John Orchard is a sports physician and sports injury researcher based in Sydney, Australia. He is a Conjoint Senior Lecturer at the University of New South Wales and a Senior Fellow at the University of Melbourne. Dr Orchard is Medical Director for the Sydney Roosters Rugby League Football Club. He is Injury Survey Co-ordinator for the Australian Cricket Board and the Australian Football League, and is a board member for the New South Wales Sporting Injuries Committee.
Dr Orchard is also an editorial Board Member for The British Journal of Sports Medicine and is Clinical Assistant Editor of The Journal of Science and Medicine in Sport. Dr Orchard disseminates his work and keeps the public informed on topical sports injury subjects at www.injuryupdate.com.au – Australia’s premier sports injury website.
Muscle strains have been shown to account for around 30% of all injuries in English professional soccer. How does this compare with the ‘funny shaped balls’ and football codes that are played ‘down under’?
“The overall percentage (30%) is about the same in Aussie Rules football, which is similar to soccer in having a lot of open play and kicking. The rugby codes have slightly less muscle strains, particularly in the forwards who generally only run for short distances, to be tackled or make a tackle, and who rarely kick. The backs in rugby are much more likely to strain a hamstring or quadriceps muscle than the forwards, making their risk similar to Australian Football and soccer players.
“Because Aussie Rules players all kick and run there is no significant positional difference in muscle strain risk. Obviously in soccer, the goalkeepers are less likely to strain muscles because they don’t run as far. Although I haven’t seen the soccer statistics, I imagine that goalies wouldn’t strain their quadriceps much, as we have found in Australia that it is kicking on the run that causes a quadriceps strain, rather than kicking from a stoppage.”
There is (in our opinion, an academic) debate amongst those involved in the preparation of professional teams, concerning static versus more dynamic stretching techniques and their role in injury prevention. What are your thoughts on different stretching methods and their role in pre activity preparation?
“The scientific evidence on stretching suggests that it is far more important for sprint performance than for injury prevention. Dynamic techniques seem to have a very small risk of actually causing an injury during a stretch. I do distance running myself and don’t stretch, because there is some evidence that tight muscles improve running economy in distance running.
“I would encourage sprinters to do stretching to run faster and, to be honest, I would leave the technique decision to the coaches because I think it is a performance issue rather than an injury prevention issue. When the hamstrings tighten up after a strain, it probably helps prevent a re-injury because it decreases the stride length, but this also makes the athlete run slower.”
The hamstring muscle group is still the most commonly affected by injury in English professional soccer. Could you briefly tell us why the hamstrings are so frequently injured?
“The hamstring is by far the most common injury in 100m sprinters, accounting for two-thirds of all injuries in this event. This shows that in maximal speed sprinting, the hamstring muscle group is the tissue closest to its injury threshold. In sports played on big fields, like soccer and Aussie Rules, players often have to run at maximum speed and so hamstring strains are always going to be a common injury in these sports.”
It is also common to find a player who suffers a recurrence of their hamstring muscle strain. Why do certain players suffer from these recurrent problems?
“Although hamstring strains differ greatly in their severity, I think that the ‘average’ hamstring strain probably takes 4-6 weeks to fully repair, rather than the 2-3 weeks that most people think. Most players can come back before full repair by running with a slightly decreased stride length on the injured side. This takes a tiny edge off speed but protects the injured hamstring.
“I think players who often suffer recurrences are ones who don’t know how to make this gait adjustment. Although it is only a theory, I strongly believe that the players who have a large number of recurrences almost certainly have a degree of nerve entrapment as an underlying factor. This is difficult to prove, and at this stage, even more difficult to reverse.”
It seems prevention is better than cure when it comes to hamstring muscle strains. What strategies would you recommend in order to minimise the risk of a hamstring muscle strain?
“The only definite advice based on scientific evidence is to regularly strengthen the hamstrings as much as the quadriceps to prevent a strength imbalance. On anecdote, I think that players should avoid sprint training in a fatigued state. For example, if a team is going to do weights and field training in the one day, it is safer to do the field training before the weights rather than the other way around. Although it hasn’t been tested, I think that players at high risk could have coaching to try to run with a shorter stride length which, perhaps at the cost of a touch of speed, can almost certainly protect the hamstrings.”
Dr Orchard’s published work is notable for the fact that it is practical and provides meaningful information to sports medicine clinicians. Much of Dr Orchard’s research is available at www.injuryupdate.com.au and includes:
Benefits and risks of using local anaesthetic for pain relief to allow early return to play in professional football, Orchard JW, British Journal of Sports Medicine 2002, 36:209-213.
Exact moment of a gastrocnemius muscle strain captured on video [case report], Orchard JW, Alcott E, James T, Farhart P, Portus M, Waugh SR, British Journal of Sports Medicine 2002, 36:222-223.
Injuries in Australian cricket at first class level 1995/6 to 2000/01, Orchard J, James T Alcott E, Carter S, Farhart P, British Journal of Sports Medicine 2002, 36 (4): 270-274.
Is there a relationship between ground and climatic conditions and injuries in football? Orchard J, Sports Medicine 2002, 32 (7): 419-432.
Intrinsic and Extrinsic Risk Factors for Anterior Cruciate Ligament injury in Australian Football, Orchard J, Seward H, McGivern J, Hood S, American Journal of Sports Medicine 2001, 29 (2): 196-200.
Intrinsic and Extrinsic Risk Factors for muscle strains in Australian Football, Orchard J, American Journal of Sports Medicine 2001, 29 (3): 300-303.
The AFL Penetrometer study: work in progress, Orchard J, Journal of Science and Medicine in Sport 2001, 4(2): 220-232.
Hamstring muscle strain injury caused by isokinetic testing [case report]. Orchard J, Steet E, Walker C, Ibrahim A, Rigney L, Houang M. Clinical Journal of Sport Medicine 2001, 11: 274-276.
Epidemiology of injuries in the Australian Football League 1997-2000, Orchard J, Seward H, British Journal of Sports Medicine 2002, 36:39-44.
The management of muscle strain injuries: An early return versus risk of recurrence [guest editorial], Orchard J, Best T, Clinical Journal of Sports Medicine 2002, 12: 3-5.
Preseason Hamstring Weakness associated with Hamstring Injury in Australian Footballers, Orchard J, Marsden J, Lord S, Garlick D, American Journal of Sports Medicine 1997, 25 (1): 81-85.