In professional sports, athletes rely on their on- and off-season training to develop and enhance current sports specific movements that further prepares their bodies for maximizing sports performance. Unfortunately, many athletes encounter injuries which impede their growth and performance, and ultimately reduces playing time.

Soccer is one of the most popular sports globally. Very few sports are played across very large fields, with long playing times, and infrequent rest periods, which makes soccer a challenge for sports performance training. It is not uncommon to see athletes succumb to injuries throughout the season. Coaches rely on athletic training to allow their players to mitigate injury and perform at the best of their ability. Unfortunately, no matter how hard you train, sometimes the demand of the sport can be too much on your body, or an unforeseen play can lead to an injury.

Running injuries remain a hot topic in sports medicine, especially among soccer athletes. The hamstring muscles is one of the most common sites to be injured among soccer athletes. This group of muscles is comprised of the biceps femoris (BF), semitendinosus (ST) and semimembranosus (SB), and are commonly injured following explosive movements or kicking activities which puts biomechanical stresses along muscle-tendon units while in the frontal plane[i]. Research has shown us that when these three muscle bellies (BF, SMT, SMB) are not capable of engaging synergistically to provide adequate contractions, this causes the muscles to fatigue prematurely, ultimately resulting in injury[ii]. Research has also shown us that the cause of initial injury can be due to metabolic changes after the eccentric phase (unloading, kick follow through) which is found more often in the BF as a result of reduced activation of the ST, with recurring injuries due to poor endurance training. Unfortunately, it is difficult to isolate the training of these muscles bellies to unify neuromuscular recruitment, but strength endurance training can help prevent any neuromuscular inhibition or fatigue of the group which can further help prevent injury. Keeping all this in mind, it is not at a surprise that injuries often occur towards the end of a season or end of a match when fatigability settles into the muscles and thus heightens the chance of injury or re-injury.

Looking forward, in attempting to protect the hamstring against structural or functional damage, the soccer athlete should seek out effective training that involves plyometrics and heavy eccentric loading in the distal ranges of motion. An exercise to consider which has been shown to help with these training goals is prone leg curls until exhaustion[iii]. A recent study recommended an 8 week in-season plyometric training program that included various drills for 20-25 minutes, twice per week. Plyometric drills included multiple jumps (ankle hop, vertical and lateral hurdle jump), horizontal and lateral bounding, skipping, and footwork (speed ladder). Each plyometric session was composed of 4 different exercises and 2 to 4 sets of 6 to 12 repetitions[iv].

Prone Leg Curl
Demonstration of the Prone Leg curl.

Keeping in mind with injury prevention and training, clinical rehabilitation is very important to consider such as the use of acupuncture which helps disrupt taut bands of muscle that often would otherwise contribute to biomechanical dysfunction, fatigue, and imbalanced muscle tone[v]. Acupuncture has also been shown to reduce referral pain, improve range of motion and decrease trigger point irritability. Moreover, the use of spinal manipulative therapy, muscle release therapy techniques are also helpful in improving range of motion deficits and other biomechanical areas subject to stress such as the hips and mid and lower back. Together, these conservative therapies in combination with an eccentric and endurance exercise program are helpful in mitigating hamstring injuries among soccer athletes, and can be implemented across many other athletic disciplines.

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Dr. Nourus Yacoub, DC
Chiropractor/ART
Medical Acupuncture Provider
Dr. Yacoub is the owner and Chiropractor at the Royal Chiropractic and Sports Injury Clinic. He currently works with The Sports Clinic at the University of Toronto Mississauga , and is the medical trainer for the University of Toronto Mississauga Varsity Eagles., Team Chiropractor for the Evolution Martial Arts Fight Team and the MAFA Fight Team.
References:
[i] Opar D, Williams MD, Shield AJ. Hamstring injuries: factors that lead to injury and re-injury. Sports Med. 2012;42:209-226
[ii] Schuermans J, Van Tiggelen D, Danneels L, et al. Biceps femoris and semitendinosus: team mates of competitors? New insights into hamstring injury mechanisms in male football players: a muscle functional MRI study. Br J Sports Med. 2014; 48:1599-1606.
[iii] Schuermans J, Van Tiggelen D, Danneels L and Witvrouw E. Resonance Imaging Susceptibility to Hamstring Injuries in Soccer: A Prospective Study Using Muscle Functional Magnetic. Am J Sports Med. 2016; 20-31.
[iv] Meyland C and Malatesta D. 2009. Effects of in-season plyometric training within soccer practice on explosive actions of young players. Journal of Strength and Conditioning Research. 23(9) 2605–2613
[v] DeWitt J and Vidale T. 2014. Recurrent hamstring injury: consideration following operative and non-operative management. The International Journal of Sports Physical Therapy. 9(6) 798-812.
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