Hamstring injuries – decoding football’s most notorious impediment

It all comes to a screeching halt when the player pulls up, clutching the back of his thigh and gingerly resigns to the deck as physios run to his aid because they, like the rest of us, know exactly what’s transpired and the severity of its consequences.

The dreaded hamstring injury is a frustratingly common setback for athletes across the world of sport and one that footballers are rather well acquainted with.

The lunges, sudden changes in direction and explosiveness that its game play demands render players increasingly susceptible to the injury.

Despite being among the most common injuries for a footballer to suffer, it remains rather complex and has severely impeded a number of blossoming careers.

Michael Owen was a prime example. When he burst onto the scene as a teenager at Liverpool, his searing pace made him one of the most exciting talents in world football.

But a serious hamstring injury during a clash with Leeds United as a teenager would alter the course of his career. Chasing after a through ball and bearing down on goal, as he had down so many times before, he pulled out of the pursuit suddenly and fell to the ground.

“My hamstring gave way in an away game at Leeds at the tender age of 19 and from that moment on my career as a professional footballer was compromised,” Owen said post-retirement when reflecting on the injury.

He would still enjoy a prolific career as a goal-scorer but was regularly haunted by muscle injuries and had to adapt his game dramatically. He went from being a devastating threat in behind, running the channels and tearing defences apart to reinventing himself as an elite goal-poacher.

One of the more high-profile players who appears similarly cursed in present day is Barcelona’s Ousmane Dembele. The pacey forward has seen most of his career at Camp Nou spent on the sidelines.

Dembele’s inability to showcase his immense talent on the pitch due to recurring hamstring issues has been a great source of frustration for Barcelona.

So why do hamstring injuries continue to plague football and how can they be managed?

FOOTBALL’S CURSE

Nature of the game

It may be the beautiful game but there’s a lot more involved than tidy passing triangles, silky skills and a sumptuous effort that nestles in the top corner.

It’s hard work and extremely physically demanding.

“Football requires endurance and speed, which makes it tough on the body,” explains Kane Read, a physiotherapist for Dubai’s Orthosports Medical Center.

According to FIFA last year, Flamengo winger Bruno Henrique reached a top speed of 38 km/h during the Copa Libertadores quarter-final against Internacional, setting a new record, beating Gareth Bale’s best of 36.9 km/h.

On the other hand, Crystal Palace’s Luka Milivojevic covered 447.1km in the 2018/18 Premier League campaign.

“This means the hamstring has to be capable of doing both but it is better designed for speed. We will often see most hamstring injuries happen in the last 30 minutes of games because of muscle fatigue,” Read added.

Price of pace

There’s no substitute for raw pace. If you’ve got a yard on your opponent on the football pitch, you’re immediately in a position of great advantage.

However, players with explosive speed put a lot of load on their hamstrings and are therefore more susceptible to injuring them.

“The quicker the runner the more the hamstring is used during the running gait. So the quicker players are naturally loading their hamstrings more,” Read says.

It makes sense then that the players most affected by hamstring injuries are full-backs, wingers and strikers. Operating in these positions demands repetitive high-speed sprinting, increasing the risk of injury.

According to Read, the cost of every one of those sprints is some micro trauma and build up of lactic acid in the muscle tissue. The more these actions are repeated, the greater potential for injury.

COLD WEATHER

Hamstring injuries are recognised as the most prevalent in football and while there’s a significant risk of it sidelining players under normal circumstances, there is greater cause for concern in cold weather.

Low temperatures mean less heat in the muscles, causing them to contract and that tightness elevates the possibility of a strain.

The main impact of cooler climates on hamstrings, Read points out, is the reduced elasticity of the muscles. Hamstrings need to elongate in full stride, so when the likes of Jamie Vardy sets off on one of his trademark darts in behind the defence, those muscles need to be able to stretch sufficiently and quickly enough to avoid injury. If his hamstrings are too cold, they could give way.

The other aspect of this is energy consumption.

“During colder temperatures the body will burn more energy to maintain body temperature, meaning less energy for the muscles and more likelihood of fatigue,” Read says.

This muscle fatigue reduces strength in the hamstrings, increasing the chances of an as overload.

So the science behind the correlation between cold weather and hamstring vulnerability is sound. But according to fitness expert Mark Armitage, it shouldn’t really be a factor at the highest level.

Armitage runs his own fitness centre, ECCR Ltd, in England and has worked with Premier League clubs Arsenal, Southampton, Norwich City and Huddersfield as part of the first team staff.

In his experience, top-flight players aren’t hugely affected by the influence of cooler climates on hamstrings owing to the practices in place.

“Premier League players undertake extensive warm-up protocols before playing and training led by highly skilled and experienced practitioners, therefore their muscles should be warm,” he says.

“Whilst warm-ups are important and should be seen as best practice, the primary objective is to increase core and muscle temperature. In colder environments this might take slightly longer to achieve but should be done so easily in elite environments with practitioners ensuring the players are warmed and ready to go without being fatigued.”

FATIGUE

Hamstrings are a fragile group of muscles and over the course of the festive fixtures in the Premier League this season, they took a beating.

Of the 53 injuries that occurred in England’s top flight during the festive period, a whopping 34 per cent were hamstring-related.

Premier League teams played four matches in 12 days over Christmas and New Year, limiting the time for recovery between games dramatically.

Newcastle United emerged from that period in the worst shape having suffered four injuries in 20 minutes during their clash with Leicester City on New Year’s Day, prompting manager Steve Bruce to blast the fixture list.

“You get injuries by forcing players to play tired,” he said. “To ask players to play four games in 10 days is ludicrous. This is the consequence.”

Meanwhile, Liverpool played nine matches in December including two at the Club World Cup in Qatar, leading Jurgen Klopp to label the scheduling of games within 48 hours of each other “a crime”.

Fixture congestion can be brutal on the players’ muscles and Armitage knows there’s no turning away from that.

“Logically, an increase in match demands will place more strain on the players causing them to become fatigued and perhaps increase their chances of sustaining injury.”

The sudden increase in match frequency during the festive period can have a dramatic effect on the players’ ability to recover between games while the fact that they’ve already endured nearly half a season at this stage only adds to the risk involved.

RECOVERY

Hamstring injuries can be tricky to treat and often results in a relapse if the player doesn’t rehabilitate properly.

The most important aspect of recovery is one that frustrates players who are eager to get back into action.

“Time, I find is the biggest cause for a re-occurrence of a hamstring injury if the player returns too soon,” Read says.

In fact, a premature return to action is a recipe for repeating the injury which is likely to be more severe than the original one.”

The process of rehabilitation must be completed in full. This involves thorough work in terms of muscle flexibility, strength and endurance. The player must be at a hundred per cent before making a comeback.

PREVENTIVE MEASURES

Compression wear

The compression shorts or skins footballers wear under their kit can make a significant difference. It’s made of a moisture-wicking fabric that effectively dissipates heat generated, retaining some of it.

“Tactical sensation (feeling on the skin) and the physical compression of shorts have many benefits including reducing the chance of injury,” according to Read.

This tactical sensation excites sensory nerve endings in the skin and facilitates local blood flow that increases muscle force and endurance.

The compression aids in returning used blood to the heart to be oxygenated and replenished. The less waste products in the muscle tissue, the better their ability to function.

Training

When Lionel Messi emerged at Barcelona, he immediately seemed destined for great things. But if there was one thing that could keep him from that destiny it was injuries.

The Argentine suffered numerous thigh and hamstring issues during his early career but steadily improved after changing his diet and fitness routine under Pep Guardiola.

For a number of years now, Messi has been able to manage his early hamstring issues and that is no fluke. The role proper training plays in preventing these kinds of injuries is key.

A certainty with these injuries is that once a players falls victim to them, he will do so again. Messi falls in that category.

That’s why the Argentine over the years has focused on rest and recovery which is vital. However, that needs to be balanced with fitness training so he can be prepared to cope with the demands of the game.

“Hamstring injuries are extremely complex and individual in nature, but generally there is a growing consensus of a need to work players hard in the gym (i.e. weights) and on the pitch (i.e. high speed running and sprinting),” Armitage says.

It’s important to balance the demands of football with controlled strength training. In order to do this many experts have recommended the Nordic hamstring exercise that has grown so popular.

“The Nordic hamstring exercise has shown to reduce the chances of injury across all sports by around 50 per cent,” Read says.

This exercise works on hamstrings’ strength while extending as well as at its limit and Read is a firm believer that it should form a key component of any hamstring program.

CONCLUSION

Hamstring injuries are not going away. Particularly in a sport like football, that muscle group is integral to players’ performance and athletes will likely continue to fall victim to it.

With growing viewership comes swelling demands for more football and that leads to more competitive matches for the top teams, pushing the physical limits of their players.

The game is not going to slow down, it’s up to the sports science and fitness professionals to keep up.