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Abstract
Background More 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. Objective To 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 Design Systematic review. Methods Seven 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. Results Twenty-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. Conclusion Only 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 material The online version of this article (doi:10.1007/s40279-015-0468-7) contains supplementary material, which is available to authorized users.
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602
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Matthews MJ, Heron K, Todd S, Tomlinson A, Jones P, Delextrat A, Cohen DD. Strength and endurance training reduces the loss of eccentric hamstring torque observed after soccer specific fatigue. Phys Ther Sport 2017; 25:39-46. [PMID: 28364615 DOI: 10.1016/j.ptsp.2017.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate the effect of two hamstring training protocols on eccentric peak torque before and after soccer specific fatigue. PARTICIPANTS Twenty-two university male soccer players. DESIGN Isokinetic strength tests were performed at 60°/s pre and post fatigue, before and after 2 different training interventions. A 45-min soccer specific fatigue modified BEAST protocol (M-BEAST) was used to induce fatigue. Players were randomly assigned to a 4 week hamstrings conditioning intervention with either a maximum strength (STR) or a muscle endurance (END) emphasis. MAIN OUTCOME MEASURES The following parameters were evaluated: Eccentric peak torque (EccPT), angle of peak torque (APT), and angle specific torques at knee joint angles of 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80° and 90°. RESULTS There was a significant effect of the M-BEAST on the Eccentric torque angle profile before training as well as significant improvements in post-fatigue torque angle profile following the effects of both strength and muscle endurance interventions. CONCLUSIONS Forty-five minutes of simulated soccer activity leads to reduced eccentric hamstring torque at longer muscle lengths. Short-term conditioning programs (4-weeks) with either a maximum strength or a muscular endurance emphasis can equally reduce fatigue induced loss of strength over this time period.
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Affiliation(s)
- Martyn J Matthews
- School of Health Sciences, Centre for Health Sciences Research, University of Salford, Salford, M66PU, UK.
| | - Kate Heron
- School of Health Sciences, Centre for Health Sciences Research, University of Salford, Salford, M66PU, UK
| | - Stefanie Todd
- School of Health Sciences, Centre for Health Sciences Research, University of Salford, Salford, M66PU, UK
| | - Andrew Tomlinson
- School of Health Sciences, Centre for Health Sciences Research, University of Salford, Salford, M66PU, UK
| | - Paul Jones
- School of Health Sciences, Centre for Health Sciences Research, University of Salford, Salford, M66PU, UK
| | - Anne Delextrat
- Faculty of Sport and Health Sciences, Oxford Brookes University, Oxford, UK
| | - Daniel D Cohen
- Instituto de Investigaciones, Escuela de Medicina, Universidad de Santander, Bucaramanga, Santander, Colombia
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603
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Wangensteen A, Tol JL, Roemer FW, Bahr R, Dijkstra HP, Crema MD, Farooq A, Guermazi A. Intra- and interrater reliability of three different MRI grading and classification systems after acute hamstring injuries. Eur J Radiol 2017; 89:182-190. [DOI: 10.1016/j.ejrad.2017.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 01/31/2017] [Accepted: 02/05/2017] [Indexed: 10/20/2022]
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604
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Abstract
Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the "sports hip triad," these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention.
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605
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van der Horst N, Backx FJG, Goedhart EA, Huisstede BMA. Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making. Br J Sports Med 2017; 51:1583-1591. [DOI: 10.1136/bjsports-2016-097206] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 01/08/2023]
Abstract
There are three major questions about return to play (RTP) after hamstring injuries: How should RTP be defined? Which medical criteria should support the RTP decision? And who should make the RTP decision? The study aimed to provide a clear RTP definition and medical criteria for RTP and to clarify RTP consultation and responsibilities after hamstring injury. The study used the Delphi procedure. The results of a systematic review were used as a starting point for the Delphi procedure. Fifty-eight experts in the field of hamstring injury management selected by 28 FIFA Medical Centres of Excellence worldwide participated. Each Delphi round consisted of a questionnaire, an analysis and an anonymised feedback report. After four Delphi rounds, with more than 83% response for each round, consensus was achieved that RTP should be defined as ‘the moment a player has received criteria-based medical clearance and is mentally ready for full availability for match selection and/or full training’. The experts reached consensus on the following criteria to support the RTP decision: medical staff clearance, absence of pain on palpation, absence of pain during strength and flexibility testing, absence of pain during/after functional testing, similar hamstring flexibility, performance on field testing, and psychological readiness. It was also agreed that RTP decisions should be based on shared decision-making, primarily via consultation with the athlete, sports physician, physiotherapist, fitness trainer and team coach. The consensus regarding aspects of RTP should provide clarity and facilitate the assessment of when RTP is appropriate after hamstring injury, so as to avoid or reduce the risk of injury recurrence because of a premature RTP.
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606
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Seymore KD, Domire ZJ, DeVita P, Rider PM, Kulas AS. The effect of Nordic hamstring strength training on muscle architecture, stiffness, and strength. Eur J Appl Physiol 2017; 117:943-953. [PMID: 28280975 DOI: 10.1007/s00421-017-3583-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/26/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE Hamstring strain injury is a frequent and serious injury in competitive and recreational sports. While Nordic hamstring (NH) eccentric strength training is an effective hamstring injury-prevention method, the protective mechanism of this exercise is not understood. Strength training increases muscle strength, but also alters muscle architecture and stiffness; all three factors may be associated with reducing muscle injuries. The purpose of this study was to examine the effects of NH eccentric strength training on hamstring muscle architecture, stiffness, and strength. METHODS Twenty healthy participants were randomly assigned to an eccentric training group or control group. Control participants performed static stretching, while experimental participants performed static stretching and NH training for 6 weeks. Pre- and post-intervention measurements included: hamstring muscle architecture and stiffness using ultrasound imaging and elastography, and maximal hamstring strength measured on a dynamometer. RESULTS The experimental group, but not the control group, increased volume (131.5 vs. 145.2 cm3, p < 0.001) and physiological cross-sectional area (16.1 vs. 18.1 cm2, p = 0.032). There were no significant changes to muscle fascicle length, stiffness, or eccentric hamstring strength. CONCLUSIONS The NH intervention was an effective training method for muscle hypertrophy, but, contrary to common literature findings for other modes of eccentric training, did not increase fascicle length. The data suggest that the mechanism behind NH eccentric strength training mitigating hamstring injury risk could be increasing volume rather than increasing muscle length. Future research is, therefore, warranted to determine if muscle hypertrophy induced by NH training lowers future hamstring strain injury risk.
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Affiliation(s)
- Kayla D Seymore
- Kinesiology Department, East Carolina University, Greenville, NC, USA. .,Center for Orthopaedic and Biomechanics Research, Boise State University, Boise, ID, USA.
| | - Zachary J Domire
- Kinesiology Department, East Carolina University, Greenville, NC, USA
| | - Paul DeVita
- Kinesiology Department, East Carolina University, Greenville, NC, USA
| | - Patrick M Rider
- Kinesiology Department, East Carolina University, Greenville, NC, USA
| | - Anthony S Kulas
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
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607
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van Heumen M, Tol JL, de Vos RJ, Moen MH, Weir A, Orchard J, Reurink G. The prognostic value of MRI in determining reinjury risk following acute hamstring injury: a systematic review. Br J Sports Med 2017; 51:1355-1363. [DOI: 10.1136/bjsports-2016-096790] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 11/03/2022]
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608
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Zambaldi M, Beasley I, Rushton A. Return to play criteria after hamstring muscle injury in professional football: a Delphi consensus study. Br J Sports Med 2017; 51:1221-1226. [DOI: 10.1136/bjsports-2016-097131] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 11/04/2022]
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609
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Rusciano A, Corradini G, Stoianov I. Neuroplus biofeedback improves attention, resilience, and injury prevention in elite soccer players. Psychophysiology 2017; 54:916-926. [PMID: 28220500 DOI: 10.1111/psyp.12847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 01/17/2017] [Indexed: 01/07/2023]
Abstract
Performance and injury prevention in elite soccer players are typically investigated from physical-tactical, biomechanical, and metabolic perspectives. However, executive functions, visuospatial abilities, and psychophysiological adaptability or resilience are also fundamental for efficiency and well-being in sports. Based on previous research associating autonomic flexibility with prefrontal cortical control, we designed a novel integrated autonomic biofeedback training method called Neuroplus to improve resilience, visual attention, and injury prevention. Herein, we introduce the method and provide an evaluation of 20 elite soccer players from the Italian Soccer High Division (Serie-A): 10 players trained with Neuroplus and 10 trained with a control treatment. The assessments included psychophysiological stress profiles, a visual search task, and indexes of injury prevention, which were measured pre- and posttreatment. The analysis showed a significant enhancement of physiological adaptability, recovery following stress, visual selective attention, and injury prevention that were specific to the Neuroplus group. Enhancing the interplay between autonomic and cognitive functions through biofeedback may become a key principle for obtaining excellence and well-being in sports. To our knowledge, this is the first evidence that shows improvement in visual selective attention following intense autonomic biofeedback.
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Affiliation(s)
- Aiace Rusciano
- AC ChievoVerona Football Club, Neuro-psychophysiology Lab, Veronello Sport Center, Verona, Italy.,Department of Psychology, University of Trieste, Trieste, Italy
| | - Giuliano Corradini
- AC ChievoVerona Football Club, Medical Staff, Veronello Sport Center, Verona, Italy
| | - Ivilin Stoianov
- Laboratoire de Psychologie Cognitive, CNRS UMR-7290, Marseille, France.,Institute of Cognitive Sciences and Technologies, CNR, Padova, Italy
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610
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Ramos GA, Arliani GG, Astur DC, Pochini ADC, Ejnisman B, Cohen M. Rehabilitation of hamstring muscle injuries: a literature review. Rev Bras Ortop 2017; 52:11-16. [PMID: 28194375 PMCID: PMC5290083 DOI: 10.1016/j.rboe.2016.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/24/2016] [Indexed: 12/26/2022] Open
Abstract
Hamstring injuries are among the most frequent in sports. The high relapse rate is a challenge for sports medicine and has a great impact on athletes and sport teams. The treatment goal is to provide the athlete the same functional level as before the injury. Thus, functional rehabilitation is very important to the success of the treatment. Currently, several physical therapy modalities are used, according to the stage of the lesion, such as cryotherapy, laser therapy, therapeutic ultrasound, therapeutic exercise, and manual therapy. However, the evidence of the effectiveness of these modalities in muscle injuries is not fully established due to the little scientific research on the topic. This article presents an overview of the physiotherapy approach in the rehabilitation of hamstring muscle injuries.
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Affiliation(s)
- Gabriel Amorim Ramos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Gustavo Gonçalves Arliani
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Diego Costa Astur
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Alberto de Castro Pochini
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Moisés Cohen
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
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611
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HASER CHRISTIAN, STÖGGL THOMAS, KRINER MONIKA, MIKOLEIT JÖRG, WOLFAHRT BERND, SCHERR JOHANNES, HALLE MARTIN, PFAB FLORIAN. Effect of Dry Needling on Thigh Muscle Strength and Hip Flexion in Elite Soccer Players. Med Sci Sports Exerc 2017; 49:378-383. [DOI: 10.1249/mss.0000000000001111] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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612
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Røksund OD, Kristoffersen M, Bogen BE, Wisnes A, Engeseth MS, Nilsen AK, Iversen VV, Mæland S, Gundersen H. Higher Drop in Speed during a Repeated Sprint Test in Soccer Players Reporting Former Hamstring Strain Injury. Front Physiol 2017; 8:25. [PMID: 28190999 PMCID: PMC5271334 DOI: 10.3389/fphys.2017.00025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/11/2017] [Indexed: 01/26/2023] Open
Abstract
Aim: Hamstring strain injury is common in soccer. The aim of this study was to evaluate the physical capacity of players who have and have not suffered from hamstring strain injury in a sample of semi-professional and professional Norwegian soccer players in order to evaluate characteristics and to identify possible indications of insufficient rehabilitation. Method: Seventy-five semi-professional and professional soccer players (19 ± 3 years) playing at the second and third level in the Norwegian league participated in the study. All players answered a questionnaire, including one question about hamstring strain injury (yes/no) during the previous 2 years. They also performed a 40 m maximal sprint test, a repeated sprint test (8 × 20 m), a countermovement jump, a maximal oxygen consumption (VO2max) test, strength tests and flexibility tests. Independent sample t-tests were used to evaluate differences in the physical capacity of the players who had suffered from hamstring strain injury and those who had not. Mixed between-within subject's analyses of variance was used to compare changes in speed during the repeated sprint test between groups. Results: Players who reported hamstring strain injury during the previous two years (16%) had a significantly higher drop in speed (0.07 vs. 0.02 s, p = 0.007) during the repeated sprint test, compared to players reporting no previous hamstring strain injury. In addition, there was a significant interaction (groups × time) (F = 3.22, p = 0.002), showing that speed in the two groups changed differently during the repeated sprint test. There were no significant differences in relations to age, weight, height, body fat, linear speed, countermovement jump height, leg strength, VO2max, or hamstring flexibility between the groups. Conclusion: Soccer players who reported hamstring strain injury during the previous 2 years showed significant higher drop in speed during the repeated sprint test compared to players with no hamstring strain injury. The maximal speed, leg strength, ability to produce maximal power, endurance capacity, and hamstring flexibility was similar for both groups. Thus, a repeated sprint test consisting of 8 × 20 m could be used as a field-based diagnostic tool to identify players in need of reconditioning programs to ensure complete post-injury rehabilitation.
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Affiliation(s)
- Ola D Røksund
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College Bergen, Norway
| | - Morten Kristoffersen
- Department of Sport and Physical Activity, Bergen University College Bergen, Norway
| | - Bård E Bogen
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College Bergen, Norway
| | - Alexander Wisnes
- The Norwegian Olympic Sports Center (Olympiatoppen-Vest) Bergen, Norway
| | - Merete S Engeseth
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College Bergen, Norway
| | - Ann-Kristin Nilsen
- Department of Sport and Physical Activity, Bergen University College Bergen, Norway
| | - Vegard V Iversen
- Department of Sport and Physical Activity, Bergen University College Bergen, Norway
| | - Silje Mæland
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University CollegeBergen, Norway; Uni Research HealthBergen, Norway
| | - Hilde Gundersen
- Department of Sport and Physical Activity, Bergen University College Bergen, Norway
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613
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van Doormaal MCM, van der Horst N, Backx FJG, Smits DW, Huisstede BMA. No Relationship Between Hamstring Flexibility and Hamstring Injuries in Male Amateur Soccer Players: A Prospective Study. Am J Sports Med 2017; 45:121-126. [PMID: 27582278 DOI: 10.1177/0363546516664162] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In soccer, although hamstring flexibility is thought to play a major role in preventing hamstring injuries, the relationship between hamstring flexibility and hamstring injuries remains unclear. PURPOSE To investigate the relationship between hamstring flexibility and hamstring injuries in male amateur soccer players. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This study included 450 male first-class amateur soccer players (mean age, 24.5 years). Hamstring flexibility was measured by performing the sit-and-reach test (SRT). The relationship between hamstring flexibility and the occurrence of hamstring injuries in the following year, while adjusting for the possible confounding effects of age and previous hamstring injuries, was determined with a multivariate logistic regression analysis. RESULTS Of the 450 soccer players, 21.8% reported a hamstring injury in the previous year. The mean (±SD) baseline score for the SRT was 21.2 ± 9.2 cm. During the 1-year follow-up period, 23 participants (5.1%) suffered a hamstring injury. In the multivariate analysis, while adjusting for age and previous injuries, no significant relationship was found between hamstring flexibility and hamstring injuries ( P = .493). CONCLUSION In this group of soccer players, hamstring flexibility (measured with the SRT) was not related to hamstring injuries. Age and previous hamstring injuries as possible confounders did not appear to influence this relationship. Other etiological factors need to be examined to further elucidate the mechanism of hamstring injuries.
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Affiliation(s)
- Mitchell C M van Doormaal
- Department of Rehabilitation, Nursing Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nick van der Horst
- Department of Rehabilitation, Nursing Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank J G Backx
- Department of Rehabilitation, Nursing Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dirk-Wouter Smits
- Department of Rehabilitation, Nursing Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bionka M A Huisstede
- Department of Rehabilitation, Nursing Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands
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614
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Fernández-Cuevas I, Arnáiz Lastras J, Escamilla Galindo V, Gómez Carmona P. Infrared Thermography for the Detection of Injury in Sports Medicine. BIOLOGICAL AND MEDICAL PHYSICS, BIOMEDICAL ENGINEERING 2017. [DOI: 10.1007/978-3-319-47410-6_4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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615
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Ramos GA, Arliani GG, Astur DC, Pochini ADC, Ejnisman B, Cohen M. Reabilitação nas lesões musculares dos isquiotibiais: revisão da literatura. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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616
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Wangensteen A, Bahr R, Van Linschoten R, Almusa E, Whiteley R, Witvrouw E, Tol JL. MRI appearance does not change in the first 7 days after acute hamstring injury—a prospective study. Br J Sports Med 2016; 51:1087-1092. [DOI: 10.1136/bjsports-2016-096881] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/04/2022]
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617
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Jónasson G, Helgason A, Ingvarsson Þ, Kristjánsson AM, Briem K. The Effect of Tibial Rotation on the Contribution of Medial and Lateral Hamstrings During Isometric Knee Flexion. Sports Health 2016; 8:161-6. [PMID: 26721286 PMCID: PMC4789934 DOI: 10.1177/1941738115625039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Selective atrophy of hamstring components may result from muscle strain or graft harvesting for anterior cruciate ligament reconstruction. Assessment and rehabilitation that specifically targets medial (MH) or lateral (LH) hamstring components may improve patient outcomes. The purpose of this study was to evaluate effects of volitional tibial rotation medially (MR) versus laterally (LR) on activation levels of MH versus LH and strength measures during isometric testing of knee flexors. Hypothesis: Muscle activation of MH and LH during knee flexor strength testing will be augmented when coupled with MR and LR of the tibia, respectively, without affecting knee flexor strength measures. Study Design: Cross-sectional laboratory study. Level of Evidence: Level 3. Methods: Surface electrodes were used to record neuromuscular activity from MH and LH of the right lower limb in 40 healthy young men and women during isometric knee flexor strength testing at 40° of knee flexion, where participants maintained concurrent volitional MR or LR of the tibia. Statistical analyses of variance included general linear models for repeated measures. Results: A significant interaction was found for tibial rotation and hamstring component variables (P < 0.01). When isometric knee flexion was coupled with LR, normalized activation levels were similar for MH and LH. When performed with MR, a significant drop in LH activation led to dissimilar activation levels of the 2 components. Significantly greater strength measures were found when isometric knee flexion was performed with concurrent LR of the tibia (P < 0.01). Both sexes demonstrated the same rotation-dependent differences. Conclusion: Coupling tibial rotation with knee flexor activities primarily affects the LH component. Clinical Relevance: Strategies involving volitional tibial rotation may be considered for specific assessment/rehabilitation of the MH or LH component.
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Affiliation(s)
| | - Andri Helgason
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland
| | | | | | - Kristín Briem
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland
- * Kristín Briem, PT, PhD, Research Centre of Movement Science, Department of Physical Therapy, University of Iceland, Saemundargata 2, Reykjavik IS101, Iceland ()
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618
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Abstract
Muscle injuries are frequent and represent one of the most substantial medical problems in professional football. They can have both traumatic and overuse causes with direct practical consequence due to differences in terms of the post-primary care regimen and prognosis. An accurate diagnosis is the first step towards a specific treatment and usually allows to predict return to play (RTP). Current treatment principles have no firm scientific basis; they are practiced largely as empirical medicine due to a lack of prospective randomised studies. Immediate treatment usually follows the PRICE-principle (protection, rest, ice, compression, elevation). Depending on the type of the muscle injury, specific physical and physiotherapeutical procedures as well as rehabilitative exercises and gradual training therapy are used to recondition the injured structure, to restore coordination and proprioception, and to normalise movement patterns. Injection therapy with various substances is frequently used, with positive results empirically, but evidence in form of prospective randomised studies is lacking. A precise rehabilitation plan should be developed for every muscle injury, including recommendations for sport-specific training with increasing intensity. Since there are no guidelines regarding safe RTP, regular follow-up examinations on the current muscle status are crucial to evaluate the progress made in terms of healing and to determine when the injured muscle can be exposed to the next step of load. This narrative review describes the various factors that a medical team should consider during assessment, treatment and rehabilitation of a muscle injury with particular focus on professional football.
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Affiliation(s)
- Peter Ueblacker
- a MW Center of Orthopedics and Sports Medicine , Munich , Germany.,b Department of Osteology and Biomechanics , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Lutz Haensel
- a MW Center of Orthopedics and Sports Medicine , Munich , Germany
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619
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The biomechanical and physiological response to repeated soccer-specific simulations interspersed by 48 or 72 hours recovery. Phys Ther Sport 2016; 22:81-87. [DOI: 10.1016/j.ptsp.2016.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/08/2016] [Accepted: 06/30/2016] [Indexed: 01/08/2023]
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620
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Yoshida K, Itoigawa Y, Maruyama Y, Saita Y, Takazawa Y, Ikeda H, Kaneko K, Sakai T, Okuwaki T. Application of shear wave elastography for the gastrocnemius medial head to tennis leg. Clin Anat 2016; 30:114-119. [DOI: 10.1002/ca.22788] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/21/2016] [Accepted: 08/29/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Keiichi Yoshida
- Department of Orthopaedic Surgery; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yoshitomo Saita
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Yuji Takazawa
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Hiroshi Ikeda
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Tatsuo Sakai
- Department of Anatomy; Juntendo University; Tokyo Japan
| | - Toru Okuwaki
- Department of Sports Medicine; Japan Institute of Sports Science; Tokyo Japan
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621
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Jakobsen JR, Mackey AL, Knudsen AB, Koch M, Kjaer M, Krogsgaard MR. Composition and adaptation of human myotendinous junction and neighboring muscle fibers to heavy resistance training. Scand J Med Sci Sports 2016; 27:1547-1559. [PMID: 27781307 DOI: 10.1111/sms.12794] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/27/2022]
Abstract
The myotendinous junction (MTJ) is a common site of strain injury and yet understanding of its composition and ability to adapt to loading is poor. The main aims of this study were to determine the profile of selected collagens and macrophage density in human MTJ and adjoining muscle fibers, and to investigate whether heavy exercise loading would alter this profile. Fifteen individuals scheduled for anterior cruciate ligament repair surgery were randomized into three groups: control, acute or 4 weeks heavy resistance training. MTJ samples were collected from the semitendinosus and gracilis muscles and were sectioned and stained immunohistochemically for collagen types I, III, VI, XII, XIV, XXII, Tenascin-C and CD68. Macrophage density and distribution was evaluated and the amount of each collagen type in muscle and MTJ was graded. Collagen XXII was observed solely at the MTJ, while all other collagens were abundant at the MTJ and in muscle perimysium or endomysium. The endomysial content of collagen XIV, macrophages and Tenascin-C increased following 4 weeks of training. These findings illustrate the heterogeneity of collagen type composition of human MTJ. The increase in collagen XIV following 4 weeks of training may reflect a training-induced protection against strain injuries in this region.
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Affiliation(s)
- J R Jakobsen
- Section for Sports Traumatology M51, Department of Orthopaedic Surgery, Bispebjerg Hospital, Copenhagen, Denmark
| | - A L Mackey
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A B Knudsen
- Section for Sports Traumatology M51, Department of Orthopaedic Surgery, Bispebjerg Hospital, Copenhagen, Denmark
| | - M Koch
- Institute for Dental Research and Oral Musculoskeletal Biology, and Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
| | - M Kjaer
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M R Krogsgaard
- Section for Sports Traumatology M51, Department of Orthopaedic Surgery, Bispebjerg Hospital, Copenhagen, Denmark
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622
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Renshaw A, Goodwin PC. Injury incidence in a Premier League youth soccer academy using the consensus statement: a prospective cohort study. BMJ Open Sport Exerc Med 2016; 2:e000132. [PMID: 27900186 PMCID: PMC5125417 DOI: 10.1136/bmjsem-2016-000132] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background There is an established risk of injury to young athletes exposed to high training loads. Identifying and monitoring injury risk is essential to aid prevention. The aim of this study was to use the consensus statement to determine the incidence and pattern of injury in 1 English Premier League soccer academy during 1 season. Methods A prospective cohort study included 181 elite academy soccer players during the 2012–2013 season. Players were divided into 5 age groups between 9 and 18 years. The number, type and incidence of injuries were recorded during matches and training. Incidence was calculated per 1000 hours of exposure. Results 127 injuries occurred during 29 346 hours of soccer exposure. 72% of injuries were non-contact related. Under (U)18 players sustained the highest number of match injuries. U12–14 players sustained the highest number of training injuries and injuries overall. U16 players sustained the highest number of severe injuries, and U18 players sustained the highest number of moderate injuries. U18 players sustained the highest number of injuries/1000 hours of training and overall. U15 players sustained the highest number of injuries/1000 hours of matches, the highest number of recurrent injuries and the highest incidence of recurrence. The most common injuries were muscle injuries in U15 and U18 players. The most common injury location was the anterior thigh, with the majority of these occurring in training. Conclusions Using the consensus statement, this study used a repeatable method to identify the injury profile of elite academy-level soccer players.
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Affiliation(s)
| | - Peter C Goodwin
- Department of Health Professions , Manchester Metropolitan University , Manchester , UK
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623
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Validation of the FASH (Functional Assessment Scale for Acute Hamstring Injuries) questionnaire for German-speaking football players. J Orthop Surg Res 2016; 11:130. [PMID: 27776547 PMCID: PMC5078932 DOI: 10.1186/s13018-016-0464-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background The FASH (Functional Assessment Scale for Acute Hamstring Injuries) questionnaire has been recently developed as a disease-specific self-administered questionnaire for use in Greek, English, and German languages. Its psychometric qualities (validity and reliability) were tested only in Greek-speaking patients mainly representing track and field athletes. As hamstring injuries represent the most common football injury, we tested the validity and reliability of the FASH-G (G = German version) questionnaire in German-speaking footballers suffering from acute hamstring injuries. Methods The FASH-G questionnaire was tested for reliability and validity, in 16 footballers with hamstring injuries (patients’ group), 77 asymptomatic footballers (healthy group), and 19 field hockey players (at-risk group). Known-group validity was tested by comparing the total FASH-G scores of the injured and non-injured groups. Reliability of the FASH-G questionnaire was analysed in 18 asymptomatic footballers using the intra-class coefficient. Results Known-group validity was demonstrated by significant differences between injured and non-injured participants (p < 0.001). The FASH-G exhibited very good test–retest reliability (intra-class correlation coefficient = 0.982, p < 0.001). Internal consistency was excellent (α = 0.938). Compared with the results presented in the original publication, no statistical differences were found between healthy athletes (p = 0.257), but patients’ groups and at-risk groups presented scoring differences (p = 0.040 and <0.001, respectively). Conclusions The FASH-G is a valid and reliable instrument to assess and determine the severity of hamstring injuries in German footballers.
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624
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Can Clinical Evaluation Predict Return to Sport after Acute Hamstring Injuries? A Systematic Review. Sports Med 2016; 47:1123-1144. [DOI: 10.1007/s40279-016-0639-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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625
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Evangelidis PE, Massey GJ, Ferguson RA, Wheeler PC, Pain MTG, Folland JP. The functional significance of hamstrings composition: is it really a "fast" muscle group? Scand J Med Sci Sports 2016; 27:1181-1189. [PMID: 27739112 DOI: 10.1111/sms.12786] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 01/28/2023]
Abstract
Hamstrings muscle fiber composition may be predominantly fast-twitch and could explain the high incidence of hamstrings strain injuries. However, hamstrings muscle composition in vivo, and its influence on knee flexor muscle function, remains unknown. We investigated biceps femoris long head (BFlh) myosin heavy chain (MHC) composition from biopsy samples, and the association of hamstrings composition and hamstrings muscle volume (using MRI) with knee flexor maximal and explosive strength. Thirty-one young men performed maximal (concentric, eccentric, isometric) and explosive (isometric) contractions. BFlh exhibited a balanced MHC distribution [mean ± SD (min-max); 47.1 ± 9.1% (32.6-71.0%) MHC-I, 35.5 ± 8.5% (21.5-60.0%) MHC-IIA, 17.4 ± 9.1% (0.0-30.9%) MHC-IIX]. Muscle volume was correlated with knee flexor maximal strength at all velocities and contraction modes (r = 0.62-0.76, P < 0.01), but only associated with late phase explosive strength (time to 90 Nm; r = -0.53, P < 0.05). In contrast, BFlh muscle composition was not related to any maximal or explosive strength measure. BFlh MHC composition was not found to be "fast", and therefore composition does not appear to explain the high incidence of hamstrings strain injury. Hamstrings muscle volume explained 38-58% of the inter-individual differences in knee flexor maximum strength at a range of velocities and contraction modes, while BFlh muscle composition was not associated with maximal or explosive strength.
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Affiliation(s)
- Pavlos E Evangelidis
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Garry J Massey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Richard A Ferguson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Patrick C Wheeler
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matthew T G Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jonathan P Folland
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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626
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Ehrmann FE, Duncan CS, Sindhusake D, Franzsen WN, Greene DA. GPS and Injury Prevention in Professional Soccer. J Strength Cond Res 2016. [PMID: 26200191 DOI: 10.1519/jsc.0000000000001093] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated the relationship between GPS variables measured in training and gameplay and injury occurrences in professional soccer. Nineteen professional soccer players competing in the Australian Hyundai A-League were monitored for 1 entire season using 5 Hz Global Positioning System (GPS) units (SPI-Pro GPSports) in training sessions and preseason games. The measurements obtained were total distance, high-intensity running distance, very-high-intensity running distance, new body load, and meters per minute. Noncontact soft tissue injuries were documented throughout the season. Players' seasons were averaged over 1- and 4-week blocks according to when injuries occurred. These blocks were compared with each other and with players' seasonal averages. Players performed significantly higher meters per minute in the weeks preceding an injury compared with their seasonal averages (+9.6 and +7.4% for 1- and 4-week blocks, respectively) (p < 0.01), indicating an increase in training and gameplay intensity leading up to injuries. Furthermore, injury blocks showed significantly lower average new body load compared with seasonal averages (-15.4 and -9.0% for 1- and 4-week blocks, respectively) (p < 0.01 and p = 0.01). Periods of relative underpreparedness could potentially leave players unable to cope with intense bouts of high-intensity efforts during competitive matches. Although limited by Fédération Internationale de Football Association regulations, the results of this study isolated 2 variables predicting soft tissue injuries for coaches and sports scientists to consider when planning and monitoring training.
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Affiliation(s)
- Fabian E Ehrmann
- 1Department of Health Science, School of Exercise Science, Australian Catholic University, Sydney, Australia; 2Football Federation Australia, Sydney, Australia; 3Medical Imaging, School of Medicine, The University of Western Sydney, Sydney, Australia; and 4Department of Education and Arts, School of Arts, Australian Catholic University, Sydney, Australia
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627
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Konopinski M, Graham I, Johnson MI, Jones G. The effect of hypermobility on the incidence of injury in professional football: A multi-site cohort study. Phys Ther Sport 2016; 21:7-13. [DOI: 10.1016/j.ptsp.2015.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
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628
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Cavalcante MLC, Teixeira PRL, Sousa TCS, Lima PODP, Oliveira RR. Índice de fadiga do músculo quadríceps femoral em atletas de futebol após reconstrução do ligamento cruzado anterior. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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629
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Cavalcante MLC, Teixeira PRL, Sousa TCS, Lima PODP, Oliveira RR. Index of fatigue quadriceps in soccer athletes after anterior cruciate ligament reconstruction. Rev Bras Ortop 2016; 51:535-540. [PMID: 27818974 PMCID: PMC5091019 DOI: 10.1016/j.rboe.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 12/14/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate the muscle fatigue of the quadriceps muscle in high-performance soccer players undergoing (anterior cruciate ligament) ACL reconstruction. METHODS We evaluated 17 high-performance soccer players from three professional soccer teams of a state in Brazil from August 2011 to July 2012. All subjects were evaluated between 5.5 and 7 months after ACL reconstruction with a Biodex® isokinetic dynamometer (System 4 Pro) with test protocol CON/CON at 60°/s and 300°/s with 5 and 15 repetitions, respectively. In the calculation of local muscle fatigue, the fatigue index was used, which is calculated by dividing the labor done in the first one-third of the repetitions by that done at the final one-third of the repetitions, and multiplying by 100 to express a unit in percentage (i.e., as a discrete quantitative variable). RESULTS All subjects were male, with a mean age of 21.3 ± 4.4 years and mean BMI 23.4 ± 1.53 cm; left dominance was observed in 47% (n = 8) of athletes, and right dominance, in 53% (n = 9) of athletes; and the limb involved in the lesion was the dominant in 29% (n = 5) and the non-dominant in 71% (n = 12). Fatigue rates were 19.6% in the involved limb and 29.0% in the non-involved limb. CONCLUSION The results allow us to conclude that there was no significant difference between the limbs involved and not in ACL injuries regarding local muscle fatigue. No association was observed between the dominant side and the limb involved in the ACL injury.
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Affiliation(s)
| | - Paulo Renan Lima Teixeira
- Universidade Federal do Ceará (UFC), Hospital Universitário Walter Cantídio (HUWC), Fortaleza, CE, Brazil
| | | | - Pedro Olavo de Paula Lima
- Universidade Federal do Ceará (UFC), Hospital Universitário Walter Cantídio (HUWC), Fortaleza, CE, Brazil
| | - Rodrigo Ribeiro Oliveira
- Universidade Federal do Ceará (UFC), Hospital Universitário Walter Cantídio (HUWC), Fortaleza, CE, Brazil
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630
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Shalaj I, Tishukaj F, Bachl N, Tschan H, Wessner B, Csapo R. Injuries in professional male football players in Kosovo: a descriptive epidemiological study. BMC Musculoskelet Disord 2016; 17:338. [PMID: 27519820 PMCID: PMC4983041 DOI: 10.1186/s12891-016-1202-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence and severity of football-related injuries has been found to differ strongly between professional leagues from different countries. The aims of this study were to record the incidence, type and severity of injuries in Kosovarian football players and investigate the relationship between injury incidence rates (IRs), players' age and playing positions. METHODS Players' age, anthropometric characteristics and playing positions, training and match exposure as well as injury occurrences were monitored in 11 teams (143 players) of Kosovo's top division during the 2013/14 season. The exact type, severity and duration of football-related injuries were documented following International Federation of Football Associations (FIFA) recommendations. RESULTS A total of 272 injuries were observed, with traumatic injuries accounting for 71 %. The overall injury IR was 7.38 (CI: 7.14, 7.63) injuries per 1,000 exposure hours and ~11x lower during training as opposed to matches. Strains and ruptures of thigh muscles, ligamentous injuries of the knee as well as meniscus or other cartilage tears represented the most frequent differential diagnoses. While no statistical differences were found between players engaged in different playing positions, injury IR was found to be higher by 10-13 % in younger (IR = 7.63; CI: 7.39, 7.87) as compared to middle-aged (IR = 6.95; CI: 6.41, 7.54) and older players (IR = 6.76; CI: 5.71, 8.00). CONCLUSIONS The total injury IR in elite football in Kosovo is slightly lower than the international average, which may be related to lesser match exposure. Typical injury patterns agree well with previously reported data. Our finding that injury IR was greater in younger players is related to a higher rate of traumatic injuries and may indicate a more aggressive and risky style of play in this age group.
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Affiliation(s)
- I Shalaj
- Institute of Sport Science, University of Vienna, Auf der Schmelz 6, A-1150, Vienna, Austria.
| | - F Tishukaj
- Institute of Sport Science, University of Vienna, Auf der Schmelz 6, A-1150, Vienna, Austria
| | - N Bachl
- Institute of Sport Science, University of Vienna, Auf der Schmelz 6, A-1150, Vienna, Austria.,Austrian Institute of Sports Medicine, Auf der Schmelz 6, A-1150, Vienna, Austria
| | - H Tschan
- Institute of Sport Science, University of Vienna, Auf der Schmelz 6, A-1150, Vienna, Austria
| | - B Wessner
- Institute of Sport Science, University of Vienna, Auf der Schmelz 6, A-1150, Vienna, Austria
| | - R Csapo
- Department of Sport Science, University of Innsbruck, Fürstenweg 187, A-6020, Innsbruck, Austria
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631
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Wangensteen A, Tol JL, Witvrouw E, Van Linschoten R, Almusa E, Hamilton B, Bahr R. Hamstring Reinjuries Occur at the Same Location and Early After Return to Sport: A Descriptive Study of MRI-Confirmed Reinjuries. Am J Sports Med 2016; 44:2112-21. [PMID: 27184543 DOI: 10.1177/0363546516646086] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite relatively high reinjury rates after acute hamstring injuries, there is a lack of detailed knowledge about where and when hamstring reinjuries occur, and studies including imaging-confirmed reinjuries are scarce. PURPOSE To investigate the location, radiological severity, and timing of reinjuries on magnetic resonance imaging (MRI) compared with the index injury. STUDY DESIGN Case series; Level of evidence, 4. METHODS A MRI scan was obtained ≤5 days after an acute hamstring index injury in 180 athletes, and time to return to sport (RTS) was registered. Athletes with an MRI-confirmed reinjury in the same leg ≤365 days after RTS were included. Categorical grading and standardized MRI parameters of the index injury and reinjury were scored by a single radiologist (with excellent intraobserver reliability). To determine the location of the reinjury, axial and coronal views of the index injury and reinjury were directly compared on proton density-weighted fat-suppressed images. RESULTS In the 19 athletes included with reinjury, 79% of these reinjuries occurred in the same location within the muscle as the index injury. The median time to RTS after the index injury was 19 days (range, 5-37 days; interquartile range [IQR], 15 days). The median time between the index injury and reinjury was 60 days (range, 20-316 days; IQR, 131 days) and the median time between RTS after the index injury and the reinjury was 24 days (range, 4-311 days; IQR, 140 days). More than 50% of reinjuries occurred within 25 days (4 weeks) after RTS from the index injury and 50% occurred within 50 days after the index injury. All reinjuries with more severe radiological grading occurred in the same location as the index injury. CONCLUSION The majority of the hamstring reinjuries occurred in the same location as the index injury, early after RTS and with a radiologically greater extent, suggesting incomplete biological and/or functional healing of the index injury. Specific exercise programs focusing on reinjury prevention initiated after RTS from the index injury are highly recommended.
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Affiliation(s)
- Arnlaug Wangensteen
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Amsterdam Center for Evidence Based Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Erik Witvrouw
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department Rehabilitation Science and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Emad Almusa
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Bruce Hamilton
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar High Performance Sport NZ, Sport Research Institute of New Zealand, Millennium Institute of Sport and Health, Mairangi Bay, Auckland, New Zealand
| | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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632
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Strength Measurements in Acute Hamstring Injuries: Intertester Reliability and Prognostic Value of Handheld Dynamometry. J Orthop Sports Phys Ther 2016; 46:689-96. [PMID: 27170527 DOI: 10.2519/jospt.2016.6363] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cohort study, repeated measures. Background Although hamstring strength measurements are used for assessing prognosis and monitoring recovery after hamstring injury, their actual clinical relevance has not been established. Handheld dynamometry (HHD) is a commonly used method of measuring muscle strength. The reliability of HHD has not been determined in athletes with acute hamstring injuries. Objectives To determine the intertester reliability and the prognostic value of hamstring HHD strength measurement in acute hamstring injuries. Methods We measured knee flexion strength with HHD in 75 athletes at 2 visits, at baseline (within 5 days of hamstring injury) and follow-up (5 to 7 days after the baseline measurement). We assessed isometric hamstring strength in 15° and 90° of knee flexion. Reliability analysis testing was performed by 2 testers independently at the follow-up visit. We recorded the time needed to return to play (RTP) up to 6 months following baseline. Results The intraclass correlation coefficients of the strength measurements in injured hamstrings were between 0.75 and 0.83. There was a statistically significant but weak correlation between the time to RTP and the strength deficit at 15° of knee flexion measured at baseline (Spearman r = 0.25, P = .045) and at the follow-up visit (Spearman r = 0.26, P = .034). Up to 7% of the variance in time to RTP is explained by this strength deficit. None of the other strength variables were significantly correlated with time to RTP. Conclusion Hamstring strength can be reliably measured with HHD in athletes with acute hamstring injuries. The prognostic value of strength measurements is limited, as there is only a weak association between the time to RTP and hamstring strength deficit after acute injury. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2016;46(8):689-696. Epub 12 May 2016. doi:10.2519/jospt.2016.6363.
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633
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Rey E, Paz-Domínguez Á, Porcel-Almendral D, Paredes-Hernández V, Barcala-Furelos R, Abelairas-Gómez C. Effects of a 10-Week Nordic Hamstring Exercise and Russian Belt Training on Posterior Lower-Limb Muscle Strength in Elite Junior Soccer Players. J Strength Cond Res 2016; 31:1198-1205. [PMID: 27467517 DOI: 10.1519/jsc.0000000000001579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rey, E, Paz-Domínguez, Á, Porcel-Almendral, D, Paredes-Hernández, V, Barcala-Furelos, R, and Abelairas-Gómez, C. Effects of a 10-week Nordic hamstring exercise and Russian belt training on posterior lower-limb muscle strength in elite junior soccer players. J Strength Cond Res 31(5): 1198-1205, 2017-The purpose of this study was to assess the effect of 2 eccentric hamstring training exercises, Nordic hamstring exercise (NHE) and Russian belt (RB), on lower-limb strength and bilateral asymmetry using the single-leg hamstring bridge (SLHB) test. Forty-seven elite junior soccer players (age 17.7 ± 0.5 years, height 175.3 ± 3.6 cm, body mass 68.1 ± 7.4 kg) were randomized into 1 of 3 groups, the NHE group (n = 16), RB group (n = 15), or the control group (CG) (n = 16). The eccentric training intervention consisted of 27 supervised training sessions over 10 weeks. Within-group analysis showed significant improvements (p < 0.001) in right SLHB (+25.52% for NHE and +18.33% for RB) and left SLHB (+28.92% for NHE and +20.08% for RB) from pretest to posttest in NHE and RB. However, no significant pre-post changes were observed for the CG in any variable. In addition, a significant time effect (p = 0.028) was also observed for NHE in bilateral asymmetry decreasing from pre- to posttest. In the between-groups analysis, significant better results were found in right SLHB and left SLHB, in the NHE group and RB group in comparison with CG. However, there were no differences between the eccentric training groups (NHE vs. RB). The RB seems to be a viable alternative to the NHE to developing posterior lower-limb muscle strength based on SLHB.
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Affiliation(s)
- Ezequiel Rey
- 1Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain; 2Rayo Vallecano of Madrid S.A.D., Madrid, Spain; 3The Camilo José Cela University, Madrid, Spain; and 4Faculty of Health Sciences, European Atlantic University, Santander, Spain
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634
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Purohit NB, King LJ. Ultrasound of lower limb sports injuries. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016; 23:149-57. [PMID: 27433251 DOI: 10.1177/1742271x15588809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Musculoskeletal ultrasound utilises high-frequency linear transducers to produce high-resolution images of soft tissue structures. It is an increasingly useful tool in the assessment of both acute and chronic musculoskeletal injuries; it is relatively cheap, portable and can be used to facilitate targeted injections. In this review paper, we aim to provide a summary on the normal and abnormal appearances of skeletal tissue in the setting of acute and chronic lower limb sporting injuries.
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Affiliation(s)
- Neeraj B Purohit
- Department of Musculoskeletal Radiology, University Hospital Southampton, Southampton, Hampshire, UK
| | - Leonard J King
- Department of Musculoskeletal Radiology, University Hospital Southampton, Southampton, Hampshire, UK
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635
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Calf injuries in professional football: Treat the patient or the scan? - A case study. Phys Ther Sport 2016; 21:63-7. [PMID: 27428536 DOI: 10.1016/j.ptsp.2016.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 12/27/2015] [Accepted: 01/22/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe a case of a professional football player with significant imaging findings despite a rather innocuous clinical presentation with gradual onset of calf pain and who was able to continue training and playing with minor medical intervention. To discuss some of the limitations of existing muscle injury grading systems and their potential to cover the full range of injury presentations for calf injuries. DESIGN Case report. SETTING A professional football player was assessed by physical examination, clinical testing and imaging (MRI) after a gradual onset of a calf injury. After returning to training and competition, a follow-up of his symptoms was performed with regular ultrasound imaging assessments. PARTICIPANT A professional football player (35 years, 1.90 m, 88 kg) male, African, striker, playing in the Professional Arabian Gulf League. CONCLUSION The discordance between the clinical presentation and the imaging findings resulted in a challenging situation regarding the decision of whether to allow the player to train and compete. In addition, existing muscle injury grading systems do not seem to cover the full range of injuries seen in clinical practice.
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636
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Carvalho A, Brown S, Abade E. Evaluating injury risk in first and second league professional Portuguese soccer: muscular strength and asymmetry. J Hum Kinet 2016; 51:19-26. [PMID: 28149364 PMCID: PMC5260546 DOI: 10.1515/hukin-2015-0166] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Strength imbalances between the hamstrings and quadriceps are an essential predictor for hamstring strain in soccer. The study aimed to investigate and compare the muscle strength imbalances of professional soccer players of different performance levels. One hundred and fifty nine senior male professional soccer players from first (n = 75) and second league (n = 84) Portuguese clubs participated in this study. Muscle strength was evaluated with a REV9000 isokinetic dynamometer. Maximal peak torque data were used to calculate quadriceps and hamstrings strength during concentric and eccentric actions, bilateral asymmetry, conventional strength ratios and dynamic control ratios. Second league athletes produced slightly lower conventional strength ratios in the right and left legs (ES = 0.22, p = 0.17 and ES = 0.36, p = 0.023, respectively) compared to the first league athletes. No significant differences were found in dynamic control ratios or in bilateral asymmetry among first and second league athletes. These findings do not show a clear link between the competitive level and injury risk in soccer players. However, some of the differences found, particularly in conventional strength ratios, highlight the importance of performing off-season and pre-season strength assessments to prescribe and adjust individual strength training programs among professional soccer players.
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Affiliation(s)
- Alberto Carvalho
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI, Portugal
| | - Scott Brown
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Eduardo Abade
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI, Portugal
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637
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van Dyk N, Bahr R, Whiteley R, Tol JL, Kumar BD, Hamilton B, Farooq A, Witvrouw E. Hamstring and Quadriceps Isokinetic Strength Deficits Are Weak Risk Factors for Hamstring Strain Injuries: A 4-Year Cohort Study. Am J Sports Med 2016; 44:1789-95. [PMID: 27002102 DOI: 10.1177/0363546516632526] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A hamstring strain injury (HSI) has become the most common noncontact injury in soccer. Isokinetic muscle strength deficits are considered a risk factor for HSIs. However, underpowered studies with small sample sizes unable to determine small associations have led to inconclusive results regarding the role of isokinetic strength and strength testing in HSIs. PURPOSE To examine whether differences in isokinetic strength measures of knee flexion and extension represent risk factors for hamstring injuries in a large cohort of professional soccer players in an adequately powered study design. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 614 professional soccer players from 14 teams underwent isokinetic strength testing during preseason screening. Testing consisted of concentric knee flexion and extension at 60 deg/s and 300 deg/s and eccentric knee extension at 60 deg/s. A clustered multiple logistic regression analysis was used to identify variables associated with the risk of HSIs. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity. RESULTS Of the 614 players, 190 suffered an HSI during the 4 seasons. Quadriceps concentric strength at 60 deg/s (odds ratio [OR], 1.41; 95% CI, 1.03-1.92; P = .03) and hamstring eccentric strength at 60 deg/s (OR, 1.37; 95% CI, 1.01-1.85; P = .04) adjusted for bodyweight were independently associated with the risk of injuries. The absolute differences between the injured and uninjured players were 6.9 N·m and 9.1 N·m, with small effect sizes (d < 0.2). The ROC analyses showed an area under the curve of 0.54 and 0.56 for quadriceps concentric strength and hamstring eccentric strength, respectively, indicating a failed combined sensitivity and specificity of the 2 strength variables identified in the logistic regression models. CONCLUSION This study identified small absolute strength differences and a wide overlap of the absolute strength measurements at the group level. The small associations between lower hamstring eccentric strength and lower quadriceps concentric strength with HSIs can only be considered as weak risk factors. The identification of these risk factors still does not allow the identification of individual players at risk. The use of isokinetic testing to determine the association between strength differences and HSIs is not supported.
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Affiliation(s)
- Nicol van Dyk
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar The Sports Physician Group, Department of Sports Medicine, St Lucas Andreas Hospital, Amsterdam, the Netherlands Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Bhavesh D Kumar
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Bruce Hamilton
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Sports Performance Research Institute New Zealand (SPRINZ), Millennium Institute of Sport and Health, Auckland, New Zealand
| | | | - Erik Witvrouw
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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638
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Muscle injuries of the lower extremity: a comparison between young and old male elite soccer players. Knee Surg Sports Traumatol Arthrosc 2016; 24:2293-9. [PMID: 25668604 DOI: 10.1007/s00167-015-3527-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to make a comparison between players in two age groups in an elite male soccer team regarding injury localisation within the muscle-tendon unit, injury size and muscle group in terms of muscle injuries of the lower extremity. METHODS Cohort study based on data collected from a Swedish elite male soccer team during the seasons 2007-2012. In total, 145 muscle injuries were included. Injury localisation to the tendon or muscle, the size of haematoma and the affected muscle group were assessed using ultrasound. Age comparison was made between younger players (≤23 years) and older players (>23 years). RESULTS No difference regarding injury localisation to either the tendon or the muscle, or the size of haematoma between the two age groups was found. However, the older group of players suffered a significantly higher number of injuries to the triceps surae than the younger players (p = 0.012). CONCLUSIONS In a Swedish team of male soccer players at elite level, there was no difference between players 23 years or younger and players older than 23 years, in terms of injury distribution to muscles or tendons. Players older than 23 years sustained more injuries to triceps surae when compared with players 23 years or younger. The clinical relevance is to pay attention to muscle function of triceps surae in older players and to screen those players who may need an injury prevention programme. LEVEL OF EVIDENCE II.
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639
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Thorborg K, Bandholm T, Zebis M, Andersen LL, Jensen J, Hölmich P. Large strengthening effect of a hip-flexor training programme: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2016; 24:2346-52. [PMID: 25796586 DOI: 10.1007/s00167-015-3583-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 03/11/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the effect on hip-flexion strength of a 6-week hip-flexor training programme using elastic bands as resistance. We hypothesized that the training group, compared to a control group, would increase their hip-flexion strength more. METHODS Thirty-three healthy subjects (45 % females), 24(5) years of age, were included in a randomized controlled trial and allocated to heavy strength training of the hip-flexor muscles or to control (no strength training). Strength training of the hip-flexors (dominant leg) was performed three times 10 min per week for 6 weeks. The strength training group progressed from 15 repetition maximum (RM) (week 1) to 8 RM (week 6). Isometric hip-flexion strength (primary outcome) was measured by a blinded assessor using a reliable test procedure. RESULTS In the strength training group, the isometric hip-flexion strength of the trained leg increased by 17 %, (p < 0.001). The between-group difference in hip-flexion strength change in the trained leg (dominant leg, training group) versus the non-trained leg (dominant leg, control group) was significantly different from baseline to follow-up, corresponding to a mean change of 0.34 (95 % CI 0.17-0.52) Nm/kg, in favour of the strength training group (p < 0.001). CONCLUSION Simple hip-flexor strength training using elastic bands as external loading, for only 6 weeks, substantially improves hip-flexor muscle strength. This simple exercise programme seems promising for future prevention and treatment of acute and longstanding hip-flexor injuries, such as acute rectus femoris injuries and longstanding iliopsoas-related pain and impingement. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Kristian Thorborg
- Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Hvidovre, Italiensvej 1, 2300, Copenhagen S, Denmark. .,Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), and Departments of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), and Departments of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Copenhagen, Denmark.,Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Mette Zebis
- Gait Analysis Laboratory, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jesper Jensen
- Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Hvidovre, Italiensvej 1, 2300, Copenhagen S, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Hvidovre, Italiensvej 1, 2300, Copenhagen S, Denmark
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640
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Svensson K, Alricsson M, Eckerman M, Magounakis T, Werner S. The correlation between the imaging characteristics of hamstring injury and time required before returning to sports: a literature review. J Exerc Rehabil 2016; 12:134-42. [PMID: 27419106 PMCID: PMC4934955 DOI: 10.12965/jer.1632558.279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/20/2016] [Indexed: 11/22/2022] Open
Abstract
Injuries to the hamstring muscles are common in athletes. Track and field, Australian football, American football and soccer are examples of sports where hamstring injuries are the most common. The purpose of this study was to investigate whether there is a correlation between a hamstring injury prognosis and its characteristics of imaging parameters. The literature search was performed in the databases PubMed and CINAHL, and eleven articles were included. Seven out of the 11 articles showed a correlation between the size of the hamstring injury and length of time required before returning to sports. Different authors have reported contrasting results about length of time required before returning to sports due to location of injury within specific muscle. Majority of the articles found hamstring strain correlated to an extended amount of time required before returning to sports.
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Affiliation(s)
- Kjell Svensson
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marie Alricsson
- Swedish Winter Sport Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden; Department of Sports Science, Linnaeus University, Kalmar, Sweden
| | - Mattias Eckerman
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Suzanne Werner
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Capio Artro Clinic, Stockholm, Sweden
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641
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Zanon G, Combi F, Combi A, Perticarini L, Sammarchi L, Benazzo F. Platelet-rich plasma in the treatment of acute hamstring injuries in professional football players. JOINTS 2016; 4:17-23. [PMID: 27386443 DOI: 10.11138/jts/2016.4.1.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE muscle injuries have a high incidence in professional football and are responsible for the largest number of days lost from competition. Several in vitro studies have confirmed the positive role of platelet-rich plasma (PRP) in accelerating recovery and in promoting muscle regeneration, and not fibrosis, in the healing process. This study examines the results of intralesional administration of PRP in the treatment of primary hamstring injuries sustained by players belonging to a major league football club. METHODS twenty-five hamstring injuries (grade 2 according to MRI classification) sustained by professional football players during a 31-months observation period were treated with PRP and analyzed. Sport participation absence (SPA), in days, was considered to correspond to the healing time, and we also considered the re-injury rate, and tissue healing on MRI. The mean follow-up was 36.6 months (range 22-42). RESULTS there were no adverse events. The mean SPA for the treated muscle injuries was 36.76±19.02 days. The re-injury rate was 12%. Tissue healing, evaluated on MRI, was characterized by the presence of excellent repair tissue and a small scar. CONCLUSIONS this study confirmed the safety of PRP in treating hamstring lesions in a large series of professional football players. PRP-treated lesions did not heal more quickly than untreated lesions described in the literature, but they showed a smaller scar and excellent repair tissue. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Giacomo Zanon
- Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Alberto Combi
- Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Loris Perticarini
- Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigi Sammarchi
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Benazzo
- Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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642
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The effects of accumulated muscle fatigue on the mechanomyographic waveform: implications for injury prediction. Eur J Appl Physiol 2016; 116:1485-94. [DOI: 10.1007/s00421-016-3398-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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643
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Nery C, Raduan F, Baumfeld D. Foot and Ankle Injuries in Professional Soccer Players: Diagnosis, Treatment, and Expectations. Foot Ankle Clin 2016; 21:391-403. [PMID: 27261812 DOI: 10.1016/j.fcl.2016.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Soccer is one of the most popular sports in the world. It has undergone many changes in recent years, mainly because of increased physical demands, and this has led to an increased injury risk. Direct contact accounts for half of all injuries in both indoor and outdoor soccer and ankle sprains are the most common foot and ankle injury. There is a spectrum of foot and ankle injuries and their treatment should be individualized in these high-demand patients. An injury prevention program is also important and should the players, the trainer, responsible physician, and physical therapists.
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Affiliation(s)
- Caio Nery
- Foot and Ankle Clinic, UNIFESP - Escola Paulista de Medicina, São Paulo, São Paulo, Brazil.
| | - Fernando Raduan
- UNIFESP - Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Daniel Baumfeld
- UFMG - Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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644
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Pfirrmann D, Herbst M, Ingelfinger P, Simon P, Tug S. Analysis of Injury Incidences in Male Professional Adult and Elite Youth Soccer Players: A Systematic Review. J Athl Train 2016; 51:410-24. [PMID: 27244125 DOI: 10.4085/1062-6050-51.6.03] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The incidence of injury for elite youth and professional adult soccer players is an important concern, but the risk factors for these groups are different. OBJECTIVE To summarize and compare the injury incidences and injury characteristics of male professional adult and elite youth soccer players. DATA SOURCES We searched MEDLINE and Web of Science using the search terms elite, international, European, soccer, football, injury, injuries, epidemiology, incidence, prevalence, not female, not American football, and not rugby. We also used the search terms professional for studies on professional adult soccer players and high-level, soccer academy, youth, adolescent, and young for studies on elite youth soccer players. STUDY SELECTION Eligible studies were published in English, had a prospective cohort design, and had a minimum study period of 6 months. To ensure that injury data were assessed in relationship to the athlete's individual exposure, we included only studies that reported on injuries and documented exposure volume. DATA EXTRACTION Two independent reviewers applied the selection criteria and assessed the quality of the studies. DATA SYNTHESIS A total of 676 studies were retrieved from the literature search. Eighteen articles met the inclusion criteria: 6 for elite youth and 12 for professional adult soccer players. CONCLUSIONS Injury rates were higher for matches than for training for both youth and adult players. Youth players had a higher incidence of training injuries than professionals. Efforts must be made to reduce the overall injury rate in matches. Therefore, preventive interventions, such as adequately enforcing rules and focusing on fair play, must be analyzed and developed to reduce match-related injury incidences. Reducing training injuries should be a particular focus for youth soccer players.
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Affiliation(s)
- Daniel Pfirrmann
- Department of Sport Medicine, Johannes Gutenberg University of Mainz, Germany
| | - Mark Herbst
- Department of Sport Medicine, Johannes Gutenberg University of Mainz, Germany
| | - Patrick Ingelfinger
- University Hospital, Center for Musculoskeletal Surgery and Orthopedic Hospital, Mainz, Germany
| | - Perikles Simon
- Department of Sport Medicine, Johannes Gutenberg University of Mainz, Germany
| | - Suzan Tug
- Department of Sport Medicine, Johannes Gutenberg University of Mainz, Germany
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645
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Bianco A, Spedicato M, Petrucci M, Messina G, Thomas E, Nese Sahin F, Paoli A, Palma A. A Prospective Analysis of the Injury Incidence of Young Male Professional Football Players on Artificial Turf. Asian J Sports Med 2016; 7:e28425. [PMID: 27217929 PMCID: PMC4870829 DOI: 10.5812/asjsm.28425] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/27/2015] [Accepted: 05/30/2015] [Indexed: 11/16/2022] Open
Abstract
Background: The effects of synthetic surfaces on the risk of injuries is still debated in literature and the majority of published data seems to be contradictory. For such reasons the understanding of injury incidence on such surfaces, especially in youth sport, is fundamental for injury prevention. Objectives: The aim of this study was to prospectively report the epidemiology of injuries in young football players, playing on artificial turfs, during a one sports season. Patients and Methods: 80 young male football players (age 16.1 ± 3.7 years; height 174 ± 6.6 cm; weight 64.2 ± 6.3 kg) were enrolled in a prospective cohort study. The participants were then divided in two groups; the first included players age ranging from 17 to 19 (OP) whereas the second included players age ranging from 13 to 16 (YP). Injury incidence was recorded prospectively, according to the consensus statement for soccer. Results: A total of 107 injuries (35 from the OP and 72 from the YP) were recorded during an exposure time of 83.760 hours (incidence 1.28/1000 per player hours); 22 during matches (incidence 2.84/1000 per player hours, 20.5%) and 85 during training (incidence 1.15/1000 per player hours, 79.5%). Thigh and groin were the most common injury locations (33.6% and 21.5%, respectively) while muscle injuries such as contractures and strains were the most common injury typologies (68.23%). No statistical differences between groups were displayed, except for the rate of severe injuries during matches, with the OP displaying slightly higher rates compared to the YP. Severe injuries accounted for 10.28% of the total injuries reported. The average time lost due to injuries was 14 days. Re-injuries accounted for 4.67% of all injuries sustained during the season. Conclusions: In professional youth soccer injury rates are reasonably low. Muscle injuries are the most common type of injuries while groin and thigh the most common locations. Artificial turf pitches don’t seem to contribute to injury incidence in young football players.
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Affiliation(s)
- Antonino Bianco
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | | | - Marco Petrucci
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
- U.S. Città di Palermo Football Club, Palermo, Italy
| | - Giuseppe Messina
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
- Postura Lab Research Institute, Palermo, Italy
| | - Ewan Thomas
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
- Corresponding author: Ewan Thomas, Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy. Tel: +39-09123896910, Fax: +39-09123860894, E-mail:
| | - Fatma Nese Sahin
- Faculty of Physical Education and Sport, Ankara University, Ankara, Turkey
| | - Antonio Paoli
- Department of Biomedical Science, University of Padova, Padova, Italy
| | - Antonio Palma
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
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646
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Kuenze C, Eltoukhy M, Kelly A, Kim CY. Impact of quadriceps strengthening on response to fatiguing exercise following ACL reconstruction. J Sci Med Sport 2016; 20:6-11. [PMID: 27247167 DOI: 10.1016/j.jsams.2016.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 03/23/2016] [Accepted: 04/26/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients commonly experience altered response to fatiguing exercise after ACL reconstruction (ACLR). The objective of this study was to assess the impact of quadriceps strengthening on response to exercise after ACLR. DESIGN Clinical trial. METHODS Ten participants with a history of primary, unilateral ACLR (sex=9F/1M, age=21.0±2.8 years, BMI=23.7±2.7kg/m2) and 10 healthy participants (sex=9F/1M, age=22.2±3.2 years, BMI=23.8±3.9kg/m2) participated. ACLR participants completed a 2-week quadriceps strengthening intervention including 14 progressive strengthening exercise sessions. Normalized knee extension maximum voluntary isometric contraction (MVIC) torque (Nm/kg) and quadriceps central activation ratio (%, CAR) were measured before and after a 30-minute fatiguing exercise protocol. ACLR participants completed testing before and after the 2-week intervention while control participants completed a single testing session. RESULTS The intervention significantly improved normalized knee extension MVIC torque (pre-intervention=1.85±0.67Nm/kg, post-intervention=2.09±0.81Nm/kg, p=0.04) and quadriceps CAR in the ACLR involved limb (pre-intervention=86.51±5.03%, post-intervention=92.94±5.99%, p=0.02). Quadriceps CAR (pre-intervention=1.13±9.04%, post-intervention=-3.97±4.59%, p=0.16) and normalized knee extension MVIC torque (pre-intervention=0.26±20.90%, post-intervention=-8.02±12.82%, p=0.30) response to exercise did not significantly change from pre-intervention to post-intervention conditions. CONCLUSIONS Two weeks of quadriceps strengthening reduced this between group difference in the involved limb which may indicate restoration of more optimal quadriceps neuromuscular function and increased demand on the quadriceps during physical activity.
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Affiliation(s)
| | - Moataz Eltoukhy
- Department of Kinesiology and Sport Sciences, University of Miami, USA
| | - Adam Kelly
- Department of Kinesiology, Michigan State University, USA
| | - Chang-Young Kim
- Department of Kinesiology and Sport Sciences, University of Miami, USA
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647
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Abstract
Groin pain encompasses a number of conditions from the lower abdomen, inguinal region, proximal adductors, hip joint, upper anterior thigh and perineum. The complexity of the anatomy, the heterogeneous terminology and the overlapping symptoms of different conditions that may co-exist epitomise the challenges in diagnosis and treatment. Inguinal-related and adductor-related pain is the most common cause of groin pain and will be discussed in this article.
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648
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MRI findings and return to play in football: a prospective analysis of 255 hamstring injuries in the UEFA Elite Club Injury Study. Br J Sports Med 2016; 50:738-43. [DOI: 10.1136/bjsports-2016-095974] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/21/2016] [Indexed: 11/03/2022]
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649
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Wilke J, Fleckenstein J, Krause F, Vogt L, Banzer W. Sport-specific functional movement can simulate aspects of neuromuscular fatigue occurring in team sports. Sports Biomech 2016; 15:151-61. [DOI: 10.1080/14763141.2016.1159322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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650
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Crema MD, Guermazi A, Tol JL, Niu J, Hamilton B, Roemer FW. Acute hamstring injury in football players: Association between anatomical location and extent of injury—A large single-center MRI report. J Sci Med Sport 2016; 19:317-22. [DOI: 10.1016/j.jsams.2015.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/04/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
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