Hamstring Injuries - Are We Missing Something?

[sven_inc]

Hey all,

I'm back again with another article. I'm not sure if anyone delved too deep into my last one (I started the Jaeger thread and posted it there - it has since gone a little off topic ) but please feel free to have a read.

This time I decided to focus on the Hamstring injury. As a Physio, I've been seeing a heap of things recently that just doesn't seem to be well explained by my industry - with the Hammy being one.

They're so popular but for some reason we aren't any better at solving them than we were a decade ago.

I work hard to try and uncover the causes of things and feel I've found a few interesting ideas related to why it seems so common.

Admittedly I've taken Cyril's issues a few years ago and centred it around that, but from what I'm finding it could easily be applied to Nathan Freeman, Aaron Sandilands, Jonno O'Rourke etc.

I read today that Jeremy Cameron is now out for a few with his persistent Hammy. Monty's copped a nasty one a few weeks ago, as has Stringer, as has Gaz over the last month or so. Cockatoo just suffered his 3rd one I believe.

They're everywhere and don't seem to be going away anytime soon.

Hopefully I can shed some light on why with what I think im finding.

Anyway have a browse and let me know what you think.

Feedback from the last one was immense .

Cheers.

http://yourwellnessnerd.com/hamstring-injury-feat-cyril-rioli/

 

[HaroLad]

I like it

 

[Furn2]

You need to reference if you are going to state things as fact.

 

[Anja_Nees]

Better to describe hamstring injuries as 'common' rather than 'popular'.

 

[sven_inc]

You need to reference if you are going to state things as fact.

In what sense mate? Everything mentioned is based off of what I'm finding first hand in the clinic. I've tried to reference everything else. Happy to correct things if I've overlooked something...

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[Aeglos]

Imo all injuries are a lot more random in nature than sports docs, physios, S&C coaches etc would like them to be.
You can perhaps mitigate risk (see studies on FIFA 11+ warm up) but apart from controlling training volume/intensity there's not a great deal that's likely to be able to be done about it.
I'm also weary of anyone making claims from purely anecdotal evidence, otherwise we begin to open ourselves up to legitimate quackery.
Bias and lack of control populations are also a problem eg I treated a few people with low back pain and none could do dead bug properly so I concluded that they could be a good screen, however through trial and error including a healthy population at the gym I work at I couldn't find any correlation between abdominal strength/function as tested by the dead hug and low back pain.
And even if I had found a link, I'd have to question whether the abdominal weakness came before the back pain or visa versa.

Regardless, I thought it was an interesting read and that there is certainly merit to your ideas.
Interestingly enough, a few guys at footy use one of Carltons physios/docs and his claim is that the number of hamstring muscle belly injuries has decreased but the number of tendon based injuries have increased. Through my own observation there also seems to be more players missing with "tightness" than previously.

 

[Golden_6]

Interesting read. As a 22 year old that's had 6 hamstring injuries, including 2 tendon related issues, I always find these types of articles relevant. I'm still amazed and a little annoyed that it took 4 different physios to finally find one that focused on my lower back. I work at a desk job so have no doubt my posture was a major factor and have since bought a stand up desk for work. I've put a lot of work in and have played 6 games in a row up to this point, which is a far cry from what I've been able to produce the past couple of years.

 

[Rotayjay]

The bodies of AFL players get more punishment than most other athletes in yhe world. In what other sport do you run 15 ks (a lot of them being repeat sprints) while getting full body contact and being slammed into the ground in tackles?

 

[sven_inc]

The bodies of AFL players get more punishment than most other athletes in yhe world. In what other sport do you run 15 ks (a lot of them being repeat sprints) while getting full body contact and being slammed into the ground in tackles?

It's definitely a brutal sport. An interesting counterpoint is that Hamstrings aren't just specific to the AFL or even AFL-level athletes. Not all AFL player's do Hammies, and not every guy that does a Hammy does both sides. They're not specific to "dominant" sides etc. My interest has always been focused on why something happens. If you keep going broader and broader a lot seems to keep coming back to the back and our day to day spinal shapes - at least that's what I seem to find everyday clinically. We are designed to sprint and run long distances, change direction etc but not necessarily after we've spent half our day in a bad resting spinal shape at work, in the car, on the couch etc. Again all just my opinion, but hopefuly a refined one based on a fair few years at the coal face.

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[sven_inc]

Interesting read. As a 22 year old that's had 6 hamstring injuries, including 2 tendon related issues, I always find these types of articles relevant. I'm still amazed and a little annoyed that it took 4 different physios to finally find one that focused on my lower back. I work at a desk job so have no doubt my posture was a major factor and have since bought a stand up desk for work. I've put a lot of work in and have played 6 games in a row up to this point, which is a far cry from what I've been able to produce the past couple of years.

Brilliant to hear. Absolute best of luck mate!

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[sven_inc]

Imo all injuries are a lot more random in nature than sports docs, physios, S&C coaches etc would like them to be.
You can perhaps mitigate risk (see studies on FIFA 11+ warm up) but apart from controlling training volume/intensity there's not a great deal that's likely to be able to be done about it.
I'm also weary of anyone making claims from purely anecdotal evidence, otherwise we begin to open ourselves up to legitimate quackery.
Bias and lack of control populations are also a problem eg I treated a few people with low back pain and none could do dead bug properly so I concluded that they could be a good screen, however through trial and error including a healthy population at the gym I work at I couldn't find any correlation between abdominal strength/function as tested by the dead hug and low back pain.
And even if I had found a link, I'd have to question whether the abdominal weakness came before the back pain or visa versa.

Regardless, I thought it was an interesting read and that there is certainly merit to your ideas.
Interestingly enough, a few guys at footy use one of Carltons physios/docs and his claim is that the number of hamstring muscle belly injuries has decreased but the number of tendon based injuries have increased. Through my own observation there also seems to be more players missing with "tightness" than previously.

It's a fair point you make about randomness. There will always be an element of bad luck with some injuries. From what I see though I feel like it's actually the opposite. For me, too much emphasis is given to things that may apparently be out of our control. I only say this because i think it can often be disproved in real time. Maybe not in every single case but if you look hard enough and broadly enough there often seems to be something tangible that can be tweaked and then a change witnessed in real time.

There are a lot of tangible sport-specific things that can be tweaked and modified (warm ups, strength, conditioning etc) to try and decrease the risk if these issues, but from what I'm finding the things athletes are doing when they're not being athletes may set them up to fail. It potentially goes far beyond the athletic spectrum of activity and may just end up in the things we do as regular humans - of which poor sitting seems to fit from what I see.

IMHO my industry often mistakes "not knowing" for "bad luck" or "uncontrollable".
It doesn't mean it's all preventable but from what I can see day to day whilst working on these things in real time there's a lot more that my industry can do to nail these issues.

 

[sven_inc]

Having a conversation on Reddit about Cockatoo and his unfortunate run of Hammies and was directed to his Instagram account.

Each of these show Cocky in really poor low back shapes. Pics are a really crappy way to highlight anything as they're just a quick moment in time but they're a start.

Interesting to note there aren't any of Cocky in a decent shape other than standing.

I'm unsure of the rules about posting directly here from Insta so please let me know if this is inappropriate.

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[demondavey]

You need to reference if you are going to state things as fact.

If you've got something to add then pull him up. He is a physio, his practical findings are factual. He isn't completing a thesis and referencing sources directly, he is finding this information out first hand.

 

[deck]

I'm pretty sure most persistent hamstring injuries occur due to the player not knowing when he is right to go. Players who have a longer history with the injury learn how to read the body and know that it is to early to comeback.

Players are eager to get back out there and feel right to go but when you step into full game scenario it turns out it's not the case.

 

[who_let_the_dogs_out]

Having a conversation on Reddit about Cockatoo and his unfortunate run of Hammies and was directed to his Instagram account.

Each of these show Cocky in really poor low back shapes. Pics are a really crappy way to highlight anything as they're just a quick moment in time but they're a start.

Interesting to note there aren't any of Cocky in a decent shape other than standing.

I'm unsure of the rules about posting directly here from Insta so please let me know if this is inappropriate.

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As in his posture?

Would that also cause tears in quad muscles by any chance? I was continually dogged by them during my time playing footy.

 

[sven_inc]

As in his posture?


Would that also cause tears in quad muscles by any chance? I was continually dogged by them during my time playing footy.

His spinal positions/posture in these photos are pretty poor with all due respect to him of course.

Was hoping to keep some powder dry for future articles but absolutely so. The stiffness may just be up a little higher to be more inclusive of the Femoral Nerve (goes down through the Quads) as opposed to the Sciatic N.

Don't take my word for it, grab a foam roller and go hunting for some stiffness at/just below the base of your rib cage and see what you can find. It may not necessarily hurt, but it may feel quite stiff.

Let me know how you go!

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[sven_inc]

I'm pretty sure most persistent hamstring injuries occur due to the player not knowing when he is right to go. Players who have a longer history with the injury learn how to read the body and know that it is to early to comeback.

Players are eager to get back out there and feel right to go but when you step into full game scenario it turns out it's not the case.

I wouldn't be surprised if that had a little to do with it to honest. It's tough to work out as once the tissue itself becomes injured the goal posts shift a little in terms of what's going on. The tissue has to heal and be re-conditioned (which it's designed to do to be honest) and clearly there's confidence and game conditioning etc.

Interestingly from my perspective, they still have to fix the original underlying issues otherwise everything else may just become a cycle of symptomatic treatment and rehab.

It's just trying to work out what the main thing is that the rest feed off.

They may have to become more aware of their body's tolerances to activity, but what does even mean if the system still is functioning normally to begin with.

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[madmug]

I've had a 'crook' back for many years. Its started off with a sharp pain when digging out a hill in our back yard. So I got to know Physios & Chiros quite well over the years.

The other thing was that I use to run a lot but started getting Hamstring strains when playing cricket.
I'm talking 20 years of off & on problems. I also use to sit at a desk all day.

In the gym I struggled with low limb exs like squats & deadlifts, ever since.

I learned, as I think the professionals learned the link of posture, strength, flexibility & function. Id say the Chiro did well in alleviating my pains when I got the times when 'it went' & I got pain & spasms in my back & one leg got a tight 'hammy'. But over time the approach through Physio has enabled me to improve & be 'pretty good' these days.

Doctors (30yrs ago or more) talked about surgery. Im bloody glad I didn't go down that path. Maybe others need to, I dont know.

I'm a lot older now , but Im better than I was back then. I work hard at my low back flexibility. I dont go silly with 'core exs', but I do some. I do general Gym exs regularly, but always warm up & stretch my back (extensions & rotations). I walk whenever I can, not a million miles but a good hour on occassion. & use the stairs at work. Pool work is good too. But More than anything, I try to not sit for too long, avoid crappy low chairs & couches like the plague, & I stretch my low back a lot.

I have a disc bulge, but its so much better now through learning from therapists & being consistent with my exercises.

Its always on my mind when I go to garden or lift things. But Im aware of what to do & not worry myself out of keeping active.

So keep moving!!!

 

[PAFCsince1870]

BrockBlitz Thoughts on this mate?

 

[sven_inc]

I've had a 'crook' back for many years. Its started off with a sharp pain when digging out a hill in our back yard. So I got to know Physios & Chiros quite well over the years.

The other thing was that I use to run a lot but started getting Hamstring strains when playing cricket.
I'm talking 20 years of off & on problems. I also use to sit at a desk all day.

In the gym I struggled with low limb exs like squats & deadlifts, ever since.

I learned, as I think the professionals learned the link of posture, strength, flexibility & function. Id say the Chiro did well in alleviating my pains when I got the times when 'it went' & I got pain & spasms in my back & one leg got a tight 'hammy'. But over time the approach through Physio has enabled me to improve & be 'pretty good' these days.

Doctors (30yrs ago or more) talked about surgery. Im bloody glad I didn't go down that path. Maybe others need to, I dont know.

I'm a lot older now , but Im better than I was back then. I work hard at my low back flexibility. I dont go silly with 'core exs', but I do some. I do general Gym exs regularly, but always warm up & stretch my back (extensions & rotations). I walk whenever I can, not a million miles but a good hour on occassion. & use the stairs at work. Pool work is good too. But More than anything, I try to not sit for too long, avoid crappy low chairs & couches like the plague, & I stretch my low back a lot.

I have a disc bulge, but its so much better now through learning from therapists & being consistent with my exercises.

Its always on my mind when I go to garden or lift things. But Im aware of what to do & not worry myself out of keeping active.

So keep moving!!!

Great to hear mate, well done. To be honest any potential links between the back and Hammy injuries seem to be more obvious when someone goes through a more significant back issue like yourself.

In the extremes the links may be more clear. IMO this is one of the reasons why Hamstring issues are still a really common issue is because not everyone has to reach the scale that you unfortunately did in order to appreciate it/go after it.

Most with issues atm may have absolutely no apparent 'issue' with their backs. It doesn't hurt, it doesn't feel stiff or crappy. So why would anyone consider it as a crucial piece of the puzzle.

This is why the low back dysfunction that i feel is really important needs to be hunted for a lot of the time.

Sitting/being in bad shapes - may annoy an already vulnerable back like yours if your not as careful as you clearly seem to be, but for someone like Cyril or Cocky the bad shapes may have no obvious, immediate consequences.

They may just accrue a little more stiffness or little more deactivation of their trunk, but then go out on a Saturday and have to be freakishly athletic in the hope that new dysfunction doesn't amount to anything.

Unfortunately as far as I can see most can only buffer these things to a point.

Cheers for the reply

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[Animus]

Hey if you didnt already know, being a physio is one of the golden occupations that banks love so getting a home loan is a lot easier.

Youre welcome and happy house hunting

 

[BrockBlitz]

Nice article mate. I'm not a Physio but have worked in S&C and biomechanics and for what it's worth I agree completely. The problem is how do you rectify it ? Most players/people aren't self aware enough to maintain good posture throughout at day. Most are too lazy to make it habitual. It's a symptom of our time.

I slouch all the time and I know exactly how bad it is.

 

[Aeglos]

Having a conversation on Reddit about Cockatoo and his unfortunate run of Hammies and was directed to his Instagram account.

Each of these show Cocky in really poor low back shapes. Pics are a really crappy way to highlight anything as they're just a quick moment in time but they're a start.

Interesting to note there aren't any of Cocky in a decent shape other than standing.

I'm unsure of the rules about posting directly here from Insta so please let me know if this is inappropriate.

Sent from my SM-G935F using Tapatalk

The counter argument is I could take dozens of AFL players with no history of soft tissue injury and find them sitting/standing in similar postures

 

[sven_inc]

Nice article mate. I'm not a Physio but have worked in S&C and biomechanics and for what it's worth I agree completely. The problem is how do you rectify it ? Most players/people aren't self aware enough to maintain good posture throughout at day. Most are too lazy to make it habitual. It's a symptom of our time.

I slouch all the time and I know exactly how bad it is.

I see it more as constant refining and less so a permanent fix. No one will ever have perfect posture forever because the things we do will vary and it's always a moving target.

Knowing what a good position feels like to be in essential. If you get a sense of what it feels like then you can immediately get an idea of how good any shape or seat is.

It's just an awareness thing for the most part. No judgement involved as most get sucked into a bad shape without even ever realising.

It's at the stage now where, as you mentioned, thanks to the modern world we can't really neglect it anymore. It should now be in the same boring sphere as brushing your teeth, having a shower, bending your knees when you life etc.

Certainly not sexy in the slightest, but a requirement to be a modern human.

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[IllBeTheJudge]

The counter argument is I could take dozens of AFL players with no history of soft tissue injury and find them sitting/standing in similar postures

Isn't that a bit like countering "smoking is bad for you" with "I know heaps of smokers that don't have cancer"?