John Orchard
Adjunct Associate Professor, Sydney Medical School, University of Sydney.
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Hamstrings are most susceptible to injury during the late stance phase of sprinting
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John Orchard - hamstrings injuries
1. Hamstrings are most susceptible to injury during the early stance phase of sprinting
John Orchard, MBBS BA MD PhD FACSP FACSM FASMF FFSEM (UK)
Ass Prof, School of Public Health, University of Sydney
October 13, 2014
6th MuscleTech Network
Workshop, Barcelona
Delivered remotely
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2. When do muscles strain?
Muscle strains are amongst the most common injuries in football players and sprint athletes although little is proven about the time of occurrence of strains
Strains can be recreated in the laboratory, but in vivo occur so rapidly that the forces resulting in strain are very hard to assess
An implanted force transducer into hamstring tendon could measure forces in the various phases
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3. Clinical occurrence of strains
Hamstring
Football, sprints
Full pace
?swing ?stance
Quadriceps
Soccer, ARF
Kicking
?ball/swing/ ground
Calf
Tennis, squash
Take-off
Ground contact
Groin
Soccer, ARF
Change direction
Ground contact
Upper limb
clinically rare
tackling
Player contact
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4. Laboratory occurrence of strains
Strain model simulated in lab by over- stretch of isolated rabbit muscle (i.e. not rabbit muscle during a running activity)
Strain in this fashion occurs at musculotendinous junction (MTJ)
Real life: MTJ (most common) as well as tendon, muscle belly, myofascial
Presumably similar pathology, but in real life activities (e.g. sprinting) maximal range of motion of muscle groups is not reached
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5. When do muscles strain?
In real life activities, highest range of motion (stretch) generally occurs during swing phases (most susceptible phase)
However, highest external joint moments generally occur during ground phases
Does low(er) force in a high(er) risk phase cause the injury or high(er) force in a lower risk phase cause the injury?
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6. Forces on muscles and joints
Change of movement of a joint is determined by a sum of net muscle moment and net external moment
Mann (1981): muscle moments for knee flexion and hip extension were both highest in the early ground phase of sprinting
He concluded that this is when hamstring strains occur (initial contact)
Recent supported by Takashi Ono (biomechanics, Waseda Uni, Tokyo)
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7. Clinical paradigm
Teaching of Garrett et al. suggests that 2- joint muscles strain when undergoing an eccentric contraction
This suggests that hamstring muscles may strain in late swing phase (eccentric phase) rather than early ground contact (when already contracting concentrically)
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8. Forces responsible for strain
Leiber et al. (1993, JAP) showed that in the laboratory strain model, muscle strain damage correlated with external force applied rather than over activity of the muscle.
Suggests that Ralph Mann’s explanation of muscle strain pathogenesis was wrong, but phase (early stance) could be correct
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9. Wrong for right reasons?
However, muscle force correlates strongly with degree of stretch (i.e. eccentric contractions are much stronger than concentric contractions)
Therefore maximal net muscle moments probably coincide with maximal external moments in the other direction
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10. Eccentric or isometric?
Kurokawa et al. (JAP, 2001) have shown that there is a phase after eccentric contraction where musculo-tendinous unit as a whole is isometric
However, using realtime U/S of gastroc during jumping have shown that initially the muscle component contracts while the tendon component continues to lengthen
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13. Quad strains - dominant kicking leg in football codes
Quadriceps strains more common in dominant kicking leg (RR 2.13, 95% CI 1.59-28.6)
Hamstring and calf fairly evenly distributed
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14. Quadriceps strains?
Anecdotal description of occurrence during ball contact
But, this would clearly be when shortening
Why wouldn’t triceps strain when serving or spiking in volleyball if ball contact can strain a shortening muscle?
Could quadriceps strain occur in back- swing or even ground contact?
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15. Type of kicks at risk for QdStr
Running kicks rather than standing kicks
Rare on kicking out from goal, or kicking after a mark (Aust football) or goalkeepers (soccer)
Very rare in punters in NFL
Rare in goalkickers in rugby codes
Related to speed of running rather than distance of kick
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16. Biomechanics: calf strains
Occur during push-off phase
Presumably ground contact
Video – one calf strain available of Steve Waugh from StumpCam
Occurs during second step of take-off towards end of ground contact cycle
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18. Biomechanics: calf strains
Occur during ground contact phase
Occur during close to full range (increased stretch) but not maximal range
Close to an isometric phase (moving from eccentric to concentric)
Occur during push-off (acceleration) of second step
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19. Biomechanics: hamstring
Hamstring strains are likely to occur during overstriding when close to maximum speed and trying to maintain speed
Again near maximum stretch but not at maximal length
Again moving from eccentric to concentric
?Start of ground contact
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20. Biomechanics: quadriceps strains
Can occur when running (slowing down) not just kicking
Related to dry weather rather than wet weather (?ground contact)
Mechanism: perhaps caused by under- striding of kicking leg during final step (when slowing down) before the kicking motion
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21. Can force in a tendon be directly measured?
Answer – Yes; but it has only been done to date by one research group and for Achilles (calf) and patella (quadriceps) tendons in taking off and landing.
Finni T. et al. “In Vivo…” Eur J Appl Physiol (2000). 83: 416-26 and Eur J Appl Physiol (2001). 85: 170-76
Forces in tendons in swing phases negligible compared to ground contact
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23. Conclusion
Lower limb muscles prob. strain during stance phase, when external joint moments (& muscle reactive moments) are high
These instances probably are in situations of relative overstretch (but not maximum)
In gait cycle hamstring probably early stance (?phase of eccentric tendon/concentric muscle if an overstride)
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