Management Of Hamstring Injuries Research Articles

Can We Modify Maximal Speed Running Posture? Implications for Performance and Hamstring Injury Management.

Sprint kinematics have been linked to hamstring injury and performance. This study aimed to examine if a specific 6-week multimodal intervention, combining lumbopelvic control and unning technique exercises, induced changes in pelvis and lower-limb kinematics at maximal speed and improved sprint performance. Healthy amateur athletes were assigned to a control or intervention group (IG). A sprint test with 3-dimensional kinematic measurements was performed before (PRE) and after (POST) 6 weeks of training. The IG program included 3 weekly sessions integrating coaching, strength and conditioning, and physical therapy approaches (eg,manual therapy, mobility, lumbopelvic control, strength and sprint "front-side mechanics"-oriented drills). Analyses of variance showed no between-group differences at PRE. At POST, intragroup analyses showed PRE-POST differences for the pelvic (sagittal and frontal planes) and thigh kinematics and improved sprint performance (split times) for the IG only. Specifically, IG showed (1)a lower anterior pelvic tilt during the late swing phase, (2)greater pelvic obliquity on the free-leg side during the early swing phase, (3)higher vertical position of the front-leg knee, (4)an increase in thigh angular velocity and thigh retraction velocity, (5)lower between-knees distance at initial contact, and (6)a shorter ground contact duration. The intergroup analysis revealed disparate effects (possibly to very likely) in the most relevant variables investigated. The 6-week multimodal training program induced clear pelvic and lower-limb kinematic changes during maximal speed sprinting. These alterations may collectively be associated with reduced risk of muscle strain and were concomitant with significant sprint performance improvement.

Tears of biceps femoris, semimembranosus, and semitendinosus are not equal-a new individual muscle-tendon concept in athletes.

Objectives:Hamstring injuries are common and can now be accurately diagnosed. In addition, novel surgical indications have been introduced. However, evidence-based guidelines on the hamstring injuries in management of top-level athletes are missing.Methods:The management methods and outcomes of treatment are classically based on relatively small case series. We discuss a novel concept based on the fact that each tendon of the hamstrings muscle should be managed in an individual fashion. Furthermore, suitable indications for hamstring surgery in athletes are introduced.Results:The present study introduces modern treatment principles for hamstring injury management. Typical clinical and imagining findings as well as surgical treatment are presented based on a critical review of the available literature and personal experience.Conclusions:Hamstring injuries should not be considered to be all equal given the complexity of this anatomical region: The three separate tendons are different, and this impacts greatly on the decision-making process and outcomes in athletes.

Match High-Speed Running Distances Are Often Suppressed After Return From Hamstring Strain Injury in Professional Footballers.

Background:High-speed running is commonly implicated in the genesis of hamstring injury. The success of hamstring injury management is typically quantified by the duration of time loss or reinjury rate. These metrics do not consider any loss in performance after returning to play from hamstring injury. It is not known to what extent high-speed running is altered on return to play after such injury.Hypothesis:Match high-speed running distance will change after returning from hamstring injury.Study Design:Non-randomized cohort.Level of Evidence:Level 3.Methods:Match high-speed running distance in highest level professional football (soccer, Rugby League, Rugby Union, and Australian Rules) were examined for a minimum of 5 games prior and subsequent to hamstring strain injury for individual differences using a linear regression models approach. A total of 22 injuries in 15 players were available for analysis.Results:Preinjury cumulative high-speed running distances were strongly correlated for each individual (r2 = 0.92-1.0; P < 0.0001). Pre- and postinjury high-speed running data were available for a median of 15 matches (range, 6-15). Variance from the preinjury high-speed running distance was significantly less (P = 0.0005) than the post injury values suggesting a suppression of high-speed running distance after returning from injury. On return to play, 7 of the 15 players showed a sustained absolute reduction in preinjury high-speed running distance, 7 showed no change, and 1 player (only) showed an increase. Analysis of subsequent (second and third injury) return to play showed no differences to return from the index injury.Conclusion:Return to play was not associated with return to high-speed running performance for nearly half of the players examined, although the same number showed no difference. Persisting deficits in match high-speed running may exist for many players after hamstring strain injury.Clinical Relevance:Returning to play does not mean returning to (high-speed running) performance for nearly half of the high-level professional football players examined in this study. This suggests that successful return to play metrics should be expanded from simple time taken and recurrence to include performance.

Management of hamstring injuries: current concepts review.

Injuries to the hamstring muscle complex are common in athletes, accounting for between 12% and 26% of all injuries sustained during sporting activities. Acute hamstring injuries often occur during sports that involve repetitive kicking or high-speed sprinting, such as American football, soccer, rugby, and athletics. They are also common in watersports, including waterskiing and surfing. Hamstring injuries can be career-threatening in elite athletes and are associated with an estimated risk of recurrence in between 14% and 63% of patients. The variability in prognosis and treatment of the different injury patterns highlights the importance of prompt diagnosis with magnetic resonance imaging (MRI) in order to classify injuries accurately and plan the appropriate management. Low-grade hamstring injuries may be treated with nonoperative measures including pain relief, eccentric lengthening exercises, and a graduated return to sport-specific activities. Nonoperative management is associated with highly variable times for convalescence and return to a pre-injury level of sporting function. Nonoperative management of high-grade hamstring injuries is associated with poor return to baseline function, residual muscle weakness and a high-risk of recurrence. Proximal hamstring avulsion injuries, high-grade musculotendinous tears, and chronic injuries with persistent weakness or functional compromise require surgical repair to enable return to a pre-injury level of sporting function and minimize the risk of recurrent injury. This article reviews the optimal diagnostic imaging methods and common classification systems used to guide the treatment of hamstring injuries. In addition, the indications and outcomes for both nonoperative and operative treatment are analyzed to provide an evidence-based management framework for these patients. Cite this article: Bone Joint J 2020;102-B(10):1281-1288.

Learn to drill like bolt! running drills for hamstring injury management

Hamstring injuries pose significant problems for amateur and professional athletes. Hamstring strain injury (HSI) accounts for 50 % of injuries in sprinters, and remains the most prevalent injury in Australian Rules, and the most common muscle injury in soccer and rugby. Proximal hamstring tendinopathy (PHT) frequents running-based sports, however, is distinctly different to HSI due to the chronic, overuse nature of the condition, and its tendency to affect long distance runners more than sprinters. There is emerging evidence that aberrant running biomechanics may be a contributing risk factor for hamstring injuries. Running drills are a valuable gait retraining technique and may alter force production and associated injury risk.

High-density electromyography activity in various hamstring exercises.

Proximal-distal differences in muscle activity are rarely considered when defining the activity level of hamstring muscles. The aim of this study was to determine the inter-muscular and proximal-distal electromyography (EMG) activity patterns of hamstring muscles during common hamstring exercises. Nineteen amateur athletes without a history of hamstring injury performed 9 exercises, while EMG activity was recorded along the biceps femoris long head (BFlh) and semitendinosus (ST) muscles using 15-channel high-density electromyography (HD-EMG) electrodes. EMG activity levels normalized to those of a maximal voluntary isometric contraction (%MVIC) were determined for the eccentric and concentric phase of each exercise and compared between different muscles and regions (proximal, middle, distal) within each muscle. Straight-knee bridge, upright hip extension, and leg curls exhibited the highest hamstrings activity in both the eccentric (40%-54%MVIC) and concentric phases (69%-85%MVIC). Hip extension was the only BF-dominant exercise (Cohen's d=0.28 (eccentric) and 0.33 (concentric)). Within ST, lower distal than middle/proximal activity was found in the bent-knee bridge and leg curl exercises (d range=0.53-1.20), which was not evident in other exercises. BFlh also displayed large regional differences across exercises (d range=0.00-1.28). This study demonstrates that inter-muscular and proximal-distal activity patterns are exercise-dependent, and in some exercises are affected by the contraction mode. Knowledge of activity levels and relative activity of hamstring muscles in different exercises may assist exercise selection in hamstring injury management.

Effects of a Novel Neurodynamic Tension Technique on Muscle Extensibility and Stretch Tolerance: A Counterbalanced Crossover Study.

Neurodynamic tension affects hamstring extensibility and stretch tolerance and is considered important in hamstring injury management. Neurodynamic tension was postulated to affect segmental muscle extensibility and stretch tolerance and potentially also to demonstrate extrasegmental and contralateral effects. To assess the effects of a novel sciatic-tibial neurodynamic tension technique, the modified long sit slump (MLSS), on segmental, extrasegmental, and contralateral muscle extensibility and stretch tolerance. Counterbalanced crossover study. University research laboratory. 13 healthy and active subjects (mean ± SD age 24 ± 8y; BMI, 23.1 ± 2.8kg/m2). MLSS application (5s, 5 repetitions, 3 sets) on 2 occasions with a 3-wk washout period, and either stance- or skill-leg treated in a counterbalanced manner. Segmental and extrasegmental muscle extensibility was measured using passive straight-leg raise (PSLR) and prone knee bend (PKB) at pre-, immediately post-, and 1h postintervention. Stretch-intensity ratings were measured using a simple numerical rating scale (SNRS). MLSS significantly increased PSLR and PKB bilaterally (P < .001). The effect for PSLR was greater in the ipsilateral leg compared to the contralateral leg (baseline to 1h post: +9° ± 6° and +5° ± 5°, respectively, P < .001) but not for PKB (baseline to 1h post: ipsilateral leg +5° ± 5°, contralateral leg +5° ± 4°). For both PSLR and PKB the effect of the first session was retained at the start of the second session 3wk later. SNRS data were consistent with increased stretch tolerance. Application of a novel sciatic-tibial neurodynamic tension technique, the MLSS, increases muscle extensibility and stretch tolerance segmentally, extrasegmentally and contralaterally. 2C outcomes research.

Return to Play After Hamstring Injuries: A Qualitative Systematic Review of Definitions and Criteria.

BackgroundMore than half of the recurrent hamstring injuries occur within the first month after return-to-play (RTP). Although there are numerous studies on RTP, comparisons are hampered by the numerous definitions of RTP used. Moreover, there is no consensus on the criteria used to determine when a person can start playing again. These criteria need to be critically evaluated, in an attempt to reduce recurrence rates and optimize RTP.ObjectiveTo carry out a systematic review of the literature on (1) definitions of RTP used in hamstring research and (2) criteria for RTP after hamstring injuries.Study DesignSystematic review.MethodsSeven databases (PubMed, EMBASE/MEDLINE, CINAHL, PEDro, Cochrane, SPORTDiscus, Scopus) were searched for articles that provided a definition of, or criteria for, RTP after hamstring injury. There were no limitations on the methodological design or quality of articles. Content analysis was used to record and analyze definitions and criteria for RTP after hamstring injury.ResultsTwenty-five papers fulfilled inclusion criteria, of which 13 provided a definition of RTP and 23 described criteria to support the RTP decision. “Reaching the athlete’s pre-injury level” and “being able to perform full sport activities” were the primary content categories used to define RTP. “Absence of pain”, “similar strength”, “similar flexibility”, “medical staff clearance”, and “functional performance” were core themes to describe criteria to support the RTP decision after hamstring injury.ConclusionOnly half of the included studies provided some definition of RTP after hamstring injury, of which reaching the athlete’s pre-injury level and being able to perform full sport activities were the most important. A wide variety of criteria are used to support the RTP decision, none of which have been validated. More research is needed to reach a consensus on the definition of RTP and to provide validated RTP criteria to facilitate hamstring injury management and reduce hamstring injury recurrence.PROSPERO systematic review registration number: CRD42015016510.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-015-0468-7) contains supplementary material, which is available to authorized users.

Hamstring injury management—Part 2: Treatment

The management of hamstring injuries can be described as vexed at best. One reason for this may be because of a lack of high-quality research into the methods of treatment, rehabilitation and prevention. As a result, an evidence-based approach to injury management does not exist. Management is based on clinical experience, anecdotal evidence and the knowledge of the biological basis of tissue repair. Previous hamstring injury is the most recognized risk factor for injury, which indicates that treatment approaches may be suboptimal under certain conditions. The identification of these risk factors and the methods best designed to manage them should be addressed with future research efforts. Much anecdotal and indirect evidence exists to suggest that several non-local factors contribute to injury. Despite the knowledge that these factors may exist, the literature appears almost devoid of research investigating their possible identification and treatment. Treatment has traditionally been in the form of altering the muscle repair process through the application of electrophysical therapy and various soft-tissue-based and exercise-based techniques. Little research has investigated the role of other forms of manual therapy particularly when directed at non-local structures. This paper will explore and speculate on this potential connection and offer some new contributive factors for hamstring injury management.

The management of hamstring injury—Part 1: Issues in diagnosis

Hamstring injuries are the most prevalent muscle injury in sports involving rapid acceleration and maximum speed running. Injury typically occurs in an acute manner through an eccentric mechanism at the terminal stages of the swing phase of gait. Biceps femoris is most commonly injured. Re-injury rates are high and management is a challenge given the complex multi-factorial aetiology. The high rates of hamstring injury and re-injury may result from a lack of high-quality research into the aetiological factors underlying injury. Re-injury may also result from inaccuracy in diagnosis that results from the potential multi-factorial causes of these conditions. Inaccuracy in diagnosis could lead to multiple potential diagnoses that may result in the implementation of variable management protocols. Whilst potentially useful, such variability may also lead to the implementation of sub-optimal management strategies. Previous hamstring injury is the most recognized risk factor for injury, which indicates that future research should be directed at preventative measures. Much anecdotal and indirect evidence exists to suggest that several non-local factors contribute to injury, which may be addressed through the application of manual therapy. However, this connection has been neglected in previous research and literature. This paper will explore and speculate on this potential connection and offer some new contributive factors for hamstring injury management. This first paper of a two part series on hamstring injury will explore diagnostic issues relevant to hamstring injury and the second will investigate various established and speculative management approaches.