In August 2017, one of sport’s true greats, Usain Bolt, stepped into London’s Olympic Stadium for his final ever race at the World Championships. Having been pipped at the post by pantomime villain Justin Gatlin in the blue riband 100m a few days earlier, the 4x100m relay was his chance to go out on a high – anchoring the Jamaican quartet in a fairytale finish to a historic, mesmerising career. Bolt received the baton in third place, about 3m off the lead. The stage was set for one final Bolt blitz in front of 90,000 adoring fans. Much like the 100m though, it wasn’t to be. This time, 30m into the final leg, Bolt pulled up clutching the back of his left leg. He had fallen victim to one of the most common injuries in sport – a pulled hamstring.

Thankfully for Bolt, many people no longer even remember this happening. And with a career like his, it’s easy for it to fade into the background behind the many world records and Olympic golds. 

Relatively, Bolt had a career that was free from big injuries, especially during key events. But not all are as lucky. And for many athletes it is that same injury, the hamstring pull, that can be the cause of such torment.

Today we’re going to look at when and how hamstring injuries happen, how they can be prevented and how you might break the cycle of recurrences if they’re already ruining your training and competing. So, let’s talk about what for many is the most frustrating soft-tissue injury in sport.

TYPES OF HAMSTRING INJURIES

If we want to understand how we can avoid or treat hamstring injuries, we need to work out why they’re happening in the first place. One of the tricky things with the hamstrings is they’re what’s known as biarticular, which means they are involved in moving two joints – they extend (or move backwards) the hip as well as flexing (or bending) the knee. It is often when the hamstring is stretching, not contracting, that it is most likely to become injured. For example, a very common mechanism of injury is when, during running, the hip moves forwards and the knee straightens at the same time as we move our foot from behind us to put it back down in front of us.

The reason behind this is we are stretching the hamstring both at the knee and hip simultaneously, with great force. This is a lot to ask if our hamstrings aren’t conditioned for this, or if there are other underlying issues. And when you consider how many sports involve explosive running, jumping, changes of direction or other high-powered movements, you can see why this type of injury is so common.

HAMSTRING INJURY RISK FACTORS

Now we understand how this muscle may sustain more injuries than others, let’s think about the underlying reasons.

One thing athletes need to be aware of is the difference between overtraining and overreaching. Overtraining is ultimately when we do too much. We ask more of our body than it is able to do for a sustained period, which can lead to injury or illness. Overreaching is what we want. It’s how we create change in a good way from exercise. This occurs by pushing our body slightly beyond where it is conditioned (like moving the pin on the weights machine down one plate after a few weeks, or upping the treadmill speed slightly). When this is done over a long period, supported by adequate rest and fueling, this brings about positive adaptation.

We can think about the conditioning level of the hamstrings in a similar way. If we go and do a session with a lot of sprinting in it, which asks a lot from our hamstrings, then we are more likely to sustain an injury if we are not conditioned for it. Conversely — and this is a constant balancing act for conditioning coaches — if we don’t do enough training then we are never able to build up our tolerance to cope with higher demands when they arise, which is typically during competition, when we need it most!

As well as risk factors based on our level of and approach to conditioning, which we might think of as external factors, there are also some internal risk factors to consider. Unsurprisingly, having weak hamstrings makes them more susceptible to injury but so does having one weaker than the other – what we know as an asymmetry.

Beyond strength levels, there is also an old adage that the biggest predictor of injury is previous injury. Sadly, we can’t magic an old injury away and similarly we can’t change our age, which is also a risk factor, with older individuals experiencing more hamstring injuries. Thankfully though, we now understand some of the techniques we can employ to help us to prevent such injuries even if we do tick some of the risk factor boxes listed above. 

To minimise the risk of hamstring injuries, eccentric hamstring strength and unilateral work is of key importance.

PREVENTING HAMSTRING INJURIES

In soccer, where hamstring injuries account for 12-16 % of all injuries, making them the most common injury, they typically occur more frequently during the later stages of each half. This suggests that strengthening the hamstrings generally to resist an accumulation of fatigue is very important.

Specifically, improving eccentric strength is important – this is the strength that is used when the muscle is lengthening. If you imagine being on a leg curl machine, eccentric strength is used if you resist the weight as your leg straightens. If you think back to our mechanism of injury section, this type of strength helps us to combat those injuries occurring during such stretches under high force when we train or compete. It can be trained specifically by simply having a slower eccentric phase of typical exercises such as squats, leg presses or leg curls. The Nordic hamstring exercise is another great one to look up for improving eccentric hamstring strength.

Minimising the asymmetries we spoke of would also be advantageous. This can be done by incorporating some single leg, or unilateral, exercises such as lunges or step ups into your program. This removes the chance for our dominant leg to take more of the load when doing double leg exercises such as deadlifts or leg presses. 

RECOVERING FROM HAMSTRING INJURIES

As I’ve mentioned, hamstring injuries have been shown to be more common in those who have had them previously. This suggests that perhaps people often rush back from such injuries and shows how important correct and appropriate rehab can be.

Beyond simply improving the strength of your hamstrings, another aspect that should be factored into rehab programs from hamstring injuries is improving your hip stability. Broadly the idea here is around reducing an undesirable amount of movement at the pelvis. As the pelvis is responsible for transferring forces between the spine and the lower limbs, it is thought that too much motion at this joining point can put the hamstrings under greater strain and therefore increase injury risk. This suggests a program of core and hip stability should be factored in when looking to reduce hamstring injury risk.

You may also think that hamstring flexibility might keep injuries at bay. The evidence here is a little ambiguous but it does seem that practices such as yoga can help with increasing range of motion and improve recovery time following injury,

Finally, moving forwards, it is recommended that a focus on movement quality should be sought where possible. In professional clubs this will be achieved by a structured, detailed assessment of a series of movement patterns such as how well an athlete squats, lunges, jumps etc. We should think of these movements as the foundation of a building – unless they are solid, you don’t want to build on them.

Similarly, if your fundamental movements aren’t of high quality, if you’re wobbling around all over the place for example, then no amount of increased single leg strength might save you from future injury. The reason for this importance is that sport is chaotic – we rarely move in nice straight, ordered lines like we do in the gym. This is why we need to ensure the basics are right first so when the chaos arrives we are better able to cope with it.

Although you may not be working in a professional environment, a physio or accredited strength and conditioning professional would be able to assess your movement competency and prescribe appropriate exercises to address any potential deficiencies. 

STRINGING IT ALL TOGETHER

Hamstring injuries certainly are best avoided. They can lead to lengthy spells on the sidelines as well as being difficult to shake without the correct rehab.

The best way to avoid them in the first place is through a mixture of overreaching of hamstring strength and sprinting in your training to bring about progressive overload while incorporating appropriate recovery periods. Specifically, eccentric hamstring strength and unilateral work is of key importance and will certainly serve you well.

If you’re unlucky enough to already be in the pattern of recurrent hamstring injuries then patience is key. Rushing back may be what you want to do but it won’t have a happy ending in the long run. Take your time, build your strength, and reap the rewards when you’re competing like Usain in his heyday!

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Fitness testing, irrelevant of budget, is critical for creating and developing a periodised program to improve performance.

FITNESS TESTING: NOT JUST FOR THE BIG SPENDERS

Many elite organisations have massive budgets that enable them to utilise the latest fitness testing to ensure their athletes are primed for competition. But for those not working in an elite team, budgets can be slim and the prospect of fitness testing can be daunting.

But a leading physical performance coach says too much is made of expensive fitness testing and there are plenty of effective ways coaches and athletes can complete performance tests on limited budgets.

“An effective performance testing program can be performed without a large price tag. Irrelevant of budget, testing is critical because it enables coaches to understand the physical and physiological components of their athletes and the demands of their respective sport. This is central to creating and developing a periodised program to improve performance,” said physical performance coach Tom Watkins during his Science for Sport presentation titled ‘Fitness testing with Zero Budget’.

WHY BOTHER WITH FITNESS TESTING?

According to Watkins, it is important for all coaches to test the fitness of their athletes, irrespective of budget. The physical performance coach outlined the following distinct benefits of fitness testing:

1. Assess an athlete’s readiness to perform.
2. Establish the strengths and weaknesses of athletes (individually and collectively).
3. Compare and benchmark athletes (athlete-to-athlete or year-on-year).
4. Assess and evaluate the effectiveness of each phase of the periodisation training plan.
5. Inform program design.
6. To be used as a pre-injury marker, before a competition.

FITNESS TESTING WITH A LIMITED (OR ZERO!) BUDGET

“Coaches and athletes with little-to-no budget will need to adopt a bottom-up approach when completing their fitness testing process,” said Watkins.

A bottom-up approach refers to starting with what can be done immediately and beginning with the problems at hand (e.g. equipment, facilities, and the performance level of athletes) rather than with a vision and objectives (top-down).

“A top-down approach is often used by more elite teams that possess extensive budgets,” Watkins said. “They use this approach to create a ‘picture’ of what they want to see (or objectives they want to achieve) from their performance testing. [But] without significant infrastructure — time, resources, and budget – it is too hard to create an objective picture.

“So those with limited or zero budgets should default to a bottom-up approach, assessing and evaluating the challenges they are faced with currently.”

So, what fitness testing can you complete on a limited or zero budget? Watkins described various options coaches should engage with either on the field or in the gym.

TESTING PROCESS CONSIDERATIONS

Whilst engaging in the tests listed above, Watkins stated that coaches should follow the following testing order in the hope of reducing the risk of injuries:

1. Non-fatiguing power-based testing
2. Agility testing
3. Maximal strength testing
4. Fatiguing anaerobic capacity tests
5. Aerobic capacity tests.

“Slight adjustments can be made to this process to allow for discrepancies in facilities or equipment, but coaches should follow this process as closely as possible to ensure tests are completed in the least risky manner with respect to injuries. Also, following this process makes it easier for coaches to establish a form of testing consistency, improving the reliability and validity during year-on-year and athlete-to-athlete comparisons,” said Watkins.

And finally, Watkins explained: “Testing is part of the process to improve performance and your test should enable you to take action as a coach. For instance, will the test data be used to adapt your training program or shape the direction of your program and how your athletes train and compete? If not, then stop the test and chose an alternative that allows you to take constructive action.”

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SPORTS NEEDS ANALYSIS: AN INTRODUCTION

There are myriad variables an athlete and their coach must navigate when it comes to performance – training, injury risk, human biology and strength and conditioning to name just a few. But one way to mitigate this complexity is through a sports needs analysis, a leading physical performance coach says. 

“Factors [coaches must juggle] include, although not limited to: sport and athlete context, athlete biology, training programming, nutrition, injury risk, conditioning and speed,” said Adam Crook during his Science for Sport presentation titled ‘Holistic Sport Needs Analysis’.

“So, coaches should complete a sport needs analysis, [which is a] formal process of identifying and assessing the training that athletes should engage with to meet the specific demands of a sport and its competitions.” 

A needs analysis is often referred to as situational analysis, problem assessment, and/or diagnosis which involves the collecting of background information, understanding the demands of the sport, identifying benchmarks, potential obstacles, and the resources required to perform.

The process of creating a needs analysis is one of the most time-consuming aspects of developing a performance strategy.

“Yet, it is valuable. They are not an evaluation, instead, more of a process of identifying the facts around performance and the athlete to help coaches identify and close the gaps and/or differences between what is done in training and what athletes should be doing as part of a performance strategy,” explained Crooks.

WHY COMPLETE A NEEDS ANALYSIS?

Crook says coaches should engage in a needs analysis for four main reasons:

• Best practice

“A needs analysis enables coaches to better understand the demands of the sport played, competition level, age groups, positional differences, and build a library of resources for future use and objective reflection.”

• Knowledge exchange

“With the objective assessment of an athlete’s needs complete, your multi-disciplinary team (physio/medical, sports coach, strength and conditioning, sports science, nutritional, psychology) can exchange information and create an athlete-specific plan for their development and performance improvement.”

• Education

“The information you can build around your sport and athlete is particularly important for those staff new to your organisation. It enables them to get up to speed quickly on the demands of the sport, what the short- and long-term plans are for the athlete, and support the team as effectively and quickly as possible.”

• Value

“Your sport needs analysis work contributes back to the athletes and provides value for others trying to model their training and/or performance levels.”

HOLISTIC VERSUS TRADITIONAL APPROACH

Ultimately, a sport needs analysis enables coaches to fully assess and therefore understand the context in which their athletes are performing. A traditional approach to a sport needs analysis considers the following factors:

• Metabolic – What are the main physiological demands of the sport, athletes, and position?
• Biomechanical – What are the main movement pattern demands of the sport, athlete, and position?
• Injury – What are the common injuries?

Crook suggests the approach to a sport needs analysis needs to be more holistic in nature than as described above, as the traditional approach does not encompass the modern nature of sport and is sport-specific rather than athlete-specific.

“Performance is complex and multifactorial – a focus on a single coach/team department is too limiting, so sport needs analysis’ should integrate all interdisciplinary departments. Keep the athlete as the focus of your plan rather than just assessing the demands of the sport, and be progressive enough to reflect sport changes (rule/competition) and an athlete’s lifestyle (relationship/family developments),” explained Crook.

HOW TO BUILD A SPORTS NEEDS ANALYSIS

When creating a sport needs analysis, the athlete should be seen as the glue that provides the context and background to any decisions and findings. Crook outlined seven pillars coaches should follow to build a comprehensive sport needs analysis.

• Athlete

Assess: background, context, social environment, training history, and previous medical/physiotherapy.

“Social factors are a key component in providing context to an athlete’s background … and technical competency frameworks (inventory of anticipated knowledge, skills and abilities) such as an OHS Assessment can be used to gather this critical information. Also, screening tools are subjective but they can be utilised for detecting underlying musculoskeletal limitations that might predispose an athlete to injury,” said Crooks.

• Sport

Assess: physiological, biomechanical, and physical.

Crooks explained: “during this stage, coaches should gauge aerobic and lactic capacity required, kinetics and movement demands, movement type, duration, intensity, and frequency, movement patterns and categorisation, and the desired strength, power, and speed of the sport.”

• Injury risk

Assess: relationship to sports activity, mode of onset, mechanism, and injury classification.

“Injury risk is arguably the most important, yet overlooked pillar. If not already in place, practitioners should record injury data according to the classification systems of: Sport Medicine Diagnostic Coding System (SMDCS) & Orchard Sports Injury & Illness Classification System (OSIICS). Also, they should be cautious about claims surrounding ‘injury prediction’ and ‘injury prevention’,” mentioned Crooks.

• Psychology

Assess: Behaviours, traits, and values.

Crooks suggested: “practitioners spend a large amount of time, effort, and energy profiling an athlete’s physical qualities. Less can be said for an athlete’s psychological profile. Subjective archetyping (pattern of behaviour) may be a useful tool for better understanding individual preferences and communication styles. It is important to note that any psychometric evaluation/interventions should come from a qualified sports psychologist.”

• Monitoring

Assess: Testing practices and reliability.

“Monitoring practices are vital for understanding baselines, ranking athletes, evaluating training impact, informing rehabilitation and programming,” explained Crooks.

Performance testing (fitness testing) should follow a logical sequence and should be standardised to ensure the reliability of results.

• Programming

Assess: Rationale and justification for exercise selection and implementation.

“Use the sport and athlete context derived from the other pillars to objectively assess your plan for your athletes, and use it as a reflection tool in the future,” said Crooks.

• Annual plan

Assess: calendar, key fixtures, and travel.

“Extended competition seasons, multiple training goals, concurrent training, time constraints, and impact of physical stress from the sport should all be assessed during an annual plan. Annual plans extend far beyond just the sport and its competition, it should also consider an athlete’s personal calendar,” outlined Crooks.

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