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The Most Effective Hamstring Injury Prevention Program

Hamstring injuries have been reported as one of the most common injuries across a variety of sports that involve repetitive kicking and/or high speed running, such as soccer, track and field, football, and rugby. Re-injury rates are also an issue affecting many athletes long term, with roughly 30% of athletes suffering a re-injury to the hamstring within the first year. In order to prevent hamstring injuries it is important to understand WHY they occur, and to develop a prevention program which targets these risk factors.

The hamstrings are a group of 3 muscles, the biceps femoris, the semitendinosus, and the semimembranosus. Their main purpose is to bring the hip back and bend the knee. The majority of injuries to the hamstrings are strains to the biceps femoris long head muscle. Injury occurs mainly during sprinting, as the muscles contract eccentrically to decelerate the leg.

What are the Risk Factors?

Age
Unfortunately, the older you get, the higher your chance for hamstring injury. The age when the risk starts to significantly increase is 25 years old, with research suggesting a 30% increase in risk annually thereafter.

Decreased flexibility
Tight hamstrings aren’t the only problem; tight hip flexors and/or quads are also problematic.

Muscle Imbalance/weakness
Muscle imbalance within the lumbopelvic region and/or weakness in the hamstrings;

Previous injury
Previous injury to the hamstring, groin and/or knee.

The Most Effective Hamstring Prevention Program

Eccentric Strengthening Program
The majority of hamstring injuries occur during sprinting when the muscle is working eccentrically. As such, eccentric strengthening programs have been shown to decrease the risk of hamstring injury by 65-70%. The most popular and widely studied exercise for hamstring injury prevention is The Nordic Hamstring Exercise. We strongly encourage all athletes to add this exercise to their strengthening regime. However, it shouldn’t be the only hamstring exercise you do. While it has been shown to decrease the risk of hamstring injury significantly, it only activates part of the hamstring muscles (specifically the semitendinosus and short head of the biceps femoris). 80% of hamstring injuries occur to the long head of the biceps femoris, which is better activated with a hip extension exercise such as deadlifts. The most effective hamstring injury prevention program should focus on targeting all the hamstring muscles with both knee and hip dominant movements. Below you will find 2 different exercises: the nordic hamstring exercise and straight leg weighted deadlifts. We recommend doing both for the greatest benefit. See a progressive 12 week schedule below:

Frequency 2x/week x 12 weeks.
Week 1-3: 3 sets of 5-6 reps
Week 4-6: 4 sets of 6-7 reps
Week 7-9: 4 sets of 8-9 reps
Week 10-12: 4 sets of 10-12 reps

Nordic Hamstring Exercise: Can be completed with a partner holding your legs or hooking feet under something heavy. Lower yourself forward, keeping your back and hips straight. Once you cannot go any further push yourself back into start position.

 

Weighted Deadlifts:

Work on your core
While strengthening the hamstrings is important, you can’t forget about everything else that helps support, align and coordinate the hips. If there is an imbalance around the hip such as tight hip flexors, weak glutes, etc., the hamstrings will be more susceptible to injury. In addition, exercise programs that focus on trunk stabilization and agility vs. a traditional program of ONLY hamstring stretching and strengthening post injury results in a quicker return to sport and significantly much lower reoccurrence rate (7% vs. 70%).

Running Program
Most hamstring injuries occur during sprinting, especially later in the game when fatigue sets in. Therefore, strengthening and isolating the hamstrings in the gym is essential, but you must also include interval speed training to improve coordination, large hip/knee joint torques, and explosive strength. Weekly sprint workouts have been shown to prevent hamstring injuries. Like all training loads, ensure the sprinting load (distance, reps and speed) is progressed gradually.

Where to go from here?

If you currently are suffering from a hamstring injury it is best to book an appointment with a therapist and get on an individualized rehab plan. If you are currently injury free and would like to stay that way, then add the above hamstring exercises to your current strengthening program following the 12-week plan. If you want more bang for your buck, then add some core and hip stability exercises as well. If you still have questions or want more guidance on injury prevention book an appointment with one of the Sheddon Physiotherapy and Sports Medicine therapists at 905-849-4576.

Heiderscheit et al., (2010). Hamstring strain injuries: Recommendations for Diagnosis, Rehabilitation and Injury Prevention. Journal of Sports Physical Therapy. 67-81.
Liu et al., (2012). Injury rate, mechanism, and risk factors of hamstring strain injuriesin sports. A review of the literature. Journal of Sport and Health Science. 92-101.
Prior et al., (2009). An evidence based approach to hamstring strain injury. A systematic review of the literature. Sports Health. 154-164.

How to Recognize a Concussion?

Concussions make up roughly 22% of all soccer related injuries. Despite public awareness and athlete education surrounding concussions, roughly 50% of athletes do NOT report their concussions and return to sport while still symptomatic. These athletes either see no harm in playing with a concussion, believe it will make them look weak, or truly do not realize that they have sustained a concussion. In reality, a concussion should be taken seriously. Playing any sport with a concussion will prolong recovery, and if the athlete were to sustain a second impact, there is the potential for additional and more complicated injuries to the brain, which could even be fatal. This article is meant to educate coaches, athletes, trainers, and parents on how to recognize and manage concussions more effectively.

Concussion Recognition

Recognizing a concussion is the most important step in the management of the injury. Concussions are extremely difficult to recognize because you must rely heavily on athletes reporting their symptoms, and no two people will experience a concussion in the same way. If an athlete sustained a significant hit to the head OR body, you should suspect a concussion. REMOVE THEM FROM PLAY, and assess for symptoms. There are a number of different symptoms that people will experience, including physical symptoms (i.e., headaches, fatigue, dizziness, blurry vision, neck pain, balance issues, nausea), cognitive issues (i.e., poor concentration, memory issues, confusion) and/or emotional disturbances (i.e., irritability, sadness, emotional). If an athlete denies any symptoms, there are still some signs you need to look for:

  • Does the athlete appear to be disoriented, slow, or uncoordinated?
  • Does the athlete seem to be starring into space or appear dazed and confused?
  • Is the athlete sick and vomiting?
  • Is the athlete acting odd or out of character?
  • Did the athlete lose consciousness?
  • Is the athlete unable to respond to simple questions? Is their speech slurred?

If the athlete has any of the above signs or symptoms it is best to err on the side of caution and have a medical practitioner assess and diagnose properly. Early concussion recognition and intervention has been shown to significantly decrease recovery time and improve long-term outcomes. At Sheddon Physiotherapy and Sports Medicine all of our therapists are trained in concussion management and we strive to assess athletes with suspected concussions as quickly as possible.

Importance of a Concussion Baseline Test

A concussion impacts how the brain functions; therefore an MRI and other brain scans will NOT detect a concussion. Furthermore, there is no single clinical test that can be done to know when an athlete has sustained or fully recovered from a concussion. Occasionally, athletes sustain a hit and have a vague concussion presentation, whereby they deny symptoms, but parents feel that something seems off. In unclear cases like these, a preseason concussion baseline test comes in handy since it tests different areas of the brain that could potentially be affected by a concussion. Post injury test results need to be compared to pre-injury values in order to know if/when an athlete is at their normal pre-concussion baseline values. If an athlete does not achieve their pre-concussion baseline value in one or more components of the test, then a concussion is diagnosed. The baseline test is also essential for return to play decision-making. Research has shown that if sport clearance is based solely on symptom resolution, which occurs much sooner than brain recovery, athletes may be at risk for returning to sport too quickly. As such, the best way to ensure that you return to sport safely following a concussion is to get baseline tested BEFORE a concussion even occurs.

Concussion baseline testing is currently recommended in the National Concussion Guidelines for all athletes. This guideline was developed by chief medical experts of the Canadian Paraylmpic Committee, Own the Podium, and the network of high performance sport institute across the country. At Sheddon Phyiotherapy and Sports Medicine, we offer the most comprehensive and research proven concussion baseline testing of any sports medicine clinic in the Mississauga and Oakville area. Teams and athletes across the GTA have trusted in our baseline testing for many years. To date, we have completed over a thousand baseline tests and successfully treated well over 800 concussions.

All of the therapists at Sheddon Physiotherapy and Sports Clinic have undergone extensive training with the Complete Concussion Management program in order to be educated with the most recent research-proven concussion management strategies. CASM and the Canadian Concussion Collaborative strongly promote a multidisciplinary approach to concussion management, which extends beyond the family doctor to include health care professionals with developed skills and expertise in concussions. If you have experienced a concussion and are still suffering from symptoms, contact one of the therapists at SPSC in order to assess and treat them immediately. If you have not suffered a concussion, but play a high-risk sport, contact SPSC regarding our baseline testing at 905-849-4576.

rugby injury prevention sheddon physio oakville

Rugby Injury Prevention Strategies

Rugby is growing in popularity across the GTA among both male and female athletes. It is a high collision, high intensity sport which also has one of the highest injury rates among athletes. Who is most at risk and what can you do to prevent these injuries?


Mechanism of Injury


80% of rugby injuries occur during contact, with the tackle accounting for the majority of injuries, followed by the ruck. It was also found that the tackler was more at risk for injury than the person being tackled, while forwards experienced more injuries than backs.


Common Injuries


Knee and ankle ligament injuries, along with hamstring injuries, account for 33% of all rugby injuries. Preseason exercise based intervention programs have reduced these injuries by 62-70 %. Read more here on prevention strategies.

The shoulder is also commonly injured, with an AC joint dislocation being the most common shoulder injury, and is mainly caused by a tackle, impact with players or the ground.

Concussions account for roughly 20% of all rugby injuries. Rugby has also been shown to have the highest amount of concussions compared to all other team sports. In the past couple of years, there has been a huge push in the education and awareness of head injury and its prevention in rugby. Studies have shown there to be three main risk factors for concussions in rugby:
1. The tackle was the most likely cause of head injury;
2. The tackler was the player most likely to sustain the concussion;
3. The risk was 4x greater in high contact tackles (i.e., when the tackler was upright and his head was at or near the level of the ball carrier’s head and shoulders).


World rugby took this information and decided to make changes by penalizing players for high tackles and heavily encouraging lower and safer tackles.


Injury Prevention Strategies

  1. Exercise based intervention programs such as FIFA 11 focus on exercises to improve balance, coordination, strength and power in order to prevent lower extremity injuries. FIFA 11 has been shown to reduce lower extremity injuries across many sports, including Rugby. However, they do not focus on upper extremity injuries, which account for 41 % of all rugby related injuries. As a result, the FIFA 11 program is helpful, but additional upper body exercises focused on shoulder and neck strengthening need to be supplemented in order to target rugby specific injuries.
  2. Tackling education and good tackling technique are prudent for injury reduction, since the majority of injuries are contact related, especially concussions. This is especially important at the youth levels. If players are taught early on to tackle safely, it will follow them throughout their athletic career.
  3. Preseason functional movement screening (FMS) can help determine if athletes have adequate strength, movement flexibility and stability required for optimal performance. The FMS is a screening tool consisting of seven different movements, and can identify abnormal movement patterns that can lead to injuries. At Sheddon Physiotherapy and Sports Clinic we see individual athletes for preseason assessment as well as teams.
  4. Concussion baseline testing is essential and is currently recommended in the National Concussion Guidelines for all athletes. This guideline was developed by chief medial experts of the Canadian Olympic Committee, Canadian Paralympic Committee, Own the Podium and the Network of High Performance Sport Institutes across the country. To learn more about Sheddon Physiotherapy and Sports Clinics comprehensive baseline testing click here.
  5. Sheddon will be hosting a concussion baseline testing day on April 6, 2019, where athletes will save 40% off regular baseline pricing. Click here to learn more.

(2019, Jan 10). Concussion rates in rugby: Rates down, now pull on ONE rope, all together. Retrieved from www.Sportsscientists.com.

SPECIAL EVENT Concussion Baseline Testing

Have you completed your Concussion Baseline Testing? Don’t wait any longer, we are having a one day event where you save 40% from individual testing. Continue reading below for details:

WHAT
Concussion Baseline Testing open to all athletes (Cost is $70/athlete)

WHEN
Saturday April 6th, 2019
8:00-2:00pm
Please book in advance this is NOT a drop in

WHERE
Sheddon Physiotherapy and Sports Clinic
1300 Cornwall Unit 103
Oakville Ontario

HOW to book
Call at 905-849-4576 or
Email at admin@sheddonphysio.com

WHY
The multimodal testing that we go through is a series of physical and cognitive tests that provide a pre-injury overview of healthy brain function. This offers an objective benchmark on which to compare should an athlete sustain a concussion. Which also takes the guess work out of return to play decisions. Many organizations may use a single test or a small group of tests as a baseline but we will be using the Complete Concussion Management (CCMI) approach, which uses a variety of tests offering more objective insights, data and improved accuracy and reliability. 

Important notes:

  • Testing time is roughly 30 minutes, there may be a home portion depending on age. No extra fees apply

Frequently Asked Questions:

  • The season has already started, are we too late for concussion baseline tests?
    • NO! Preseason is the ideal time for testing, but anytime during the year prior to a concussion is better than no baseline.
  • WIll the cost be covered through my insurance?
    • The cost of the baseline is covered under most Extended Health Plans since it is administered by a physiotherapist.
  • My child had a baseline done over a year ago, why should we do it again?
    • As young athletes mature, their baseline scores can change greatly from one year to the next. Therefore, it is recommended that athletes get a baseline at the beginning of each season.
  • My hockey team did the impact test preseason, isn’t that good enough?
    • No! Computerized neuropsychological tests, such as the ImPACT test are only assessing one aspect of concussions, neurocognitive function. In order to properly manage concussions a baseline test must be multidimensional, assessing the full spectrum of concussion outcomes (i.e., balance, reaction time, visual processing, physical capacity AND neurocognitive function). In order to know when an athlete has fully recovered, the different areas of the brain that could potentially be affected with a concussion must be assessed prior to and after a concussion.
  •  It’s not mandatory for my childs team.
    • Concussion baseline tests are becoming widely used in many sports at all levels. Although not mandatory (yet) in all high-risk sports, it is one of the most important and effective tools for concussion management. Without a baseline test there is no way to accurately know when an athlete has fully recovered from a concussion. Research has shown that concussion symptoms improve much sooner than brain recovery, which may put athletes at risk for returning to sport too quickly, especially if sport clearance is based solely on symptoms.
  •  Those dates don’t work for my child or team?
    • If you are part of a team or an individual who would like to participate in Concussion Baseline Testing but you cannot fit these dates into your schedule, please contact us and we will try to arrange for another date and time.

Book Your Appointment

Questions? Contact us

Tara Campbell sports physiotherapist Sheddon Oakville

Welcome New Physiotherapist Tara Campbell

Tara graduated from Queen Margaret University, Scotland with a Masters of Science, Honors in Physiotherapy. Prior to her physiotherapy studies, she gained her Bachelor of Arts, Kinesiology degree from Western University in London Ontario. Tara enjoys keeping busy with many sports and hobbies, including field hockey, downhill skiing, yoga, cooking, hiking and ultimate frisbee. She played for the women’s varsity field hockey team during her undergraduate degree at Western, and continued to play while at school in Scotland. Tara has experience with soccer and football team therapy, volunteer experience at the Lithuanian Olympics and elderly rehabilitation programs. Through her education and personal experiences, Tara is dedicated to helping clients achieve their rehabilitation, fitness and wellness goals.  Tara is pursuing advanced concussion training with Complete Concussion Management, and will be working towards Medical Acupuncture Licensing. As an enthusiastic, engaging therapist, Tara loves that she is able to work with new and returning clients everyday. Further, Tara is committed to continuous learning, and is eager to advance her clinical education.