Decrease in eccentric hamstring strength in runners in the Tirol Speed Marathon

Associations Among Eccentric Hamstrings Strength, Hamstrings Stiffness, and Jump-Landing Biomechanics

CONTEXT

Anterior cruciate ligament (ACL) injury risk can be assessed from landing biomechanics. Greater hamstrings stiffness is associated with a landing-biomechanics profile consistent with less ACL loading but is difficult to assess in the clinical setting. Eccentric hamstrings strength can be easily evaluated by clinicians and may provide a surrogate measure for hamstrings stiffness.

OBJECTIVE

To examine associations among eccentric hamstrings strength, hamstrings stiffness, and landing biomechanics linked to ACL injury risk.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 34 uninjured, physically active participants (22 women, 12 men; age = 20.2 ± 1.6 years, height = 171.5 ± 9.7 cm, mass = 67.1 ± 12.7 kg).

INTERVENTION(S)

We collected eccentric hamstrings strength, active hamstrings stiffness, and double- and single-legged landing biomechanics during a single session.

MAIN OUTCOME MEASURE(S)

Bivariate associations were conducted between eccentric hamstrings strength and hamstrings stiffness, vertical ground reaction force, internal knee-extension moment, internal knee-varus moment, anterior tibial shear force, knee sagittal-plane angle at initial ground contact, peak knee-flexion angle, knee frontal-plane angle at initial ground contact, peak knee-valgus angle, and knee-flexion displacement using Pearson product moment correlations or Spearman rank-order correlations.

RESULTS

We observed no association between hamstrings stiffness and eccentric hamstrings strength (r = 0.029, P = .44). We also found no association between hamstrings stiffness and landing biomechanics. However, greater peak eccentric strength was associated with less vertical ground reaction force in both the double-legged (r = -0.331, P = .03) and single-legged (r = -0.418, P = .01) landing conditions and with less internal knee-varus moment in the single-legged landing condition (r = -0.326, P = .04).

CONCLUSIONS

Eccentric hamstrings strength was associated with less vertical ground reaction force during both landing tasks and less internal knee-varus moment during the single-legged landing but was not an acceptable clinical estimate of active hamstrings stiffness.

Positive Work Contribution Shifts from Distal to Proximal Joints during a Prolonged Run

PURPOSE

To investigate the joint-specific contributions to the total lower-extremity joint work during a prolonged fatiguing run.

METHODS

Recreational long-distance runners (n = 13) and competitive long-distance runners (n = 12) performed a 10-km treadmill run with near-maximal effort. A three-dimensional motion capture system synchronized with a force-instrumented treadmill was used to calculate joint kinetics and kinematics of the lower extremity in the sagittal plane during the stance phase at 13 distance points over the 10-km run.

RESULTS

A significant (P < 0.05) decrease of positive ankle joint work as well as an increase of positive knee and hip joint work was found. These findings were associated with a redistribution of the individual contributions to total lower-extremity work away from the ankle toward the knee and hip joint which was more distinctive in the recreational runner group than in the competitive runner group. This redistribution was accomplished by significant (P < 0.05) reductions of the external ground-reaction force lever arm and joint torque at the ankle and by the significant (P < 0.05) increase of the external ground-reaction force lever arm and joint torque at the knee and hip.

CONCLUSIONS

The redistribution of joint work from the ankle to more proximal joints might be a biomechanical mechanism that could partly explain the decreased running economy in a prolonged fatiguing run. This might be because muscle-tendon units crossing proximal joints are less equipped for energy storage and return compared with ankle plantar flexors and require greater muscle volume activation for a given force. To improve running performance, long-distance runners may benefit from an exercise-induced enhancement of ankle plantar flexor muscle-tendon unit capacities.

ASSOCIATION OF ISOMETRIC STRENGTH OF HIP AND KNEE MUSCLES WITH INJURY RISK IN HIGH SCHOOL CROSS COUNTRY RUNNERS

BACKGROUND

High school cross country runners have a high incidence of overuse injuries, particularly to the knee and shin. As lower extremity strength is modifiable, identification of strength attributes that contribute to anterior knee pain (AKP) and shin injuries may influence prevention and management of these injuries.

PURPOSE

To determine if a relationship existed between isometric hip abductor, knee extensor and flexor strength and the incidence of AKP and shin injury in high school cross country runners.

MATERIALS/METHODS

Sixty-eight high school cross country runners (47 girls, 21 boys) participated in the study. Isometric strength tests of hip abductors, knee extensors and flexors were performed with a handheld dynamometer. Runners were prospectively followed during the 2014 interscholastic cross country season for occurrences of AKP and shin injury. Bivariate logistic regression was used to examine risk relationships between strength values and occurrence of AKP and shin injury.

RESULTS

During the season, three (4.4%) runners experienced AKP and 13 (19.1%) runners incurred a shin injury. Runners in the tertiles indicating weakest hip abductor (chi-square = 6.140; p=0.046), knee extensor (chi-square = 6.562; p=0.038), and knee flexor (chi-square = 6.140; p=0.046) muscle strength had a significantly higher incidence of AKP. Hip and knee muscle strength was not significantly associated with shin injury.

CONCLUSIONS

High school cross country runners with weaker hip abductor, knee extensor and flexor muscle strength had a higher incidence of AKP. Increasing hip and knee muscle strength may reduce the likelihood of AKP in high school cross country runners.

LEVEL OF EVIDENCE

2b.

Decrease in eccentric quadriceps and hamstring strength in recreational alpine skiers after prolonged skiing

Background

To effectively prevent injury in recreational alpine skiing, it is important to identify modifiable risk factors that can be targeted through exercise and training. Fatigue is a potential risk factor in recreational skiing, but no investigations have evaluated concentric/eccentric quadriceps and hamstring fatigue in recreational skiers. We tested the hypothesis that recreational skiing is associated with more pronounced eccentric as compared with concentric muscle fatigue.

Methods

Twenty-four healthy and fit recreational skiers (14 male and 10 female) performed an isokinetic muscle test 1 day before, 1 h after, and 24 h after a 4 h skiing session. The testing protocol consisted of concentric and eccentric quadriceps and hamstring contractions for both legs.

Results

Eccentric peak hamstring torque (both thighs) and eccentric peak quadriceps torque (left thigh) were reduced in male and female participants (p<0.05). Reduced peak torques were still present 24 h after the skiing session. There were no other significant findings.

Summary

Recreational skiing is associated with prolonged (at least 24 h) eccentric quadriceps (left thigh) and hamstring (both thighs) fatigue in men and women. Eccentric quadriceps and hamstring fatigue may be a potential injury risk factor in male and female recreational skiers. This provides some justification for judicious use of additional eccentric training modalities for alpine skiing.

Gluteal pain in athletes: how should it be investigated and treated?

Gluteal pain is a frequent symptom in athletes, and defining it etiologically is a challenge for orthopedists. In the present study, using an anatomical approach to the posterior region of the pelvis and the proximal femur, divided into four quadrants, systematized investigation is proposed with the aim of optimizing the treatment and accelerating athletes' return to their sport, through correct diagnosis.

The effects of incline and level-grade high-intensity interval treadmill training on running economy and muscle power in well-trained distance runners

Despite a paucity of evidence, uphill running has been touted as a sport-specific resistance-to-movement training tactic capable of enhancing metabolic, muscular, and neuromuscular processes in distance runners in ways similar to previously established resistance-to-movement training methods, such as heavy and/or explosive strength training and plyometric training. Therefore, the purpose of this investigation included documenting the effects of incline and level-grade interval treadmill training on indices of running economy (RE) (i.e., oxygen consumption [VO2] and blood lactate [BLa] responses of submaximal running) and muscle power. Thirty-two well-trained distance runners (age, 27.4 ± 3.8 years; body mass, 64.8 ± 8.9 kg; height, 173.6 ± 6.4 cm; and VO2max, 60.9 ± 8.5 ml·min(-1)·kg(-1)) received assignment to an uphill (GHill = 12), level-grade (GFlat = 12), or control (GCon = 8) group. GHill and GFlat completed 12 interval and 12 continuous run sessions over 6 weeks, whereas GCon maintained their normal training. Dependent variables measured before and after training were VO2 and BLa at 2 separate velocities associated with lactate threshold (VLT) (VO2-60% and VO2-80%; and BLa-60% and BLa-80%, respectively); percentage of VO2max at lactate threshold (%VO2max at VLT); muscle power as assessed through a horizontal 5-jump test (5Jmax); and isokinetic knee extension and flexion at 3 angular velocities (90, 180, and 300°·s(-1)). Statistical significance was set to p ≤ 0.05. All groups significantly improved 5Jmax, VO2-60%, VO2-80%, BLa-60%, and BLa-80%. Additionally, GHill and GFlat significantly improved %VO2max at VLT. Other indices of RE and muscle power did not improve. We conclude incline treadmill training effective for improving the components of RE, but insufficient as a resistance-to-movement exercise for enhancing muscle power output.

Effects of Motorized vs Non-Motorized Treadmill Training on Hamstring/Quadriceps Strength Ratios

Previous literature suggests that muscular involvement and biomechanical changes elicit different responses between overground and treadmill training. The objective of this study was to examine the effects of training on two different treadmill designs on the conventional (CR; concentric only) and functional (FR; eccentric to concentric) hamstring and quadriceps strength ratios. Fifteen men and sixteen women were randomly divided into three groups: motorized (MT), non-motorized (NMT) or control (C). Subjects completed pre and post-test isokinetic concentric and eccentric quadriceps and hamstring testing of both legs. Subjects completed 4 weeks of training on their respective treadmills with mileage increasing ½ mile each week, beginning with 2 miles. The C group did not participate in any training. The CR revealed a significant two way interaction of group x time with MT increasing (pre: 0.80 ± 0.09 to post: 0.84 ± 0.09), NMT decreasing (pre: 0.76 ± 0.13 to post: 0.74 ± 0.10), and C showing no change (pre: 0.79 ± 0.10 to post: 0.79 ± 0.09. The FR revealed a significant two way interaction of speed x sex with the FR increasing as speeds increased for men (60 degrees.s(-1): 1.04 ± 0.11; 180 degrees.s(-1): 1.66 ± 0.27; 300 degrees.s(-1): 2.36 ± 0.45) and women (60 degrees.s(-1): 1.05 ± 0.16; 180 degrees.s(-1): 1.90 ± 0.26; 300 degrees.s(-1): 2.75 ± 0.47) but women increased greater relative to men. Training mode elicited a specific change in concentric hamstring and quadriceps strength resulting in specific changes to the CR; however, neither training mode had an effect on eccentric hamstrings nor the FR. Special attention should be given to the mode of endurance training when the goal is to alter the hamstring/quadriceps CR.

KEY POINTS

Specificity of treadmill training had different effects on concentric strength.Specificity of treadmill training had little or no effect on eccentric strength.Conventional and functional strength ratios may give different results based on training mode.Four weeks is long enough for strength results to be apparent in untrained people.

The natural history and management of hamstring injuries

Hamstring injuries in sport can be debilitating. The anatomical complexity of this muscle makes uniform assessment of injury epidemiology difficult and insures that post-injury management strategies must be individually focused. This article reviews the anatomy of the hamstring, its role in athletic movement, common mechanisms of injury, and management guidelines with the goal of return into sporting activity in mind.

[Long-term success and risk for marathon runners]

The popularity of marathon running has increased during recent years, which is reflected by the dramatic increase in the number of competitions and participants. Running a marathon itself does not usually cause any severe lesions of the joints but the problems mostly occur during training prior to the marathon. Before the event runners often question whether they can successfully take part in the competition and cope with the pain that might occur during running. In addition to the rare acute trauma, which is in general caused by falls or slipping, chronic injuries are of particular relevance for long distance running.This article describes the typical patterns of injuries to long distance runners, the positive effects of running a marathon and the risk factors for injuries.