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Sprinting: a key piece of the hamstring injury risk management puzzle

Article in British Journal of Sports Medicine · August 2022

DOI: 10.1136/bjsports-2022-105532

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This is an accepted version of the Editorial published in British Journal of Sports Medicine:
https://bjsm.bmj.com/content/early/2022/08/04/bjsports-2022-105532

Sprinting: a key piece of the hamstring injury risk management puzzle

Pascal Edouard1,21, Jurdan Mendiguchia3, Kenny Guex4,5, Johan Lahti6, Caroline Prince7,8, Pierre Samozino7, Jean-
Benoît Morin1,9
1 Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France
2 Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
3 Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
4 School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
5 Swiss Athletics, Haus des Sports, Ittigen, Switzerland.
6 Université Côte d’Azur, LAMHESS, Nice, France
7 Univ Savoie Mont Blanc, Inter-university Laboratory of Human Movement Biology, EA 7424, F-73000 Chambéry, France
8 Physiotherapy department and motion analysis lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland,
9 Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, New Zealand

Improvements in hamstring injury risk management optimal adaptation to biomechanical strain presents a
strategies are necessary, especially in sports requiring higher risk for damage. At high velocity (>7m/s or
“sprinting” (i.e., maximal acceleration and/or velocity). >26km/h), a 30% increase in running velocity leads to
Sprinting represents about two-thirds of hamstring a ~100% increase in hamstring muscle requirements.[7]
injury mechanisms.[1] Several sprinting-related We suggest that athletes mostly or only exposed to
parameters are associated with hamstring injury.[2–5] high but not maximal running velocity (i.e. ≤90% of
Thus, this editorial aims to 1) emphasize the maximal velocity) often have not exposed their
importance of sprinting and 2) provide general hamstring muscles to the sprinting-specific mechanical
principles for practical implementation of sprinting requirements needed for adequate preparation and
interventions as a component of hamstring injury risk prevention.[7]
management in primary and secondary prevention.
How to implement sprinting within a hamstring
Why should we consider sprinting as a piece of the injury risk management approach?
hamstring injury risk management puzzle? Sprinting should be considered a key component of a
First, as an injury mechanism,[1] sprinting represents comprehensive, multifactorial (i.e., physical and
one parameter on which we can act to reduce psychological), individualised hamstring injury risk
hamstring injury risk. Sprinting kinematics such as management approach contextualized to each sport.
greater anterior pelvic tilt and thoracic side bending Within this global approach, the complex and unique
during swing phase[4] and kinetics such as lower sprinting movement biomechanics (e.g., leg
horizontal force production capacity during sprint interaction, elastic energy transfer, reflexes,
acceleration[5] are associated with higher hamstring kinematics, kinetics, lumbo-pelvic control) should be
injury risk. the focus of the preparation and prevention in sports
Second, optimal exposure to maximal or near-maximal requiring high running velocities.
running velocity is suggested as a protective factor.[3]
Since an acute and rapid increase in sprinting volume We suggest that sprinting implementation should follow
is associated with markedly increased hamstring injury a loop including 1) evaluation, 2)
risk,[2] a lack of regular preparatory sprint training may intervention/preparation based on the evaluation, and
induce a higher risk of sprint-related injuries.[6] Simply repeat of step 1 by re-evaluation and progression
put, the hamstring muscles need to be prepared to (figure 1).
safely provide the “function” it is to perform, and sub-

1
Pascal Edouard, MD PhD, Department of Clinical and Exercise Physiology, Sports Medicine Unit, IRMIS, Campus Santé Innovations,
University Hospital of Saint-Etienne, 42 055 Saint-Etienne cedex 2, France. Tel.: +33 674 574 691; Fax numbers: +33 477 127 229; E-mail:
[email protected]
 Edouard et al. 2022 – Brit J Sports Med - Sprinting for hamstring injury risk management

Sprin&ng implementa&on for hamstring injury risk management

Evaluation / Re-Evaluation Intervention

• Sprin&ng ‘structures’: lower extremity • Individualized
range of mo0on, mobility, strength, and
stability • Prepare the structure to sprin&ng:
↘ constraints (sprin0ng technique, pelvic
• Sprin&ng kinema&cs: thigh angular kinema0c)
movement, pelvic 0lt, trunk incline[3,6] ↗ func0on (sprin0ng exposure, hamstring
strengthening)

• Sprin&ng kine&cs: horizontal force • Progressivity

produc0on capacity during sprin0ng using
field tools (e.g., radar, laser, photocells, Global
Posi0oning Systems or high-speed videos if
• Varia&on: normal, heavy sled or downhill
available)[4,5] running

• Sprin&ng exposure: consider Global • Regularity: no break >7-10 days

Posi0oning System to quan0fy the weekly
distance of high-velocity running (i.e., <90% • Periodiza&on: 48h recovery between
individual maximal velocity) and sprin0ng sessions
monitoring/regula0ng week aJer week[1,2]

Figure 1: Proposed guidelines for implementation of sprinting interventions for hamstring injury risk management in
primary and secondary prevention.

Evaluation/Re-evaluation recovery between sprinting sessions.[6] Variation in

Evaluation of the sprinting ‘structures’, kinetics,[5] force and velocity of sprinting can be promoted by
kinematics,[4,8] and/or exposure,[2,3] can be done using heavy sled or downhill running. Examples of
according to the time and level of athlete. For example, programmes have been proposed to improve sprinting
Lahti et al.[9] has proposed an on-field evaluation kinematics[8] or sprinting kinetics,[9] or to introduce
procedure with two assessments over the football sprinting as a preventive strategy in male football
season of four musculoskeletal categories: posterior players.[10]
chain strength, range of motion, lumbopelvic control,
and sprint mechanics. Such evaluations allow Finally, we think that such a sprint-oriented hamstring
individualising the sprinting intervention/preparation by risk management strategy can potentially reduce
tailoring to the athlete’s specific individual capabilities injuries while also improving sprint performance. This
and deficiencies.[6,9] win-win performance-prevention strategy could have a
higher impact on athletes and coaches’ buy-in, leading
Intervention/Preparation to easier implementation and higher adherence.
Finding the appropriate balance for each individual
athlete and avoiding under- and over-exposure to Sprint regularly to reduce hamstring injuries: use it
sprinting is critical.[3] We suggest first targeting the or lose it!
sprinting pattern before considering sprinting ‘load’ by Sprinting is an irreplaceable measure for hamstring
preparing the system to sustain the sprinting injury risk management and should be integrated
constraints: “form first, load second”. Then, a through a multifactorial approach (box 1). Such an
progressive increase in the volume, intensity and approach using sprinting can be viewed by athletes and
exposure to sprinting is suggested, tending towards coaches as a gradual mitigation process given the
regular, micro-dosed sprinting (>90% of maximal regular, progressively increased exposure to the risk
velocity) at least once a week without ignoring the factor - sprinting - to build up ‘immunity’ for sprint-
sprinting pattern.[6] Regularity in sprinting practice is related hamstring injury. Sprinting should not only be
critical, ensuring a season-long exposure with no considered as a part of the problem but also, and more
substantial interruption of more than 7 or 10 days and importantly, as a part of the solution.
periodization of training including at least 48 hours of
 Edouard et al. 2022 – Brit J Sports Med - Sprinting for hamstring injury risk management

“SPRINT” to reduce the risk of hamstring injuries:

• Sprint! prepare/train the athlete to run/sprint at maximal velocity, individually through a loop of evaluation and
intervention/preparation, with progressivity (e.g., “form first, load second”), diversity/variation, regularity and
periodization/recovery, including preparation of the structure/system to sustain the sprinting constraints, drills
and technical skills, and regular exposure to maximal sprints;
• Plurifactorial and plurimodal individualized approach, including physical, psychological and
contextual/sociological approaches, including healthy and safe lifestyle, taking into account the context and
the facilitators and barriers for intervention implementation, and with education of the athletes and stakeholders
around them;
• Repair/rehabilitate all injuries, with a sprint-oriented strategy, from early stages and until maximal capabilities
are recovered and return to sport is permitted, and continue to monitor that there is no sequel deficiency;
• Increase capacities of tissues by strengthening, stretching, and training sensorimotor control, going from
isolated/non-functional to functional exercises;
• Note/pay attention to pain and/or fatigue and take care of it properly, improve athletes’ ability to listen to their
bodies, know their capabilities and limits, and learn warning signals to better self-efficacy in their daily practice;
• Train smartly, individually adapt and monitor the load, increase volume and intensity progressively.

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Scientific contributions of each author:

PE, JM and JBM were responsible for the concept. PE was responsible for the write-up. All authors had editorial input
into the manuscript.

Funding: No funding.
Competing Interest: None declared. PE is Associate Editor for the BJSM and the BMJ Open Sports and Exercise
Medicine.
Ethics approval: Not applicable
No additional data.

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