During these three hours, I composed answers regarding a case study that I has been previously given and then presented my findings to other students in a group seminar.

Reflective Summary

The case study that I got given was an office worker who plays football socially and had sustained a grade two hamstring strain approximately three months ago. I was told that they were pain free but do not complete a warm up or cool down.

Warming up is important as it can improve subsequent exercise performance via increases in adenosine triphosphate turnover, muscle cross-bridge cycling rate and oxygen uptake kinematics, which enhances muscular function (McGowan, Pyne,Thompson & Rattray, 2015). I explained to the group that is is essential to educate the players so they know why warming up is so important. Sport-specific exercises should be incorporated into a warm up because the demands of training and competition differ between sports (Ehlert, 2019). The football player could satisfy this by including the HamSprints drills which consists of running, high knee marching, skips, leg pawing, ankle pops, forward falling running and squat jumps into an explosive start, within their warm up. HamSprint drills were specifically used to improve running technique, coordination and hamstring function. Shamsehkohan, Meghdadi, Yadegari & Moradi (2012) study found that a HamSprint programme was effective in promoting return to sport and preventing recurrence of injury for those who had sustained an acute hamstring strain. Therefore, not only can it be used to warm the athlete up, it can help to prevent a recurring hamstring strain. 

Another topic which I discussed in the seminar was whether warm ups shoulder include static or dynamic stretching; mechanically, static stretching decreases musculotendinous unit stiffness, which leads to a lower rate of force production and a delay in muscle activation (Paradisis et al., 2014). This can actually increase the risk of injury. Research suggests that dynamic stretching can increase acute power, sprint or jump performance (Opplert & Babault, 2018) all of which would be beneficial to a footballer. Further evidence shows that an acute bout of dynamic stretching can enhance ROM at a joint, leading to recommendations for dynamic stretches to be included in a warm up rather than static stretches (Opplert & Babault, 2018). 

I researched if there is a link between hamstring strains and range of motion (ROM). A study by van Dyk, Farooq, Bahr & Witvrouw (2018) results suggested that deficits in passive hamstring range of motion were a weak risk factor for hamstring strains. Furthermore a study by Tokutake et al. (2018), found greater hip ROM in the injured group, compared with the control. They suggested that to understand hamstring strain occurrence and to aid prevention, it is necessary to consider the behaviour of the joint during high-speed running, opposed to just passive ROM measurements.

I also thought of specific exercises that all of the players could be doing to prevent injury; there is evidence that a programme of eccentric hamstring exercises, such as the nordic hamstring exercise (NHE) could reduce hamstring muscle injury (Brukner, 2015). The recommended programme for NHE of 3 sessions per week during a 10 weak preseason programme and subsequently one session a week has been incorporated into training for many football clubs, in order to prevent hamstring injuries (Petersen, Thobord, Nielsen, Budtz-Jørgensen & Holmich, 2011). This is important to address as hamstring injuries are the most prevalent muscle injury in football, where 12-33% of players who have had a previous hamstring injury, will experience a recurrence within a year after the initial injury (Van Der Horst, Backx, Goedhart & Huisstede, 2017).

What Went Well

I thoroughly researched specific contemporary topics relating to the case study and presented it clearly to the other students using evidence based practice.

Areas for Improvement	Action Plan
Ensure I can rationalise sets and reps for all prescribed exercises	Look at the evidence surrounding sets and reps for the different components in a rehabilitation plan
Use Rated Perceived Exertion (RPE) scale with strength exercises to understand how challenging the client is finding them	Next time I am prescribing strengthening exercises, ensure I implement the RPE scale with the client
When implementing sets and reps consider the clients pain tolerance	When prescribing exercises use the VAS pain scale to understand the clients pain tolerance

Closing the Loop

Since writing this reflection, I have looked at the evidence regarding sets and reps so I am able to rationalise my choice in my final year exams. With this it is important to consider evidence based practice AND what the client can tolerate.

References

Brukner, P. (2015). Hamstring injuries: prevention and treatment—an update. British journal of sports medicine, 49(19), 1241-1244.

Ehlert, A., & Wilson, P. . (2019). A Systematic Review of Golf Warm-ups: Behaviors, Injury, and Performance. The Journal of Strength & Conditioning Research, 33(12), 3444–3462.

McGowan, C. J., Pyne, D. B., Thompson, K. G., & Rattray, B. (2015). Warm-up strategies for sport and exercise: mechanisms and applications. Sports medicine, 45(11), 1523-1546.

Opplert, J., & Babault, N. (2018). Acute effects of dynamic stretching on muscle flexibility and performance: an analysis of the current literature. Sports Medicine, 48(2), 299-325.

Paradisis, G. P., Pappas, P. T., Theodorou, A. S., Zacharogiannis, E. G., Skordilis, E. K., & Smirniotou, A. S. (2014). Effects of static and dynamic stretching on sprint and jump performance in boys and girls. The Journal of Strength & Conditioning Research, 28(1), 154-160.

Petersen, J., Thorborg, K., Nielsen, M. B., Budtz-Jørgensen, E., & Hölmich, P. (2011). Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. The American journal of sports medicine, 39(11), 2296-2303.

Shamsehkohan, P., Meghdadi, M., Yadegari, M., & Moradi, Y. (2012). Measurements of Injured Hamstring Muscle Volume Before and after Eccentric Exercises and Hamsprint Exercises with MR Observations. Middle-East Journal of Scientific Research, 12(3), 376-381.

Tokutake, G., Kuramochi, R., Murata, Y., Enoki, S., Koto, Y., & Shimizu, T. (2018). The risk factors of hamstring strain injury induced by high-speed running. Journal of Sports Science & Medicine, 17(4), 650–655.

Van Der Horst, N., Backx, F. J. G., Goedhart, E. A., & Huisstede, B. M. (2017). Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making. British Journal of Sports Medicine, 51(22), 1583-1591.

van Dyk, N., Farooq, A., Bahr, R., & Witvrouw, E. (2018). Hamstring and ankle flexibility deficits are weak risk factors for hamstring injury in professional soccer players: A prospective cohort study of 438 players including 78 injuries. The American journal of sports medicine, 46(9), 2203-2210.