ADDING TO THE HAMSTRING PUZZLE
2nd May 2013
As we posted last week the incidence of hamstring injuries is not decreasing. Our research (see below) links movement faults to a history of hamstring injuries. We used the specifically designed Football Matrix to identify weak links
History of hamstring injuries is associated with poor control of lumbar extension
Mottram S 1, Barr A 2, Roussel N 3, Comerford M 4
Football Medicine Strategies for Knee Injuries International Conference on Sports Rehabilitation and Traumatology Isokinetic 2012 Conference, Stamford Bridge Stadium, Chelsea FC, London UK
Movement control tests can identify uncontrolled movement (UCM) in people with and without musculoskeletal pain. A link has been established between aberrant movement control (uncontrolled movement) and risk of injury (Roussel et al 2009). The presence of uncontrolled movement may also be a potential predictor of re-injury. A battery of movement control tests has been designed to identify the site, direction and threshold of aberrant movement control (UCM) in professional footballers (The Football Matrix). Hamstring injuries are one of the most common injuries in footballers. This study explores the association of aberrant movement control with a history of injury in professional footballers.
Ninety male professional footballers from two UK premier league football clubs and one Dutch football club were screened with The Football Matrix Movement and Performance Screen. The Football Matrix uses a series of twenty multi-joint functionally relevant movement control tests that identify the site, direction and threshold of uncontrolled movement. These movement control tests are based on the theory of movement dissociation (Sahrmann 2002). The Movement and Performance Screen includes 5 tests to identify low threshold uncontrolled movements, 5 tests to identify high threshold uncontrolled movements, 5 sport relevant (high threshold) tests and 5 tests to identify restrictions. The tests identify specific sites of UCM (e.g. low back, scapula, hip). They further classify the direction of the UCM at the problem site (e.g. low back - flexion, scapula - forward tilt). In addition, this classification process evaluates the threshold of control failure as being either low threshold (related to movement coordination and timing) or high threshold (related to strength or speed deficiencies). The MPS identifies multiple movement weak links that are classified in terms of their site, direction and threshold of uncontrolled movement. Each movement weak link is prioritised as high risk (fix now) or low risk (fix soon). Each player reported history of injury(s). An exploratory analysis was undertaken to identify if the failure of any particular test (site, direction and threshold of uncontrolled movement) was associated with a history of previous injury.
99% of this group of professional footballers failed tests of lumbopelvic movement control tests.The sites and direction of uncontrolled movements for the low back and hip and the high risk areaare detailed in Table 1.
79% of these footballers demonstrated uncontrolled lumbar extension in the series of high threshold tests (strength and speed) of lumbopelvic movement control.Knee pain was the most common reported previous injury (47%). Hamstring injury was the second most common reported previous injury (20%). Neither of these injuries varied in prevalence by Club (P>0.05). Uncontrolled low back extension (high load) showed a significant association with a history of a hamstring injury (P>0.05).
Uncontrolled movement is frequently observed in professional footballers. Uncontrolled high threshold lumbopelvic extension shows a significant association with a history of hamstring injury. The Football Matrix Movement and Performance Screen can identify uncontrolled movement. Further research should analyse movement control retraining following injury, and explore how movement control retraining can be used to prevent injuries.
Roussel N A, Nijs J, Mottram S, van Moorsel A, Truijen S, Stassijns G. Altered lumbopelvic movement control but not generalised joint hypermobility is associated with increased injury in dancers. A prospective study. Manual Therapy 2009a; 14(6): 630-635.
Sahrmann SA. Diagnosis & treatment of movement impairment syndromes. Ist ed. Missouri: Mosby; 2002.
1 Movement Performance Solutions, Chichester, UK, 2 Movement Performance Solutions , New York, USA, 3 University of Antwerp, Antwerp, Belgium, 4 Movement Performance Solutions , Chichester, UK