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      A Preseason Training Program With the Nordic Hamstring Exercise Increases Eccentric Knee Flexor Strength and Fascicle Length in Professional Female Soccer Players

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          Abstract

          Background

          Training programs that include the Nordic hamstring exercise (NHE) have been shown to increase eccentric knee flexor strength and biceps femoris fascicle length in male athletes. However, the effect of NHE on female athletes remains unknown.

          Purpose

          To investigate the collective and individual responses of professional female soccer players engaged in a preseason training program with the NHE regarding eccentric knee flexor strength and biceps femoris long head fascicle length.

          Study Design

          Quasi-experimental study.

          Methods

          Sixteen amateur female soccer players (without a NHE training routine) were evaluated 8-weeks apart to: (1) assess reliability of eccentric knee flexor strength and biceps femoris fascicle length measures; and (2) determine the typical error of measures that would be used to discriminate training responders and non-responders. The NHE training group had 17 professional female soccer players who performed an 8-week training program with the NHE during preseason. Within-group analysis was performed with paired sample t-tests (pre- vs. post-training), and individual responses were determined using the typical error criteria.

          Results

          The non-trained group’s data demonstrated that measures of strength (ICC=0.82-0.87, typical error = 12-13 N) and fascicle length (ICC=0.92-0.97; typical error = 0.19-0.38 cm) were reliable. In the NHE training group, both limbs increased the eccentric knee flexor strength (~13%; ES=0.74-0.82) and the biceps femoris fascicle length (~6%; ES=0.44-0.65). Twelve players (~71%) were considered responders to the NHE training program for the eccentric knee flexor strength, while eight athletes (~47%) were responders for the biceps femoris fascicle length.

          Conclusion

          The 8-week preseason training program with the NHE increased both eccentric knee flexor strength and biceps femoris fascicle length in professional female soccer players. More than two-thirds of players demonstrated a meaningful increase in eccentric strength, while nearly half achieved consistent fascicle length increases with the NHE training.

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          Most cited references41

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          A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research.

          Intraclass correlation coefficient (ICC) is a widely used reliability index in test-retest, intrarater, and interrater reliability analyses. This article introduces the basic concept of ICC in the content of reliability analysis.
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            Understanding injury mechanisms: a key component of preventing injuries in sport.

            Anterior cruciate ligament (ACL) injuries are a growing cause of concern, as these injuries can have serious consequences for the athlete with a greatly increased risk of early osteoarthrosis. Using specific training programmes, it may be possible to reduce the incidence of knee and ankle injuries. However, it is not known which programme components are the key to preventing knee and ankle injuries or how the exercises work to reduce injury risk. Our ability to design specific prevention programmes, whether through training or other preventive measures, is currently limited by an incomplete understanding of the causes of injuries. A multifactorial approach should be used to account for all the factors involved-that is, the internal and external risk factors as well as the inciting event (the injury mechanism). Although such models have been presented previously, we emphasise the need to use a comprehensive model, which accounts for the events leading to the injury situation (playing situation, player and opponent behaviour), as well as to include a description of whole body and joint biomechanics at the time of injury.
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              Hamstring strain injuries: factors that lead to injury and re-injury.

              Hamstring strain injuries (HSIs) are common in a number of sports and incidence rates have not declined in recent times. Additionally, the high rate of recurrent injuries suggests that our current understanding of HSI and re-injury risk is incomplete. Whilst the multifactoral nature of HSIs is agreed upon by many, often individual risk factors and/or causes of injury are examined in isolation. This review aims to bring together the causes, risk factors and interventions associated with HSIs to better understand why HSIs are so prevalent. Running is often identified as the primary activity type for HSIs and given the high eccentric forces and moderate muscle strain placed on the hamstrings during running these factors are considered to be part of the aetiology of HSIs. However, the exact causes of HSIs remain unknown and whilst eccentric contraction and muscle strain purportedly play a role, accumulated muscle damage and/or a single injurious event may also contribute. Potentially, all of these factors interact to varying degrees depending on the injurious activity type (i.e. running, kicking). Furthermore, anatomical factors, such as the biarticular organization, the dual innervations of biceps femoris (BF), fibre type distribution, muscle architecture and the degree of anterior pelvic tilt, have all been implicated. Each of these variables impact upon HSI risk via a number of different mechanisms that include increasing hamstring muscle strain and altering the susceptibility of the hamstrings to muscle damage. Reported risk factors for HSIs include age, previous injury, ethnicity, strength imbalances, flexibility and fatigue. Of these, little is known, definitively, about why previous injury increases the risk of future HSIs. Nevertheless, interventions put in place to reduce the incidence of HSIs by addressing modifiable risk factors have focused primarily on increasing eccentric strength, correcting strength imbalances and improving flexibility. The response to these intervention programmes has been mixed with varied levels of success reported. A conceptual framework is presented suggesting that neuromuscular inhibition following HSIs may impede the rehabilitation process and subsequently lead to maladaptation of hamstring muscle structure and function, including preferentially eccentric weakness, atrophy of the previously injured muscles and alterations in the angle of peak knee flexor torque. This remains an area for future research and practitioners need to remain aware of the multifactoral nature of HSIs if injury rates are to decline.
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                Author and article information

                Journal
                Int J Sports Phys Ther
                Int J Sports Phys Ther
                2159
                International Journal of Sports Physical Therapy
                NASMI
                2159-2896
                1 April 2021
                2021
                : 16
                : 2
                : 459-467
                Affiliations
                [1 ] Universidade Federal de Ciências da Saúde de Porto Alegre
                Author notes

                Corresponding author: Bruno Manfredini Baroni; Federal University of Health Sciences of Porto Alegre (UFCSPA); Sarmento Leite St, 245 – zipcode 90050-170; Porto Alegre, Rio Grande do Sul, Brazil; Phone/fax +55 51 3303-8876; Email: bmbaroni@yahoo.com.br

                Article
                19452
                10.26603/001c.19452
                8016438
                33842041
                a6ec2f2d-651a-4ab1-9e23-36db0c98c0ae

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (4.0) which permits non-commercial use and sharing in any medium or format, provided the original author and source are credited. If you remix, transform, or build upon this work, you may not distribute the modified material.

                History
                : 17 February 2020
                : 4 July 2020
                Categories
                Original Research

                knee flexors,injury prevention,eccentric training,football

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