The Hamstrings Explained

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Plenty has already been written about hamstrings and hamstring injuries. The moment we search for the word “hamstrings” on Google scholar, 43,000 articles will “pop up”. One could assume that almost everything has been said about this topic, so then why this book? For me, the main reason for this book is that I want to share my knowledge acquired over years of study and work experience with my colleagues and anyone else who may be interested in this topic.

The curious thing about hamstrings injuries is that, despite our advancing knowledge and despite all the progress made over the years, the amount of injuries in professional sports has more or less stayed the same. In 1982, Dr. Muckle wrote in the British Journal of Sports Medicine: “Although accounting for only 14% of all sports injuries, the amount of playing time lost is disproportionately high. In one season they were responsible for almost 30 per cent of missed match minutes” (1)
32 years later, John deWit mentioned in the International Journal of Sports Physical Therapy: “In the National Football league for example, hamstring injuries have been reported to account for 12% of all primary injuries and their recurrent rate is remarkable, at 32% (2).
So, what is the reason that in almost every article written over the past 32 years, the number of injuries has always fluctuated between 11-16%? One of the reasons might be that the hamstring muscle group (Medical professionals refer to this grouping as the ‘’Hamstring Muscle Complex’’) is incredibly complex. “The hamstring muscle group is one of the most complex sets of muscles in the body, intricately involved in both locomotion and stability of the lower extremity” (William G.Coole Jr.,MEd,ATC, JOPT) (3)
Whatever the case, there has been plenty of hamstring and hamstring injury research over the course of the years. However, almost all of the articles written only discuss data, scientific foundation, etc. Only a few articles elaborate on the practical implications for the professional in the field. What are the return to play (RTP) criteria, which rehab form is used at which injury, what is the difference in approach to a biceps femoris compared to a semimembranosus injury and which protocol is best practice? Those are the questions asked by the responsible professional.
My initial contact with the complexity of this injury was when I began working for a professional Dutch soccer team. On my first day I met a young and very talented player who had already been struggling with a hamstring injury for over six months at the time we met. Although he was very young, because of his many recurrent injuries and many visits to numerous doctors and physiotherapists without results, he already started to doubt whether he would be capable of playing at the highest level of soccer.

Over the next six months, we worked together on a one to one basis. Day in and day out, I had to deal with the complexity of this injury. Due to the notoriety of the club, I was lucky to travel to Sweden, where I met Carl Asklin. Mr. Asklin is considered the “godfather” of hamstrings. Led by him, I was able to further expand on my hamstring knowledge, experience and clinical skills. Together we developed a protocol that is, in my opinion, one of the strongest and safest in the market today. This protocol can be used both in the professional setting, as well as in recreational sports. I will not say that this protocol is the solution to all hamstring injuries/problems. What I will say is that because of my daily experience of working with elite athletes, my clinical knowledge acquired through both Carl Asklin and scientific research, I know that our protocol is the best available today.

The purpose of this book is not to compare all of the different articles published over the years, but to share my knowledge with my professional colleagues. I hope to paint a picture of what, in my opinion, is one of the best hamstring protocols today. It is based on both scientific evidence and hands-on expertise. It is something that has been a big part of my life over the last five years. It is not a “Cookbook”, but an attempt to create more practical clarity. By doing so it can be helpful as a tool for those who have many questions, like I had in the past.

I owe many thanks to Carl Asklin, for it was he who opened my eyes on this subject. I am also thankful for his incredible knowledge and enthusiasm, and because he was willing to share this knowledge with me, I consider myself more or less an expert. Thanks to Mr. Asklin, I am able to share my knowledge all around the world through clinical presentations. In 2015, I will be presenting lectures about hamstrings injuries and rehab in Madrid, Sao Paulo Brazil, and Mexico City.

Finally, I would like to thank my inspirational young soccer player. He didn’t want me to mention his name, but he has challenged me to the limit to get the job done. I am grateful to him for that.

120 pages in English language

Contents

Part One: Theory

Foreword
Preface

1. What led me to write this book?
2. Theory and Anatomy
3. Risk Factorspage
4. Gait Cyclepage
5. Return to Play
6. Explosive Injuries versus Stretch Injuries

Part Two: The Protocol

7. John’s Story
8. Isometric Exercises and Muscle Testing
9. Indoor Training
10. Pool Training
11. Hill Training
12. High Speed Training
13. Non-Hamstring Strength Training
14. Massage
15. Soccer Training and Completing the Protocol
16. Epilogue

Part Three: Additional Information

17. Notes and Glossary of Terms and Abbreviations
18. About the Author and how to get in touch

About the Author

Ralph van der Horst graduated from the “Leffelaar” Academy of Physiotherapy, part of Amsterdam’s college of higher education, in 1989.

Immediately after his degree he moved to Melbourne, Florida, to work in a sports clinic where he soon came across athletes with complicated knee injuries. He decided to focus on the rehabilitation of knee injuries, in particular the ACL (Anterior Cruciate Ligament) rehabilitation after surgery. After two years he was invited to come set up a sports clinic in Switzerland. Next to working in the Swiss clinic, he taught in sports rehabilitation and anatomy at the college of higher education known as “Thim van der Laan”.

In 1996 Ralph returned to the United States where he was invited to come and work in Tampa, Florida and later in New York State. Here he received the opportunity to solely focus on knee injuries.

In 1999 Ralph returned to the Netherlands to become co-owner of a large sports rehabilitation clinic in Beverwijk, a city close to Amsterdam. Next to knee rehabilitation, he expanded his field to cover shoulder and hamstring injuries. In 2003 the clinic opened its second practice in Zaandam, a city further north of Amsterdam. It was at this location that Ralph had the opportunity to arrange the clinic according to how he wanted to work, which led to the creation of a very specialized elite sports rehabilitation clinic, with an emphasis on ACL, Hamstrings and Shoulder rehabilitation.

In 2012 Ralph was asked to work for A.F.C. Ajax, a world-renowned soccer club. He received responsibility for long-term injuries for the first team as well as the U19; the most promising team. He was able to help the players with his passion for hamstring injuries.

Nowadays, Ralph is in the process of setting up a new and unique elite sports center near Amsterdam. He is also a co-founder of the “Performance Week Series” cycle, a group of conferences where state of the art lectures and workshops are taught by leading professionals in the field of sports rehabilitation and strength & conditioning. The Performance Weeks take place all over the world. The first Performance Week was kept in Madrid, Spain, in May 2015. The next Performance Week is scheduled to take place in Sao Paulo in November 2015, followed by the Performance Week in Mexico City, Mexico, in December 2015 and the Performance Week in Amsterdam, the Netherlands, in May 2016.

Ralph is married and lives in Beverwijk, the Netherlands, together with his wife Anna, son Mart and daughter Warwara.

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