A Prospective Study of the Relationship between Lower Body Stiffness and Hamstring Injury in Professional Australian Rules Footballers

“…Watsford et al 52 demonstrated prospectively that individuals who sustained acute hamstrings strain injuries had greater hamstrings stiffness than an uninjured cohort. However, whereas the bilateral average hamstrings stiffness differed between groups, that of the injured limb was not different from the uninjured group.…”

Section: Summary and Clinical Applicationmentioning

confidence: 99%

Hamstrings Stiffness and Landing Biomechanics Linked to Anterior Cruciate Ligament Loading

Blackburn

Norcross

Cannon

et al. 2013

Journal of Athletic Training

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Context: Greater hamstrings stiffness is associated with less anterior tibial translation during controlled perturbations. However, it is unclear how hamstrings stiffness influences anterior cruciate ligament (ACL) loading mechanisms during dynamic tasks.Objective: To evaluate the influence of hamstrings stiffness on landing biomechanics related to ACL injury.Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: A total of 36 healthy, physically active volunteers (18 men, 18 women; age ¼ 23 6 3 years, height ¼ 1.8 6 0.1 m, mass ¼ 73.1 6 16.6 kg).Intervention(s): Hamstrings stiffness was quantified via the damped oscillatory technique. Three-dimensional lower extremity kinematics and kinetics were captured during a doublelegged jump-landing task via a 3-dimensional motion-capture system interfaced with a force plate. Landing biomechanics were compared between groups displaying high and low hamstrings stiffness via independent-samples t tests.Main Outcome Measure(s): Hamstrings stiffness was normalized to body mass (N/mÁkg À1 ). Peak knee-flexion and -valgus angles, vertical and posterior ground reaction forces, anterior tibial shear force, internal knee-extension and -varus moments, and knee-flexion angles at the instants of each peak kinetic variable were identified during the landing task. Forces were normalized to body weight, whereas moments were normalized to the product of weight and height.Results: Internal knee-varus moment was 3.6 times smaller in the high-stiffness group (t 22 ¼ 2.221, P ¼ .02). A trend in the data also indicated that peak anterior tibial shear force was 1.1 times smaller in the high-stiffness group (t 22 ¼ 1.537, P ¼ .07). The high-stiffness group also demonstrated greater knee flexion at the instants of peak anterior tibial shear force and internal knee-extension and -varus moments (t 22 range ¼ 1.729-2.224, P , .05).Conclusions: Greater hamstrings stiffness was associated with landing biomechanics consistent with less ACL loading and injury risk. Musculotendinous stiffness is a modifiable characteristic; thus exercises that enhance hamstrings stiffness may be important additions to ACL injury-prevention programs.Key Words: viscoelastic, musculotendinous, valgus, anterior tibial shear force Key PointsIndividuals with greater hamstrings stiffness displayed more favorable landing biomechanics for anterior cruciate ligament (ACL) loading and injury risk than individuals with less hamstrings stiffness as evidenced by smaller frontalplane knee moments and a more-flexed knee at the instants of critical biomechanical knee events. Greater hamstrings stiffness was associated with smaller anterior tibial shear forces. A high level of hamstrings stiffness may limit ACL injury risk by limiting frontal-and sagittal-plane ACL-loading mechanisms.

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“…Since the majority of the injuries in ARF are to the lower-limbs, and particularly hamstrings, this region has been the focus of several studies attempting to discover modifiable, intrinsic injury risk factors. The potential risk factors for hamstring injuries that have been investigated include strength [32,45,46], flexibility [34,39,45,47], movement discrimination ability [46] and musculotendinous stiffness [40]. During a game of ARF the hamstring muscles may experience high forces during sprinting, kicking and jumping, as well as lunging for the ball.…”

Section: Modifiable Intrinsic Risk Factorsmentioning

confidence: 99%

“…Stiffness of the hamstrings can be determined using the free oscillation technique where a perturbation is applied to the limb maintained in a static contraction and the resultant oscillation is recorded by an accelerometer attached to the distal lower-limb. Lower- limb stiffness, which includes contributions from joint structures, bones as well as musculotendinous units, can be determined using a unilateral hopping test on a force platform to record the displacement of the centre of mass and the ground reaction forces [40]. It has been found that high bilateral lower-limb stiffness, as well as high bilateral hamstring stiffness, increased the risk of hamstring injuries in professional footballers, but bilateral difference was not shown to be a risk factor in this study [40].…”

Section: Modifiable Intrinsic Risk Factorsmentioning

confidence: 99%

“…Lower- limb stiffness, which includes contributions from joint structures, bones as well as musculotendinous units, can be determined using a unilateral hopping test on a force platform to record the displacement of the centre of mass and the ground reaction forces [40]. It has been found that high bilateral lower-limb stiffness, as well as high bilateral hamstring stiffness, increased the risk of hamstring injuries in professional footballers, but bilateral difference was not shown to be a risk factor in this study [40]. A smaller study with players from one professional club found that high bilateral differences in leg stiffness measured monthly, increased the risk of lower-body soft tissue injuries; a bilateral difference in stiffness may cause an imbalance of forces applied to each limb [13].…”

Section: Modifiable Intrinsic Risk Factorsmentioning

confidence: 99%

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Injury Incidence, Risk Factors and Prevention in Australian Rules Football

Hrysomallis

2013

Sports Med

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Along with the enjoyment and the other positive benefits of sport participation, there is also the risk of injury that is elevated in contact sport. This review provides a summary of injury incidence in Australian rules football (ARF), identifies injury risk factors, assesses the efficacy of interventions to reduce injury risk and makes recommendations for future research. The most common injuries were found to be muscle strains, particularly hamstrings; joint ligament sprains, especially ankle; haematomas and concussion. The most severe joint injury was anterior cruciate ligament rupture. Mouthguards are commonly worn and have been shown to reduce orofacial injury. There is evidence that thigh pads can reduce the incidence of thigh haematomas. There is a reluctance to wear padded headgear and an attempt to assess its effectiveness was unsuccessful due to low compliance. The most readily identified risk factor was a history of that injury. There were conflicting findings as to the influence strength imbalances or deficit has on hamstring injury risk in ARF. Static hamstring flexibility was not related to risk but low hip flexor/quadriceps flexibility increased hamstring injury risk. High lower-limb and high hamstring stiffness were associated with an elevated risk of hamstring injury. Since stiffness can be modulated through strength or flexibility training, this provides an area for future intervention studies. Low postural balance ability was related to a greater risk of ankle injury in ARF, players with poor balance should be targeted for balance training. There are preliminary data signifying a link between deficiencies in hip range of motion and hip adductor strength with groin pain or injury. This provides support for future investigation into the effectiveness of an intervention for high-risk players on groin injury rate. Low cross-sectional area of core-region muscle has been associated with more severe injuries and a motor control exercise intervention that increased core muscle size and function resulted in fewer games missed due to injury. A randomized controlled trial of the effectiveness of eccentric hamstring exercise in decreasing hamstring injury rate in ARF players was unsuccessful due to poor compliance from muscle soreness; a progressive eccentric training intervention for ARF should be given future consideration. Jump and landing training reduced injury risk in junior ARF players and it would be advisable to include this component as part of a neuromuscular training intervention. A multifaceted programme of sport-specific drills for hamstring flexibility while fatigued, sport skills that load the hamstrings and high-intensity interval training to mimic match playing conditions showed some success in reducing the incidence of hamstring injuries in ARF. A countermeasure designed to reduce injury risk is more likely to be adopted by coaches and players if it also has the scope to enhance performance.

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A Prospective Study of the Relationship between Lower Body Stiffness and Hamstring Injury in Professional Australian Rules Footballers

Cited by 181 publications

References 43 publications

Pattern of muscle injuries and predictors of return-to-play duration among Malaysian athletes

Pattern of muscle injuries and predictors of return-to-play duration among Malaysian athletes

Hamstrings Stiffness and Landing Biomechanics Linked to Anterior Cruciate Ligament Loading

Injury Incidence, Risk Factors and Prevention in Australian Rules Football

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