Un système « evidence-based » d’exercices de renforcement pour prévenir les blessures aux ischio jambiers
Introduction et donnée de la littérature
Avec en moyenne 17 jours d’arrêt d’entrainement et de compétition, et un coût moyen de 280 000 euros par blessure pour les clubs, les lésions musculaires des ischio jambiers (IJ), sont le fléau du football professionnel.
Alors que l’étiologie est multifactorielle, le renforcement des IJ est une composante incontournable des pratiques en matière de prévention, et occupe une place importante dans la littérature depuis des années. Malgré cela, les données longitudinales suggèrent que le taux de lésions n’a pas diminué depuis une décennie dans le football australien.
Le but de cet article est de fournir une structure « evidence-based » pour la prévention des lésions des IJ. Il sera fait le point sur la force des IJ comme facteur de risque, les preuves du rôle du renforcement des IJ, ainsi que le schéma d’activation des IJ dans différents exercices et leur malléabilité architecturale.
La force comme facteur de risque pour les blessures des IJ
Tout part d’un constat réalisé à partir d’une étude sur des lapins, montrant que des muscles faiblement activés absorbent moins d’énergie avant d’être mis en échec (rupture) par rapport à des muscles pleinement activés. Alors que tout cela semble intuitif, les preuves issues de différentes études prospectives sont variées.
Dans des études utilisant la dynamométrie isocinétique, un grand nombre d’auteurs semblent valider la diminution de force des IJ comme facteur de risque :
Certaines études n’ont néanmoins pas retrouvé d’association entre la force isocinétique des IJ et un risque de lésion (38,42,52)
Des mesures de terrain ont également retrouvé une corrélation entre force musculaire et risque de blessures. Par exemple, les sujets ayant un moins haut niveau de force mesurée lors d’un Nordic Hamstring auraient 4,3 fois plus de chance de se blesser la saison suivante que leurs homologues plus forts.
Là encore la littérature est riche. Un grand nombre d’études au cours de la dernière décennie ont établi que les exercices de renforcement des IJ basés sur l’excentrique et la course externe réduisent le risque de blessures, tant que la compliance reste élevée (12-17). La plupart des protocoles dans ces études mettent en œuvre des exercices comme le Nordic Hamstring, le glider ou encore le YoYo flywheel.
Des mesures de terrain ont également retrouvé une corrélation entre force musculaire et risque de blessures. Par exemple, les sujets ayant un moins haut niveau de force mesurée lors d’un Nordic Hamstring auraient 4,3 fois plus de chance de se blesser la saison suivante que leurs homologues plus forts.
Le renforcement protège-t-il contre les lésions des IJ ?
Là encore la littérature est riche. Un grand nombre d’études au cours de la dernière décennie ont établi que les exercices de renforcement des IJ basés sur l’excentrique et la course externe réduisent le risque de blessures, tant que la compliance reste élevée (12-17). La plupart des protocoles dans ces études mettent en œuvre des exercices comme le Nordic Hamstring, le glider ou encore le YoYo flywheel.
Impact de la sélection des exercices sur l’activation des IJ
De nombreuses études, utilisant l’EMG de surface ou l’IRM fonctionnelle, fournissent des preuves suggérant que les ischio jambiers ne sont pas activés de la même manière en fonction de l’exercice réalisé.
Les études EMG semblent révéler la tendance suivante (variabilité de résultats en fonction des études) :
- Les mouvements orientés autour de la flexion du genou active préférentiellement le semi tendineux
- Les mouvements orientés autour de l’extension de hanche active la longue portion du biceps fémoral (LPBF)et le semi membraneux.
La figure suivante représente le ratio d’activation du LPBF par rapport au semi tendineux en fonction de différents exercices, mesuré par EMGs. Un ratio supérieur à 1.0 indique un plus haut niveau d’activation du LPBF que du semi tendineux.
Une autre façon d’attester la différence d’activation des IJ en fonction des exercices est la mesure des dégâts musculaires causés après exercice. Une augmentation retardée du signal T2 (LPBF) est à mettre en parallèle comme conséquence d’un œdème suite aux dégâts musculaires.
Kubota (83) a donc montré qu’un exercice de Leg Curl excentrique résulte en un T2 élevé pour le ST, mais pas pour le LPBF ou le SM, 72 heures après l’exercice.
Des preuves récentes (44) suggèrent que les joueurs de foot professionnels avec une plus petite longueur fasciculaire du LPBF (< 10,56 cm), sont 4,1 fois plus exposé à une blessure de ce même muscle que ceux ayant une longueur plus importante. La probabilité de réduction de blessures est de 21% par centimètre de longueur fasciculaire gagné.
Il a été montré que la longueur fasciculaire du LPBF peut être augmentée après avoir suivi un entrainement excentrique, mais pas concentrique. Par exemple, Potier (31) observe une augmentation de 34% de la longueur fasciculaire de LPBF après 8 semaines d’exercice de Leg Curl excentrique. D’autres études montrent au contraire une diminution de la longueur fasciculaire suite à un entrainement concentrique.
Kubota (83) a donc montré qu’un exercice de Leg Curl excentrique résulte en un T2 élevé pour le ST, mais pas pour le LPBF ou le SM, 72 heures après l’exercice.
Adaptation architecturale, morphologique et performance suite à différents exercices.
Des preuves récentes (44) suggèrent que les joueurs de foot professionnels avec une plus petite longueur fasciculaire du LPBF (< 10,56 cm), sont 4,1 fois plus exposé à une blessure de ce même muscle que ceux ayant une longueur plus importante. La probabilité de réduction de blessures est de 21% par centimètre de longueur fasciculaire gagné.
Il a été montré que la longueur fasciculaire du LPBF peut être augmentée après avoir suivi un entrainement excentrique, mais pas concentrique. Par exemple, Potier (31) observe une augmentation de 34% de la longueur fasciculaire de LPBF après 8 semaines d’exercice de Leg Curl excentrique. D’autres études montrent au contraire une diminution de la longueur fasciculaire suite à un entrainement concentrique.
Il est aussi suggéré qu’une aponévrose plus large influence la localisation et l’ampleur d’une tension appliqué au muscle. Rehorn et Blemker (96) rapporte qu’une diminution de 80% de la largeur de l’aponévrose proximale du LPBF augmente de la tension de la jonction myotendineuse proximal de 60%. Or, 4 semaines de renforcement impliquant l’exercice de Nordic Hamstring, Leg Curl et l’extension de hanche modifie l’expression collagénique de l’endomésium des fibres musculaires.
Enfin, une amélioration de 2,4% dans les courses de plus de 30 mètres a été rapporté après 10 semaines d’entrainement comprenant le flywheel leg curl (54).
Ainsi lors de nos prises en charge, on ne rééduquera pas une lésion des ischio jambiers de la même façon, en fonction du muscle et de la portion touchée. Il en va de même pour la prévention. Une prévention basée sur un seul type d’exercice protégera plus la partie des ischio jambiers étant plus activée pour cet exercice donné, mais moins les autres.
De même, l’architecture d’un muscle peut l’exposer à un risque de blessures plus élevé. Nous avons la capacité d’influencer plusieurs paramètres architecturaux et morphologiques du muscle. Cela doit se faire en corrélation avec la physiologie musculaire et l’implication fonctionnelle de la structure lors du geste sportif.
An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury . Matthew N. Bourne • Ryan G. Timmins• David A. Opar • Tania Pizzari • Joshua D. Ruddy • Casey Sims • Morgan D. Williams • Anthony J. Shield
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108. Mendiguchia J, Martinez-Ruiz E, Morin JB, et al. Effects of hamstring-emphasized neuromuscular training on strength and sprinting mechanics in football players. Scand J Med Sci Sports. 2015;25(6):e621–9.
109. Brockett C, Morgan D, Proske U. Human hamstring muscles adapt to eccentric exercise by changing optimum length. Med Sci Sports Exerc. 2001;33(5):783–90.
110. Clark R, Bryant A, Culgan J-P, et al. The effects of eccentric hamstring strength training on dynamic jumping performance and isokinetic strength parameters: a pilot study on the impli- cations for the prevention of hamstring injuries. Phys Ther Sport. 2005;6(2):67–73.
111. Brughelli M, Mendiguchia J, Nosaka K, et al. Effects of eccentric exercise on optimum length of the knee flexors and extensors during the preseason in professional soccer players. Phys Ther Sport. 2010;11(2):50–5.
112. Kilgallon M, Donnelly AE, Shafat A. Progressive resistance training temporarily alters hamstring torque-angle relationship. Scand J Med Sci Sports. 2007;17(1):18–24.
Enfin, une amélioration de 2,4% dans les courses de plus de 30 mètres a été rapporté après 10 semaines d’entrainement comprenant le flywheel leg curl (54).
Implication dans la stratégie de prévention
Ainsi lors de nos prises en charge, on ne rééduquera pas une lésion des ischio jambiers de la même façon, en fonction du muscle et de la portion touchée. Il en va de même pour la prévention. Une prévention basée sur un seul type d’exercice protégera plus la partie des ischio jambiers étant plus activée pour cet exercice donné, mais moins les autres.
De même, l’architecture d’un muscle peut l’exposer à un risque de blessures plus élevé. Nous avons la capacité d’influencer plusieurs paramètres architecturaux et morphologiques du muscle. Cela doit se faire en corrélation avec la physiologie musculaire et l’implication fonctionnelle de la structure lors du geste sportif.
Article original
An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury . Matthew N. Bourne • Ryan G. Timmins• David A. Opar • Tania Pizzari • Joshua D. Ruddy • Casey Sims • Morgan D. Williams • Anthony J. Shield
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109. Brockett C, Morgan D, Proske U. Human hamstring muscles adapt to eccentric exercise by changing optimum length. Med Sci Sports Exerc. 2001;33(5):783–90.
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