A Survey of Flexibility Training Protocols and Hamstring Strains in Professional Football Clubs in England

B Dadebo, J White and K P George

British Journal of Sports Medicine

2004, Vol 38, pages 388-394.

UK researchers in Nottingham and Manchester have investigated the relationship between current flexibility training protocols, including stretching, and hamstring strain rates in English professional football clubs, in a study published in The British Journal of Sports Medicine. Dadebo et al used a questionnaire survey to collect data from 30 professional English teams in order to ascertain any relationship between hamstring muscle strains and training methods, particularly stretching techniques.

The authors found that flexibility training protocols were characterised by wide variability, with static stretching the most popular stretching technique used. The Premiership clubs devoted almost 40% of total training time to flexibility training, with about 30% on endurance and 30% on strength/resistance training (presumably the authors examined only physical training). Division 3 clubs also exhibited similar training protocol distributions. In Division 1, nearly 50% of training time was devoted to flexibility training, with about 30% and 20% to endurance and strength/resistance training respectively. Division 2 clubs used the least flexibility training, representing a third of total training time a week, while almost 40% of time was used for endurance training.

Typical of previous similar research and The PhysioRoom.com Injury Database study of English Premier League injuries during 2003 – 2004, hamstring strains represented 11% of all injuries and one third of all muscle strains. About 14% of hamstring strains were re-injuries. Dadebo et al found that hamstring strain rates were highest in the Premiership (13.3 (9.4)/1000 hours) with the lowest rates in Division 2 (7.8 (2.9)/1000 hours). Most (97%) hamstring strains were grade I and II, two thirds of which occurred late during training/matches. Forwards were found to be injured most often. The authors examined the type of stretching undertaken and their findings suggest that the more a ‘standard stretching protocol' is used, the lower the hamstring strain rate.

Dadebo et al concluded that flexibility training protocols in the professional clubs were variable and appeared to depend on staffing expertise. Static stretching was reported as the most popular stretching technique used among all clubs in this study. In most cases, static stretching was used in combination with Proprioceptive Neuromuscular Facilitation (PNF) stretching techniques (where the therapist helps the player stretch in a functional pattern.

The authors found that hamstring stretching hold times (SHT) exhibited wide variability. The longest SHT reported was about 30 seconds by the Premiership clubs, whereas players in Division 3 clubs stretched for only about half this time, with Division 1 and 2 clubs holding stretches for about 20 seconds. Players in the Premiership and Division 2 on average stretched with fewer repetitions per session than those in Divisions 1 and 3.

Hamstring stretching was claimed to be the most important training factor associated with hamstring strain rate, and the authors advocate modification of stretching protocols, as a strategy to reduce hamstring strains in professional footballers. Dadebo et al recommend that the flexibility training protocols currently used by the professional football clubs need to be reviewed to ensure consistency in the use of static stretching/PNF with a stretch holding time of 15–30 seconds.

While this appears sensible advice, the authors concede that stretching is just one component of hamstring injury prevention. They rightly assert that the causes of hamstring strain are complicated and multifactorial; involving other factors such as muscle strength imbalance, inadequate warm up, lack of flexibility, muscle fatigue, and previous strain/inadequate rehabilitation.

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