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Liverpool’s battling 1-­0 victory over Stoke at the Britannia was overshadowed by yet more hamstring problems, with Dejan Lovren and Philippe Coutinho the latest to fall foul of the injury.

Hamstring, dubbed Jurgen Klopp’s “S**t” word of the year back in December, sees Liverpool now without six key players, this without counting the already long lay offs for Joe Gomez and Danny Ings’ cruciate ligament layoffs, and skipper Jordan Henderson’s long standing heel problems.

Lovren and Coutinho joined fellow teammates Daniel Sturridge, Jordan Rossiter, Martin Skrtel and Divock Origi on the club’s long list of lay offs, with criticism coming from various pundits blaming Klopp’s style of play and training methods for the setbacks.

And the bad news is that the biggest risk of injury is previous injury – so those Liverpool players suffering now could be more susceptible going forward.

Speaking on Sky after the Stoke game, Liverpool legend turned pundit Graeme Souness said: “A new manager comes in and all the chat was about high press further up the field. It’s hard work to do that for 90 minutes. You can do it in bursts. You can do it for an hour, you can do it for 70 minutes, but to do it for 90 minutes is a big demand on your legs.

“I just think they’ve fallen foul of that. It’s not a coincidence, five hamstrings. To have them all at one time, I think they have to look at what they’re doing in training.”

But do the theories stand up to close scrutiny? How prevalent are hamstring injuries? And what are the key factors in causing them?

The ECHO spoke to Professor Steven Doherty, professor and head of medicine at University of New England in Australia and a member of Sports Medicine Australia. He has lectured in sports injury prevention and is a life-long Liverpool FC fan who grew up in the Wirral and still coaches and plays football.

His wife Claire Doherty is a senior physiotherapist and annual speaker at the Global congress of medicine and health in sport and is deemed an expert on the topic, having played football herself as well as dealing with sporting muscle injuries on a day to day basis with her job, one that has even taken her to LA to run an injury prevention workshop with doctors there.

Professor Doherty said: “There are obviously many intrinsic and extrinsic factors which contribute to injury, but for individual players previous injury is the biggest risk factor – so the key is not to get injured in the first place.

“Player load (training and matches) etc is obviously part of this but there are very specific things that can and should be done and it would be interesting to know how much of it is done at Liverpool.

“I am amazed in Australian sport how little attention is paid to injury prevention at the sub elite level. Even at higher levels, basics are not done properly.

“I paid three visits to Anfield last year and watched Liverpool’s warm ups closely and the ‘form’ of the players with the injury prevention aspect of it could have been better (Tranmere Rovers warmed up much better in a match I watched two years ago).

“The spate of hamstring injuries this year, two ACLs, calf injuries and plantar fasciitis....many of those are very preventable and certainly very manageable.”

We delved further into this muscle conundrum and Professor Doherty tried to adapt some of Claire’s academic work to explain to ECHO readers just what might be the problem at Liverpool...

Hamstring injuries (HSI) are common in sports that involve sprinting and kicking, and in football it accounts for 16% of all injuries, a rate which jumps to 20% higher in the Premier League

What’s worrying for Reds’ fans though is the next fact...HSI has a very high re-injury rate of 40%, and the biggest risk factor for injury is prior injury.

What does the hamstring do?

The key here is that muscles do not work alone. Muscles are part of a team that needs to work together – “You’ll Never Walk Alone” is the perfect phrase for how muscles, including hamstrings work.

When sprinting the hamstring of the back leg rapidly contracts (ie it gets smaller and bulges – like a strong man flexing his arm biceps) and this helps other muscles in extending the hip (or making the thigh move backwards) and bending the knee.

The front leg hamstring works very differently. The powerful quad muscles at the front of the thigh are straightening out the knee getting ready for the foot to strike the ground, the hamstrings are getting longer (this is called working eccentrically) and trying to control this movement.

It is in this phase that most hamstrings are torn.

The teammates

There are multiple ‘team­mates’ for the hamstrings, some of the key ones are the core muscles (especially the gluteals...those things you sit on), the guadriceps muscles and the neuromotor control system (or how body movements are controlled)

Risks for Injury ­- here come the scientific bit...

Previous injury and muscle imbalances such as weak hamstrings, weak gluteals and weak hamstrings relative to the quadriceps can all predispose to injury.

Muscle trauma can be considered as micro or macro.

Macrotrauma occurs when the trauma load is greater than the muscle’s capacity for that load, like when trying to lift something too heavy or the crash and bash injuries we see.

Microtrauma occurs when the trauma load is less than the muscle’s capacity but repeated overload of muscle leads to its failure.

Most non­-traumatic soft tissue injury (like HSI) is due to too much load placed on injured tissue but it is not just bad luck.

Hamstring - villain or victim

Occasionally the hamstring is the villain because it may be weak or tight or not “warmed up.” Mostly though the hamstring is the victim because there is a problem with the other components.

Our mobilising muscles are our “guns” and in the leg they include the hamstrings, the quads, the calf and the groin muscles. These produce movement and power, they are “fast twitch” fibres.

Our neuromotor control system co­ordinates all of this, it conducts the orchestra. In the ideal world the pelvis is stable and the legs can work optimally. When we run, six times our weight needs to be absorbed through ground, better movement patterns will absorb these forces better.

The problem is usually with the team...

Problems are often with the hamstrings’ team­mates rather than the component itself. eg. If your gluteal muscles (the largest muscles in your body) are weak then there is a problem.

To work efficiently the hamstrings need a stable, strong and flexible pelvis - ‘You can’t fire a cannon out of a canoe’ - and this is the responsibility of other members of the muscle team.

For those thinking this is going slightly off track, in essence if you don’t have a stable pelvis to support your gluteal muscles, and your abs aren’t supporting you correctly and doing their job, it is now your hamstrings and gluteals that become the stabilisers, adding an enormous amount of pressure onto both aspects.

Your gluteals are strong enough to cope with this added weight, but added to the already huge pressure on your hamstrings to help you sprint, run, jump, then it is easy to see why so many footballers (who will all weigh a fair bit due to muscle mass) can easily pick up tears and pulls to their hamstring.

It is crucial not to overload players with too many matches and too much training.

Fitness of course is vitally important, but not just cardiovascular fitness. Muscle strength, endurance, power, agility and balance, joint mobility and muscle flexibility and control at key sites are all vital for footballers to prevent injury.

General levels of aerobic fitness, age, over training, sufficient recovery (very relevant with fixture congestion) and fatigue all have good evidence to support them as contributing to hamstring injury. There is also overwhelming evidence that a good warm up/cool down is very effective in reducing HSI. The only problem, is whilst these drills may focus on hamstrings, the other key components that can support them, aren’t being used as much.

To sum up...

Hamstring injuries are common and have a high re­-injury rate high so prevention is very important. There are multiple things that can place players at increased risk and these can be modified. Players at risk should be specifically targeted but all players need to dedicate themselves to injury prevention strategies. Pelvic control, strength and flexibility are just as important as hamstring strength, endurance and flexibility.

Now, anyone fit for Friday?