Dougherty: Old-school answers for NFL's non-contact injury epidemic
James Marshall’s two hobbyhorses are non-contact sports injuries and the Green Bay Packers.
His interest in injuries is natural. He has been a strength and conditioning coach with three professional rugby teams in the United Kingdom and is a personal trainer for athletes there.
But the Packers? For a guy whose work in team sports has been primarily in rugby an ocean away?
When the NFL started televising games in the UK in the early 1980s, Marshall chose the Packers as his team mainly because of their small-town roots. And it was strange indeed this week to hear him rattling off the Packers’ recent run of injuries to David Bakhtiari, Bryan Bulaga, Jason Spriggs and Davon House, among others, just like any fan who keeps a close eye on the team.
Marshall also follows the NFL closely enough to know about the devastating blow that the Packers’ NFC North Division rival Minnesota Vikings absorbed last weekend when rookie running back Dalvin Cook sustained a non-contact torn ACL.
So it’s both professional and personal for Marshall to monitor NFL injuries, especially the Packers’, from afar. And professionally, he views injuries as a disciple of Vern Gambetta. Gambetta is a functional-training guru who has worked for numerous professional sports teams in the U.S. and internationally, and for a decade has run a highly respected sports-performance clinic called GAIN (Gambetta Athletic Improvement Network) that features coaches from all over the world.
“Most of these non-contact (injuries) are preventable,” Marshall said in a telephone interview this past week.
Now, it turns out the hamstring injuries that sidelined Bakhtiari and landed Spriggs on injured reserve don’t fall cleanly into the preventable category – both were hurt by contact that forced their leg to stretch to the point of injury.
Regardless, there’s still the larger issue: Pulled hamstrings and non-contact ACLs remain prevalent, even epidemic, in the NFL.
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House, for instance, missed the first three preseason games because of a hamstring injury. And a quick look through the NFL’s injury report this week was an eye-opener: 28 players were listed as having hamstring injuries, another 13 with groin injuries and five with calf injuries. Wow.
Let’s start with the premise that nobody has a monopoly on wisdom when it comes to training NFL players. And there are trainers out there with all different kinds of philosophies who think they have the best answer.
We also have to take into account that players are much bigger than they were 40 and 50 years ago. In Super Bowl II 50 years ago, the Packers’ heaviest starter was defensive tackle Ron Kostelnik at 260 pounds. Against Dallas on Sunday it will be guard Jahri Evans at 318. Bigger players mean bigger collisions and more stress on their bodies.
But it does seem that the more teams and performance coaches have learned in recent years, the more they’ve moving to integrate training that looks a lot like it did decades ago before weightlifting became king.
Of course, conventional weightlifting has to be a core part of any program, but as injury studies and GPS movement data accrue, training is evolving to workouts that are more sport specific, not just to improve performance but also to reduce injuries such as pulled hamstrings and non-contact ACL tears. So, for instance, in sports, or specific positions, that requiring sprinting or cutting, players have to emphasize practicing sprinting and cutting, and not just the sprinting and cutting they do in competitive drills in practice.
“Train movements, not muscles,” said John Pryor, a former strength and conditioning coach in Australia’s highest professional rugby league and a trainer for pro athletes in that country as well as for Japan’s national rugby team. “It’s a simple thing to say, but to have that reflected in the way you prepare – it takes more effort, it takes more thinking, it takes a certain qualitative approach.”
In some ways, UK and Australian pro sports are a little ahead of the United States because they’ve been using GPS tracking on their athletes since the early 2000s. The Packers, on the other hand, have been using it for only about five or six years, and they were among the early adopters in the NFL.
Also, even with the help of consultants from overseas, the Packers and other NFL teams have to adapt their use of GPS to football, which has a different tempo than rugby, and a variety of positions that demand markedly different athletic traits and movements. For linemen and receivers, football really is two different games.
“It probably took six years of use before we really refined the way in which we’re using (GPS),” Pryor said.
Initially, GPS looked like a way to prevent overtraining injuries by quantifying players’ workloads in practice and finding patterns for when they’re more susceptible to injury. But that really only told a small part of the story.
Gambetta, the functional-training guru who has worked with teams in all major sports though only infrequently in the NFL, thinks GPS used incorrectly has contributed to undertraining athletes for what they’re asked to do in games. And he thinks that has led to preventable non-contact injuries.
“We’re so overprotective of the athletes that we’ve created fragile athletes,” he said in an interview late this past week. “We’re not preparing them for the rigors of what happens in the game. And this is not the boot-camp mentality.”
It also turns out that the best way to prevent hamstring injuries isn’t performing exercises that isolate the hamstring, such as the currently in-vogue hamstring exercise Nordic curls, regardless of what some oversimplified studies say.
Non-contact hamstring pulls occur almost exclusively when sprinting. The hamstring connects at two joints (the knee and hip) that move when running, so hamstrings have to be regularly trained at full speed in an amount the player would run in a game. Gambetta thinks that the sprinting players do in practice drills isn’t enough.
“There is too much isolated hamstring strengthening work being done and not enough emphasis on sprinting at top speed with proper mechanics,” Gambetta said. "… (Sprinting in practice drills) is not anywhere – you have to go faster than you do in the game in order to inoculate yourself.”
Standing, one- and two-legged hamstring-specific exercises are common among pro sports teams and helpful, but players who sprint and cut also need regular sprinting work plus hamstring- and ACL-specific running drills.
Pryor, for example, will set up a large figure eight on half a rugby pitch and have players run around it full speed. That trains their hamstrings and ACLs at the various angles they might move in a game. As training progresses, he’ll make it harder by strapping relatively lightweight to their shoulders, so they still can run fast but with more resistance.
It’s all about reminding the body of the timing and form required from the hips, hamstrings and knees when moving full speed and changing directions, so there’s not excessive stress on any one joint or muscle. Non-contact ACL tears, for instance, are a deceleration injury. That is, they occur when a player stops or cuts suddenly, and the force shears the ACL. Proper neuromuscular timing protects the ACL.
“Essentially we’re in the business of training coordination, and we need to train that coordination with resistance … to make those (movement) patterns more robust,” Pryor said. “… If you (move) in such a way that before your foot ever hits the ground you’ve recruited hamstring, you’ve recruited core, then the force is distributed through a much larger area (than the knee). Your entire leg, your torso.”
And Gambetta is a big believer in routinely training players in awkward positions, such as landing on one foot while trying to catch a ball, “so that they’re ready for unusual positions, so they’re robust and the game is no surprise.”
One disadvantage for NFL teams is they can’t use GPS on players in games, so they can’t measure exactly how often or for how long a wide receiver, running back or defensive back is accelerating or going full speed in a game. Pryor has that data for his rugby players, so he can train them for the worst-case load they might see in a game.
He says that in the five months he worked with Japan’s national team for the Rugby World Cup in 2015, his team had no pulled hamstrings or calves, and no torn ACLs. In pool play, Japan upset South Africa in what The Guardian newspaper called “the biggest shock in rugby history, bar none.”
“If they’re not hitting those top speeds in training, I might have them do some extra work to replicate that,” Pryor said. “Conversely, if you see a player who normally has a high acceleration profile and all of a sudden it’s down a little bit (according to GPS), he might have some inhibition going on around the knee and that could be a precursor to a knee injury.”
Another disadvantage for the NFL is that there are significant stretches of time in the offseason – from the end of the season until about April, and from later June to late July – when they aren’t allowed to work with their players because of the collective bargaining agreement. At those times, players work with personal trainers.
“(Players) could be going off to some personal trainer, some guru someplace and doing stuff that could be causing the injuries, not preventing them,” Gambetta said.
NFL teams have been trying to solve their injury conundrum for years now. So let’s face a fact: Injuries are a big and inevitable part of the game. These are large, fast men slamming into each other play after play. That’s not going away.
But sometimes it’s hard not to think that injuries in this league have reached the level of absurdity. And isn’t it something that as the people who study sports performance learn more, there’s a sense they’re turning back the clock to the days before weightlifting was king?
“(Some teams still) just want guys getting bigger in the gym because size wins games,” said Marshall, who is steeped enough in Packers' history to have read a book by Vince Lombardi.
“Lombardi wrote a book ‘Run to Daylight’ that was the philosophy speed, speed, speed, quality of movement, repeat the quality of movement, repeat the quality of movement.”
So there it is. The seeds of this answer, like many in football, might be found in looking back to Lombardi.