Check out our next video https://www.clinicalphysio.com.au/post/late-stage-hamstring-tear-rehab-weeks-5-6 for the final weeks exercise progressions.
These exercise progressions are designed for a Grade 2 Hamstring Tear.
They should be close to pain-free to perform.
Hamstring tears can vary in severity from a Grade 1A (small, intramuscular, 1-2 weeks) to Grade 3 C (Full thickness tendon attachment rupture – surgery + 6months) so your exercise’s, progressions and recovery timeframe will vary depending on the severity.
Check out our next video https://www.clinicalphysio.com.au/post/late-stage-hamstring-tear-rehab-weeks-5-6 for the final weeks exercise progressions.
Don’t forget to include short sprints (10x40m)as part of your return to play preparation. If you can’t handle these exercises, go back to the early stage exercises https://www.clinicalphysio.com.au/post/hamstring-tear-rehab-exercises-stage-1-2
About the authors.
Vas Krishnan is in his final year of Sports & Exercise Science at the University of Sydney.
Stephen Andreazza is a Titled Sports & Musculoskeletal Physiotherapist.
Lets face it, injuries are annoying and expensive. They result in lost hours of training and game time as well as dollars spent on physio, doctors and imaging, and in some cases, surgery. So what are the best ways to prevent injury? We highlight the key points taken from the most recent research as well as from Leicester City’s incredible Premier League Title in 2016.
Workload is all things affecting the body in a sporting context. This could be internal measures which are mainly physiological or external measures which are physical work performed. [8]
Internal Load Measures
External Load Measures
When quantifying workload for usable data we usually use at least one Internal load to determine intensity (e.g. RPE) and one external load to determine physical work done (e.g. Total Distance) these together help us to quantify total load (Internal load x external Load = total load).
It was found that using an internal load and an external load measure was more effective in determining the actual load an athlete was undertaking compared to just the external load. [8]
Calculating Load for a soccer player could be as simple as Minutes on ground x RPE. If a soccer player trained 3 times per week and had 1 game on the weekend where the sessions went for 60min each and their game time on game day was 60min. For Training sessions RPE was 6 and game day RPE was 8.
Session 1 – 60×6 = 360 Units
Session 2 – 60×6 = 360 Units
Session 3 – 60×6 = 360 Units
Game 1 – 60 x 8 = 480 Units
Total Weekly Load = 360+360+360+480 = 1560 Units
The Acute: Chronic Workload Ratio is a way for athletes and coaches to determine the load their athletes should do for current and future training as to prevent injury. If load is considered to be km running/week. Acute load is Km over 1 week and Chronic load Km over 4 weeks. [5]
Using the Acute: Chronic Workload Ratio we can quantify expected and required load for decreased injury risk. [5]
It was found that when the Acute: Chronic workload ratio was greater than 1.5 there was an increase in the risk of injury. This can be clearly seen in the graph below. [5]
It was also found that >0.8 to <1.3 was the point of least injury risk. This was noted as the “sweet spot” and should be what all athletes are aiming to be in at all points of the season. [5]
>1.3 is where the risk of injury started to increase with a significant increase at 1.5 and an even greater increase at 2.0. [5]
Coaches and Athletes can use this as a guideline to determine the load that they should be using for transitioning season to season, coming back from injury or even coming back from holidays/time off. This can help the athlete and coach with injury prevention strategies, re-injury and further progression. [5]
Below is a table illustrating what the likelihood of injury is for an athlete in accordance with the Acute:Chronic workload ratio. [1]
This table compares different scenarios of acute and chronic workloads using predefined equations to determine load as a percentage of normal training.[1]
The table grades each load percentage with a percent likelihood of injury. [1]
For example if an athlete has come back from a holiday and resumed normal 100% load (Acute workload) but over the past 4 weeks has only been training at 30% of their normal load (Chronic Workload) there can be an expected 61.4% increased likelihood of injury in the following week. [1]
Athletes and coaches can use this table to determine the load they should be working at or if they are at a greater risk of injury. [1]
Acute: Chronic workload ratio should not exceed 1.3 or go below 0.8 (>0.8-<1.3) – aka “the sweet spot”
Likelihood of injury increases when the Acute: Chronic workload ratio is >1.3
Danger Zone for Injury when Acute: Chronic workload ratio is >1.5
Severe Danger Zone for injury when Acute: Chronic workload ration is >2.0 (greatest risk of injury)
The amount of “Load” that is too much is determined by how much you have been doing in the previous weeks.
An elite athlete training 6+ times per week will have a vastly different load to a high school athlete training 3 times per week, however we want their Acute: Chronic Workload Ratios to be the same!
Leicester City’s exercise scientists and coaches were meticulous about manage player loads. They used GPS tracking as one of a few tools to measure each players load.
If a player had spike in their workload, the coaches were notified and the player was pulled from the next session and sent for recovery work.
This sounds so simple but we see people get it wrong all the time.
Athletes or Individuals wanting to compete in particular events must ensure they are training specific to that event. For example if you wanted to run a half marathon, you need to run! You don’t need to be in the pool swimming or doing reps on the bike.
You can start by running small distances and build your way up to 21 km. Using the Acute: Chronic Workload ratio and increasing your distance/load by 10% per week you can safely build your load and compete in the half marathon at your best.
Leicester City was specific in their injury prevention strategies. They identified that the most common injury was a hamstring strain and that these occurred in the last 20mins of a game when a player is trying to sprint under fatigue. They used 2 training methods to specifically address this.
At the end of the season, Leicester City had the least number of injuries in the league and also had the greatest number of counter attacking goals in the league. [7]
If all of this is still confusing to you (you’re probably not alone!) then at least try to stick to these simple guidelines.
If you’re still unsure, then please don’t hesitate to contact our friendly team at clinicalphysiostives.com.au
Drew et al. (2016)
Load Management is Critical for all types of Injury Prevention. This was found in relation to both specific pathologies/injuries and in controlling injury risk factors.
Murray et al. (2016)
Sudden increases in Acute workload were found to have a significant relation to injury in the current and subsequent weeks of increased load. High Chronic workloads were found to have a protective affect against injury. Hence the need for monitoring of both Acute and Chronic Load, and the Acute:Chronic Load Ratio.
Blanch et al. (2015)
“The Acute: Chronic Workload ratio should be included in the return to sport decision-making process” (1. p.475)
To address the strength and control deficits that can increase the risk of these injuries, the following exercises should be completed at least twice a weak, at the END of a training session OR by themselves in a separate session.
If you are interested in other, more in-depth information on injury prevention, then head over to our article from last year on the topic https://www.clinicalphysiostives.com.au/blogs/top-3-injury-prevention-strategies-lessons-from-leicester-city
If you have any questions, please do not hesitate to contact us at clinicalphysiostives.com.au