Hanging in the Balance: will muscle imbalance move on in elite football (part 2)

Perceptions, Practice and Movement Analysis in Elite Football (Part 2)

This week we continue to look at current practice in elite level football by Clare Pedersen

Last time we considered perceptions, practice and the base of evidence that supports the management of injury risk within elite football. This time we dig deeper.

The hamstring puzzle

There is a mounting body of work on muscle rehabilitation for hamstring training considering such diverse aspects as; how its functional anatomy best suits its function; how the hamstrings function in gait, sprinting, alongside extensive inquiry in to EMG data related to differing joint positions. Each study reveals a extra piece to the hamstring puzzle currently plaguing elite, sprint based sport. This broadening insight is valuable as it becomes ever more apparent how the hamstring recurrence problem is simply much bigger and complex than the mere need to develop eccentric strength qualities.

If we do everything, something will work…

An article by Bruknar et al (2013) illustrated some of the problems faced by medical squads within football clubs with hamstring recurrence. The authors presented a clinical case report of an injured player and the seven point programme established as they continually worked with him in his eventual return to play.

The player in question had suffered previous injuries in various lower limb muscles and tendinopathies over an 18 month period. Specific muscle testing had failed to identify the risk for future injury as the player continued with injury arising at one site and then the next. The strategy with the (5 times) recurrent hamstring problem adopted by the medical squad was to cover all aspects of control and training related to the movement system. This included targeting;

  • lumbar spine strengthening and neuromuscular training using a selection of different exercise modalities including Pilates, lumbar training with DBC core training machinery
  • yoga
  • sprint training
  • epidurals and injections.

Essentially tackling the movement system from all aspects was achieved and the player returned to play. The cause, however, was never established and the opportunity for reinjury may still remain high because the movement diagnoses was never reached.

The repeated adductor injuries, hamstring and achilles tendinopathy sustained along the way would suggest that the player was coping poorly with the loads imposed through training and games. In such cases, analysis of movement appears to be highly justifiable when load related injuries are creating problems. Current muscle testing may not supply a sufficiently fine resolution of movement quality to inform on injury risk and absorb the demands of the sport arena. Questioning patterns of movement under load, asymmetry, and possessing greater similarity to functional task performance may provide greater insight as to why some players are more at risk then others.

Perceptions and practices are changing? No, they’ve already changed

Standing apart from the ’kitchen sink’ approach some clubs are making inroads on recurrence supporting their methods with injury data that leaves many others asking ’How?’. Such clubs are successfully making excellent business out of building strong robust players at academy level.