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Astrella A, Iordanov D, De Caro D, Jiménez-Reyes P, Mendiguchia J. Biceps femoris muscle-tendon strain during an entire overground sprint acceleration: a biomechanical explanation for hamstring injuries in the acceleration phase. Sports Biomech 2024:1-14. [PMID: 38739086 DOI: 10.1080/14763141.2024.2353233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
The objectives of this study were to analyse the peak muscle-tendon (MT) strain of the hamstring during an entire acceleration sprint overground and examine their relationship with relative joint angles and segment orientation in the sagittal plane, which are the direct causes of MT strain. Kinematic data were recorded using a 3D inertial motion capture system in 21 male semi-professional soccer players during 40-metre overground sprint. Scaled musculoskeletal models were used to estimate peak MT strain in the hamstring over 16 steps. Biceps femoris long head (BFLH) exhibited the largest peaks in MT strain compared to semitendinosus (ST) and semimembranosus (SM) muscles across all the steps, with its overall strain decreased as the number of steps and maximum speed increased. Hip flexion angle was found to be a strong predictor (p < 0.001) of joint angles, being the orientation of the pelvis in the sagittal plane of the segment with the greatest influence (p < 0.001) on the peak MT strain of BFLH during sprinting. The current study provides a biomechanical explanation for the high proportion of hamstring injuries in the acceleration phase of sprinting.
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Affiliation(s)
- Andrea Astrella
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
- Department of Muscle Science, RX2 Sports & Health, Madrid, Spain
| | - Daniel Iordanov
- Sports Department, Universidad Politecnica de Madrid, Madrid, Spain
| | - Dario De Caro
- Department of Muscle Science, RX2 Sports & Health, Madrid, Spain
| | | | - Jurdan Mendiguchia
- Department of Muscle Science, RX2 Sports & Health, Madrid, Spain
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
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2
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Bramah C, Mendiguchia J, Dos'Santos T, Morin JB. Exploring the Role of Sprint Biomechanics in Hamstring Strain Injuries: A Current Opinion on Existing Concepts and Evidence. Sports Med 2024; 54:783-793. [PMID: 37725240 PMCID: PMC11052868 DOI: 10.1007/s40279-023-01925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied mechanical strain and the capacity of the muscle to tolerate strain. To date, injury prevention and rehabilitation strategies have frequently focused on enhancing the capacity of the hamstrings to tolerate strain, with little consideration of factors directly influencing mechanical strain. Sprint running biomechanics are one factor proposed to influence the mechanical strain applied to the hamstrings that may be modified (towards reduced strain) within rehabilitation and injury prevention programs. This article aims to explore the theoretical mechanistic link between sprint running mechanics and hamstring strain injury, along with the available supporting evidence. In doing so, it hopes to provide practitioners with an understanding of mechanical parameters that may influence hamstring strain injury whilst also identifying areas for further research exploration.
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Affiliation(s)
- Christopher Bramah
- School of Health and Society, University of Salford, Allerton Building, Frederick Road Campus, Salford, M6 6PU, UK.
- Manchester Institute of Health and Performance, Manchester, UK.
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Centre, Barañain, Spain
| | - Thomas Dos'Santos
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
- Manchester Institute of Sport, Metropolitan University, Manchester, UK
| | - Jean-Benoȋt Morin
- University Jean Monnet Saint-Etienne, Lyon 1, University Savoie Mont-Blanc, Inter-University Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
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3
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Mendiguchia J, Garrues MA, Schilders E, Myer GD, Dalmau-Pastor M. Anterior pelvic tilt increases hamstring strain and is a key factor to target for injury prevention and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2024; 32:573-582. [PMID: 38391038 DOI: 10.1002/ksa.12045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 02/24/2024]
Abstract
PURPOSE Hamstring muscle strain injury is very common in sports involving high-speed running. Hamstring muscles originate from the ischial tuberosity and thus pelvic position may influence hamstring strain during different sports movements like sprinting, but this has only been evaluated by indirect methods. This study tested the hypothesis that a change in anterior pelvic tilt causes elongation of the overall hamstring complex and disproportionately elongates proximal relative to distal muscle regions. METHODS Seven fresh-frozen specimens (full lower limb with pelvis and lumbar spine) were used for this in vitro study. Specimens were dissected to enable visualization of the hamstring muscles and then fixed into a custom-made testing bench that allowed controlled movement of the pelvis over a fixed femur and tibia. Nine markers were inserted into the hamstring muscles to allow intra- and intermuscle difference measurements. Then, six different anterior pelvic angles were used to measure the difference in hamstring muscle lengthening through a three-dimensional reconstruction system based on stereoscopic machine vision technology. RESULTS An increase in anterior pelvic tilt produced a significant non-uniform increase in tissue elongation in all regions of the three hamstring muscles (semitendinosus, semimembranosus [SMB] and biceps femoris long head), which was greater in the proximal (>1 cm every 5°) compared to the distal region (≈0.4 cm every 5°). At the proximal hamstring region, SMB showed significantly greater length changes compared to conjoint tendons with nonstatistically significant elongation differences between muscles at the distal region. CONCLUSION Considering the results of the study, the pelvis segment will likely play a fundamental role as a strain regulator of hamstring muscles. These results will have an impact on injury rehabilitation and prevention processes of hamstring injuries, as well as optimize future musculoskeletal models and avoid potential underestimation of the hamstring muscle-tendon complex lengthening during high-speed running. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
| | - Mirian Aranzazu Garrues
- Physiology Department, Faculty of Medicine and Nursing, University of the Basque Country, Biscay, Spain
| | - Ernest Schilders
- Department of Orthopaedic Surgery, Fortius Clinic-FIFA Medical Centre of Excellence, London, UK
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
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4
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Edouard P, Lahti J, Fleres L, Ahtiainen J, Ulvila JJ, Lehtinen T, Virtanen N, Taipale T, Bellver M, Peltonen V, Thibault M, Huuhka T, Toivonen RM, Morin JB, Mendiguchia J. A musculoskeletal multifactorial individualised programme for hamstring muscle injury risk reduction in professional football: results of a prospective cohort study. BMJ Open Sport Exerc Med 2024; 10:e001866. [PMID: 38347859 PMCID: PMC10860081 DOI: 10.1136/bmjsem-2023-001866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
Objective To test whether a musculoskeletal multifactorial and individualised hamstring muscle injury (HMI) risk reduction programme could reduce HMI risk in professional football. Methods We conducted a prospective cohort study in Finnish premier football league teams, with the 2019 season used as a control and an intervention conducted in the 2021 season. Screening was conducted to provide individualised programmes and monitor progress. Cox regression with hazard ratio (HR) was used with HMI as outcome and season as explanatory variable, including all players for primary analysis and those who performed the two seasons for secondary analysis. Results 90 players were included in the control and 87 in the intervention seasons; 31 players performed in the 2 seasons. Twenty HMIs were recorded during the control and 16 during the intervention seasons. Cox regression analyses revealed that HMI risk at any given time was not significantly different between control and intervention seasons (for all players: HR 0.77 (95% CI 0.39 to 1.51), p=0.444; for the 31 players: HR 0.32 (95% CI 0.01 to 1.29), p=0.110)). For the 31 players, the HMI burden was significantly reduced in the intervention compared with the control season (RR 0.67 (95% CI 0.53 to 0.85)). Higher compliance with knee strength training, maximal velocity exposure and lower performance reductions in maximal theoretical horizontal force and knee flexor force were associated with lower HMI incidence. Conclusions Although the primary analysis did not reveal any significant effect of the intervention to reduce HMI risk in professional football, the programme was feasible, and additional secondary analyses showed a significant association between the intervention and lower HMI burden, incidence and risk.
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Affiliation(s)
- Pascal Edouard
- Inter‐university Laboratory of Human Movement Science (LIBM EA 7424), Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Saint Etienne, France
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
| | - Johan Lahti
- Department of Strength & Conditioning R5 Athletics & Health Performance center, Helsinki, Finland
| | - Luca Fleres
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyvaskyla, Finland
| | - Juha Ahtiainen
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyvaskyla, Finland
| | | | | | | | | | | | | | | | | | | | - Jean-Benoit Morin
- Inter‐university Laboratory of Human Movement Science (LIBM EA 7424), Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Saint Etienne, France
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
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5
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Edouard P, Mendiguchia J, Guex K, Lahti J, Prince C, Samozino P, Morin JB. Sprinting: a key piece of the hamstring injury risk management puzzle. Br J Sports Med 2023; 57:4-6. [PMID: 35927000 DOI: 10.1136/bjsports-2022-105532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Pascal Edouard
- Inter-University Laboratory of Human Movement Biology, Univ Lyon, UJM-Saint-Etienne, Saint-Etienne, France .,Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
| | - Kenny Guex
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Swiss Athletics, Haus des Sports, Ittigen, Switzerland
| | - Johan Lahti
- LAMHESS, Université Côte d'Azur, Nice, France
| | - Caroline Prince
- Inter-university Laboratory of Human Movement Biology, EA 7424, Univ Savoie Mont Blanc, Chambéry, France.,Physiotherapy department and motion analysis lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - Pierre Samozino
- Inter-university Laboratory of Human Movement Biology, EA 7424, Univ Savoie Mont Blanc, Chambéry, France
| | - Jean-Benoît Morin
- Inter-University Laboratory of Human Movement Biology, Univ Lyon, UJM-Saint-Etienne, Saint-Etienne, France.,Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
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6
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Romero V, Lahti J, Castaño Zambudio A, Mendiguchia J, Jiménez Reyes P, Morin JB. Effects of Fatigue Induced by Repeated Sprints on Sprint Biomechanics in Football Players: Should We Look at the Group or the Individual? Int J Environ Res Public Health 2022; 19:14643. [PMID: 36429363 PMCID: PMC9691012 DOI: 10.3390/ijerph192214643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to analyse the influence of fatigue on sprint biomechanics. Fifty-one football players performed twelve maximal 30 m sprints with 20 s recovery between each sprint. Sprint kinetics were computed from running speed data and a high-frequency camera (240 Hz) was used to study kinematic data. A cluster analysis (K-mean clustering) was conducted to classify individual kinematic adaptations. A large decrease in maximal power output and less efficiency in horizontally orienting the ground reaction force were observed in fatigued participants. In addition, individual changes in kinematic components were observed, and, according to the cluster analysis, five clusters were identified. Changes in trunk, knee, and hip angles led to an overall theoretical increase in hamstring strain for some players (Cluster 5, 20/51) but to an overall decrease for some others (Cluster 1, 11/51). This study showed that the repeated sprint ability (RSA) protocol had an impact on both kinetics and kinematics. Moreover, fatigue affected the kinematics in a different way for each player, and these individual changes were associated with either higher or lower hamstring length and thus strain.
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Affiliation(s)
- Valentin Romero
- Centre for Sport Studies, Rey Juan Carlos University, 28942 Madrid, Spain
| | - Johan Lahti
- Laboratory of Human Motricity, Education Sport and Health (LAMHESS), Université Côte d’Azur, F-06200 Nice, France
| | | | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, 31010 Barañain, Spain
| | | | - Jean-Benoît Morin
- Inter-University Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, F-42023 Saint Etienne, France
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7
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Higashihara A, Mendiguchia J, Ono T, Nagano Y, Sasaki S, Mineta S, Hirose N. Neuromuscular responses of the hamstring and lumbopelvic muscles during unanticipated trunk perturbations. J Sports Sci 2021; 40:431-441. [PMID: 34727847 DOI: 10.1080/02640414.2021.1996986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hamstring strain often occurs when an opponent unanticipatedly perturbs an athlete's movements. We examined the neuromuscular responses of hamstring and trunk muscles during unanticipated trunk perturbations in athletes with and without a history of hamstring strain injury. Male college athletes (11 with a history of a unilateral hamstring injury and 10 without prior injury) knelt while wearing a chest harness attached to a cable that was pulled backward. They were instructed to resist the force isometrically and maintain their position when the perturbations were applied. The pressure was released with or without a cue (CUE or NoCUE). We measured trunk acceleration, three-dimensional kinematic data, and surface electromyography (EMG) signals of the erector spinae, internal oblique, gluteus maximus, biceps femoris long head, and semitendinosus muscles. Maximum trunk acceleration and displacement were greater with NoCUE in both groups (p < 0.05). EMG amplitude did not differ after perturbation of any investigated muscle. The injured group demonstrated a delayed onset of the gluteus maximus and erector spinae muscles in NoCUE versus CUE stimuli (p < 0.05). Athletes with a history of hamstring strain injury exhibited a reduced neuromuscular coordination of the lumbopelvic muscles in response to unanticipated trunk movement.
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Affiliation(s)
| | - Jurdan Mendiguchia
- Department of Physical Therapy, Zentrum Rehabilitation and Performance Center, Pamplona, Spain
| | - Takashi Ono
- Faculty of Economics, Tokuyama University, Yamaguchi, Japan
| | - Yasuharu Nagano
- Department of Sports Wellness Sciences, Japan Women's College of Physical Education, Tokyo, Japan
| | - Shogo Sasaki
- Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Shinshiro Mineta
- School of Physical Education, Osaka University of Health and Sport Sciences, Osaka, Japan
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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8
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Edouard P, Lahti J, Nagahara R, Samozino P, Navarro L, Guex K, Rossi J, Brughelli M, Mendiguchia J, Morin JB. Low Horizontal Force Production Capacity during Sprinting as a Potential Risk Factor of Hamstring Injury in Football. Int J Environ Res Public Health 2021; 18:ijerph18157827. [PMID: 34360125 PMCID: PMC8345704 DOI: 10.3390/ijerph18157827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 01/09/2023]
Abstract
Clear decreases in horizontal force production capacity during sprint acceleration have been reported after hamstring injuries (HI) in football players. We hypothesized that lower FH0 is associated with a higher HI occurrence in football players. We aimed to analyze the association between sprint running horizontal force production capacities at low (FH0) and high (V0) velocities, and HI occurrence in football. This prospective cohort study included 284 football players over one season. All players performed 30 m field sprints at the beginning and different times during the season. Sprint velocity data were used to compute sprint mechanical properties. Players' injury data were prospectively collected during the entire season. Cox regression analyses were performed using new HI as the outcome, and horizontal force production capacity (FH0 and V0) was used at the start of the season (model 1) and at each measurement time point within the season (model 2) as explanatory variables, adjusted for individual players' (model 2) age, geographical group of players, height, body mass, and previous HI, with cumulative hours of football practice as the time scale. A total of 47 new HI (20% of all injuries) were observed in 38 out of 284 players (13%). There were no associations between FH0 and/or V0 values at the start of the season and new HI occurrence during the season (model 1). During the season, a total of 801 measurements were performed, from one to six per player. Lower measured FH0 values were significantly associated with a higher risk of sustaining HI within the weeks following sprint measurement (HR = 2.67 (95% CI: 1.51 to 4.73), p < 0.001) (model 2). In conclusion, low horizontal force production capacities at low velocity during early sprint acceleration (FH0) may be considered as a potential additional factor associated with HI risk in a comprehensive, multifactorial, and individualized approach.
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Affiliation(s)
- Pascal Edouard
- UJM-Saint-Etienne, Laboratory Interuniversity of Human Movement Sciences, University Lyon, EA 7424, F-42023 Saint-Etienne, France; (J.R.); (J.-B.M.)
- Sports Medicine Unity, Department of Clinical and Exercise Physiology, Faculty of Medicine, University Hospital of Saint-Etienne, CEDEX 2, F-42055 Saint-Etienne, France
- Correspondence: ; Tel.: +33-674-574-691
| | - Johan Lahti
- LAMHESS, Université Côte d’Azur, F-06200 Nice, France;
| | - Ryu Nagahara
- Sports Research and Development Core, University of Tsukuba, Ibaraki 305-8574, Japan;
- Faculty of Sports and Budo Coaching Studies, National Institute of Fitness and Sports in Kanoya, Kagoshima 891-2393, Japan
| | - Pierre Samozino
- Laboratory Interuniversity of Human Movement Sciences, University Savoie Mont Blanc, EA 7424, F-73000 Chambéry, France;
| | - Laurent Navarro
- Mines Saint-Etienne, Centre CIS, Université de Lyon, Université Jean Monnet, INSERM, U 1059 Sainbiose, F-42023 Saint-Etienne, France;
| | - Kenny Guex
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland;
- Department of Sprints, Hurdles and Relays, Swiss Athletics, Haus des Sports, 3063 Ittigen, Switzerland
| | - Jérémy Rossi
- UJM-Saint-Etienne, Laboratory Interuniversity of Human Movement Sciences, University Lyon, EA 7424, F-42023 Saint-Etienne, France; (J.R.); (J.-B.M.)
| | - Matt Brughelli
- Sports Performance Research Institute New Zealand, Auckland University of Technology, 1010 Auckland, New Zealand;
| | - Jurdan Mendiguchia
- Department of Physical Therapy, Zentrum Rehabilitation and Performance Center, 31002 Pamplona, Spain;
| | - Jean-Benoît Morin
- UJM-Saint-Etienne, Laboratory Interuniversity of Human Movement Sciences, University Lyon, EA 7424, F-42023 Saint-Etienne, France; (J.R.); (J.-B.M.)
- LAMHESS, Université Côte d’Azur, F-06200 Nice, France;
- Sports Performance Research Institute New Zealand, Auckland University of Technology, 1010 Auckland, New Zealand;
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9
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Prince C, Morin JB, Mendiguchia J, Lahti J, Guex K, Edouard P, Samozino P. Sprint Specificity of Isolated Hamstring-Strengthening Exercises in Terms of Muscle Activity and Force Production. Front Sports Act Living 2021; 2:609636. [PMID: 33554110 PMCID: PMC7859261 DOI: 10.3389/fspor.2020.609636] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
To train hamstring muscle specifically to sprint, strengthening programs should target exercises associated with horizontal force production and high levels of hamstring activity. Therefore, the objectives of this study were to analyze the correlation between force production capacities during sprinting and hamstring strengthening exercises, and to compare hamstring muscle activity during sprinting and these exercises. Fourteen track and field regional level athletes performed two maximal 50-m sprints and six strengthening exercises: Nordic hamstring exercises without and with hip flexion, Upright-hip-extension in isometric and concentric modalities, Standing kick, and Slide-leg-bridge. The sprinting horizontal force production capacity at low (F0) and high (V0) speeds was computed from running velocity data. Hamstring muscle performances were assessed directly or indirectly during isolated exercises. Hamstring muscle electromyographic activity was recorded during all tasks. Our results demonstrate substantially large to very large correlations between V0 and performances in the Upright-hip-extension in isometric (rs = 0.56; p = 0.040), Nordic hamstring exercise without hip flexion (rs = 0.66; p = 0.012) and with 90° hip flexion (rs = 0.73; p = 0.003), and between F0 and Upright-hip-extension in isometric (rs = 0.60; p = 0.028) and the Nordic hamstring exercise without hip flexion (rs = 0.59; p = 0.030). However, none of the test exercises activated hamstring muscles more than an average of 60% of the maximal activation during top-speed sprinting. In conclusion, training programs aiming to be sprint-specific in terms of horizontal force production could include exercises such as the Upright-hip-extension and the Nordic hamstring exercise, in addition to maximal sprinting activity, which is the only exercise leading to high levels of hamstring muscle activity.
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Affiliation(s)
- Caroline Prince
- University of Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité (EA7424), Chambéry, France.,Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - Jean-Benoît Morin
- University of Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Science (LIBM EA 7424), Saint-Étienne, France.,Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
| | - Johan Lahti
- University of Côte d'Azur, LAMHESS, Nice, France
| | - Kenny Guex
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Head Coach Sprint/Hurdles/Relays Coach 400m/400m Hurdles Swiss Athletics, Haus des Sports, Ittigen, Switzerland
| | - Pascal Edouard
- University of Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Science (LIBM EA 7424), Saint-Étienne, France.,Sports Medicine Unit, Department of Clinical and Exercise Physiology, Faculty of Medicine, Regional Institute of Medicine and Sports Engineering (IRMIS), University Hospital of Saint-Etienne, Saint-Ètienne, France
| | - Pierre Samozino
- University of Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité (EA7424), Chambéry, France
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10
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Mendiguchia J, Gonzalez De la Flor A, Mendez-Villanueva A, Morin JB, Edouard P, Garrues MA. Training-induced changes in anterior pelvic tilt: potential implications for hamstring strain injuries management. J Sports Sci 2020; 39:760-767. [PMID: 33172346 DOI: 10.1080/02640414.2020.1845439] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An association has been reported between dynamic anterior pelvic tilt (APT) and hamstring injuries; however, no research has examined if a training-based preventive intervention could alter APT. Therefore, the aim of the present study was to examine if a specific 6-week multimodal intervention, based on the theoretical influence of neighbouring joints and biomechanical interactions between muscles that are inserted to the pelvis, induced changes in APT, during walking gait, hamstring flexibility and trunk endurance. Thirty-five active healthy males volunteered for this single-blind controlled trial and were split into two groups based on baseline data: a control group (CG, n = 20, continued their normal physical activities), and an intervention group (IG, n = 15, performed the intervention programme for 18 sessions over 6 weeks). A significant (p = 0.001) decrease in the APT kinematics during gait, significant increase in the Active Knee Extension Test (p = 0.001), and a significant increase in trunk endurance performance for flexion (p = 0.001), extension (p = 0.001) and side bridge (p = 0.001) were observed, in IG after the 6-week programme, compared to CG.
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Affiliation(s)
- Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
| | - Angel Gonzalez De la Flor
- Department of Physical Therapy and Sport Medicine, Hospital Universitario Quironsalud Madrid, Madrid, Spain.,Faculty of Sport Sciences, Universidad Europea De Madrid, Madrid, Spain
| | | | | | - Pascal Edouard
- Inter-university Laboratory of Human Movement Science (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint Etienne, France.,Department of Clinical and Exercise Physiology, Sports Medicine Unit, Faculty of Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Mirian Aranzazu Garrues
- Faculty of Medicine and Nursing, Physiology Department, University of the Basque Country, Biscay, Spain
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11
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Lahti J, Mendiguchia J, Ahtiainen J, Anula L, Kononen T, Kujala M, Matinlauri A, Peltonen V, Thibault M, Toivonen RM, Edouard P, Morin JB. Multifactorial individualised programme for hamstring muscle injury risk reduction in professional football: protocol for a prospective cohort study. BMJ Open Sport Exerc Med 2020. [DOI: 10.1136/bmjsem-2020-000758] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IntroductionHamstring muscle injuries (HMI) continue to plague professional football. Several scientific publications have encouraged a multifactorial approach; however, no multifactorial HMI risk reduction studies have been conducted in professional football. Furthermore, individualisation of HMI management programmes has only been researched in a rehabilitation setting. Therefore, this study aims to determine if a specific multifactorial and individualised programme can reduce HMI occurrence in professional football.Methods and analysisWe conducted a prospective cohort study over two seasons within the Finnish Premier League and compare the amount of HMI sustained during a control season to an intervention season. Injury data and sport exposure were collected during the two seasons (2019–2020), and a multifactorial and individualised HMI risk reduction programme will be implemented during intervention season (2020). After a hamstring screening protocol is completed, individual training will be defined for each player within several categories: lumbo-pelvic control, range of motion, posterior chain strength, sprint mechanical output and an additional non-individualised ‘training for all players’ category. Screening and respective updates to training programmes were conducted three times during the season. The outcome will be to compare if there is a significant effect of the intervention on the HMI occurrence using Cox regression analysis.Ethics and disseminationApproval for the injury and sport exposure data collection was obtained by the Saint-Etienne University Hospital Ethics Committee (request number: IORG0007394; record number IRBN322016/CHUSTE). Approval for the intervention season was obtained from the Central Finland healthcare District (request and record number: U6/2019).
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Morales-Artacho AJ, Mendiguchia J, Guilhem G. Effects Of An 8-week Nordic Hamstring Vs. Isokinetic Eccentric Training Intervention On Biceps Femoris Muscle-tendon Interactions. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676344.25776.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Mendiguchia J, Conceição F, Edouard P, Fonseca M, Pereira R, Lopes H, Morin JB, Jiménez-Reyes P. Sprint versus isolated eccentric training: Comparative effects on hamstring architecture and performance in soccer players. PLoS One 2020; 15:e0228283. [PMID: 32045411 PMCID: PMC7012429 DOI: 10.1371/journal.pone.0228283] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 01/10/2020] [Indexed: 01/22/2023] Open
Abstract
AIMS The purpose of this study was to compare the effects of hamstring eccentric (NHE) strength training versus sprint training programmed as complements to regular soccer practice, on sprint performance and its mechanical underpinnings, as well as biceps femoris long head (BFlh) architecture. METHODS In this prospective interventional control study, sprint performance, sprint mechanics and BFlh architecture variables were compared before versus after six weeks of training during the first six preseason weeks, and between three different random match-pair groups of soccer players: "Soccer group" (n = 10), "Nordic group" (n = 12) and "Sprint group" (n = 10). RESULTS For sprint performance and mechanics, small to large pre-post improvements were reported in "Sprint group" (except maximal running velocity), whereas only trivial to small negative changes were reported in "Soccer group" and "Nordic group". For BFlh architecture variables, "Sprint" group showed moderate increase in fascicle length compared to smaller augment for the "Nordic" group with trivial changes for "Soccer group". Only "Nordic" group presented small increases at pennation angle. CONCLUSIONS The results suggest that sprint training was superior to NHE in order to increase BFlh fascicle length although only the sprint training was able to both provide a preventive stimulus (increase fascicle length) and at the same time improve both sprint performance and mechanics. Further studies with advanced imaging techniques are needed to confirm the validity of the findings.
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Affiliation(s)
- Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
| | - Filipe Conceição
- Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sports, University of Porto, Porto, Portugal
- LABIOMEP—Porto Biomechanics Laboratory, University of Porto, Porto, Portugal
| | - Pascal Edouard
- Inter‐university Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint Etienne, France
- Department of Clinical and Exercise Physiology, Faculty of medicine, Sports Medicine Unity, University Hospital of Saint-Etienne, Saint-Etienne, France
- Medical Commission, French Athletics Federation (FFA), Paris, France
| | - Marco Fonseca
- Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sports, University of Porto, Porto, Portugal
- LABIOMEP—Porto Biomechanics Laboratory, University of Porto, Porto, Portugal
- Health and Performance Unit of Portuguese Football Federation, Portugal
| | - Rogerio Pereira
- Clínica do Dragão, Espregueira-Mendes Sports Centre–FIFA Medical centre of Excellence, Porto, Portugal
| | - Hernani Lopes
- DEM-ISEP, School of Engineering, Polytechnic of Porto, Porto, Portugal
| | | | - Pedro Jiménez-Reyes
- Centre for Sport Studies, Rey Juan Carlos University, Madrid, Spain
- * E-mail: ,
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Matinlauri A, Alcaraz PE, Freitas TT, Mendiguchia J, Abedin-Maghanaki A, Castillo A, Martínez-Ruiz E, Carlos-Vivas J, Cohen DD. A comparison of the isometric force fatigue-recovery profile in two posterior chain lower limb tests following simulated soccer competition. PLoS One 2019; 14:e0206561. [PMID: 31050674 PMCID: PMC6499418 DOI: 10.1371/journal.pone.0206561] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/23/2019] [Indexed: 11/26/2022] Open
Abstract
Aim To evaluate the reliability of isometric peak force (IPF) in a novel “long-length” 90°Hip:20°Knee (90:20) strength test and to compare the simulated soccer match induced fatigue-recovery profile of IPF in this test with that of an isometric 90°Hip:90°Knee (90:90) position test. Methods Twenty semi-professional soccer players volunteered for the study of which 14 participated in the first part of the study which assessed 90:20 reliability (age = 21.3 ± 2.5 years, height = 1.79 ± 0.07 m, body mass = 73.2 ± 8.8 kg), while 17 completed the second part of the study evaluating fatigue-recovery (age 21.2±2.4 yrs., height = 180 ± 0.09 m, body mass 73.8 ± 8.9 kg). We evaluated the inter-session reliability of IPF in two 90:20 test protocols (hands on the wall (HW); and hands on chest (HC)) both performed on two occasions, 7 days apart. We then assessed 90:20 (HC) and 90:90 IPF immediately before (PRE) and after (POST) after a simulated soccer match protocol (BEAST90mod) and 48 (+48 h) and 72 hours (+72 h) later. Results Part one: the 90:20 showed moderate to high overall reliability (CV’s of 7.3% to 11.0%) across test positions and limbs. CV’s were lower in the HW than HC in the dominant (7.3% vs 11.0%) but the opposite happened in the non-dominant limb where CV’s were higher in the HW than HC (9.7% vs 7.3%). Based on these results, the HC position was used in part two of the study. Part two: 90:20 and 90:90 IPF was significantly lower POST compared to PRE BEAST90mod across all testing positions (p<0.001). IPF was significantly lower at +48 h compared to PRE in the 90:20 in both limbs (Dominant: p<0.01,Non-dominant: p≤0.05), but not in the 90:90. At +72 h, IPF was not significantly different from PRE in either test. Conclusions Simple to implement posterior IPF tests can help to define recovery from competition and training load in football and, potentially, in other multiple sprint athletes. Testing posterior chain IPF in a more knee extended 90:20 position may provide greater sensitivity to fatigue at 48 h post simulated competition than testing in the 90:90 position, but also may require greater degree of familiarization due to more functional testing position.
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Affiliation(s)
- Anton Matinlauri
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain.,Department of Performance, HJK Helsinki, Helsinki, Finland
| | - Pedro E Alcaraz
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain.,Faculty of Sport Sciences, UCAM, Catholic University of Murcia, Murcia, Spain
| | - Tomás T Freitas
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
| | - Jurdan Mendiguchia
- Department of Physical Therapy, Zentrum Rehabilitation and Performance Center, Pamplona, Spain
| | - Afshin Abedin-Maghanaki
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
| | - Alberto Castillo
- Faculty of Sport Sciences, UCAM, Catholic University of Murcia, Murcia, Spain
| | | | - Jorge Carlos-Vivas
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
| | - Daniel D Cohen
- Faculty of Health Sciences, University of Santander (UDES), Bucaramanga, Colombia
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Edouard P, Mendiguchia J, Lahti J, Arnal PJ, Gimenez P, Jiménez-Reyes P, Brughelli M, Samozino P, Morin JB. Sprint Acceleration Mechanics in Fatigue Conditions: Compensatory Role of Gluteal Muscles in Horizontal Force Production and Potential Protection of Hamstring Muscles. Front Physiol 2018; 9:1706. [PMID: 30555346 PMCID: PMC6283907 DOI: 10.3389/fphys.2018.01706] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/13/2018] [Indexed: 12/28/2022] Open
Abstract
Aim: Hamstring muscle injury is the main injury related to sports requiring sprint acceleration. In addition, hamstring muscles have been reported to play a role in horizontal force production during sprint acceleration performance. The aim of the present study was to analyze (i) the determinants of horizontal force production and (ii) the role of hip extensors, and hamstring muscles in particular, for horizontal force production during repeated sprint-induced fatigue conditions. Method: In this experimental laboratory setting study including 14 sprint-trained male athletes, we analyzed (i) the changes in sprint mechanics, peak torque of the knee and hip extensors and flexors, muscle activity of the vastus lateralis, rectus femoris, biceps femoris, and gluteus, and sagittal plane lower limb motion, before and after twelve 6-s sprints separated by 44 s rest on an instrumented motorized treadmill, and (ii) the determinants of horizontal force production (FH ) during the sprint acceleration in a fatigue state (after 12 sprints). Results: The repeated-sprint protocol induced a decrease in maximal power output (Pmax) [-17.5 ± 8.9%; effect size (ES): 1.57, large] and in the contact-averaged horizontal force component (FH ) (-8.6 ± 8.4%; ES: 0.86, moderate) but not meaningful changes in the contact-averaged resultant (total) force (FTot ) (-3.4 ± 2.9%; ES: 0.55, small) and vertical force component (FV ) (-3.1 ± 3.2%; ES: 0.49, small). A decrease was found in concentric peak torque of the knee flexors and extensors and in gluteus and vastus lateralis muscle activity during entire swing and end-of-swing phase. An increase was found in contact time and swing time, while step frequency and knee speed before ground contact decreased. Muscular determinants associated with FH and its decrease after the repeated-sprint protocol were concentric peak torque of the hip extensors (p = 0.033) and a decrease in gluteus maximus activity at the end-of-swing (p = 0.007), respectively. Conclusion: Sprint-induced fatigue lead to changes in horizontal force production muscular determinants: hamstring muscle seems not to have the same role than in non-fatigue condition. Horizontal force production seems to be more dependent on the hip extensors and gluteus maximus function. Given the fatigue-induced decrease in hamstring muscle strength, we can hypothesize that muscle compensatory and kinematic strategies reported in a fatigued state could be an adaptation to allow/maintain performance and a protective adaptation to limit hamstring muscles constraints.
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Affiliation(s)
- Pascal Edouard
- Inter-University Laboratory of Human Movement Science (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint Etienne, France.,Department of Clinical and Exercise Physiology, Sports Medicine Unity, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Étienne, France.,Medical Commission, French Athletics Federation, Paris, France
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
| | - Johan Lahti
- Université Côte d'Azur, LAMHESS, Nice, France.,Faculty of Sports and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Philippe Gimenez
- Laboratory Culture Sport Health Society (EA 4660), University of Bourgogne Franche-Comté, Besançon, France
| | - Pedro Jiménez-Reyes
- Faculty of Sport, Catholic University of San Antonio, Murcia, Spain.,Centre for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - Matt Brughelli
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Pierre Samozino
- Univ Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Chambéry, France
| | - Jean-Benoit Morin
- Université Côte d'Azur, LAMHESS, Nice, France.,Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
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16
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Edouard P, Guex K, Besson C, Mendiguchia J, Gremeaux V. [Hamstring injury prevention]. Rev Med Suisse 2018; 14:1354-1357. [PMID: 29998638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hamstring muscle injury is the first diagnosis of injury in sports involving sprints. Its prevention represents a fundamental challenge for the technical and health professionals around the athletes. Risk factors have been described and can be used for screening at-risk individuals (age, history of hamstring injury, strength deficit). Although every determinant of the occurrence of these injuries has not yet been determined, and currently available preventive measures are not fully effective (eccentric muscle strengthening and strength deficit screening), these preventive measures do exist and must be implemented to the benefit of athletes before more comprehensive approaches are developed and demonstrate greater efficiency.
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Affiliation(s)
- Pascal Edouard
- Unité de médecine du sport, Service de physiologie clinique et de l'exercice, CHU de Saint-Etienne, 42055 Saint-Etienne, France
- Laboratoire de biologie de la motricité (EA 7424), Université de Lyon, Université Jean-Monnet, 42100 Saint-Etienne, France
- Commission médicale, Fédération française d'athlétisme, 75013 Paris, France
| | - Kenny Guex
- Filière physiothérapie, Haute école de santé Vaud (HESAV), Haute école spécialisée de Suisse Occidentale (HES-SO), 2800 Delémont
| | - Cyril Besson
- Swiss olympic medical center, Division de médecine physique et réadaptation, CHUV, 1011 Lausanne
| | - Jurdan Mendiguchia
- Department of Physical Therapy, Zentrum Rehab and Performance Center, 31010 Barañain, Espagne
| | - Vincent Gremeaux
- Swiss olympic medical center, Division de médecine physique et réadaptation, CHUV, 1011 Lausanne
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Alcaraz PE, Matinlauri A, Abedin-Maghanagi A, Freitas TT, Martínez-Ruiz E, Castillo A, Mendiguchia J, Cohen DD. A COMPARISON OF THE ISOMETRIC FORCE FATIGUE-RECOVERY PROFILE IN TWO POSTERIOR CHAIN LOWER LIMB TESTS FOLLOWING SIMULATED FOOTBALL. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097372.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Edouard P, Arnal P, Gimenez P, Samozino P, Jimenez-Reyes P, Brughelli M, Mendiguchia J, Morin JB. Athletic injury prevention: Determinants of sprint performance. Ann Phys Rehabil Med 2016. [DOI: 10.1016/j.rehab.2016.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
This study investigated, in male professional players: (a) fluctuations in rating of local-muscular (sRPEmus) and central-respiratory (sRPEres) perceived exertion measured after the completion of each training and competitive session, over a 9-week competitive period and (b) the influence of quantitative assessment of different training and competition modes on changes in physical performance. sRPEres, sRPEmus, and heart rate were measured in 21 players in 847 individual training and competitive sessions. Training load was calculated by multiplying sRPEmus or sRPEres by the duration of the training or competition sessions. A test battery (vertical jump, sprint, and endurance running) was performed before and after the studied period. At the end of official matches, average sRPEmus was higher (7.4 ± 0.6; p ≤ 0.05) than sRPEres (6.4 ± 1.3). Significant negative correlations were observed between the values of total training and competition time (r = -0.62; p < 0.01) or total added sRPEmus (r = -0.59; p ≤ 0.05), and vertical jump or sprint running velocity changes, respectively. This suggests that sRPEmus should be considered the main fatigue rating during a soccer match. Training and competition volume may have negative effects on the muscle power performance gains of the legs.
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Affiliation(s)
- Asier Los Arcos
- 1Department of Physical Education and Sport, Faculty of Physical Activity and Sport Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain; 2Department of Physical Therapy, Zentrum Rehabilitation and Performance Center, Pamplona, Spain; and 3Studies, Research and Sport Medicine Center, Government of Navarre, Pamplona, Spain
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20
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Morin JB, Gimenez P, Edouard P, Arnal P, Jiménez-Reyes P, Samozino P, Brughelli M, Mendiguchia J. Sprint Acceleration Mechanics: The Major Role of Hamstrings in Horizontal Force Production. Front Physiol 2015; 6:404. [PMID: 26733889 PMCID: PMC4689850 DOI: 10.3389/fphys.2015.00404] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/08/2015] [Indexed: 12/02/2022] Open
Abstract
Recent literature supports the importance of horizontal ground reaction force (GRF) production for sprint acceleration performance. Modeling and clinical studies have shown that the hip extensors are very likely contributors to sprint acceleration performance. We experimentally tested the role of the hip extensors in horizontal GRF production during short, maximal, treadmill sprint accelerations. Torque capabilities of the knee and hip extensors and flexors were assessed using an isokinetic dynamometer in 14 males familiar with sprint running. Then, during 6-s sprints on an instrumented motorized treadmill, horizontal and vertical GRF were synchronized with electromyographic (EMG) activity of the vastus lateralis, rectus femoris, biceps femoris, and gluteus maximus averaged over the first half of support, entire support, entire swing and end-of-swing phases. No significant correlations were found between isokinetic or EMG variables and horizontal GRF. Multiple linear regression analysis showed a significant relationship (P = 0.024) between horizontal GRF and the combination of biceps femoris EMG activity during the end of the swing and the knee flexors eccentric peak torque. In conclusion, subjects who produced the greatest amount of horizontal force were both able to highly activate their hamstring muscles just before ground contact and present high eccentric hamstring peak torque capability.
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Affiliation(s)
- Jean-Benoît Morin
- Laboratory of Human Motricity, Education Sport and Health (EA6312), Faculty of Sport Sciences, University of Nice Sophia Antipolis Nice, France
| | - Philippe Gimenez
- Laboratory Culture Sport Health Society (EA 4660), University of Franche-Comté Besançon, France
| | - Pascal Edouard
- Laboratory of Exercise Physiology (EA4338), University of LyonSaint-Etienne, France; Sports Medicine Unit, Department of Clinical and Exercise Physiology, Faculty of Medicine, University Hospital of Saint-EtienneSaint-Etienne, France
| | - Pierrick Arnal
- Laboratory of Exercise Physiology (EA4338), University of Lyon Saint-Etienne, France
| | - Pedro Jiménez-Reyes
- Faculty of Physical Sciences and Sport, Catholic University of San Antonio Murcia, Spain
| | - Pierre Samozino
- Laboratory of Exercise Physiology (EA4338), University Savoie Mont Blanc Le Bourget-du-Lac, France
| | - Matt Brughelli
- School of Sport and Recreation, Sports Performance Research Institute New Zealand, Auckland University of Technology Auckland, New Zealand
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center Barañain, Spain
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Mendiguchia J, Edouard P, Samozino P, Brughelli M, Cross M, Ross A, Gill N, Morin JB. Field monitoring of sprinting power–force–velocity profile before, during and after hamstring injury: two case reports. J Sports Sci 2015; 34:535-41. [DOI: 10.1080/02640414.2015.1122207] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Tsaklis P, Malliaropoulos N, Mendiguchia J, Korakakis V, Tsapralis K, Pyne D, Malliaras P. Muscle and intensity based hamstring exercise classification in elite female track and field athletes: implications for exercise selection during rehabilitation. Open Access J Sports Med 2015; 6:209-17. [PMID: 26170726 PMCID: PMC4492645 DOI: 10.2147/oajsm.s79189] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hamstring injuries are common in many sports, including track and field. Strains occur in different parts of the hamstring muscle but very little is known about whether common hamstring loading exercises specifically load different hamstring components. The purpose of this study was to investigate muscle activation of different components of the hamstring muscle during common hamstring loading exercises. Methods Twenty elite female track and field athletes were recruited into this study, which had a single-sample, repeated-measures design. Each athlete performed ten hamstring loading exercises, and an electromyogram (EMG) was recorded from the biceps femoris and semitendinosus components of the hamstring. Hamstring EMG during maximal voluntary isometric contraction (MVIC) was used to normalize the mean data across ten repetitions of each exercise. An electrogoniometer synchronized to the EMG was used to determine whether peak EMG activity occurred during muscle-tendon unit lengthening, shortening, or no change in length. Mean EMG values were compared between the two recording sites for each exercise using the Student’s t-test. Results The lunge, dead lift, and kettle swings were low intensity (<50% MVIC) and all showed higher EMG activity for semitendinosus than for biceps femoris. Bridge was low but approaching medium intensity, and the TRX, hamstring bridge, and hamstring curl were all medium intensity exercises (≥50% or <80% MVIC). The Nordic, fitball, and slide leg exercises were all high intensity exercises. Only the fitball exercise showed higher EMG activity in the biceps femoris compared with the semitendinosus. Only lunge and kettle swings showed peak EMG in the muscle-tendon unit lengthening phase and both these exercises involved faster speed. Conclusion Some exercises selectively activated the lateral and medial distal hamstrings. Low, medium, and high intensity exercises were demonstrated. This information enables the clinician, strength and conditioning coach and physiotherapist to better understand intensity- and muscle-specific activation during hamstring muscle rehabilitation. Therefore, these results may help in designing progressive strengthening and rehabilitation and prevention programs.
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Affiliation(s)
- Panagiotis Tsaklis
- Department of Physiotherapy, Laboratory of Biomechanics and Ergonomics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece ; Department of Mechanical Engineering, Bioengineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Nikos Malliaropoulos
- National Track and Field Centre, Sports Injury Clinic, Sports Medicine Clinic of SEGAS, Greece ; Thessaloniki Sports Medicine Clinic, Thessaloniki, Greece ; Rheumatology Department, Sports Medicine Clinic, Mile End Hospital, London, UK ; Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK
| | - Jurdan Mendiguchia
- Department of Physical Therapy, Zentrum Rehabilitation and Performance Center, Pamplona, Spain
| | - Vasileios Korakakis
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar ; Faculty of Physical Education and Sport Science, University of Thessaly, Trikala, Greece ; Hellenic Orthopaedic Manipulative Therapy Diploma, Athens, Greece
| | | | - Debasish Pyne
- Rheumatology Department, Sports Medicine Clinic, Mile End Hospital, London, UK
| | - Peter Malliaras
- Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK
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Brughelli M, Morin JB, Mendiguchia J. Asymmetry after Hamstring Injury in English Premier League: Issue Resolved, Or Perhaps Not? Int J Sports Med 2015; 36:603. [PMID: 26076012 DOI: 10.1055/s-0035-1554628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M Brughelli
- Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand
| | - J-B Morin
- Laboratory of Human Motricity, Education Sport and Health, University of Nice Sophia Antipolis, Nice, France
| | - J Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
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24
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Arcos AL, Martínez-Santos R, Yanci J, Mendiguchia J, Méndez-Villanueva A. Negative Associations between Perceived Training Load, Volume and Changes in Physical Fitness in Professional Soccer Players. J Sports Sci Med 2015; 14:394-401. [PMID: 25983590 PMCID: PMC4424470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/13/2015] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to examine the usefulness of the rating of perceived exertion training load for monitoring changes in several aerobic fitness and neuromuscular performance variables during 9 weeks of soccer training in young professional players. Nineteen male soccer players (20.2 ± 1.9 years) belonging to the same reserve team of a Spanish La Liga Club participated in this study. Countermovement jump (CMJ), CMJ arm swing, single leg CMJ, a sprint running test (i.e., 5 m and 15 m times) and an aerobic fitness running test were performed at the start of the pre-season (Test 1) and 9 weeks later (Test 2). During 9 weeks, after each training session and match, players reported their rating of perceived exertion (RPE) separately for respiratory (RPEres) and leg musculature (RPEmus) effort. The training load (TL) was calculated by multiplying the RPE value by the duration in minutes of each training session or match. Accumulated RPEmus, and associated TL, as well as accumulated training volume were negatively correlated with the changes in most physical fitness attributes after 9 weeks of training (r = -0.51 to -0.64). Present results suggest that a high perception of leg muscular effort associated with training sessions and matches, as well as an excessive accumulation of training volume (time), can impair the improvement in several physical fitness variables believed to be relevant for on-field soccer performance. Therefore, the independent assessment of leg muscular effort to quantify TL can be an interesting additional monitoring measure in soccer training. Key pointsThe purpose of this study was to examine the usefulness of the perceived exertion-derived TL for monitoring changes in several aerobic fitness and neuromuscular parameters during 9 weeks of soccer training in young professional players.A high perception of leg muscular effort associated with training and matches, as well as an excessive accumulation of training volume (time), can impair several physical fitness factors believed to be relevant for on-field soccer performance.The independent assessment of muscular effort to quantify TL can be an interesting additional monitoring measure in soccer training.
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Affiliation(s)
- Asier Los Arcos
- University School of Teaching, University of the Basque Country , UPV/EHU, Vitoria-Gasteiz, Spain
| | - Raul Martínez-Santos
- Faculty of Physical Activity and Sports Science, University of the Basque Country , UPV/EHU, Vitoria-Gasteiz, Spain
| | - Javier Yanci
- Faculty of Physical Activity and Sports Science, University of the Basque Country , UPV/EHU, Vitoria-Gasteiz, Spain
| | - Jurdan Mendiguchia
- Department of Physical Therapy, Zentrum Rehab and Performance Center , Pamplona, Spain
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Yanci J, Arcos AL, Salinero JJ, Mendiguchia J, Gil E, Santesteban D, Grande I. Effects of different agility training programs among first-grade elementary school students. Coll Antropol 2015; 39:87-92. [PMID: 26040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the study was to determine which agility training program (low, moderate or high contextual interference) was more effective in first-grade primary school students to provide reliable information to physical education teachers for designing more effective agility programs. A total of 57 first-grade elementary school students participated in the present study. They were randomized into three groups to compare the effects of three different agility training programs based on contextual interference: low contextual interference (N = 19), moderate contextual interference (N = 19), and high contextual interference (N = 19). Contextual interference refers to the relative amount of interference created when integrating two or more tasks into a particular aspect of a training session. Significant improvements in agility were found in the low (p < 0.01, ES = 1.79) and moderate (p < 0.05, ES = 0.61) contextual interference groups after a 4-week training period. These improvements were higher in the low contextual interference group. The high contextual interference group showed no improvements (p > 0.05, ES = 0.28) after the intervention program. Our results suggested that the low contextual interference program is still more effective than the moderate contextual interference program in this group of primary school students.
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Mendiguchia J, Martinez-Ruiz E, Morin JB, Samozino P, Edouard P, Alcaraz PE, Esparza-Ros F, Mendez-Villanueva A. Effects of hamstring-emphasized neuromuscular training on strength and sprinting mechanics in football players. Scand J Med Sci Sports 2014; 25:e621-9. [PMID: 25556888 DOI: 10.1111/sms.12388] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/30/2022]
Abstract
The objective of this study was to examine the effects of a neuromuscular training program combining eccentric hamstring muscle strength, plyometrics, and free/resisted sprinting exercises on knee extensor/flexor muscle strength, sprinting performance, and horizontal mechanical properties of sprint running in football (soccer) players. Sixty footballers were randomly assigned to an experimental group (EG) or a control group (CG). Twenty-seven players completed the EG and 24 players the CG. Both groups performed regular football training while the EG performed also a neuromuscular training during a 7-week period. The EG showed a small increases in concentric quadriceps strength (ES = 0.38/0.58), a moderate to large increase in concentric (ES = 0.70/0.74) and eccentric (ES = 0.66/0.87) hamstring strength, and a small improvement in 5-m sprint performance (ES = 0.32). By contrast, the CG presented lower magnitude changes in quadriceps (ES = 0.04/0.29) and hamstring (ES = 0.27/0.34) concentric muscle strength and no changes in hamstring eccentric muscle strength (ES = -0.02/0.11). Thus, in contrast to the CG (ES = -0.27/0.14), the EG showed an almost certain increase in the hamstring/quadriceps strength functional ratio (ES = 0.32/0.75). Moreover, the CG showed small magnitude impairments in sprinting performance (ES = -0.35/-0.11). Horizontal mechanical properties of sprint running remained typically unchanged in both groups. These results indicate that a neuromuscular training program can induce positive hamstring strength and maintain sprinting performance, which might help in preventing hamstring strains in football players.
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Affiliation(s)
- J Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
| | - E Martinez-Ruiz
- Chair of Sports Traumatology, Catholic University of San Antonio, Murcia, Spain
| | - J B Morin
- Laboratory of Exercise Physiology, University of Saint-Etienne, Saint-Etienne, France
| | - P Samozino
- Laboratory of Exercise Physiology, University of Savoie, Le Bourget du Lac, France
| | - P Edouard
- Laboratory of Exercise Physiology, University of Saint-Etienne, Saint-Etienne, France.,Department of Physical Medicine and Rehabilitation, Saint-Etienne University Hospital, Saint-Etienne, France.,Laboratory of Exercise Physiology (EA 4338), University of Lyon, Lyon, France
| | - P E Alcaraz
- Research Center for High Performance Sport, Catholic University of San Antonio, Murcia, Spain
| | - F Esparza-Ros
- Chair of Sports Traumatology, Catholic University of San Antonio, Murcia, Spain
| | - A Mendez-Villanueva
- Aspire, Academy for Sports Excellence, Performance Enhancement and Talent Identification Section, Doha, Qatar
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Martínez-Ruiz E, Mendiguchia J, Rubio-Arias JA, Alcaraz PE, Esparza-Ros F. EFFECTS OF A PREVENTION PROGRAM FOR HAMSTRING STRAIN INJURY ON OPTIMUM LENGTH OF THE KNEE FLEXORS. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mendiguchia J, Samozino P, Martinez-Ruiz E, Brughelli M, Schmikli S, Morin JB, Mendez-Villanueva A. Progression of Mechanical Properties during On-field Sprint Running after Returning to Sports from a Hamstring Muscle Injury in Soccer Players. Int J Sports Med 2014; 35:690-5. [DOI: 10.1055/s-0033-1363192] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J. Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
| | - P. Samozino
- Laboratory of Exercise Physiology (EA4338), University of Savoy, Le Bourget du Lac, France
| | - E. Martinez-Ruiz
- Chair of Sports Traumatology, Catholic University of San Antonio, Murcia, Spain
| | - M. Brughelli
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - S. Schmikli
- Department of Rehabilitation and Sports Medicine, Rudolf Magnus Institute of Neuroscience, Utrecht, Netherlands
| | - J.-B. Morin
- Laboratory of Exercise Physiology, University of Saint-Etienne, France
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Mendiguchia J, Arcos AL, Garrues MA, Myer GD, Yanci J, Idoate F. The Use of MRI to Evaluate Posterior Thigh Muscle Activity and Damage During Nordic Hamstring Exercise. J Strength Cond Res 2013; 27:3426-35. [DOI: 10.1519/jsc.0b013e31828fd3e7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mendiguchia J, Garrues MA, Cronin JB, Contreras B, Malliaropoulos N, Maffulli N, Idoate F. In Response. J Strength Cond Res 2013. [DOI: 10.1519/jsc.0b013e3182a882d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mendiguchia J, Garrues MA, Cronin JB, Contreras B, Los Arcos A, Malliaropoulos N, Maffulli N, Idoate F. Nonuniform Changes in MRI Measurements of the Thigh Muscles After Two Hamstring Strengthening Exercises. J Strength Cond Res 2013; 27:574-81. [DOI: 10.1519/jsc.0b013e31825c2f38] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Mendiguchia J, Alentorn-Geli E, Idoate F, Myer GD. Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med 2012; 47:359-66. [PMID: 22864009 DOI: 10.1136/bjsports-2012-091250] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Quadriceps muscle strains frequently occur in sports that require repetitive kicking and sprinting, and are common in football in its different forms around the world. This paper is a review of aetiology, mechanism of injury and the natural history of rectus femoris injury. Investigating the mechanism and risk factors for rectus femoris muscle injury aims to allow the development of a framework for future initiatives to prevent quadriceps injury in football players.
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Affiliation(s)
- Jurdan Mendiguchia
- Department of Physical Therapy, Zentrum Rehab and Performance Center, Barañain, Navarre, Spain.
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Malliaropoulos N, Mendiguchia J, Pehlivanidis H, Papadopoulou S, Valle X, Malliaras P, Maffulli N. Hamstring exercises for track and field athletes: injury and exercise biomechanics, and possible implications for exercise selection and primary prevention. Br J Sports Med 2012; 46:846-51. [DOI: 10.1136/bjsports-2011-090474] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Following the onset of maturation, female athletes have a significantly higher risk for anterior cruciate ligament (ACL) injury compared with male athletes. While multiple sex differences in lower-extremity neuromuscular control and biomechanics have been identified as potential risk factors for ACL injury in females, the majority of these studies have focused specifically on the knee joint. However, increasing evidence in the literature indicates that lumbo-pelvic (core) control may have a large effect on knee-joint control and injury risk. This review examines the published evidence on the contributions of the trunk and hip to knee-joint control. Specifically, the sex differences in potential proximal controllers of the knee as risk factors for ACL injury are identified and discussed. Sex differences in trunk and hip biomechanics have been identified in all planes of motion (sagittal, coronal and transverse). Essentially, female athletes show greater lateral trunk displacement, altered trunk and hip flexion angles, greater ranges of trunk motion, and increased hip adduction and internal rotation during sport manoeuvres, compared with their male counterparts. These differences may increase the risk of ACL injury among female athletes. Prevention programmes targeted towards trunk and hip neuromuscular control may decrease the risk for ACL injuries.
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Affiliation(s)
- Jurdan Mendiguchia
- Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA
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Brughelli M, Cronin J, Mendiguchia J, Kinsella D, Nosaka K. Contralateral Leg Deficits in Kinetic and Kinematic Variables During Running in Australian Rules Football Players With Previous Hamstring Injuries. J Strength Cond Res 2010; 24:2539-44. [DOI: 10.1519/jsc.0b013e3181b603ef] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mendiguchia J, Brughelli M. A return-to-sport algorithm for acute hamstring injuries. Phys Ther Sport 2010; 12:2-14. [PMID: 21256444 DOI: 10.1016/j.ptsp.2010.07.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 07/09/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
Acute hamstring injuries are the most prevalent muscle injuries reported in sport. Despite a thorough and concentrated effort to prevent and rehabilitate hamstring injuries, injury occurrence and re-injury rates have not improved over the past 28 years. This failure is most likely due to the following: 1) an over-reliance on treating the symptoms of injury, such as subjective measures of "pain", with drugs and interventions; 2) the risk factors investigated for hamstring injuries have not been related to the actual movements that cause hamstring injuries i.e. not functional; and, 3) a multi-factorial approach to assessment and treatment has not been utilized. The purpose of this clinical commentary is to introduce a model for progression through a return-to-sport rehabilitation following an acute hamstring injury. This model is developed from objective and quantifiable tests (i.e. clinical and functional tests) that are structured into a step-by-step algorithm. In addition, each step in the algorithm includes a treatment protocol. These protocols are meant to help the athlete to improve through each phase safely so that they can achieve the desired goals and progress through the algorithm and back to their chosen sport. We hope that this algorithm can serve as a foundation for future evidence based research and aid in the development of new objective and quantifiable testing methods.
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Affiliation(s)
- Jurdan Mendiguchia
- Head of Rehabilitation Department at Athletic Club de Bilbao, Garaioltza 147 CP:48196, Lezama (Bizkaia), Spain.
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