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Hamstring issues in sports: still a major clinical and research challenge
  1. Nikos Malliaropoulos1,2,
  2. Nicola Maffulli3
  1. 1National Track & Field Centre, Sports Injury Clinic, Sports Medicine Clinic of SEGAS, Thessaloniki, Greece
  2. 2ECOSEP (European College of Sports and Exercise Physicians),
  3. 3The London School of Medicine and Dentistry Institute of Health Sciences Education Centre for Sports and Exercise Medicine Mile End Hospital, London, UK
  1. Correspondence to Nikos Malliaropoulos, G.Seferi 34, Harilaoy, 54250, Thessaloniki, Greece; contact{at}

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It will not be long until the Olympic 100 metre competitions. As certain as death, taxes and politicians' lies, more than one athlete's 4-year dream will vanish as his or her hamstring tears. This injury remains a great challenge in clinical practice and academic research. This issue of BJSM, with its striking cover, provides insights into the mechanisms that underpin hamstring injuries, guidance for clinical practice and suggestions for future research.

Debate – when do hamstring tears occur?

Hamstring tears occur during high-speed running but which phase of the gait cycle is the culprit? In Head to Head, Elizabeth S Chumanov and colleagues (see page 90) from the Universities of Wisconsin and Melbourne provide the conventional wisdom that hamstrings are frequently injured during eccentric overload at the end of the swing phase. Serial iconoclast John W Orchard (see page 88) argues that the early stance phase of sprinting is more likely the culprit but has evaded attention to date. This interesting debate might make you rethink your rehabilitation approach for hamstring injuries and it may prompt coaches to change their training prescription.

Hamstring tears have personalities!

A main predictor of prognosis after acute hamstring is the mechanism of the injury. The Karolinska Institute's Carl Askling has been a pioneer in highlighting that there exist at least two distinctly different types of acute hamstring injuries. The first occurs during high-speed running and concentric muscle contraction; the injury occurs to the long head of the biceps femoris and the proximal muscle–tendon junction. The second occurs during extensive lengthening of the hamstrings, such as with high kicking, sliding tackles and …

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