Strength and conditioning (S&C) play a vital role in any sports rehabilitation training programme or even in conventional training programmes, which targets to reduce the risk of potential injuries. Although, sport rehabilitation and S&C are believed to be two separate fields within the sports industry, implementation of the basic principles of both areas would facilitate a faster recovery (Leppänen et al., 2014). However, in order for the sports rehabilitators to be able to successfully implement S&C training principles and segments in to athlete’s rehabilitation protocols, both the athlete and their chosen sport need to be analysed at multiple levels. This would often require a good relationship between the different departments within the sport medical team in order to have reliable results from all parts of the spectrum, which could then potentially allow clinicians to design an effective rehabilitation protocol (Reiman and Lorenz, 2011).

Rehabilitation programmes follow the widely accepted principles of musculoskeletal injury rehabilitation, which focuses on two main areas; returning the athlete to pre-injury performance and minimising the risk of injury reoccurrence (Brukner and Khan, 2007), (Heiderscheit et al., 2010), (Sherry and Best, 2004), (Schmitt et al., 2012). Both in those phases can S&C play a vital role in order to achieve these targets.

In traditional muscle training there are four main objectives, on which the training programme would potentially be focusing. Training to improve strength, power, endurance or to induce muscle hypertrophy are typically targeted with conventional muscle training programmes (Reiman and Lorenz, 2011). However, each of these training objectives require different programme design. In order to accurately administer a specific training programme for an athlete, the athlete’s one repetition maximum (1RM) has to be determined to measure dynamic muscle strength (Bertrand et al., 2007). One repetition maximum has been described by Bertrand et al. (2007) as the maximum weight a person can lift only once in a complete range of motion. Once 1RM has been determined the load or the intensity of the exercises would be established. Training for strength requires weights of 80-100% of the individuals 1RM and performing one to six repetitions in each sets. Power training however, would require a different training design. Individuals required to train in order to improve their muscle power would have to work with lighter weights 75-90% of 1RM, compared to the weights in strength training, and would have to perform the exercises with faster movements and less repetitions (Binkley 2002). Respectively, hypertrophy and endurance training programmes are working with higher number of repetitions within each sets and are utilising lighter weights for the training exercises. Weights for hypertrophy training exercises are usually 70-85% of individuals 1RM and for endurance training exercises around 50% (Binkley 2002).

There is a wide selection of available academic studies, which studies are investigating the beneficial effects of the inclusion of strength training principles in long-term rehabilitation and prehabilitation programmes. One of the most researched area is the inclusion of eccentric exercises in hamstring strain rehabilitation protocols.

Hamstring strains are the most frequent soft tissue injuries in professional football (Ekstrand et al., 2011; Askling et al., 2013). Askling et al. (2013) emphasise that the results of their study showed that a football team with 25 players may expect and suffer five hamstring injuries in a season. This would accumulate into 80 days a season during which these players would be unavailable for matches or training sessions. Many academic articles support the theory of including the Nordic Hamstring exercises into hamstring strain rehabilitation programmes as their effectiveness in reducing re-injury and future hamstring strains have been proven by field leading researchers (Malliaropoulos et al., 2012), (Brukner et al., 2014), (McCall et al., 2014), (Gill, 2014), (Bahr et al., 2015). In a report revealed by Bahr et al. (2015) Nordic Hamstring exercises have the ability to reduce prevalance of acute hamstring strain injuries by 50%. Eccentric muscle training in general have multiple benefits in muscle training by overloading the muscles to a greater extent; enhanced muscle mass, strength and power at a significantly reduced energy expenditure (Malliaropoulos et al., 2012). The recommendations on exercise volume, loading and intensity are not yet clear or universal for eccentric hamstring exercises, Malliaropoulos et al. (2012) advises that eccentric training programmes should be designed with gradual progression in order to minimise the risk of exercise induced injury, while they still provide sufficient stimulus to induce adaptations.

Plyometric exercises have also been shown to be beneficial components of any hamstring rehabilitation programmes due to their agility, muscle power and strength enhancing capabilities. It has been reported that plyometric exercises that are respecting and following appropriate techniques result in improved hamstring strength and in greater force production (Stege et al., 2014). These findings are in accordance with the conclusion of Váczi et al. (2013) which states that performing plyometric exercises for 10-20 minutes per training session can significantly improve complex soccer specific dynamic performance.

According to Reiman and Lorenz (2011) planning a rehabilitation programme that is based on short duration linear periodisation would allow the sports rehabilitator to focus on each individual muscle training segment separately as going forward with the rehabilitation process. These individual segment would ultimately be built on each other, normally starting the with muscle training that focuses on hypertrophy, moving on to strength and then power training.

Performing a needs analysis is essential in order to be able to come up with a specific rehabilitation plan, which respects the nature and both physical and physiological requirements of the sport the athlete or the individual is involved in (Reiman and Lorenz, 2011). By doing so the rehabilitation programme may become tailored to the specific needs of the individual, facilitating a more effective and speedier recovery from an injury and at the same time potentially reduce the risk of future re-injuries.

 

 

 

References:

 

Askling, C.M., Tengvar, M. and Thorstensson, A. (2013) Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. British Journal of Sports Medicine. Vol. 47, No. 15: 953-961.

 

Bahr, R., Thorborg, K. and Ekstrand, J. (2015) Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. British Journal of Sports Medicine. Vol. 49, No. 22: 1466-1471.

 

Bertrand, A.M., Mercier, C. and Bourbonnais, D. (2007) Muscle strength testing with one repetition maximum in the arm/shoulder for people aged 75 + – test–retest reliability. Clinical Rehabilitation. Vol. 21, No. 3: 258-265.

 

Binkley, H.M. (2002) Strength, Size, or Power?. NSCA’s Performance Training Journal . Vol. 1, No. 4: 14-18.

 

Brukner, P. and Khan, K. (2007) Clinical Sports Medicine. (3rd ed.) India: Tata McGraw-Hill.

 

Brukner, P., Nealon, A. and Morgan, C. (2014) Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. British Journal of Sports Medicine. Vol. 48, No. 11: 1-12.

 

Ekstrand, J., Haegglund, M. and Waldén, M. (2011) Injury incidence and injury patterns in professional football: the UEFA injury study. British Journal of Sports Medicine. Vol. 45, No. 7: 553-559.

 

Gill, W. (2014) Hamstring injury prevention in football, part 2. SportEX Medicine. No. 62: 19-27.

 

Heiderscheit, B.C., Sherry, M.A. and Silder, A. (2010) Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention. Journal of Orthopaedic & Sports Physical Therapy. Vol. 40, No. 2: 67-81.

 

Leppänen, M., Aaltonen, S. and Parkkari,, J. (2014) Interventions to Prevent Sports Related Injuries: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Sports Medicine. Vol. 44, No. 4: 473-487.

 

Malliaropoulos, N., Mendiguchia, J. and Pehlivanidis, H. (2012) Hamstring exercises for track and field athletes: injury and exercise biomechanics, and possible implications for exercise selection and primary prevention. British Journal of Sports Medicine. Vol. 46, No. 12: 846-852.

 

McCall, A., Carling , C. and Nedelec, M. (2014) Risk factors, testing and preventative strategies for non-contact injuries in professional football: current perceptions and practices of 44 teams from various premier leagues. British Journal of Sports Medicine. Vol. 48, No. 18: 1352-1358.

 

Reiman, M.P. and Lorenz, D.S. (2011) Integration of strength and conditioning principles into a rehabilitation program. International Journal Of Sports Physical TherapyI. Vol. 6, No. 3: 241-253.

 

Schmitt, B., Tim, T. and McHugh, M. (2012) Hamstring injury rehabilitation and prevention of reinjury using lengthened state eccentric training: a new concept. International Journal of Sports Physical Therapy. Vol. 7, No. 3: 333-341.

 

Sherry, M.A. and Best, T.M. (2004) A Comparison of 2 Rehabilitation Programs in the Treatment of Acute Hamstring Strains. Journal of Orthopaedic & Sports Physical Therapy. Vol. 34, No. 3: 116-125.

 

Stege, M., Dallinga, J. and Benjaminse, A. (2014) Effect of Interventions on Potential, Modifiable Risk Factors for Knee Injury in Team Ball Sports: A Systematic Review. Sports Medicine. Vol. 44, No. 10: 403-427.

 

Váczi, M., Tollár, J. and Meszler, B. (2013) Short-Term High Intensity Plyometric Training Program Improves Strength, Power and Agility in Male Soccer Players. Journal of Human Kinetics. Vol. 36: 17-26.