Hamstring Training and Injury Management in Team Sports, Episode 2: Conversation with Darcy Norman
After the first successful article/interview of the hamstring management series with Ken Crenshaw of Arizona Diamondbacks, it's time to introduce the second episode with the great Darcy Norman, currently Director of Performance at AS Roma.
I'm very honoured to have Darcy as a guest of this series as his concepts are always a great stimulus for discussion.
© AS Roma
AR: Darcy, you've been working in professional football for a long time now. Can you explain how your role has evolved over time and how you actually manage all the aspects related to performance and rehab?
Darcy Norman: Prior to football I had training/schooling as a physical therapist/athletic trainer and strength coach so I have worked in those individual capacities as well as integrated capacities, so that those are the glasses I look through when working with someone either as a patient or as an athlete trying to improve performance. It is all the same just different points in the spectrum of the human body. Its all the same physiology. Good or bad I have had the opportunity to work with 8 different head coaches which all do things a little differently and emphasize different things. Some promoted gym work and others not at all, so I feel like in the short time I have been in football I have had a broad experience.
At Bayern I was a rehab and performance coach or athletic coach brought by the head coach at the time, working on a team of other fitness coaches. As the head coach changed I took on more of just a rehab coach which really made me look at where the players were at their time of injury, the injury and impact that had as well as the demands the coach was asking of the team and trying to get the athlete prepared for those demands in the context of football in a very progressive and thoughtful way.
When joining the DFB I did a similar role but then also added on the data side doing the physical data analytics of training through the end of WC 2014.
When I joined AS Roma it was putting all aspects of my work career together to build a performance department where medical, physical therapy, fitness, nutrition, psych, data analysis was all working together in a harmonious way and improve the performance of our athletes and give them the best opportunity to express their abilities.
As far as how I manage all the aspects it is a little bit of a paradox. In one way I look at things a holistic perspective realizing it is all a complex system with many variables to the situation both around the club, athlete, the environment, staff etc. Realizing that I also look at things in a reductionist approach like a supply chain management style to try and make sure no rock is left unturned creating robust systems as to providing the athlete the best environment to express their abilities. At the end of the day what I think creates true success within the team is having the whole club and performance staff all on the same page moving in the same direction supporting each other.
AR: Hamstrings injury still seems to have a large impact on football players. Do you think there is still the need to emphasize hamstrings training over a more comprehensive performance program? What is your approach in pre-season and during season?
Darcy Norman: It was actually just released the other day that Hamstring injuries are actually decreasing by the standard of the UEFA Champions League Study. They say over the last 4-5 years the incidence is decreasing. I think that is due to the attention and research the study created in the first place and the work is starting to pay off. It is also of my opinion working in soccer/football that football players are inherently weaker compared to other sports mainly due to the fact that there is not the culture of strength training in the sport and I think this is what is changing as well. The strength training in general as we know it gives us a lot of benefits. It helps with recovery, it makes the athlete more robust, it in directly improves their metabolic capacity by reducing the energy per step the strong they are etc.
There are some academies out there now building monsters and changing the game and it will take a generation for this to catch up to levels of say Rugby. I think there always needs to be a comprehensive strengthening program in any sport and not just doing more of any one thing.
Personally where I think a lot of people might get it wrong is looking at the hip biomechanics and the tendency to have poor glute/hamstring/erector hip extension working relationship. I think if you referenced Shirley Saharmann's work you would see that the glutes have a significant role over hamstring health due to the control of the femur in the acetabulum and maintaining the Path of Instantaneous Center of Rotation (PICR) and this is also the case for quad and hipflexor strains as well.
AR: Most performance and rehab professionals doesn't make a proper distinction between training for hamstrings health and training for hamstrings rehab. The different situation in muscle physiology between a previous injured and a non-injured athlete leads to different methods and training variables. How do you manage the rehab process and what baseline testing and metrics you use for return to play decision?
Darcy Norman: For me the process is generally the same it just depends where on the competency spectrum the athlete is at in their abilities and the daily demands their faced with. As Charlie Weingroff says Training=Rehab and Rehab=Training. You have to assess the athlete and meet them where they are at and take them forward. For some it is a strength issue, some it is a coordination issue, some have high threshold compensations, some have low threshold compensations, some have muscle quality issues etc. The bottom line is the athlete needs good tissue quality, requisite mobility, active and passive (muscular and neural), you need requisite stability within the trunk and hips to be able to effectively push and pull from. You need to be able to use your glutes effectively with hip extension and not at the expense of your hamstrings and erectors. You need requisite strength, you need proper coordination patterning in the movement itself, you need an effective stretch shorten cycle and tendon capacity and you need requisite metabolic support. Its are goal to hit all of those in a comprehensive periodized program using a variety of methods in the various components for tackling them given the logistics we are faced with in our environment from the athlete, the facilities, our coaching, therapy capacity etc and trying to do it in the most effective and efficient manner.
AR: An holistic approach to hamstrings training seems to be supported by some recent researches as well as what we see in daily practice. How important is a proper speed and coordination training into the hamstrings conditioning process?
Darcy Norman: I think soon you will see a consensus paper coming out on this topic. I think from a coordination perspective it helps prevent problems but in both a direct and indirect way. Firstly in an indirect way the more coordinated you are the more efficient you move, the more efficient you move the less energy you burn for the same work and therefore conserving energy helps you mitigate fatigue for the same work. In a direct way it is more around the coordination of the Glute/Hamstring/Erector complex with hip extension. I think if this is done well it puts the hamstrings in a better advantage position limiting the amount of relative stress for the same work. And speed or rate of contraction is just another strength quality to the specificity of running so this also should be addressed to build up the tolerance to handle higher volumes needed for the demand.
AR: Eccentric strength and fascicles length are two fundamental parameters related to the risk of hamstrings injuries. Nordic exercise as well as flywheel eccentric can have their place into a training plan but overemphasizing a single exercise or method is a big problem in professional sport. What is your opinion about the way eccentric exercises are being used today?
Darcy Norman: I don’t know how all the ways they are being used today so its hard to comment without standing in the shoes of the people doing it in their environment under their circumstances. I think we are quick to judge others programs without really knowing or understanding the persons or programs constraints. I think more of that energy needs to be put into reviewing and refining our own programs to be the best possible we can.
I only know what I and we do and I do agree with your statement that they shouldn’t be overemphasized and not just in professional sport but all sport and they are just one more method in the in the tool box. But it is all about a balanced program for what the needs of the athlete are at that point and the demands placed against them and goals they are able to achieve. There is no one size fits all. There are many things to consider when using eccentrics. The training age of the athlete, the movement quality of the athlete, the current strength of the athlete, the exercise you are using to stress the eccentric and also the type of eccentric. Is it an overload, is it lowering time etc. Lets be clear if you are doing a full movement there is an eccentric phase to it. So theoretically we have been doing eccentrics ever since we started moving. I also have to say that I am not a fan of Nordics I use them but not to the volume you see being done. I think they are very overused for the requisite strength most athletes have in their hip complex to maintain the appropriate position while doing them. A lot of the examples you see on the net are doing them without any regard to what is happening in the hip and low back and as a result could be causing more hamstring problems by screwing up the hamstring/glute/erector balance.
© AS Roma via Getty Images
AR: Technology application is growing today and professional teams are starting to invest in high-end equipments to best assist the health of the players. Neuromuscular diagnostics systems as well as eccentric strength asymmetry testing are growing in popularity both in USA and Europe. What is your approach to monitoring hamstrings condition during the season?
Darcy Norman: For sure it is a nice to have but it is not necessarily a must have. We have to realize that there were many good programs being carried out prior to the advent of this tech. Its just another data point to help you dial in a program. As far monitoring hamstrings during the season, we are not monitoring one muscle group per se but the overall wellness of the athlete. If the athlete has muscle soreness they have muscle soreness regardless of where. We may modify the treatment or maybe some specific recovery strategies, or load volume both on the pitch or in the weight room. I think technology is great but it also takes more time for the set up and interaction with that technology with the players and when you only have 20min to get a lift in I tend to not use tech as much as it takes away from the actually training of the athlete. Technology is more easily used when you are more in a one on one setting with athletes when you may have a little more time but can be a detriment when your training a whole team at once. We are tracking their outputs in their lifts related to Hamstrings as well as isolated movements like Nordics but we are also monitoring that they are maintaining or improving their active straight leg raise. What I have noticed over time is that as the fatigue of the player gets higher their active straight leg raise decreases which I think is a key part to maintaining healthy hamstrings.
AR: The last topic i want to address is the difference between weight-bearing and non weight-bearing exercises for hamstrings function. Muscle activation as well as timing and coordination are highly influenced by foot strike dynamics and overall foot/ankle function: what is your opinion about the ratio between weight-bearing and non weight-bearing hamstrings exercises in a specific training program?
Darcy Norman: I think this question is better stated as closed chain vs open chain. I don’t really look at this ratio, we have a tendency to do as much stuff as possible with our feet on the ground in a closed chain scenario. The only thing we don’t is really our glute bridge-slideboard-physioball-Nordic hamstring progression which would be considered open chain. We always have that in the program as well as some version of a RDL/DL. So I guess I would have to say it is at minimum 1:1 WB vs NWB or CC vs OC with if I had to pick one it would be WB/CC and the ratio would only go up from there. So 2:1, 3:1 WB vs NWB. I don’t know if it would never go the other way for me unless you were looking to add a lot of volume and needed/wanted more exercise variety.
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