Effect of the Nordic Hamstring Exercise in Preventing Hamstring Injuries

Positionality and Research Questions

Introduction

Hamstring injuries (HI) are one of the most frequent non-contact injuries in sports with sprinting or jumping requirements (Petersen and Hölmich, 2005). In professional football particularly, the HI rates appear to be increased, as they constitute the 11% of preseason and 12% of the during season total muscle injuries (Liu et al, 2012). Moreover, HI seem to have quite high re-injury percentages, as according to Goode et al (2015) this possibility is about 12% – 33%. The rehabilitation procedure of HI is quite challenging for both physiotherapists and players and the athlete’ s absence during rehabilitation time is cost-effective for the team (Al Attar et al., 2017).

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The combination of all the above increased the need of creating training programmes focused on the prevention of such kind of injuries (Goode et al., 2015; Van den Horst et al., 2015). Most of these kind of programmes included strengthening, balance as well as jumping and landing exercises, having as common highlighting factor the significance of eccentric training (Goode et al., 2015) or its combination with the Nordic hamstring exercise (Al Attar et al. ,2017; Thorborg et al., 2017). Despite the fact that all of the three had a positive outcome, one of them included athletes from other sports too (Goode et al,2015), while the other two included both professional and amateur football players (Al Attar et al., 2017; Thorborg et al., 2017). So, a training programme for preventing HI in high level professional football players has not been investigated yet.

Furthermore, in spite of the interesting outcomes of these quantitative investigations, it is found that there can be an affection of the outcome because of athletes’ awareness or biases of such kind of programmes (Van den Horst et al., 2015).

Taking into consideration all of the previous information, the approach through which this study is going to be prospected is that of mixed methods, so that a combination between the use of a possibly beneficial HI preventive programme and players’ awareness or biases about that to be explored.

Methodological Choice

The research question is going to be the following: “What is the effect of a programme which includes the Nordic hamstring exercise in preventing HI in high level professional football players?”

My question is structured according to the pragmatic paradigm point of view in order both of quantitative and qualitative approaches to be covered through a mixed methods research. This is going to bring an equivalent contribution of the two kind of findings in order the outcome to be holistic approached (Shaw et al., 2010; Cooper et al., 2011).The use of mixed methods is always going to be challenged, as the purism proponents will never stop claiming that quantitative and qualitative deduction are not equally ‘weighted’, as the first one is taken more into consideration (Denzin, 2006).Despite these arguments, the rates of mixed methods use in clinical studies seem to increase (Cooper et al., 2011). Moreover, Gelo et al (2008) characterized the performance of mixed methods as a useful ‘fruitful’ context of research while Yoshikawa et al. (2008) suggested that mixing quantitative and qualitative research is ‘vital’ for scientific development, so I think that this is the most suitable approach that a pragmatist could have.

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By adjusting all of these elements of mixed methods in the particular research question, both of quantitative and qualitative findings will benefit from each other, creating this way a more powerful and spherically covered research (Johnson et al., 2007; Rauscher and Greenfield, 2009).That is going to be an outcome of the combination of the numerical collected information with the psychosocial approach of the athlete, the need of which appeared to be at least necessary (Mulder, 2007; Neupert et al., 2018). Finally, a mixed method paradigm can give the ability to generate the proven evidence through the junction of the subjective and objective information (Shaw et al., 2010; Cooper et al., 2011). However, skillful ‘handling’ is required in order this demanding procedure to be completed appropriately (Bryman, 2007).

In contrast with my pragmatic point of view, positivists would claim that the deductively interpreted statistical recorded data are the key point for a safe conclusion in a research question (Yilmaz, 2013). In addition, they would try to eliminate the interpersonal contact between the examiners and the sample’ s individuals in order any possible risks of biases to be eliminated (Teddlie and Tashakkori, 2009). For this purpose, they would probably use a self-administrated questionnaire such as FASH, which has been proved to be quite valid and reliable (Lohrer et al., 2016). They would support their opinion with evidence providing that their objectivity and the quantitative approach of a research have been presented historically more than considerable even in mental health investigation (Picton et al., 2017). Their last concern would be an enormous participating sample, so that the results to be more easily generalisable for similar instances (Bryman, 2004). However, since we do not talk about machines but people, it is very important apart from the objective side of numerical scales and monitoring, we have to act in a multidimensional athlete-centered way according to the biopsychosocial (mostly psychosocial in this certain occasion considering that football players are biomedically healthy) model (Yilmaz, 2013). This is supported even more by research that proved the feedback that these athletes need in order to maximize the effectiveness of objective tools such as monitoring systems (Neupert et al., 2018). Considering all of the above and having in mind the fact that qualitative details could enrich even more the importance of quantitative findings (Coyle and Williams, 2000), I think that the ‘umbrella of pragmatism’ could be the cover for the combination of them.

Interpretivists would have exactly the opposite opinion with positivists, as the collection of qualitative information and the inductive analysis of them is what they consider to be the most important part of the research (Yilmaz, 2013). Their approach would be supported by the already known offer of qualitative research in health related issues (Sofaer, 1999). Moreover, the feedback that has to be given to the athletes through their visuomotor system (Hülsdünker et al., 2018) as well as advice and information for the performance of the exercise (Neupert et al., 2018) require interaction between the researcher and the sample. These are affiliated with the psychosocial part of the sample’s individuals in the upper research instance and according to interpretivists information about this is inseparable part of qualitative research (Hesse-Biber, 2010). Despite the useful contribution of the qualitative information, in my pragmatic point of view, they are not adequate to investigate the research question without the adding of quantitative information. This comes as a result of restrictions such as a smaller number of individuals taking part in the investigation sample and the non-safety of extracting conclusions that could be generalisable in similar research cases or populations (Hesse-Biber, 2010). However, they would be a part of my mixed methods research approach, as their combination with the quantitative data would enrich the depth of the investigation (Rauscher and Greenfield, 2009) forming the perfect triangulation of information for a mixed methods research (Teddlie and Tashakkori, 2009; Rauscher and Greenfield, 2009; Coyle and Williams, 2000; Yoshikawa et al., 2008).

Conclusion

Since there are some first encouraging research outcomes about the use of a programme including the Nordic hamstring exercise for preventing HI injuries in some sample populations, it is absolutely worth investigating it in high level professional football players where training and gaming situations are much more demanding and the avoidance of injuries could be considered as ‘vital’. The prevention of HI is going to be a significant advantage for both players and physiotherapists due to its classification as one of the most common injuries and its high re-injury rates. However, everything should be taken into consideration according to my pragmatic point of view in order to ensure that a safe conclusion is going to be extracted, so the approach will be more multifactorial.

The mixed methods approach give the researcher the opportunity to cover all of the different aspects in such kind of investigation, as regards quantitative and qualitative findings. The contribution of these two will provide the objective (numerical) and the subjective (psychosocial) analysis respectively, giving that way a more holistic exploration of the effectiveness of such kind of programmes. Thus, the validity of the results will be stronger and safer investigation conclusions could be extracted.

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