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Tuesday Morning Scientific
Lecture
Hamstring strength, Training ‘sweet
spot’ and shared decision making
Nicol van Dyk
Rehabilitation Department
#researchinre...
Disclosure statement
Has no relevant financial
relationships to disclose
Will not be discussing
the off-label or
investiga...
1.Train smarter AND harder
2. Hamstring strength
3. Shared decision making
4. Beetroot shots performance boosters
5. Ice C...
#trainsmarterandharder@TimGabbett
Spikes in HSR (≥ 24km/hr) volumes are
associated with hamstring strain injury
Results: HSI risk vs HSR load
Thursday, after training: 40m sprint!
#researchinreallife
1. Train smarter AND harder
2.Hamstring strength
3. Shared decision making
4. Beetroot shots performance boosters
5. Ice C...
Are you sure you
want to do that?
We need to talk
about Hamstring
Strength
Argh….
• Hamstring Strain Injuries (HSI) remain the
most common muscle injury in football
(Hagglund et al 2013, Ekstrand et al 20...
• Incidence 12-15% (Opar et al 2012)
• 37% of all muscle injuries (Ekstrand et al 2011)
Annual increase
4%
Time-trend of Hamstring injury over 13 years
Jan Ekstrand et al. Br J Sports Med doi:10.1136/bjsports-
...
Cost of an injury in a line up player in a UEFA Champions League
team
– 20,000 €/day
Average absence days (28 players)
110...
@alistairmagowan
3. Introduce a
preventative
measure
Assess it’s
effectiveness by
repeating step 1
1
2. Establish etiology
and mechanisms o...
Idea for
prevention?
Test it!
Causes?2
4
3
Magnitude
1
van Mechelen et al 1992
• Previous Injury
• Increase Age
• Ethnicity
• Flexibility
• H:Q Ratio
• Weight/BMI
• Height
• Functional Measures
• Quadr...
• Previous Injury
• Increase Age
• Ethnicity
• Flexibility
• H:Q Ratio
• Weight/BMI
• Height
• Functional Measures
• Quadr...
• Previous Injury
• Increase Age
• Ethnicity
• Flexibility
• H:Q Ratio
• Weight/BMI
• Height
• Functional Measures
• Quadr...
– Rod Whiteley
– Philipp Jacobsen
– Cristiano Eirale
– Roald Bahr
– Erik Witvrouw
– Anne van der Made
– Arnlaug Wangenstee...
All Teams in
Qatar Stars
League
(n=14 teams)
2010-2014
No isokinetic tests
performed
(n=52 subjects)
Isokinetic Tests duri...
Odds Ratio p-value 95% CI
Q Con 60 0.99 0.06 0.99 - 1.00
H Con 60 0.99 0.17 0.99 - 1.00
Q Con 300 0.99 0.97 0.99 - 1.00
H ...
Hamstrings Eccentric strength
Quadriceps Concentric strength
are WEAK risk factors
HAMSTRING STRAIN INJURIES
Idea for
prevention?
Test it!
Causes?2
4
3
Magnitude
1
van Mechelen et al 1992
Health by Exercise, Geo Taylor
1880
Prevention AJSM, Petersen et al
2011
130
years!
Nordic Hamstring Exercise
Petersen et al 2011 &
van der Horst et al 2015
The Nordic Hamstring RCT’s
Dr. Anthony Shield (@das_shield)
Combined Result...
Nordic Hamstring Exercise
• Low speed
• Hip extension
• Knee flexion
• Muscle targeted
– BF(short head)
– ST
Mechanism of ...
Kiezen is
verliezen!
Kiezen is
verliezen!
Choosing is
losing!
T2 rest
T2 shift
T2 after exercise
T2 rest
T2 shift
T2 after exercise
0
5
10
15
20
25
30
35
BF ST SM
control
injury
* P=0.001
* P=0.003
T2 shift in control group and previously injured group
%...
±80% of Metabolic Activity
More symmetrical pattern
After hamstring injury
rad.washington.edu
• Max eccentric activation
• BF activated & elongated
• Main muscle: ST
• BF is not made for this work
↓ fascicular length...
Choice: Do we only treat the victim,
or also the cause?!
We also treat
the cause!
#researchinreallife
1. Train smarter AND harder
2. Hamstring strength
3.Shared decision making
4. Beetroot shots performance boosters
5. Ice C...
Communication
Got it: run fast,
score…
Just
concentrate
for the next 5
minutes
The Integrated Performance Health Management and Coaching Model.
H Paul Dijkstra et al. Br J Sports Med 2014;48:523-531
Co...
Guess Compute Consequences
Compare to
Experience/Experiment
#researchinreallife
Thank you for your attention
References
1. Aagaard P, Simonsen EB, Magnusson SP, Larsson B, Dyhre-Poulsen P. A new concept for isokinetic hamstring: qu...
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)
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Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)

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Aspetar Tue morning Scientific Lecture - #researchinreallife How we use scientific evidence to influence our daily practice!

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  • DOWNLOAD FULL BOOKS, INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
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  • DOWNLOAD FULL BOOKS, INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
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Hamstring strength, training sweet spot and shared decision making (Aspetar Lecture)

  1. 1. Tuesday Morning Scientific Lecture
  2. 2. Hamstring strength, Training ‘sweet spot’ and shared decision making Nicol van Dyk Rehabilitation Department #researchinreallife
  3. 3. Disclosure statement Has no relevant financial relationships to disclose Will not be discussing the off-label or investigational use of products Have no affiliation with Leicester City
  4. 4. 1.Train smarter AND harder 2. Hamstring strength 3. Shared decision making 4. Beetroot shots performance boosters 5. Ice Chambers -135°C Learning objectives from Leicester City
  5. 5. #trainsmarterandharder@TimGabbett
  6. 6. Spikes in HSR (≥ 24km/hr) volumes are associated with hamstring strain injury Results: HSI risk vs HSR load
  7. 7. Thursday, after training: 40m sprint! #researchinreallife
  8. 8. 1. Train smarter AND harder 2.Hamstring strength 3. Shared decision making 4. Beetroot shots performance boosters 5. Ice Chambers -135°C Learning objectives from Leicester City
  9. 9. Are you sure you want to do that? We need to talk about Hamstring Strength Argh….
  10. 10. • Hamstring Strain Injuries (HSI) remain the most common muscle injury in football (Hagglund et al 2013, Ekstrand et al 2011, Eirale et al 2013) Introduction
  11. 11. • Incidence 12-15% (Opar et al 2012) • 37% of all muscle injuries (Ekstrand et al 2011)
  12. 12. Annual increase 4% Time-trend of Hamstring injury over 13 years Jan Ekstrand et al. Br J Sports Med doi:10.1136/bjsports- 2015-095359 Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.
  13. 13. Cost of an injury in a line up player in a UEFA Champions League team – 20,000 €/day Average absence days (28 players) 1100 days (50 injuries – 22 days each) 1100 x 20,000 € = 22 million € (Sergei Palkin, CEO Shakhtar Donesk)
  14. 14. @alistairmagowan
  15. 15. 3. Introduce a preventative measure Assess it’s effectiveness by repeating step 1 1 2. Establish etiology and mechanisms of sports injuries 1. Establish the extent of the injury problem: • Incidence • Severity van Mechelen et al 1992
  16. 16. Idea for prevention? Test it! Causes?2 4 3 Magnitude 1 van Mechelen et al 1992
  17. 17. • Previous Injury • Increase Age • Ethnicity • Flexibility • H:Q Ratio • Weight/BMI • Height • Functional Measures • Quadriceps isokinetic strength • Hamstring eccentric strength • Peak Torque • Type of activity Risk factors for Hamstring Injury
  18. 18. • Previous Injury • Increase Age • Ethnicity • Flexibility • H:Q Ratio • Weight/BMI • Height • Functional Measures • Quadriceps isokinetic strength • Hamstring eccentric strength • Peak Torque • Type of activity
  19. 19. • Previous Injury • Increase Age • Ethnicity • Flexibility • H:Q Ratio • Weight/BMI • Height • Functional Measures • Quadriceps isokinetic strength • Hamstring eccentric strength • Peak Torque • Type of activity • MRI Can Strength be identified as a risk factor for Hamstring Injury?
  20. 20. – Rod Whiteley – Philipp Jacobsen – Cristiano Eirale – Roald Bahr – Erik Witvrouw – Anne van der Made – Arnlaug Wangensteen – Bruce Hamilton – Hans Tol – Bhavesh Kumar – Patrice Muxart Acknowledgement
  21. 21. All Teams in Qatar Stars League (n=14 teams) 2010-2014 No isokinetic tests performed (n=52 subjects) Isokinetic Tests during Periodic Health Evaluation (n=614 subjects) mean follow up of 2.24 years Q Con 60°/s (n= 556) H Con 60°/s (n= 555) Q Con 300°/s (n= 556) H Con 300°/s (n=556) H Ecc 60°/s (n=562) Materials & Methods 4 seasons 614 subjects 1931 Isokinetic Tests performed Total Injuries 190 1st time injuries 131 190 injuries
  22. 22. Odds Ratio p-value 95% CI Q Con 60 0.99 0.06 0.99 - 1.00 H Con 60 0.99 0.17 0.99 - 1.00 Q Con 300 0.99 0.97 0.99 - 1.00 H Con 300 0.99 0.20 0.99 - 1.00 H Ecc 60 0.99 0.12 0.99 - 1.00 Q Con 60 BW 0.71 0.03* 0.52 - 0.97 H Con 60 BW 0.75 0.29 0.43 -1.29 Q Con 300BW 1.10 0.87 0.56 - 1.89 H Con 300 BW 0.75 0.29 0.43 - 1.29 H Ecc 60 BW 0.73 0.04* 0.54 - 0.99 Q Con 60/ H Con 60 0.76 0.32 0.44 - 1.32 H Con 60/ H Ecc 60 1.08 0.90 0.34 - 3.40 Q Con 300/ H Con 300 1.46 0.26 0.76 - 2.79 Q Con 300/ H Ecc 60 1.46 0.35 0.66 - 3.25 Q Con 60 BW 0.71 0.03* 0.52 - 0.97 H Ecc 60 BW 0.73 0.04* 0.54 - 0.99 Results Q Con 60 Body Weight Effect Size 0.17 6.9 Nm H Ecc 60 Body Weight Effect Size 0.18 7.1 Nm
  23. 23. Hamstrings Eccentric strength Quadriceps Concentric strength are WEAK risk factors HAMSTRING STRAIN INJURIES
  24. 24. Idea for prevention? Test it! Causes?2 4 3 Magnitude 1 van Mechelen et al 1992
  25. 25. Health by Exercise, Geo Taylor 1880 Prevention AJSM, Petersen et al 2011 130 years! Nordic Hamstring Exercise
  26. 26. Petersen et al 2011 & van der Horst et al 2015 The Nordic Hamstring RCT’s Dr. Anthony Shield (@das_shield) Combined Results Nordic groups: 753 players → 25 injuries Control groups: 768 players → 77 injuries 67.5% reduction in hamstring injuries
  27. 27. Nordic Hamstring Exercise • Low speed • Hip extension • Knee flexion • Muscle targeted – BF(short head) – ST Mechanism of Injury • High Speed • Hip flexion • Knee extension • Muscle at risk – BF(long head) Heiderscheidt et al 2010 JOSPT It works in practice but not in theory?
  28. 28. Kiezen is verliezen!
  29. 29. Kiezen is verliezen! Choosing is losing!
  30. 30. T2 rest T2 shift T2 after exercise
  31. 31. T2 rest T2 shift T2 after exercise
  32. 32. 0 5 10 15 20 25 30 35 BF ST SM control injury * P=0.001 * P=0.003 T2 shift in control group and previously injured group % 35% 18% 9% Results ST is most metabolic active in both groups (Schache et al 2013, Oliver et al 2009, McAllister et al 2014)
  33. 33. ±80% of Metabolic Activity More symmetrical pattern After hamstring injury rad.washington.edu
  34. 34. • Max eccentric activation • BF activated & elongated • Main muscle: ST • BF is not made for this work ↓ fascicular length ↓ stretch tolerant = more likely to fail! ±80% of Metabolic ActivityWhy are BF & ST coupled? More symmetrical pattern After hamstring injury (Onishi et al 2002; Higashihara et al 2010; Schache et al 2013) rad.washington.edu
  35. 35. Choice: Do we only treat the victim, or also the cause?!
  36. 36. We also treat the cause!
  37. 37. #researchinreallife
  38. 38. 1. Train smarter AND harder 2. Hamstring strength 3.Shared decision making 4. Beetroot shots performance boosters 5. Ice Chambers -135°C Learning objectives from Leicester City
  39. 39. Communication Got it: run fast, score… Just concentrate for the next 5 minutes
  40. 40. The Integrated Performance Health Management and Coaching Model. H Paul Dijkstra et al. Br J Sports Med 2014;48:523-531 Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.
  41. 41. Guess Compute Consequences Compare to Experience/Experiment #researchinreallife
  42. 42. Thank you for your attention
  43. 43. References 1. Aagaard P, Simonsen EB, Magnusson SP, Larsson B, Dyhre-Poulsen P. A new concept for isokinetic hamstring: quadriceps muscle strength ratio. Am. J. Sports Med. 1998;26(2):231–237. 2. Arnason A, Andersen TE, Holme I, Engebretsen L, Bahr R. Prevention of hamstring strains in elite soccer: an intervention study: Prevention of hamstring strains in soccer. Scand. J. Med. Sci. Sports 2007;18(1):40-48. doi:10.1111/j.1600-0838.2006.00634.x. 3. Bahr R. Risk factors for sports injuries -- a methodological approach. Br. J. Sports Med. 2003;37(5):384-392. doi:10.1136/bjsm.37.5.384.doi:10.1136/bjsm.2005.018408.10. 4.Eirale C, Farooq A, Smiley FA, Tol JL, Chalabi H. Epidemiology of football injuries in Asia: A prospective study in Qatar. J. Sci. Med. Sport 2013;16(2):113-117. doi:10.1016/j.jsams.2012.07.001. 5. Ekstrand J, Hagglund M, Walden M. Epidemiology of Muscle Injuries in Professional Football (Soccer). Am. J. Sports Med. 2011;39(6):1226-1232. doi:10.1177/0363546510395879. 6. Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br. J. Sports Med. 2011;45(7):553-558. doi:10.1136/bjsm.2009.060582. 7. Freckleton G, Pizzari T. Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. Br. J. Sports Med. 2013;47(6):351-358. doi:10.1136/bjsports-2011-090664. 8. Hagglund M, Walden M, Ekstrand J. Risk Factors for Lower Extremity Muscle Injury in Professional Soccer: The UEFA Injury Study. Am. J. Sports Med. 2013;41(2):327-335. doi:10.1177/0363546512470634. 9. Van der Horst N, Smits D-W, Petersen J, Goedhart EA, Backx FJG. The Preventive Effect of the Nordic Hamstring Exercise on Hamstring Injuries in Amateur Soccer Players: A Randomized Controlled Trial. Am. J. Sports Med. 2015;43(6):1316-1323. doi:10.1177/0363546515574057. 10. Opar DA, Williams MD, Timmins RG, Hickey J, Duhig SJ, Shield AJ. Eccentric Hamstring Strength and Hamstring Injury Risk in Australian Footballers: Med. Sci. Sports Exerc. 15;47(4):857-865. doi:10.1249/MSS.0000000000000465. 11. Opar MDA, Williams MD, Shield AJ. Hamstring strain injuries. Sports Med. 2012;42(3):209–226. 12. Orchard J, Marsden J, Lord S, Garlick D. Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. Am. J. Sports Med. 1997;25(1):81–85. 13. Petersen J, Thorborg K, Nielsen MB, Budtz-Jorgensen E, Holmich P. Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men’s Soccer: A Cluster- Randomized Controlled Trial. Am. J. Sports Med. 2011;39(11):2296-2303. doi:10.1177/0363546511419277. 14 .Tol JL, Hamilton B, Eirale C, Muxart P, Jacobsen P, Whiteley R. At return to play following hamstring injury the majority of professional football players have residual isokinetic deficits. Br. J. Sports Med. 2014;48(18):1364-1369. doi:10.1136/bjsports-2013-093016. 15. Gabbett Br J Sports Med doi:10.1136/bjsports-2016-095973 16. H Paul Dijkstra et al. Br J Sports Med 2014;48:523-531 Erik Witvrouw presentation http://www.slideshare.net/MuscleTechNetwork/10-barcelona-2014-erik-witvrouw-40239277 18. Schuermans et al BJSM 2015 Biceps femoris and Semitendinosus – teammates or competitors Br J Sports Med 2014;48:1599-1606 doi:10.1136/bjsports-2014-094017 19. Van Dyk et al AJSM 2016 Hamstring and Quadriceps Isokinetic Strength Deficits Are Weak Risk Factors for Hamstring Strain Injuries: A 4-Year Cohort study 20. http://m.bbc.com/sport/football/36189778 References

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