Treatment Table: Dermot Simpson on the dreaded hamstring muscle injury

IN THIS WEEK’S column, Dermot Simpson examines one of the most frequent complaints suffered by sportspeople – the hamstring muscle injury.

The vast majority of GAA players who have played at senior club or inter-county level for a certain number of years would recall having a hamstring muscle injury (HMI).  

In fact, Gaelic football has a higher prevalence of HMIs than any other sport.  I don’t know if it’s something to be proud of, Gaelic football’s high-intensity nature or something to be embarrassed about, having so many injuries to one area without any apparent reduction over the years.  

A study published by the GAA on inter-county injuries in the 2007-2010 seasons found that 24 per cent of all injuries are HMI.  The most recent (unpublished) inter-county GAA study from the 2014 season showed HMI to be 26 per cent of all injuries.  Soccer, rugby or Australian Rules by contrast, have a HMI prevalence of 12 per cent to 18 per cent.

Research from Australia finds that players who have lower eccentric strength in hamstrings have a higher risk of injury.  Eccentric strength is the strength of the muscle as it stretches.  This study group has found similar results in Australian Rules, rugby and soccer.  There are numerous ways of improving this type of strength and it’s something I will talk about in future.  

The biggest risk factor is player-load.  However, if the players are not prepared physically or mentally for the training, player load matters very little.  Paul Fisher and Declan Gallagher – the Donegal Senior Football strength and conditioning coaches – with whom I worked with for the past few years, will talk about movement preparation, warm up routines, specificity of strength training and developing the energy and mental demands for in-season training, in upcoming articles.

In the Premier League this season, Swansea, Leicester City and West Brom have a total of two injuries between them and not one muscle injury.  

Although not among the top footballing teams, they have excellent medical teams and a very good reputation for player monitoring and injury prevention.  At the other end of the table, Newcastle and Arsenal have no and 8 injuries respectively (info from physioroom.com).  

I did a HMI risk factor study on all Donegal senior and minor football players for the 2014 study.  I conducted physical tests, collected questionnaires and then analysed HMIs from over 60 players throughout the year.  From the study, the greatest risk for a HMI is previous injury and older age.  This cannot be changed.  What can potentially be changed and what was found to be risk factors for injury was more than 80 minutes travel to training, positive neural tension test and increased BMI (Body Mass Index).

Re-injury rate from HMI are very high, even at the elite level.  In data collected by Uefa from Champions League clubs, 18 per cent of hamstring injuries were re-injured within two months. Numerous factors could explain this; poor compliance with rehab, pressure from management to return, stress and anxieties associated with injuries.  

The average time lost to HMI was 15 days with these teams.  The teams can argue that he will have an 82 per cent chance of avoiding injury within two months. All muscle injuries from the 14 professional football clubs here in Qatar are treated in Aspetar.  It gives fantastic database for research as well as having a tried and tested protocol for the players to follow.  

A study is currently ongoing at Aspetar regarding hamstring rehabilitation post injury.  At 12-month follow-up, only 6 per cent of hamstrings were re-injured.  Apart from a well-structured programme, the average return to sport time was 21 days.  This contrasts to the 15 days in the Uefa study.  It’s quite normal for the player to pass all the clinical tests at 15 days but the muscle may not be physiologically healed and could break down when in a fatigued state.

MRI isn’t always necessary to diagnose.  A colleague here at Aspetar, Arnlaug Wangensteen, recently published a study that showed that MRI on hamstring injury won’t given any added benefit for diagnosis and time lost to injury compared to performing a clinical examination by a qualified physiotherapist.  MRI also doesn’t have any therapeutic benefit and won’t magically heal the hamstring. It requires an appropriate exercise based rehabilitation programme.  

The most important thing is keeping a player free from HMI injury is preventing the first one.  Once a HMI is sustained, you are then seven times higher risk at sustaining a second one than a player who has never had one.  

The odds may vary depending on how much prevention work has been done but you are certainly at a higher risk.  Rory Kavanagh’s first HMI came aged 30, three weeks before the All-Ireland final in 2012. Thankfully he made a good recovery!

Dermot Simpson (pictured above with bantamweight Michael Conlan, Ireland’s first World Championships boxing gold medalist) is a physiotherapist currently working at Aspetar, a world renowned sports medicine clinic in Doha, Qatar.  Dermot has been team physiotherapist for Donegal senior football team from the 2012 to 2015 seasons.  

He holds an undergraduate degree in physiotherapy and as well as a Masters in Sports Physiotherapy from UCD, Dublin.  Dermot is the owner of Donegal Physiotherapy & Sports Injury Clinic in Letterkenny and Inishowen Physiotherapy & Sports Injury Clinic in Carndonagh.  

He will write weekly articles on sporting injuries, injury prevention and rehabilitation for Donegal Sports Hub.

Dermot’s website is donegalphysio.ie and he can be contacted on Donegal Physiotherpay Facebook.