Hamstring Muscle Injury Research Articles

Time before return to play for the most common injuries in professional football: a 16-year follow-up of the UEFA Elite Club Injury Study

ObjectivesThe objective was to describe the typical duration of absence following the most common injury diagnoses in professional football.MethodsInjuries were registered by medical staff members of football clubs participating in...

Effect of deep transverse friction massage vs stretching on football players' performance.

BACKGROUNDFlexibility, agility and muscle strength are key factors to either win or lose a game. Recently the effect of a new technique, deep transverse friction massage (DTFM) on muscle extensibility as compared to traditional stretching techniques has been examined.AIMTo compare the effect of DTFM vs static and dynamic stretching techniques on the hamstring’s extensibility, agility, and strength amongst Lebanese and Syrian football players. Recording the incidence of non-contact hamstring muscle injury was a secondary objective.METHODSThis study is a single-blinded prospective longitudinal randomized controlled trial. The experiment took place over a period of four weeks. Football players were randomized into three intervention groups (static stretching; dynamic stretching; DTFM). Participants of each group were followed-up carefully by assessors during their intervention sessions three times per week, for a total of 12 sessions and during the data collection. Extensibility, agility, and strength were compared between intervention groups at (baseline; acute; and chronic) phases. Straight leg raise and 1 repetition maximum tests were used to measure the dominant leg hamstring muscle extensibility and maximal strength respectively. T-drill test was used to assess the lower extremities agility.RESULTSOf 103 Lebanese and Syrian male football players aged between 18 and 35 were sampled from Damascus-Syria and South of Lebanon to participate in this study. Between-groups measures of acute strength (P = 0.011) and chronic extensibility (P = 0.000) solely showed a significant difference, and the static group showed to be superior as compared to the other groups. No loss to follow-up or protocol violation was recorded.CONCLUSIONStatic stretching is showing to be superior to the other techniques used, regarding gaining long-term extensibility and short-term maximal muscle strength. In addition, DTFM showed improvements but did not outweigh the effects on footballers’ performance when comparing it to static and dynamic techniques. Finally, no difference between the interventions is recorded regarding the rate of muscle injuries incidence.

Hamstring Muscle Injury Prediction by Isokinetic Ratios Depends on the Method Used.

Hamstring muscle injury prediction by isokinetic strength ratios is low but could result from the method-depending either on the use of the limbs or of the sportsmen as references. We aimed to establish a predictive model including unilateral and bilateral ratios calculated from the dominant, nondominant, right, and left limb in injured and uninjured professional soccer players. Cohort study. Soccer team of the French Professional Premier League. Ninety-one professional soccer players. Isokinetic muscle strength was prospectively measured at the beginning of 5 consecutive seasons (2009-2014). Several bilateral, conventional, and functional ratios were calculated from isokinetic measurements at different angular speeds (60 and 240 degrees/s in concentric mode and 30 degrees/s in eccentric mode). Thirty-one soccer players had a hamstring injury during the seasons and were compared with 60 uninjured players. Four models were tested to predict the occurrence of hamstring injury from isokinetic ratios calculated in accordance with the dominant, nondominant, right, and left limb. No predictive model was found when ratios were calculated from the dominant or the right limb. Two models of prediction were found when ratios were calculated from the nondominant or the left limb. In these 2 models, only the bilateral concentric hamstring-to-hamstring ratio at 60 degrees/s was predictive. The best prediction was found with the left limb. We identified 2 low predictive models for hamstring muscle injuries depending on the limbs studied. Because of a low prediction, the consensual method used to predict hamstring muscle injury must be defined in future studies.

Return-to-Play Practices Following Hamstring Injury: A Worldwide Survey of 131 Premier League Football Teams

PurposeReturn-to-play (RTP) is an on-going challenge in professional football. Return-to-play related research is increasing. However, it is unknown to what extent the recommendations presented within research are being implemented by professional football teams, and where there are gaps between research and practice. The purposes of this study were (1) to determine if premier-league football teams worldwide follow a RTP continuum, (2) to identify RTP criteria used and (3) to understand how RTP decision-making occurs in applied practice.MethodsWe sent a structured online survey to practitioners responsible for the RTP programme in 310 professional teams from 34 premier-leagues worldwide. The survey comprised four sections, based on hamstring muscle injury: (1) criteria used throughout RTP phases, (2) the frequency with which progression criteria were achieved, (3) RTP decision-making process and (4) challenges to decision-making.ResultsOne-hundred and thirty-one teams responded with a completed survey (42%). One-hundred and twenty-four teams (95%) used a continuum to guide RTP, assessing a combination of clinical, functional and psychological criteria to inform decisions to progress. One-hundred and five (80%) teams reported using a shared decision-making approach considering the input of multiple stakeholders. Team hierarchy, match- and player-related factors were common challenges perceived to influence decision-making.ConclusionsGeneral research recommendations for RTP and the beliefs and practices of practitioners appear to match with, the majority of teams assessing functional, clinical and psychological criteria throughout a RTP continuum to inform decision-making which is also shared among key stakeholders. However, specific criteria, metrics and thresholds used, and the specific involvement, dynamics and interactions of staff during decision-making are not clear.

Hamstring-to-Quadriceps Ratio in Female Athletes with a Previous Hamstring Injury, Anterior Cruciate Ligament Reconstruction, and Controls.

Muscle strength imbalances around the knee are often observed in athletes after anterior cruciate ligament (ACL) surgery and hamstring muscle injury. This study examined three hamstrings-to-quadriceps (H:Q) strength ratio types (conventional, functional, and mixed) in thirteen female athletes with a history of hamstring injury, fourteen basketball players following ACL reconstruction and 34 controls. The conventional (concentric H:Q) peak torque ratio was evaluated at 120°·s−1 and 240°·s−1. The functional (eccentric hamstring to concentric quadriceps) torque ratio was evaluated at 120°·s−1. Finally, the mixed (eccentric hamstrings at 30°·s−1 to concentric quadriceps at 240°·s−1) torque ratio was calculated. Both ACL and the hamstring-injured groups showed a lower quadriceps and hamstrings strength compared with controls (p < 0.05). However, non-significant group differences in the H:Q ratio were found (p > 0.05). Isokinetic assessment of muscle strength may be useful for setting appropriate targets of training programs for athletes with a history of ACL surgery or hamstring strain. However, isokinetic evaluation of the H:Q ratio is not injury—specific and it does not vary between different methods of calculating the H:Q ratio.

Platelet-rich plasma in hamstring muscle injuries in professional soccer players. A pilot study

Platelet-rich plasma in hamstring muscle injuries in professional soccer players. A pilot study

Return to play and recurrence rate following hamstring injury in elite football: use of the British Athletic Muscle Injury Classification

Purpose: Hamstring injuries are a significant concern in football owing to prolonged absence from competition. Predicting hamstring muscle injury and determining clinical or imaging consensus for safe return-to-play are challenging. With its potential to assist injury classification, management and prediction, use of the British Athletics Muscle Injury (BAMI) classification to inform precision rehabilitation may expedite time to return-to-play (TRTP) and reduce recurrence. To date, no research has assessed use of the BAMI classification in elite male professional football players. The objective was to evaluate use of the BAMI classification and its association with TRTP and recurrence rate following hamstring injury in elite male football players.

Validation study of the Functional Assessment Scale for Acute Hamstring injuries in Spanish professional soccer players

Objective: To cross-culturally adapt and validate the Functional Assessment Scale for acute hamstring injury for professional Spanish-speaking soccer players. Design: Clinical measurement study. Cross-cultural adaptation was conducted following international recommendations. Indicators of validity, reliability and responsiveness are provided. Subjects: The Spanish version of the Functional Assessment Scale for acute hamstring injury scale was administered to 165 participants: 45 professional soccer players with acute hamstring muscle injury diagnosis, 40 healthy subjects, 40 individuals at-risk for a hamstring muscle injury and 40 patients with injuries of the lower limb other than hamstring muscle injury. Main measures: The Functional Assessment Scale for acute hamstring injury. Reference measures: Spanish version of the Quality of Life Short-Form 36 questionnaire (SF-36) and the Lower Limb Functional Index (LLFI). Results: Cronbach’s alpha (internal consistency) for the Spanish version of the Functional Assessment Scale for acute hamstring injury scale was >0.8. The intraclass correlation coefficient using the two-way random model (ICC2,1) (test–retest) was 0.993 (95% confidence interval (CI): 0.991–0.995; P < 0.05). In the exploratory factor analysis, a one-factor solution explained 85% of the variance. Subjects with hamstring muscle injury scored significantly lower than the other groups in the Spanish version of the Functional Assessment Scale for acute hamstring injury scale (P < 0.001). The Spanish version of the Functional Assessment Scale for acute hamstring injury scale score within the hamstring muscle injury group showed moderate and significant correlations with SF-36 physical components (Spearman’s rs > 0.6; P < 0.001), and LLFI score at baseline (rs = 0.42; P < 0.01). The standard error of measurement (SEM) and minimum detectable change threshold (MDC95%) were 2.6 and 7.2 points, respectively. The responsiveness indicators have an effect size of 3.62, and the standardized response mean is 3.24. Conclusion: The Spanish version of the Functional Assessment Scale for acute hamstring injury scale showed satisfactory psychometric properties. It can be considered a reliable and valid instrument to assess the functional impact of acute hamstring muscle injury in professional Spanish-speaking football players.

Sprint Acceleration Mechanics in Fatigue Conditions: Compensatory Role of Gluteal Muscles in Horizontal Force Production and Potential Protection of Hamstring Muscles.

Aim: Hamstring muscle injury is the main injury related to sports requiring sprint acceleration. In addition, hamstring muscles have been reported to play a role in horizontal force production during sprint acceleration performance. The aim of the present study was to analyze (i) the determinants of horizontal force production and (ii) the role of hip extensors, and hamstring muscles in particular, for horizontal force production during repeated sprint-induced fatigue conditions.Method: In this experimental laboratory setting study including 14 sprint-trained male athletes, we analyzed (i) the changes in sprint mechanics, peak torque of the knee and hip extensors and flexors, muscle activity of the vastus lateralis, rectus femoris, biceps femoris, and gluteus, and sagittal plane lower limb motion, before and after twelve 6-s sprints separated by 44 s rest on an instrumented motorized treadmill, and (ii) the determinants of horizontal force production (FH) during the sprint acceleration in a fatigue state (after 12 sprints).Results: The repeated-sprint protocol induced a decrease in maximal power output (Pmax) [-17.5 ± 8.9%; effect size (ES): 1.57, large] and in the contact-averaged horizontal force component (FH) (-8.6 ± 8.4%; ES: 0.86, moderate) but not meaningful changes in the contact-averaged resultant (total) force (FTot) (-3.4 ± 2.9%; ES: 0.55, small) and vertical force component (FV) (-3.1 ± 3.2%; ES: 0.49, small). A decrease was found in concentric peak torque of the knee flexors and extensors and in gluteus and vastus lateralis muscle activity during entire swing and end-of-swing phase. An increase was found in contact time and swing time, while step frequency and knee speed before ground contact decreased. Muscular determinants associated with FH and its decrease after the repeated-sprint protocol were concentric peak torque of the hip extensors (p = 0.033) and a decrease in gluteus maximus activity at the end-of-swing (p = 0.007), respectively.Conclusion: Sprint-induced fatigue lead to changes in horizontal force production muscular determinants: hamstring muscle seems not to have the same role than in non-fatigue condition. Horizontal force production seems to be more dependent on the hip extensors and gluteus maximus function. Given the fatigue-induced decrease in hamstring muscle strength, we can hypothesize that muscle compensatory and kinematic strategies reported in a fatigued state could be an adaptation to allow/maintain performance and a protective adaptation to limit hamstring muscles constraints.

Full training but not full function: Isometric hamstring strength deficits identified up to three years following injury in Australian Football athletes

Introduction: Reduced pre-season measures of concentric and eccentric hamstring strength have been identified as risk factors for future hamstring injury in soccer and Australian Football. The subsequent implementation of eccentric strength interventions has been shown to modulate this risk. However, the use of standalone pre-season assessments to predict future injury have been questioned with screening now advocated for the identification of existing and persisting deficits which may limit current sports participation. This concept is defined as tertiary prevention – assessments and interventions aimed at identification of persisting deficits following injury which may result in future complications such as recurrence or subsequent injury. The aim of this study was to use a simple and inexpensive method to evaluate unilateral isometric hamstring strength in Australian Football athletes with and without a past-history of hamstring muscle injury sustained within the previous three seasons. This information may inform the implementation of tertiary prevention strategies.

Effectiveness of low-frequency electrical stimulation in proprioceptive neuromuscular facilitation techniques in healthy males: a randomized controlled trial.

Hamstring muscle injuries are common in the sports field, with lack of hamstring flexibility being a risk factor. Stretching the hamstring muscles is an important part of the training and rehabilitation programs used to prevent or treat injury and improve performance. We aim to compare the immediate and follow-up effect on hamstring muscle flexibility between 2 different stretching protocols, proprioceptive neuromuscular facilitation (PNF) stretching and PNF stretching combined with electrostimulation. A second aim is to determine whether physical activity level is related to flexibility. Design of study: Single-blind, randomized controlled trial; Participants: 30 healthy volunteers (30 men, 18-39 years old); Intervention: A 6-session intervention program spanning over 2 weeks and 1-week and 3-week follow-up. The control group underwent PNF stretching with a voluntary contraction. The experimental group underwent PNF stretching but the muscle contraction was triggered with an electrical stimulation device (TENS); Main outcome measu: Hamstring muscles flexibility was assessed using the Modified Sit and Reach (MSR) and the Back Saver Sit and Reach (BSSR) tests. Physical activity level was evaluated with the short form of the International Physical Activity Questionnaire (IPAQ). Both groups showed an overall increase in hamstring muscle flexibility. However, when comparing flexibility gain between baseline and the end of the stretching program (session 6), and at the 1-week and 3-week follow-ups, only the experimental group showed significant differences. No correlation between the IPAQ score and the degree of hamstring muscle flexibility was observed. Hamstring muscle PNF stretching combined with electrical stimulation to trigger muscle contraction during the muscle contraction phase of the stretch achieves better flexibility results when compared to PNF alone.

Genetic Variants and Hamstring Injury in Soccer: An Association and Validation Study.

This study aimed to investigate the association of candidate single nucleotide polymorphisms (SNP) with noncontact hamstring muscle injuries in elite soccer players and to create and validate a model to assess the risk of hamstring injury. A total of 107 elite male outfield players were prospectively followed for six seasons. Players were genotyped for 37 SNP previously investigated in relation to musculoskeletal injuries. The association of SNP, previous injury, age, level of play, position, and anthropometric data with 129 hamstring injuries (413 observations) was investigated in the discovery phase (2010-2015), and a multivariable Cox frailty model was created using forward selection. The model's discriminative ability was tested in the validation phase (2015-2016, 31 injuries, 98 observations) using Harrell's C index. Five SNP were found to be significantly associated with hamstring injury in a multivariable model: matrix metalloproteinase 3 rs679620 (A vs G, hazard ratio [HR] = 2.06, 95% confidence interval [CI] = 1.51-2.81), tenascin C rs2104772 (A vs T, HR = 1.65, 95% CI = 1.17-2.32), interleukin 6 rs1800795 (GG vs GC + CC, HR = 1.68, 95% CI = 1.11-2.53), nitric oxide synthase 3 rs1799983 (G vs T, HR = 1.35, 95% CI = 1.01-1.79), and hypoxia-inducible factor-1α rs11549465 (CC vs CT, HR = 2.08, 95% CI = 1.00-4.29). Age also entered the model (≥24 vs <24 yr, HR = 2.10, 95% CI = 1.29-3.42). The model showed acceptable discrimination in the discovery phase (C index = 0.74), but not in the validation phase (C index = 0.52). Genetic variants appear to be involved in the etiology of hamstring injuries but were not found to have predictive value by themselves. Further research, increasing the number of genetic variants and including environmental factors in complex multifactorial risk models, is necessary.

A single bout of whole-body vibration improves hamstring flexibility in university athletes: A randomized controlled trial

Hamstring muscle injuries are one of most frequent injuries in team sports. Whole-body vibration (WBV) has an important effect on flexibility that could prevent shortening of the hamstrings. To investigate both acute and residual effect of a single bout of WBV on hamstring flexibility in a group of university athletes from team sports. 70 athletes (81% men, age 21 ± 1.9 years old) were separated into three groups; control group (CG; n=24), hamstring flexibility group without vibration (-V; n=23), and hamstring flexibility group with vibration (+V; n=23). Both -V and +V groups performed the same experimental protocol, composed of 6 sets of 30 seconds of passive hamstring flexibility over a vibration platform with both legs alternately (full-length 6 minutes; 3 minutes per leg). A high-magnitude vibration loading was applied only in +V group (40 Hz and 4 mm). Hamstring flexibility was evaluated through the Modified Sit and Reach (MSR) and Passive Straight Leg Raise (PSLR) test before (baseline), immediately after (acute effect), and after 72 h (residual effect) intervention. Both experimental groups showed a significant improvement in flexibility compared to CG in all measures (p<0.05). No statistical differences were found between +V and –V, however, MSR, right PSLR, and left PSLR residual effect size (Cohen's d) were greater in +V. In conclusion, adding a WBV stimulus to flexibility training improves acute and residual hamstring flexibility in university athletes from team sports.

Are Lower Extremity Injuries Related to Spinal form Abnormalities in Professional Football Players? A Prospective Cohort Study

Background: A professional football player sustains 2 injuries per season on average. Lower extremity injuries are the most common injuries among football players. To develop a prevention programs it is essential to recognize risk factors associated with the incidence of injuries. Previous studies focused on intrinsic risk factors of lower extremity. The association between spine abnormities and lower extremity injuries in professional athletes have only been scarcely studied. Objectives: The purpose of this study was to evaluate the effects of various spinal form abnormalities on the rate of lower extremity injuries in male professional football players. Methods: This cohort study among Iranian Football players was implemented during the 2015 - 2016 season. All players were assessed for spinal alignment during Pre Participation Examinations. In total, club doctors documented information of 244 players out of 420 players. Results: There were 155 injuries recorded in total with at least one day absence from training or match, of which the most common injuries were hamstring muscle injuries (n = 41, 26%), ankle ligament injuries (n = 34, 22%) and adductor injuries (n = 25, 16%) respectively. Increasing thoracic kyphosis Cobb’s angle was associated with a reduction in the likelihood of exhibiting quadriceps injury, odds ratio (CI 95%): 0.806 (0.671 - 0.968). Conclusions: The reason why players with lower thoracic kyphosis Cobb’s angle may be at risk for quadriceps injury is not clear. But biomechanical changes such as extensibility of hamstring and the balance between hamstring and quadriceps may partially explain the increased risk.

Lesões dos isquiotibiais: artigo de atualização

Hamstring (HS) muscle injuries are the most common injury in sports. They are correlated to long rehabilitations and have a great tendency to recur. The HS consist of the long head of the biceps femoris, semitendinosus, and semimembranosus. The patient's clinical presentation depends on the characteristics of the lesion, which may vary from strain to avulsions of the proximal insertion. The most recognized risk factor is a previous injury. Magnetic resonance imaging is the method of choice for the injury diagnosis and classification. Many classification systems have been proposed; the current classifications aim to describe the injury and correlate it to the prognosis. The treatment is conservative, with the use of anti‐inflammatory drugs in the acute phase followed by a muscle rehabilitation program. Proximal avulsions have shown better results with surgical repair. When the patient is pain free, shows recovery of strength and muscle flexibility, and can perform the sport's movements, he/she is able to return to play. Prevention programs based on eccentric strengthening of the muscles have been indicated both to prevent the initial injury as well as preventing recurrence.

Hamstring injuries: update article

Hamstring (HS) muscle injuries are the most common injury in sports. They are correlated to long rehabilitations and have a great tendency to recur. The HS consist of the long head of the biceps femoris, semitendinosus, and semimembranosus. The patient's clinical presentation depends on the characteristics of the lesion, which may vary from strain to avulsions of the proximal insertion. The most recognized risk factor is a previous injury. Magnetic resonance imaging is the method of choice for the injury diagnosis and classification. Many classification systems have been proposed; the current classifications aim to describe the injury and correlate it to the prognosis. The treatment is conservative, with the use of anti-inflammatory drugs in the acute phase followed by a muscle rehabilitation program. Proximal avulsions have shown better results with surgical repair. When the patient is pain free, shows recovery of strength and muscle flexibility, and can perform the sport's movements, he/she is able to return to play. Prevention programs based on eccentric strengthening of the muscles have been indicated both to prevent the initial injury as well as preventing recurrence.

Return to play criteria after hamstring muscle injury in professional football: a Delphi consensus study

BackgroundHamstring muscle injury (HMI) is the most common injury in professional football and has a high re-injury rate. Despite this, there are no validated criteria to support return to play...

HAMSTRING MUSCLE INJURY IS THE FIRST INJURY DIAGNOSIS DURING MAJOR ATHLETICS CHAMPIONSHIPS

BackgroundDuring top-level international athletics championships, thigh muscle tear (hamstring muscle tear in particular) was the most commonly reported injury diagnosis. However, there has been no detailed characterisation of hamstring muscle...

Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes.

Background:Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied.Purpose:To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review of all acute calf muscle injuries on a single NFL team from 2003 to 2015 was performed. Player demographics and return-to-play data were obtained from the medical records. All available magnetic resonance images (MRIs) were reviewed by a musculoskeletal radiologist for specific imaging findings that correlated with return to play.Results:A total of 27 calf injuries in 24 NFL players were reviewed, yielding an incidence of 2.3 acute calf injuries per year on a single NFL team. Of these 27 injuries, 20 (74%) were isolated injuries to the gastrocnemius muscle, 4 (15%) were isolated injuries to the soleus muscle, and the remaining 3 injuries (11%) involved both. Defensive players were more likely to sustain injuries (P = .043). The mean time to return to play for all 27 players was 17.4 ± 14.6 days (range, 3-62 days). MRIs were available in 14 of the 27 injuries. The average size of the fascial defect (P = .032) and the presence of a fluid collection (P = .031) both correlated with return to play of longer than 2 weeks.Conclusion:Although less common than hamstring or quadriceps muscle injuries, calf muscle injuries occur with relative frequency in the NFL, and more so in defensive players. The majority of these injuries occur in the gastrocnemius and result in significant disability, with at least 2 weeks of missed playing time on average. MRI may have an important role in the evaluation of calf injuries in NFL players, as certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of a fluid collection, are associated with longer return-to-play times after injury.

MRI appearance does not change in the first 7 days after acute hamstring injury—a prospective study

BackgroundThe optimal timing of MRI following acute hamstring injury is not known and is mainly based on expert opinions.AimsTo describe the day-to-day changes in the extent of oedema and investigate...