Case studyApplication of eccentric exercise on an Australian Rules football player with recurrent hamstring injuries
Introduction
Hamstring muscle strain injuries are common in sports that require maximum effort sprinting and acceleration. It has been reported that hamstring injuries alone account for 16–29% of all injuries reported in soccer (Árnason et al., 2004, Crosier, 2004), Australian Rules football (Orchard & Seward, 2002) and rugby union (Brooks et al., 2005, Brooks et al., 2006). Furthermore, a significant amount of playing and practice time is lost after a hamstring injury (18 days on average) (Woods, Hawkins, & Maltby, 2004) and the risk of re-injury is very high (Orchard & Seward, 2002).
Skeletal muscles have an optimum length for producing peak tension. Muscle strain injuries are thought to occur when activated muscles are lengthened to greater than optimal lengths (Friden & Lieber, 2001). The hamstring muscles are actively lengthened during hip flexion and knee extension, which occur simultaneously during the late swing phase in running (i.e. as the air-borne leg swings forwards). It has been argued that hamstring injuries can be reduced if this optimum length can be increased through training (Brockett et al., 2001, Brockett et al., 2004). The only form of training that has been shown to consistently increase the optimum length of tension development has been eccentric exercise (Bowers et al., 2004, Brockett et al., 2001, Kilgallon et al., 2007, Pettitt et al., 2005, Philippou et al., 2004, Yeung and Yeung, 2008). The purpose of this case report was to examine the effects of an eight month eccentric exercise/rehabilitation program on the optimum length of tension development on an athlete with recurrent hamstring injuries to his right leg.
Section snippets
Case description
A 24-year-old male Australian Rules football player (weight 86.6 kg, height 187 cm) presented for athletic and lower-body physiological testing. The athlete played on the senior squad of a West Australian Football League team for the previous three years. His past medical history included three muscle strain injuries confirmed by MRI (grade II and III muscle strain injuries) to his right hamstring (long head of the biceps femoris) over the previous four years. The most recent and severe hamstring
Outcomes
As shown in Table 2, after one week of the eccentric exercise intervention, the optimum angle of peak torque in his right hamstring shifted from 37.3 degrees to 29.6 degrees (i.e. longer muscle lengths), and a further decrease of 4.3 and 1.2 degrees was found at weeks five and nine, respectively. The optimum angles during knee flexion then remained constant (between 20.8 and 24.5 degrees) for the remaining 23 weeks. The optimum angle also decrease for his non-injured leg (left leg) by 4.0
Discussion
The purpose of this case report was to describe an eccentric based intervention for an Australian Rules football player with recurrent hamstring muscle strain injuries. The most severe injury, in regards to recovery and lost playing time, occurred 16 months prior to the present testing. Most studies that have utilized eccentric based interventions have used traditional eccentric exercises such as the Nordic hamstring or YoYo curl exercise (Arnason et al., 2008, Askling et al., 2003, Brooks
Conclusions
This case report suggests that a functional approach to eccentric exercise can be safe and effective for altering the optimum angle of peak torque of the knee flexors and extensors. The results of this case report suggest a need for continued research with eccentric exercises after acute muscle strain injuries in athletic populations.
Conflict of Interest Statements
None.
Ethical approval
The subject for this study provided written, informed consent within the guidelines of Edith Cowan University. Ethics was approved by the Ethics board at Edith Cowan University.
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