Hamstring Strain Injury Rehabilitation.
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ABSTRACT:
SUBMITTER: Hickey JT
PROVIDER: S-EPMC8876884 | biostudies-literature | 2022 Feb
REPOSITORIES: biostudies-literature
Publications
Hamstring Strain Injury Rehabilitation.
Hickey Jack T JT Opar David A DA Weiss Leigh J LJ Heiderscheit Bryan C BC
Journal of athletic training 20220201 2
Hamstring strain injuries are common among athletes and often require rehabilitation to prepare players for a timely return to sport performance while also minimizing reinjury risk. Return to sport is typically achieved within weeks of the injury; however, subsequent athlete performance may be impaired, and reinjury rates are high. Improving these outcomes requires rehabilitation practitioners (eg, athletic trainers and physical therapists) to understand the causes and mechanisms of hamstring st ...[more]
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Project description:Hamstring strain injuries are common among sports that involve sprinting, kicking, and high-speed skilled movements or extensive muscle lengthening-type maneuvers with hip flexion and knee extension. These injuries present the challenge of significant recovery time and a lengthy period of increased susceptibility for recurrent injury. Nearly one third of hamstring strains recur within the first year following return to sport with subsequent injuries often being more severe than the original. This high re-injury rate suggests that athletes may be returning to sport prematurely due to inadequate return to sport criteria. In this review article, we describe the epidemiology, risk factors, differential diagnosis, and prognosis of an acute hamstring strain. Based on the current available evidence, we then propose a clinical guide for the rehabilitation of acute hamstring strains and an algorithm to assist clinicians in the decision-making process when assessing readiness of an athlete to return to sport.
| S-EPMC6189266 | biostudies-literature
Project description:Isolated injury to the long head of biceps femoris is the most common type of acute hamstring strain injury (HSI). However, the precise hamstring injury mechanism (i.e., sprint-type) is still not well understood, and research is inconclusive as to which phase in the running cycle HSI risk is the greatest. Since detailed information relating to hamstring muscle function during sprint running cannot be obtained in vivo in humans, the findings of studies investigating HSI mechanisms are based on modeling that requires assumptions to be made based on extrapolations from anatomical and biomechanical investigations. As it is extremely difficult to account for all aspects of muscle-tendon tissues that influence function during high-intensity running actions, much of this complexity is not included in these models. Furthermore, the majority of analyses do not consider the influence of prior activity or muscular fatigue on kinematics, kinetics and muscle activation during sprinting. Yet, it has been shown that fatigue can lead to alterations in neuromuscular coordination patterns that could potentially increase injury risk. The present critical review will evaluate the current evidence on hamstring injury mechanism(s) during high-intensity running and discuss the interactions between fatigue and hamstring muscle activation and function.
| S-EPMC7281534 | biostudies-literature
Project description:Study designRandomized, double-blind, parallel-group clinical trial.ObjectivesTo assess differences between a progressive agility and trunk stabilization rehabilitation program and a progressive running and eccentric strengthening rehabilitation program in recovery characteristics following an acute hamstring injury, as measured via physical examination and magnetic resonance imaging (MRI).BackgroundDetermining the type of rehabilitation program that most effectively promotes muscle and functional recovery is essential to minimize reinjury risk and to optimize athlete performance.MethodsIndividuals who sustained a recent hamstring strain injury were randomly assigned to 1 of 2 rehabilitation programs: (1) progressive agility and trunk stabilization or (2) progressive running and eccentric strengthening. MRI and physical examinations were conducted before and after completion of rehabilitation.ResultsThirty-one subjects were enrolled, 29 began rehabilitation, and 25 completed rehabilitation. There were few differences in clinical or morphological outcome measures between rehabilitation groups across time, and reinjury rates were low for both rehabilitation groups after return to sport (4 of 29 subjects had reinjuries). Greater craniocaudal length of injury, as measured on MRI before the start of rehabilitation, was positively correlated with longer return-to-sport time. At the time of return to sport, although all subjects showed a near-complete resolution of pain and return of muscle strength, no subject showed complete resolution of injury as assessed on MRI.ConclusionThe 2 rehabilitation programs employed in this study yielded similar results with respect to hamstring muscle recovery and function at the time of return to sport. Evidence of continuing muscular healing is present after completion of rehabilitation, despite the appearance of normal physical strength and function on clinical examination.Level of evidenceTherapy, level 1b-.
| S-EPMC3751188 | biostudies-literature
Project description:BackgroundHigh-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.HypothesisMatch high-speed running distance will change after returning from hamstring injury.Study designNon-randomized cohort.Level of evidenceLevel 3.MethodsMatch 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.ResultsPreinjury 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.ConclusionReturn 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 relevanceReturning 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.
| S-EPMC8079800 | biostudies-literature
Project description:BackgroundHamstring strain injuries are common in many sports. Following a hamstring injury, deficits in peak and explosive strength may persist after return to sport potentially affecting sprint performance. Assessment of repeated-sprint ability is recognized as an important part of the return to sport evaluation after a hamstring injury.Purpose: This purpose of this exploratory cross-sectional study was to compare sprinting performance obtained during a repeated-sprint test between football players with and without a previous hamstring strain injury.MethodsForty-four fully active sub-elite football players, 11 with a previous hamstring strain injury during the preceding 12 months (cases; mean age, SD: 25.6 ± 4.4) and 33 demographically similar controls (mean age, SD: 23.2 ± 3.7), were included from six clubs. All players underwent a repeated-sprint test, consisting of six 30-meter maximal sprints with 90 seconds of recovery between sprints. Sprint performance was captured using high-speed video-recording and subsequently assessed by a blinded tester to calculate maximal sprint velocity, maximal horizontal force, maximal horizontal power, and mechanical effectiveness.ResultsA significant between-group difference was seen in favor of players having a previous hamstring injury over 6 sprints for maximal velocity (mean difference: 0.457 m/s, 95% CI: 0.059-0.849, p = 0.025) and mechanical effectiveness (mean difference: 0.009, 95% CI: 0.001-0.016, p = 0.020).ConclusionRepeated-sprint performance was not impaired in football players with a previous hamstring strain injury; in fact, higher mean maximal sprinting velocity and better mechanical effectiveness were found in players with compared to without a previous hamstring injury. The higher sprinting velocity, which likely increases biomechanical load on the hamstring muscles, in previously injured players may increase the risk of recurrent injuries.Level of evidence3b.
| S-EPMC7727428 | biostudies-literature
Project description:IntroductionHamstring strain injuries (HSI) and re-injuries are endemic in high-speed running sports. The biceps femoris long head (BFlh) is the most frequently injured muscle among the hamstrings. Structural parameters of the hamstring muscle are stated to be susceptible to strain injuries at this location. This retrospective study targeted comparing the BFlh's structural parameters between previously injured and uninjured athletes.MethodsNineteen male athletes with previous BFlh strain injury history and nineteen athletes without former lower extremity injury history were included in this study. Fascicle length, mid-muscle belly and distal musculotendinous (MTJ) passive stiffnesses of the biceps femoris long head (BFlh) were examined via b-mode panoramic ultrasound scanning and ultrasound-based shear-wave elastography. Parameter comparisons of both legs within and between athletes with and without injury history were performed.ResultsComparison of the BFlh fascicle length between the injured leg of the injured group and the legs of the controls revealed a trend to shorter fascicle lengths in the injured leg (p = 0.067, d = -0.62). However, the mid-muscle belly passive stiffness of the BFlh was significantly higher in the injured legs (p = 0.009, d = 0.7) compared with the controls. Additionally, the distal MTJ stiffness was much higher in the previously injured legs compared with controls (p < 0.001, d = 1.6).ConclusionsOutcomes support the importance of BFlh properties related to stiffness, and fascicle length for injury susceptibility in athletes. Future prospective studies should determine whether the higher stiffness in the injured athletes is a cause or consequence of the HSI. Physical therapy and rehabilitation programmes after HSI should focus on BFlh muscle properties i.e., elasticity and fascicle length for reducing re-injury and increasing sports performance.
| S-EPMC10896514 | biostudies-literature
Project description: Not available
| S-EPMC8155520 | biostudies-literature
Project description:The Nordic hamstring exercise (NHE) has commonly been investigated in isolation, however, within practice multiple modalities are commonly incorporated. However, the NHE has a low level of compliance within sport, with sprinting being potentially being preferred. The present study aimed to observe the effect of a lower-limb program with either additional NHE or sprinting on the modifiable risk factors hamstring strain injury (HSI) and athletic performance. 38 collegiate athletes were randomly assigned into three groups: control standardised lower-limb training program (n = 10 (2 female, 8 male), age = 23.50 ± 2.95 years, height = 1.75 ± 0.09 m, mass 77.66 ± 11.82 kg), additional NHE (n = 15 (7 female, 8 male), age = 21.40 ± 2.64 years, height = 1.74 ± 0.04 m, mass 76.95 ± 14.20 kg) and additional sprinting (n = 13 (4 female, 9 male), age = 22.15 ± 2.54 years, height = 1.74 ± 0.05 m, mass 70.55 ± 7.84 kg). All participants performed a standardised lower-limb training program twice per week for seven weeks, including Olympic lifting derivatives, squatting movements, and the Romanian deadlift, with experimental groups performing with either additional sprinting or NHE. Bicep femoris architecture, eccentric hamstring strength, jump performance, lower-limb maximal strength and sprint ability were measured pre and post. All training groups demonstrated significant (p < 0.001), small-moderate increases in Bicep femoris architecture (g = 0.60-1.22), with significant (p < 0.001), small-large increases in absolute and relative eccentric peak force (g = 0.60-1.84). Significant and small increases were observed in take-off velocity and mean propulsion force (p < 0.02, g = 0.47-0.64), with non-significant and small increases for both the sprint and control training groups for mean propulsion force (p > 0.05, g = 0.42-0.50). Nordic and sprint training groups had significant and small increases in peak absolute and relative net force (p < 0.001, g = 0.44-0.60). The control group had a non-significant trivial increase in absolute peak net force (p > 0.05, g = 0.22), with a significant and small increase in relative peak relative net force (p = 0.034, g = 0.48). Significant and small decreases for the NHE and sprinting training groups was observed for 0-10 m, 0-20 m, and 10-20 m sprint time (p < 0.010, g = 0.47-0.71). Performing multiple modalities, with either additional NHE or sprinting, as part of a complete resistance training program was superiorly effective for measures of modifiable risk factors HSI, with similar increases observed in measures of athletic performance derived from the standardised lower-limb training program.
| S-EPMC9980768 | biostudies-literature
Project description:Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating the effectiveness of the current conservative management of proximal hamstring tendinopathy (PHT) and outcomes are lacking. The purpose of this review is to provide insights into the efficacy of conservative therapeutic interventions in the management of PHT. In January 2022, databases including PubMed, Web of Science, CINAHL, and Embase were searched for studies assessing the effectiveness of conservative intervention compared with that of a placebo or combination of treatments on functional outcomes and pain. Studies that performed conservative management (exercise therapy and/or physical therapy modalities) in adults 18-65 years were included. Studies that performed surgical interventions or whose subjects had complete hamstring rupture/avulsion greater than a 2 cm displacement were excluded. A total of 13 studies were included: five studies compared exercise interventions, while eight studies investigated a multimodal approach of either shockwave therapy and exercise or a hybrid model incorporating exercise, shockwave therapy, and other modalities, such as ultrasound, trigger point needling, or instrument-assisted soft tissue mobilization. This review supports the notion that the conservative management of PHT may best be optimized through a multimodal approach incorporating a combination of tendon-specific loading at an increased length, lumbopelvic stabilization exercises, and extracorporeal shockwave therapy. With regard to hamstring-specific exercise selection, PHT may be optimally managed by including a progressive loading program at combined angles of the hip flexion at 110 degrees and the knee flexion between 45 and 90 degrees.
| S-EPMC10053564 | biostudies-literature
Project description:ObjectiveTo measure the sensitivity and specificity of differences cut-off values for isokinetic Hcon/Qcon ratio in order to improve the capacity to evaluate (retrospectively) the injury of hamstring muscles in professional soccer screened with knee isokinetic tests.DesignRetrospective study.MethodsMedical and biomechanical data of professional football players playing for the same team for at least one season between 2010 and 2016 were analysed. Hamstring strain injury cases and the reports generated via isokinetic testing were investigated. Isokinetic concentric(con) hamstring(H) and quadriceps(Q) absolute strength in addition with Hcon/Qcon ratio were examined for the injured versus uninjured limbs among injured players, and for the injured and non-injured players. 2 x 2 contingency table was used for comparing variables: predicted injured or predicted uninjured with actual injured or actual uninjured. Sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratio were calculated for three different cut-off values (0.47 vs. 0.6 vs. 0.658) to compare the discriminative power of an isokinetic test, whilst examining the key value of Hcon/Qcon ratio which may indicate the highest level of ability to predispose a player to injury. McNemar's chi2 test with Yates's correction was used to determine agreement between the tests. PQStat software was used for all statistical analysis, and an alpha level of p <0.05 was used for all statistical comparisons.Results340 isokinetic test reports on both limbs of 66 professional soccer players were analysed. Eleven players suffered hamstring injuries during the analysed period. None of these players sustained recurrence of hamstring injury. One player sustained hamstring strain injury on both legs, thus the total number of injuries was 12. Application of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic test used as a tool for muscle injury detection. The use of 0.47 of Hcon/Qcon as a discriminate value resulted in significantly lower sensitivity when compared to 0.658 threshold (sensitivity of 16.7% vs. 91.7%, respectively; t = 6.125,p = 0.0133). Calculated values of specificity (when three different cut-off were applied) were also significantly different. Threshold of 0.6 of Hcon/Qcon resulted with significantly lower specificity compared to 0.47 value (specificity of 46.9% vs. 94.5%, respectively; t = 153.0,p<0.0001), and significantly higher specificity when compared to 0.658 (specificity of 46.9% vs. 24.1%, respectively; t = 229.0, p<0.0001).ConclusionThe use of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic testing. The interpretation of usefulness of isokinetic test as a screening tool in a group of male professional football players to predict hamstring injury occurrence within the next 12 months might be therefore significantly biased due to the different threshold values of Hcon/Qcon. Using one "normative" value as a cut-off (e.g. 0.47 or 0.60, or 0.658) to quantify soccer players (or not) to the group with a higher risk of knee injury might result in biased outcomes due to the natural strength asymmetry that is observed within the group of soccer players.
| S-EPMC5720729 | biostudies-literature