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Journal of Sport and Health Science xx (2017) 1–4

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1 Q2 Q3
bs_bs_query Opinion
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3 bs_bs_query The late swing and early stance of sprinting are most hazardous for
4
hamstring injuries
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6 bs_bs_query

7 Q1
bs_bs_query Yu Liu a,*, Yuliang Sun b, Wenfei Zhu b, Jiabin Yu c
a
8 bs_bs_query Key Laboratory of Exercise and Health Sciences of the Ministry of Education, Shanghai University of Sport, Shanghai 200438, China
b
9 bs_bs_query School of Physical Education, Shaanxi Normal University, Xi’an 710119, China
c
10 bs_bs_query Research Academy of Grand Health, Faculty of Sport Science, Ningbo University, Ningbo 315211, China
11 bs_bs_query Received 31 August 2016; revised 8 November 2016; accepted 21 November 2016
12 bs_bs_query Available online
13 bs_bs_query

14 bs_bs_query Hamstring strain injury is one of most prevalent noncontact made to measure the GRFs during overground sprinting and use 51 bs_bs_query

15 bs_bs_query injuries in sports that involve high-speed running, such as these data to estimate the hamstring kinetics during stance.3,4 To 52 bs_bs_query

16 bs_bs_query sprinting, soccer, and rugby.1 In order to optimize prevention fill this gap, we investigated the loading conditions of the ham- 53 bs_bs_query

17 bs_bs_query strategies and injury rehabilitation, studies have been con- string muscles during maximum-effort overground running.2 54 bs_bs_query

18 bs_bs_query ducted to understand hamstring function during sprinting.2–4 Our results suggest that the hamstrings are most susceptible to 55 bs_bs_query

19 bs_bs_query However, differences have long existed in the literature as to the injury during the swing and stance transitions of sprinting. 56 bs_bs_query

20 bs_bs_query cause of hamstring strain injuries. One of the most controversial We used a lower extremity intersegmental dynamics analysis 57 bs_bs_query

21 bs_bs_query topics is the debate over which phase of high-speed running is for each body segment.2,13 The intersegmental dynamics analy- 58 bs_bs_query

22 bs_bs_query most associated with hamstring injuries.5 sis we used allows for torques at each joint to be separated into 59 bs_bs_query

23 bs_bs_query Studies of running biomechanics indicate that the ham- five categories: gravitational torque (GTT), motion-dependent Q4 60 bs_bs_query

24 bs_bs_query strings are active for the entire gait cycle, with peaks in activa- torque (MDT), external contact torque (EXT), generalized 61 bs_bs_query

25 bs_bs_query tion during the early stance and the late swing phases.6,7 Mann muscle torque (MST), and net joint torque (NET), which is the 62 bs_bs_query

26 bs_bs_query and Sprague3 reported that the highest torques of hip extension vector sum of the four previous components. Detailed interac- 63 bs_bs_query

27 bs_bs_query and knee flexion occur secondary to a peak value of the ground tions between the active muscle torques and the passive torque 64 bs_bs_query

28 bs_bs_query reaction forces (GRFs) during the initial stance phase. Based on components could be quantified, giving us insight into how the 65 bs_bs_query

29 bs_bs_query this information, they concluded that the early stance was hamstrings’ function switches during the running cycle. 66 bs_bs_query

30 bs_bs_query highly associated with hamstring strains. In contrast, many Using this approach, we reached three main conclusions. 67 bs_bs_query

31 bs_bs_query subsequent researchers held the view that the late swing phase First, the MST primarily countered the MDT during the swing 68 bs_bs_query

32 bs_bs_query of sprinting is the most hazardous.4,6–9 These studies found that phase for the knee and hip joints (Fig. 1A). In late swing, the leg 69 bs_bs_query

33 bs_bs_query the hamstrings contract forcefully while reaching maximum was swinging forward due to its inertia. However, the ham- 70 bs_bs_query

34 bs_bs_query length during the late swing phase. They ignored Mann’s argu- strings were active and started to extend the hip and flex the 71 bs_bs_query

35 bs_bs_query ment of high torques as an indicator of hamstring injury risk knee joints for the subsequent ground contact (Fig. 1B). This 72 bs_bs_query

36 bs_bs_query and preferred the hypothesis that hamstring strains occur during activity of the hamstrings generated a large hip-flexion MDT Q5 73 bs_bs_query

37 bs_bs_query eccentric contractions.10 and a knee-extension MDT at the same time. Further analysis of 74 bs_bs_query

38 bs_bs_query However, most previous observers used treadmill sprinting the components of the MDT showed that MDT at both joints 75 bs_bs_query

39 bs_bs_query rather than overground sprinting in their studies.6,8,9 Although was caused mainly by torques due to the leg angular accelera- 76 bs_bs_query

40 bs_bs_query the treadmill is a convenient tool for assessment of running tion. These passive torques applied stress to the hamstring 77 bs_bs_query

41 bs_bs_query biomechanics, it has been shown that the biomechanics of muscles in the opposite direction of contraction at both joints. 78 bs_bs_query

42 bs_bs_query treadmill running differ significantly from those of overground To counter this negative effect, the hamstrings encountered 79 bs_bs_query

43 bs_bs_query running, and thus may lead to erroneous conclusions about enormous loads, approximately 10 times the subjects’ average 80 bs_bs_query

44 bs_bs_query overground running.11,12 Additionally, much of the previous body weight, to control the rapid leg rotation, which created 81 bs_bs_query

45 bs_bs_query research was aimed at investigating the kinematics of the ham- conditions for hamstring injuries. Previous studies reported that 82 bs_bs_query

46 bs_bs_query string during running alone.7–9 Limited attempts have been the hamstrings stretch to their maximum length and the muscle 83 bs_bs_query

47 bs_bs_query
force reaches its maximal value in this phase.6–8 Our results 84 bs_bs_query

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confirmed these findings and showed how they happened. The 85 bs_bs_query

49 bs_bs_query Peer review under responsibility of Shanghai University of Sport. key contributor to these high torques was the MDT created 86 bs_bs_query

50 bs_bs_query * E-mail address: yuliu@sus.edu.cn mainly due to the leg angular acceleration.2 Although there is 87 bs_bs_query

http://dx.doi.org/10.1016/j.jshs.2017.01.011
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license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article in press as: Yu Liu, Yuliang Sun, Wenfei Zhu, Jiabin Yu, The late swing and early stance of sprinting are most hazardous for hamstring injuries, Journal of Sport
and Health Science (2017), doi: 10.1016/j.jshs.2017.01.011
 ARTICLE IN PRESS JSHS367_proof ■ 8 February 2017 ■ 2/4

2 Y. Liu et al.

88 bs_bs_query Fig. 1. Averaged time-normalized graphs for joint torques at knee and hip joints during the swing (A) and stance (C) phases of sprinting. The top panels show
89 bs_bs_query positions of the lower extremity during the swing (A) and stance (C) phases. Data represent the group mean (lines) with one SD (shading). (B) Diagram of sprinting
90 bs_bs_query during the late swing phase: the inertial loads (MDT) produced by segment motion at the knee and hip joints. (D) Diagram of sprinting during the initial stance phase:
91 bs_bs_query the GRF passes anteriorly to the knee and hip joints. EXT = external contact torque; GTT = gravitational torque; MDT = motion-dependent torque; MST = muscle
92 bs_bs_query torque; NET = net torque. (Positive value indicates extension; negative value indicates flexion.)2

93 bs_bs_query

94 bs_bs_query debate as to whether eccentric muscle strain or muscle stress is weight in the initial stance phase, are susceptible to strain injury 112
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95 bs_bs_query the causative factor in muscle strain injuries,1,10 it is known that in this phase. This conclusion supports Mann’s finding.3 Addi- 113
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96 bs_bs_query an eccentric contraction occurs when the external force is tionally, we discovered that the external GRF passing anteriorly 114
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97 bs_bs_query greater than the muscle contraction force, that is, the eccentric to the knee and hip generate the peak loads on the hamstrings.2 115
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98 bs_bs_query muscle action is induced by an external force. During late As the early stance is a continuation of the late swing, the 116
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99 bs_bs_query swing, the leg angular acceleration led to a tremendous MDT, hamstrings were contracting concentrically after being fully 117
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100 bs_bs_query which caused the hamstring muscles to work eccentrically. This extended. The muscles were suffering from enormous loads 118
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101 bs_bs_query suggests that hamstring strains are associated with high loading caused by 2 different factors (the inertia and the GRFs) 119
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102 bs_bs_query caused by the inertial torque MDT. throughout this eccentric-concentric transition. 120
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103 bs_bs_query Second, the dominant passive torque switched to EXT in the Chumanov et al.6 indicated an increased loading for the 121
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104 bs_bs_query transition from late swing to initial stance (Fig. 1C). We noticed hamstring muscles during the initial stance phase. However, 122
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105 bs_bs_query that the GRFs passed anteriorly to the knee and hip joints they did not regard this phase as injurious because negative 123
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106 bs_bs_query during the initial stance phase, which generates a large exten- work (i.e., energy absorbed) during eccentric contraction has 124
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107 bs_bs_query sion torque at the knee and a flexion torque at the hip at the been shown to correlate best with muscle injuries in animal 125
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108 bs_bs_query same time (Fig. 1D). As with the knee flexors and hip extensors models. This is a widely held belief, despite experimental evi- 126
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109 bs_bs_query in the late swing phase, the hamstring muscles serve both roles dence of muscle strains being produced during concentric 127
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110 bs_bs_query required to counteract the effect of the GRFs. It is likely that the (shortening) contractions.14 However, we currently cannot know 128
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111 bs_bs_query hamstrings, which encounter at least 8 times the subjects’ body for certain if muscle strains are produced by the tremendous 129
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Please cite this article in press as: Yu Liu, Yuliang Sun, Wenfei Zhu, Jiabin Yu, The late swing and early stance of sprinting are most hazardous for hamstring injuries, Journal of Sport
and Health Science (2017), doi: 10.1016/j.jshs.2017.01.011
 ARTICLE IN PRESS JSHS367_proof ■ 8 February 2017 ■ 3/4

■■ 3

130 bs_bs_query external forces during concentric contractions in the early peak values during the early stance phase. Peak musculotendon 187 bs_bs_query

131 bs_bs_query stance of sprinting. In addition, we are aware of the evidence forces for the bi-articular hamstrings would seem to have been 188 bs_bs_query

132 bs_bs_query suggesting that loads on their own are not necessarily indicative underestimated in the early stance phase, and the authors attri- 189 bs_bs_query

133 bs_bs_query of injury risk, but accumulated effects of biomechanical loads bute this to the limitations of the inverse dynamics-based static 190 bs_bs_query

134 bs_bs_query (i.e., musculotendon strain, velocity, force, power, and work) optimization combined with a minimum-stress performance 191 bs_bs_query

135 bs_bs_query experienced by the hamstrings may result in hamstring strain criterion. However, in our opinion, this is a typical case in 192 bs_bs_query

136 bs_bs_query injuries. We cannot state conclusively that high loading creates which over-filtered data were used for an inverse dynamics 193 bs_bs_query

137 bs_bs_query injury. However, we have evidence that the risk factors for calculation. Compared with their previous results, which also 194 bs_bs_query

138 bs_bs_query hamstring injuries are high in both the late swing and the early indicated a peek knee flexion torque during the early stance 195 bs_bs_query

139 bs_bs_query stance phase for different loading mechanisms. phase,19 the peak values might have been attenuated artificially. 196 bs_bs_query

140 bs_bs_query Finally, unlike most previous research in which GRFs were To sum up, during both the late swing and the initial stance 197 bs_bs_query

141 bs_bs_query not determined,7–9 we took both kinematic and kinetic data into phase, the large passive torques at the knee and hip joints acted 198 bs_bs_query

142 bs_bs_query consideration2 and examined overground sprinting at maximum to lengthen the hamstring muscles. The values of the flexion 199 bs_bs_query

143 bs_bs_query effort in elite athletes. The average maximum speed in our study MST at the knee and the extension MST at the hip in those 2 200 bs_bs_query

144 bs_bs_query was 9.7 m/s, which approaches typical maximum sprinting phases were considerable, indicating that the knee flexors and 201 bs_bs_query

145 bs_bs_query speeds and associated enormous GRFs, and is higher than hip extensors play an important role in sprint running, espe- 202 bs_bs_query

146 bs_bs_query speeds achieved in previous studies.4,6 It has been suggested cially during the initial stance phase and the late swing phase. 203 bs_bs_query

147 bs_bs_query that the hip and knee torques, which are estimated via the The active muscle torques generated mainly by the hamstrings 204 bs_bs_query

148 bs_bs_query inverse dynamics approach, are particularly sensitive to the counteracted the passive effects generated by the inertia of the 205 bs_bs_query

149 bs_bs_query filter cutoff frequency, and the early portion of the stance phase leg (swing) and the external GRF (stance). Although different 206 bs_bs_query

150 bs_bs_query is the most affected period.15,16 Exaggerated fluctuations in the causes led to the high loads in the hamstrings in these 2 phases, 207 bs_bs_query

151 bs_bs_query knee joint torques are data-processing artifacts rather than we might think of these 2 phases as one period, the swing- 208 bs_bs_query

152 bs_bs_query genuine characteristics of the joint kinetics. Therefore, it has stance transition period, because the motions of the lower- 209 bs_bs_query

153 bs_bs_query been suggested that matched cut-off frequencies be used for extremity are continuous and the hamstring muscles function to 210 bs_bs_query

154 bs_bs_query both kinematic and kinetic data (i.e., 20-20 Hz) when applying extend the hip and flex the knee throughout the entire phase. As 211
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155 bs_bs_query inverse dynamics. Filtering at unmatched cutoff frequencies a result, during sprinting or high-speed locomotion, the ham- 212 bs_bs_query

156 bs_bs_query might affect, to some extent, the results obtained in our lab. string muscles may be more susceptible to strain injury during 213 bs_bs_query

157 bs_bs_query However, one should not universally dismiss studies that use the swing-stance transition than during any other phase in sprint 214 bs_bs_query

158 bs_bs_query unmatched cutoff frequencies. Based on our results, the joint running. 215 bs_bs_query

159 bs_bs_query muscle torques counteract the EXT, which was caused by the One limitation of our research is that the method for esti- 216 bs_bs_query

160 bs_bs_query GRFs during the stance phase. Careful examination of the raw mating muscle torques across a joint does not reveal an indi- 217 bs_bs_query

161 bs_bs_query curves of the GRFs reveal that the GRFs switch between vidual muscle’s contributions to the joint torque. In addition, 218 bs_bs_query

162 bs_bs_query passing in front and behind the knee joint during early stance. passive structures also contribute to the joint torques at the knee 219 bs_bs_query

163 bs_bs_query This phenomenon contributes to the fluctuations of the GRFs and hip. Because the hamstring muscles are the most injured 220 bs_bs_query

164 bs_bs_query and affects the derivation of the joint muscle torque. Therefore, muscles during sprinting20 and are the only bi-articular muscles 221 bs_bs_query

165 bs_bs_query the peak values of the MST in early stance are not all artifacts. that flex the knee and extend the hip, we focused our MST- 222 bs_bs_query

166 bs_bs_query In addition, the aim of data filtering is to remove noise and related discussion on the hamstring musculature. Future studies 223 bs_bs_query

167 bs_bs_query reduce the attenuation of signals as much as possible. Data need to consider the role of other active and passive structures 224 bs_bs_query

168 bs_bs_query filtering must be based on the raw signals. To estimate if the that cross the hip and knee joints. 225 bs_bs_query

169 bs_bs_query filtered data are optimally processed, we need to compare the 226 bs_bs_query

170 bs_bs_query smoothed curve with the raw data curve. In the current study, Acknowledgments 227 bs_bs_query

171 we strictly followed the protocol for estimating optimum cutoff 228 bs_bs_query

This study was supported partly by the National Natural

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frequency.17,18 The optimum cutoff frequency is not only a func-
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Science Foundation of China (grants 11372194, 81572213). It
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tion of the residual between the filtered and unfiltered data but
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was also supported by the Fundamental Research Funds for the
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is also a function of the sampling frequency. Matched combi-
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Central Universities (GK201603128, GK201603129) and the
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nations of cut-off frequencies (i.e., 20-20 Hz) can potentially
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Ministry of Education in China (MOE) Project of Humanities
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“over-smooth” the kinetic data, thereby removing crucial peak
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and Social Sciences (16XJC890001).
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values of joint torques at the instant of foot strike, which
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235 bs_bs_query

178 explains why there were no fluctuations when using matched

Authors’ contributions
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236 bs_bs_query

179 bs_bs_query cut-off frequencies. 237 bs_bs_query

180 bs_bs_query Schache et al.4 studied the mechanics of the hamstring YL designed and carried out the study and drafted the manu- 238 bs_bs_query

181 bs_bs_query muscles during overground sprinting, using an advanced mus- script; YS performed the literature review and helped to draft 239 bs_bs_query

182 bs_bs_query culoskeletal model accessed from OpenSim. They estimated the the manuscript; WZ helped to draft and revise the manuscript; 240 bs_bs_query

183 bs_bs_query loads acting on individual muscles (semitendinosus, semimem- JY participated in the design and coordination of the study and 241 bs_bs_query

184 bs_bs_query branosus, biceps femoris long head, and biceps femoris short helped to draft the manuscript. All authors have read and 242 bs_bs_query

185 bs_bs_query head) based on the joint torques at the knee and hip obtained approved the final version of the manuscript, and agree with the 243 bs_bs_query

186 bs_bs_query from inverse dynamics analysis. However, they did not find order of presentation of the authors. 244 bs_bs_query

Please cite this article in press as: Yu Liu, Yuliang Sun, Wenfei Zhu, Jiabin Yu, The late swing and early stance of sprinting are most hazardous for hamstring injuries, Journal of Sport
and Health Science (2017), doi: 10.1016/j.jshs.2017.01.011
 ARTICLE IN PRESS JSHS367_proof ■ 8 February 2017 ■ 4/4

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Please cite this article in press as: Yu Liu, Yuliang Sun, Wenfei Zhu, Jiabin Yu, The late swing and early stance of sprinting are most hazardous for hamstring injuries, Journal of Sport
and Health Science (2017), doi: 10.1016/j.jshs.2017.01.011