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Anthony Shield - does strength in the nhe predict hamstring injury

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Anthony Shield
Senior lecturer, School of Exercise and Nutrition Science Institute of Health and Biomedical Innovation Queensland University of Technology, Brisbane, Australia.
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Does strength in the Nordic hamstring exercise predict hamstring injury?
(&th MuscleTech Network workshop)
14th October, Barcelona

Published in: Health & Medicine
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Anthony Shield - does strength in the nhe predict hamstring injury

  1. 1. Does strength in the Nordic hamstring exercise predict hamstring injury? David Opar (ACU) Morgan Williams (USW) Jack Hickey Ryan Timmins (ACU) Steven Duhig (QUT) Tony Shield (QUT)
  2. 2. 2 Patent Application Opar & Shield (2012) Funding
  3. 3. Is eccentric knee flexor strength a risk factor for hamstring injury?
  4. 4. Nordic interventions reduce injury! Petersen et al., 2011. AJSM. 39(11):2296-303. Established injury prevention effects Arnason et al 2008 Petersen et al 2011 Van der Horst et al 2014 No performance feedback!
  5. 5. Nordic testing in the ‘field’ Wireless load cells, data logged to lap-top, 100Hz
  6. 6. Nordic testing in the ‘field’ Wireless load cells, data logged to lap-top, 100Hz
  7. 7. 5 AFL teams recruited 210 players in total  186 in early pre-season testing A 6th team was withdrawn due to lack of compliance
  8. 8. Timeline for reporting Retrospective Prospective Hamstring strain Muscle Mechanism Severity Calf strain Quadriceps strain Groin injury Anterior cruciate rupture Hamstring strain Nordic test results
  9. 9. Strength testing schedule Pre-season In-season Nov Dec Jan Feb Mar - Sept 2012 2013
  10. 10. Hamstring strain injuries 28 ‘initial’ Hamstring strain injuries 79% 18% 4% BF SM ST 6 of these recurred
  11. 11. Pre-season strength Group Limb NHE Strength (N.kg-1) Subsequently… Early pre Late pre Injured players Injured Uninjured 3.04±0.97 3.37±1.10 n=27 3.51±0.95 3.60±0.87 n=17 Uninjured players Ave of both 3.81±1.06 n=159 4.18±0.92 n=157  Weaker than uninjured players
  12. 12. Strength & risk of injury Cut-off n % HSI RR p Early Pre 186 14.5 <3.16 N.kg-1 66 25.8 3.1 (1.5-6.4) 0.002 >3.16 N.kg-1 120 8.3 Late Pre 174 9.8 <3.45 N.kg-1 47 23.2 5.0 (1.9-12.6) 0.001 >3.45 N.kg-1 127 4.7 HSI = hamstring strain injury, RR = relative risk Cut-offs determined by ROC curve
  13. 13. Other factors not significant Factor RR p Prior hamstring strain 2.1 (1.0-4.3) 0.093 Prior ACL rupture 2.2 (0.9-5.1) 0.146 Prior Quad strain 1.9 (0.6-6.8) 0.601 Prior Groin pain 0.4 (0.1-2.7) 0.478 Limb imbalance >10% Early pre 1.3 (0.6-2.5) Late pre 2.0 (0.8-4.8) 0.677 0.185 Age > 25.5 1.5 (0.7-3.1) 0.339
  14. 14. Logistic regressions Multivariate regressions Univariate regressions Early pre: 0.937 (0.888-0.990), p=0.020 (6.3%  in risk / 10N ) Late pre: 0.914 (0.845-0.989), p=0.026 (8.9%  in risk / 10N ) OR’s per 10N increase in strength
  15. 15. Strength  age & injury risk
  16. 16. Prior injury  strength & injury risk Not significant!
  17. 17. Conclusions & discussion Players weaker at Nordics are more prone to hamstring strain injury Allows for targeted interventions? Provides strength guidelines AFL players are weak!!! Cricket players are stronger AFL: 330±73N, Cricket: 392±86N Is strength sufficiently prioritised?
  18. 18. Limitations / Next steps No exposure data New AFL study with GPS data 8 teams & ~300 players Applicability to other sports? Rugby & soccer studies have commenced

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