Hamstring Injuries in Football

A few days ago I was interviewed by Talksport Radio regarding two injured Tottenham Hotspur players. One of the questions of the presenters was why are there so many hamstring injuries in football, specially to the faster players and is there anyway from the physiotherapy to prevent it. My answer to that is yes we can definately do something to reduce the incidence and the severity of it but firstly we need to understand the mechanisms of hamstring failure in elite football. When running the hamstring muscle acts as a decelerator of the leg so when the athlete is faster there will be more load on the muscle to slow the person down. If the load on the muscle is more than the muscle's capabilities that can lead to muscle failure. Looking at football as a sport specially this time of the year there's more matches going on following winter cancellations, more cup games and peaking towards the end of the season. More games means more playing time, more running, more sprinting and potential muscle failure. Another factor is that due to the increase game time there's less time for quality football training as well as strength and condition work. More games means more travelling to games and back and therefore more prolonged sitting postures that will affect the low back the pelvis and the lower limbs. As you can see apart from the pure sprinting there's many other factors that can expose the hamstring muscles to potential injuries. That should also include previous injuries on the hamstring themselves or other parts of the body that directly or indirectly load the hamstring muscles.The hamstring is part of a muscle groups that perform different functions at different body positions. The positions of other body parts such as the hip, the pelvis, the low back, the knee etc will affect the load that the hamstring muscle will be able to take.It has been thought that if an athlete injures a muscle then the muscle must be weak and needs strengthening. In my experience athletes in particular do not have weak muscles. They tend to have poor muscle balance and motor control. That means that the timing of muscle activity or the sequence of muscle recruitment is not normal. That will expose the muscle to overlaoding and potential failure. In theory if we make that particular muscle stronger and stronger it will be able to sustain higher loads and last longer. Unfortunately that theory is not correct. It is known that isolated muscle training has not got a functional carry over and although it increases muscle mass it does not necessarily make the muscle stronger to sustain a sporting activity. It has also been shown that extensive strenching of a non-injured muscle will increase it's length, however it increases the risk of injury as it reduces the element of active stiffness that is essential when performing a functional activity. So we as physiotherapists we have to screen the athletes regularly and perform functional tests to identify muscle imbalance or motor control problems. Once we do that we should implement the appropriate strength and condition programmes to overcome those deficiencies. In doing that we need to have a sound understanding of normal body movement and be able to adapt that to a specific sport. We also need to be specific to the player demands. Field position, body size and shape, posture, fitness, previous injuries,minutes on the pitch, style of play are all factors that need to be considered when designing a strength and condition programme for an athlete. The overall management should include other professionals such as the coach/manager, sports scientins, club doctor, strength and condition coach, nutritionist and more importantly the player. Good planning and understanding among those parties will reduce hamstring injuries to a minimum, have more players fit, and good selection problems for the manager.