RCT looking at the ability of the HE exercises to reduce Hamstring injuries across a season.

 

 

  1. Lovell et al. Hamstring Injury Prevention in Soccer: Before or After Training?. Scand J Med Sci Sports. (2017). Ahead of Print Online.

 

  • This article is an essential read if you are working in team sports whether as a Physiotherapist or Strength & Conditioning professional. It’s always a worry to carry them out before training, however post training fatigue may reduce the quality and compliance rates.
  • Three groups underwent a 12 week program, before training NHE group, after training NHE group and a core stability group.
  • The main findings from the study:
    • Changes in eccentric hamstring peak torque were greater in both NHEBEF (+11.9%; 3.6% to 20.9%) and NHEAFT (+11.6%; 2.6% to 21.5%) versus control (likely moderate effect), with no difference denoted between NHEBEF and NHEAFT .
    • The estimated change in biceps femoris fascicle length (expressed in both absolute, and relative to muscle thickness terms) was higher in NHEBEF versus both NHEAFT and CON.
    • Strength adaptation in the NHEBEF group was characterized only by an increased BF fascicle lengthening, whereas the NHEAFT cohort demonstrated the typical hypertrophic response, identified by an increased muscle thickness and pennation angle.
    • explained by the increased fascicle length that was exclusive to NHEBEF, the magnitude of which (12.9%) exceeded the minimum detectable change thresholds previously reported.
    • This study has demonstrated that scheduling Nordic hamstring exercises before or after football training has similar eccentric strengthening outcomes, but divergent architectural adaptations.

 

We know from some of the work done by David Opar and Dr. Anthony Shield group in Australia that the main protective mechanisms from Hamstring injuries is high eccentric strength and long fascicle length. The architectural adaptations for the NHE before group may be more advantageous however these may need to be explored in more detail over a longer period of time.

 

Let us know your thoughts!

 

Thomas Divilly

MSc MISCP CSCS

 

 


5 Simple Exercises to Relieve Hamstring Strain

Hamstring strain is quite a pain in the back – literally. The first sensation is that of a sharp pain in the back of your leg, sometimes accompanied by a popping sensation as well, which causes you to fall down, unable to hold your weight on the injured leg. It generally occurs when you are overtaxing your biceps femoris, semitendinosus, and semimembranosus muscles which run along the back of your leg and allow you bend the knee and extend the hip.

The hamstring strain is not something that you should take lightly. Some of the symptoms you may experience are:

Constant pain in the back of your leg with every flexing or extending move you try to make with your leg;

Tenderness and/or swelling, bruising at the back of your thigh;

Continued weakness in the leg, even days after the injury; the feeling that your knee is about to give out when you try to put pressure on it.

Recovery from hamstring strain involves anti-inflammatory medication prescribed by your doctor and lots of stretching exercises. We are trying to give you a helping hand and speed you up on the path of recovery, so we decided to put together 5 simple exercises to do every day. They will help you relieve hamstring strain, regain your full mobility and get you back to your usual life and exercising routine in no time.

1. Chair Drags

You have probably done this in your office countless times as you were trying to navigate between your computer, the printer and various other items that you needed. You will need an ergonomic office chair with swivel wheels. Sit on it and try dragging yourself forward.

During the first exercise, attempt to drag yourself forward for 10 metres. As you progress, gradually increase the number of times you perform the 10 metres drag, until you reach 10.

2. The Sitting Stretch

Sit on the floor with the legs stretched out in front of you. Lift up your feet and curl your toes and then bend forward, keeping your knees flat on the floor. Move slowly and steadily until you reach your toes with your fingertips.

Hold the position for up to 30 seconds, sit back up and repeat the exercise 2-3 times.

3. The Standing Stretch

You should proceed with this exercise only after you are comfortable doing the sitting stretch. Place your foot on a desk or table and bend forward, keeping your leg straight (do not bend the knee), until you can touch your toes with your fingertips.

Hold the position for 20-30 seconds and repeat the exercise for 4 or 5 times, in a smooth progression until you can do it 10 times.

4. The High Step-Up

Find a box, a chair or any other solid item you can step on, which causes your knee and hip to move to an angle of 90° from your body. Step up and down slowly, placing your foot firmly flat on the step. Increase the number of steps to 20 and then multiply them to 5 sessions with a 2 or 3-minute break between sessions.

5. The Supported Stretch

For this exercise, you need to lie down across an open doorway. Place the foot of the injured leg on the door frame and slowly slide it upwards until you feel a stretch in your muscle. Hold the position, slide your foot down and repeat in smooth progression until you can do the exercise 10 times with ease.

These simple exercises, which you can do at home, do not need any special equipment and will help you regain your mobility in the injured leg and recover from the hamstring strain in an optimal period of time.


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