Dispelling myths, "Conditioned athletes don't get injured"
Hamstring Injury Prevention
Dispelling Myths in Sports Medicine & Rehabilitation
Swedish FA, Stockholm, January 2018
"I'm not going to be running for a little while."
🥇 World Record Attempt: Keely Hodgkinson said she knew "it wasn't good" the moment she tore her hamstring during her final training session before attempting to break a 23-year-old world record on Saturday in Birmingham.
(Sky Sports)
Insights from James Moore's presentation, and a few of my own observations, addressing common misconceptions in sports medicine practice and rehabilitation.
Scroll down for the downloadable PDF handout.
Myth 1: "Perfect Conditioning Eliminates Injury Risk"
Reality: Even athletes with exceptional strength, balance, and conditioning sustain hamstring injuries because of the biomechanical and performance demands of sport.
Moore emphasises that hamstring injuries primarily occur during high-speed running, with approximately 70% involving the proximal biceps femoris, or during rapid lengthening movements such as high kicks, where forces can exceed 300% of body weight.
In Keely's case, the injury occurred after only a few strides during training.
Moore Hamstring Rehabilitation: Mastering Lower Limb Injuries
A 2020 video case study discusses a similar scenario involving Tyson Gay.
This full presentation is available on my YouTube channel. See the comments for links.
• Tyson Gay, at the 2008 Olympic Trials, ran a wind-assisted 9.68 seconds in the 100m. Days later, he suffered a severe hamstring injury during the 200m trials.
• A similar scenario occurred with Keely Hodgkinson, who appeared to be in world-record form before sustaining a moderate hamstring injury. Grade 3 in Keely's case.
• Bukayo Saka of Arsenal FC provides another example.
"Strength Training Alone Prevents Recurrence"
While concentric strength is important, research demonstrates that eccentric strength deficits and tendon compliance play a greater role in injury risk than maximal strength metrics alone.
Eccentric Capacity > Maximal Strength
Moore's research found that hamstring injury risk correlates more strongly with eccentric strength deficits, particularly at longer muscle lengths during stride and touchdown phases, than with absolute strength levels.
Complex Anatomy
As Keely alludes to, "near the tendon, sitting on a nerve", the anatomy of the hamstrings, with overlapping tendons and structural interrelationships, contributes significantly to the complexity of these injuries.
Tendon Compliance Matters
Athletes with greater tendon stiffness demonstrated 3.2 times higher reinjury rates, regardless of strength metrics. Tendons act as critical energy buffers during high-speed running.
Neuromuscular Timing: Brain to Muscle
Injury recurrence appears to be more closely linked to delayed biceps femoris activation, typically a 14-22 ms lag during the terminal swing phase, than to strength parameters alone.
Coaching elite 100m and 200m sprinters has taught me that when athletes are in peak condition and finely tuned, even the smallest disruption can have a significant impact, much like a ripple across a still lake.
Athlete Continuous Risk Management
All athletes should be considered at risk. However, signs of dysfunction may not always be present, visible, or obvious. Continuous monitoring, communication, and informed decision-making remain essential components of injury risk management.