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Green B, Bourne MN, van Dyk N, Pizzari T. Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport. Br J Sports Med 2020; 54:1081-1088. [PMID: 32299793 DOI: 10.1136/bjsports-2019-100983] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To systematically review risk factors for hamstring strain injury (HSI). DESIGN Systematic review update. DATA SOURCES Database searches: (1) inception to 2011 (original), and (2) 2011 to December 2018 (update). Citation tracking, manual reference and ahead of press searches. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies presenting prospective data evaluating factors associated with the risk of index and/or recurrent HSI. METHOD Search result screening and risk of bias assessment. A best evidence synthesis for each factor and meta-analysis, where possible, to determine the association with risk of HSI. RESULTS The 78 studies captured 8,319 total HSIs, including 967 recurrences, in 71,324 athletes. Older age (standardised mean difference=1.6, p=0.002), any history of HSI (risk ratio (RR)=2.7, p<0.001), a recent HSI (RR=4.8, p<0.001), previous anterior cruciate ligament (ACL) injury (RR=1.7, p=0.002) and previous calf strain injury (RR=1.5, p<0.001) were significant risk factors for HSI. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with HSI risk. The risk of recurrent HSI is best evaluated using clinical data and not the MRI characteristics of the index injury. SUMMARY/CONCLUSION Older age and a history of HSI are the strongest risk factors for HSI. Future research may be directed towards exploring the interaction of risk factors and how these relationships fluctuate over time given the occurrence of index and recurrent HSI in sport is multifactorial.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew N Bourne
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
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Eccentric hamstring strength in elite track and field athletes on the British Athletics world class performance program. Phys Ther Sport 2020; 43:217-223. [PMID: 32278105 DOI: 10.1016/j.ptsp.2020.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This novel study aims to provide unique data on eccentric hamstring strength in elite track and field athletes. DESIGN Clinical measurement, cross-sectional study. SETTING Across two British Athletics performance centres. PARTICIPANTS 44 elite British track and field athletes. MAIN OUTCOME MEASURES Eccentric hamstring force and torque were evaluated using the Nordbord device. Injury history and demographic data was collected to assess whether differences between gender, event group, limb symmetry and previous injury history were present. RESULTS Average peak force for males and females was 418.38N and 318.54N. Relative to body weight there were no gender differences (Male 5.21N.kg-1, Female 4.99N.kg-1) (p = 0.62). The right limb was significantly stronger in long sprint (400m athletes) (p = 0.00018) (d = 0.56). No differences in relative force or torque were observed between previously injured and non-injured limbs. CONCLUSIONS This study provides unique data in elite track and field athletes. Relative force per kilogram should be used when comparing male and female athletes. Unlike other studies, we found no difference in eccentric strength between previously injured and non-injured limbs. The novel finding of increased eccentric strength demonstrated in the right limb in 400m sprinters may be due to the asymmetric demands of bend running and may be considered normal.
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Crow J, Semciw A, Couch J, Pizzari T. Does a recent hamstring muscle injury affect the timing of muscle activation during high speed overground running in professional Australian Football players? Phys Ther Sport 2020; 43:188-194. [PMID: 32208357 DOI: 10.1016/j.ptsp.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate if the temporal characteristics of hamstring and gluteal muscle activation are altered during high speed overground running in professional Australian Football players following hamstring muscle injury. DESIGN Cohort study. SETTING Field-based testing. PARTICIPANTS Elite professional Australian Football players who had sustained a hamstring muscle injury in the six months prior to testing (n = 7) and a group of players from the same club who had no history of hamstring muscle injury (n = 8). MAIN OUTCOME MEASURES Muscle onset timing, muscle offset timing and muscle onset duration of the medial hamstrings, biceps femoris and gluteus maximus muscles during high-speed running using electromyographic data. RESULTS No significant differences in any of the temporal aspects of muscle activation were found between groups for any of the muscles tested (p > 0.05). CONCLUSIONS Persistent alterations to the timing of muscle activation following hamstring muscle injury that have been reported in recreational athletes were not observed during high speed running in professional athletes who have completed comprehensive rehabilitation programs.
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Affiliation(s)
- Justin Crow
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; Paralympics Australia, Melbourne, Australia.
| | - Adam Semciw
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia
| | - Jamon Couch
- Mill Park Physiotherapy Centre, Melbourne, Australia
| | - Tania Pizzari
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; Mill Park Physiotherapy Centre, Melbourne, Australia
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54
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BUHMANN ROBERT, TRAJANO GABRIELS, KERR GRAHAM, SHIELD ANTHONY. Voluntary Activation and Reflex Responses after Hamstring Strain Injury. Med Sci Sports Exerc 2020; 52:1862-1869. [DOI: 10.1249/mss.0000000000002327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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55
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Avrillon S, Hug F, Guilhem G. Bilateral differences in hamstring coordination in previously injured elite athletes. J Appl Physiol (1985) 2020; 128:688-697. [PMID: 32027546 DOI: 10.1152/japplphysiol.00411.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hamstring strain injuries (HSIs) involve tissue disruption and pain, which can trigger long-term adaptations of muscle coordination. However, little is known about the effect of previous HSIs on muscle coordination and in particular, after the completion of rehabilitation and in the absence of symptoms. This study aimed to determine if elite athletes with a prior unilateral HSI have bilateral differences in coordination between the hamstring muscle heads after returning to sport. Seventeen athletes with a unilateral history of biceps femoris (BF) injury participated in the experiment. Surface electromyography was recorded from three hamstring muscles [BF, semimembranosus (SM), and semitendinosus] during submaximal isometric torque-matched tasks at 20% and 50% of maximal voluntary contraction. The product of normalized electromyographic amplitude with functional physiological cross-sectional area (PCSA) and moment arm was considered as an index of individual muscle torque. The contribution of the injured muscle to total knee flexion torque was lower in the injured than the uninjured limb (-5.6 ± 10.2%, P = 0.038). This reduced contribution of BF was compensated by a higher contribution of the SM muscle in the injured limb (+5.6 ± 7.5%, P = 0.007). These changes resulted from a lower contribution of PCSA from the injured muscle (BF) and a larger contribution of activation from an uninjured synergist muscle (SM). In conclusion, bilateral differences in coordination were observed in previously injured athletes despite the completion of rehabilitation. Whether these bilateral differences in hamstring coordination could constitute an intrinsic risk factor that contributes to the high rate of hamstring injury recurrence remains to be investigated.NEW & NOTEWORTHY We used an experimental approach, combining the assessment of muscle activation, physiological cross-sectional area, and moment arm to estimate force-sharing strategies among hamstring muscles during isometric knee flexions. We tested athletes with a history of hamstring injury. We observed a lower contribution of the injured biceps femoris to the total knee flexor torque in the injured limb than in the contralateral limb. This decreased contribution was mainly due to selective atrophy of the injured biceps femoris muscle and was compensated by an increased activation of the semimembranosus muscle.
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Affiliation(s)
- Simon Avrillon
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France.,Laboratory Movement, Interactions, Performance (EA 4334), Nantes University, Nantes, France.,Legs & Walking Lab, Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - François Hug
- Laboratory Movement, Interactions, Performance (EA 4334), Nantes University, Nantes, France.,Institut Universitaire de France, Paris, France.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Gaël Guilhem
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
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Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2020; 50:91-103. [PMID: 32005093 DOI: 10.2519/jospt.2020.8895] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The primary aim was to compare time from acute hamstring strain injury (HSI) to return-to-play (RTP) clearance following a standardized rehabilitation protocol performed within either pain-free or pain-threshold limits. Secondary aims were to compare isometric knee flexor strength, biceps femoris long head (BFLH) fascicle length, fear of movement, and reinjury occurrence at the 6-month follow-up between pain-free and pain-threshold groups. DESIGN Randomized controlled trial. METHODS Forty-three men with acute HSIs were randomly allocated to a pain-free (n = 22) or pain-threshold (n = 21) rehabilitation group. Days from HSI to RTP clearance, isometric knee flexor strength, BFLH fascicle length, fear of movement, and reinjury occurrence at the 6-month follow-up were reported. RESULTS Median time from HSI to RTP clearance was 15 days (95% confidence interval [CI]: 13, 17) in the pain-free group and 17 days (95% CI: 11, 24) in the pain-threshold group, which was not significantly different (P = .37). Isometric knee flexor strength recovery at 90° of hip and 90° of knee flexion was greater in the pain-threshold group at RTP clearance by 15% (95% CI: 1%, 28%) and by 15% (95% CI: 1%, 29%) at 2-month follow-up, respectively. Improvement in BFLH fascicle length from baseline was 0.91 cm (95% CI: 0.34, 1.48) greater at 2-month follow-up in the pain-threshold group. Two reinjuries occurred in both the pain-free and pain-threshold groups between RTP clearance and the 6-month follow-up. CONCLUSION Pain-threshold rehabilitation did not accelerate RTP clearance, but resulted in greater recovery of isometric knee flexor strength and better maintenance of BFLH fascicle length, compared to pain-free rehabilitation. J Orthop Sports Phys Ther 2020;50(2):91-103. Epub 28 Jun 2019. doi:10.2519/jospt.2020.8895.
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Correia P, Santos P, Mil-Homens P, Gomes M, Dias A, Valamatos MJ. Rapid hamstrings to quadriceps ratio at long muscle lengths in professional football players with previous hamstring strain injury. Eur J Sport Sci 2020; 20:1405-1413. [PMID: 31917646 DOI: 10.1080/17461391.2020.1714741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hamstring strain injuries (HSI) are the most common injury in male professional football and are potentially a primary risk factor to re-injury. Although the isokinetic strength ratios have often been used to identify strength imbalances that can augment the risk of injury in football players, the rate of torque development hamstring to quadriceps ratio (RTD H/Q) has rarely been considered in previous reports. Furthermore, little consideration has been given to selective hamstring lengths (30° of knee flexion) and its influence on torque production. The aim of this study was to investigate the RTD H/Q at long hamstring lengths, conventional (concentric/concentric) and functional (eccentric/concentric) H/Q ratios in football players with and without previous HSI. Twenty-four professional male football players (12 and 12 without previous HSI) performed maximal voluntary isometric contractions at long hamstring lengths (knee and hip flexed at 30° and 85°, respectively) and isokinetic concentric and eccentric contractions at 180°.s-1 and 60°.s-1. Conventional and functional H/Q ratios based on peak torque throughout the entire isokinetic range of motion and at long hamstring lengths were calculated. The RTD H/Q was extracted at long hamstring lengths in incrementing time periods of 50 milliseconds (ms) from the onset of contraction (50-250 ms). No significant differences were found between groups in any H/Q ratios studied. However, small effects (d = 0.4) were found in previously injured hamstrings to lower RTD H/Q at 50 ms and flexor eccentric torque. Previous HSI group showed small to moderate (0.4 > d < 0.6) higher RTD H/Q in late time intervals (>100 ms).
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Affiliation(s)
- Paulo Correia
- Faculty of Human Kinetics, Neuromuscular Research Lab, University of Lisbon, Lisbon, Portugal
| | - Paulo Santos
- Faculty of Human Kinetics, Neuromuscular Research Lab, University of Lisbon, Lisbon, Portugal
| | - Pedro Mil-Homens
- Faculty of Human Kinetics, Neuromuscular Research Lab, University of Lisbon, Lisbon, Portugal.,Faculty of Human Kinetics, Laboratory of Biomechanics and Functional Morphology, University of Lisbon, Lisbon, Portugal.,Faculty of Human Kinetics, Interdisciplinary Center for the Study of Human Performance, Lisbon, Portugal
| | - Miguel Gomes
- Faculty of Human Kinetics, Neuromuscular Research Lab, University of Lisbon, Lisbon, Portugal
| | - Amândio Dias
- Faculty of Human Kinetics, Neuromuscular Research Lab, University of Lisbon, Lisbon, Portugal.,Kinesiolab - Laboratory of human movement analisys, Piaget Institute - Almada Campus, Almada, Portugal
| | - Maria João Valamatos
- Faculty of Human Kinetics, Neuromuscular Research Lab, University of Lisbon, Lisbon, Portugal.,Faculty of Human Kinetics, Laboratory of Biomechanics and Functional Morphology, University of Lisbon, Lisbon, Portugal.,Faculty of Human Kinetics, Interdisciplinary Center for the Study of Human Performance, Lisbon, Portugal
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58
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Effects of the Functional Heel Drop Exercise on the Muscle Architecture of the Gastrocnemius. J Sport Rehabil 2019; 29:1053-1059. [PMID: 31810057 DOI: 10.1123/jsr.2019-0150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/10/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT The architectural characteristics of a muscle determine its function. OBJECTIVE To determine the architectural adaptations of the lateral gastrocnemius (LG) and medial gastrocnemius (MG) muscles after a functional eccentric strength training protocol consisting of heel drop exercises, followed by a subsequent detraining period. DESIGN Pretest and posttest. SETTING Training rooms and laboratory. PARTICIPANTS The participants (N = 45) who were randomly divided into an experimental group (EG, n = 25) and a control group (CG, n = 20). INTERVENTIONS The 13-week intervention included participants (N = 45) who were randomly divided into an EG (n = 25) and a CG (n = 20). The EG performed a week of control and training, 8 weeks of eccentric training, and 4 weeks of detraining. The CG did not perform any type of muscular training. The architectural characteristics of the LG and MG muscles were evaluated at rest in both groups using 2-D ultrasound before (pretest-week 1) and after (posttest-week 9) the training, and at the end of the detraining period (retest-week 13). MAIN OUTCOME MEASURES One-way repeated measures analysis of variance was used to determine training-induced changes in each of the variables of the muscle architecture. RESULTS After the training period, the members of the EG experienced a significant increase in the fascicle length of LG (t = -9.85, d = 2.78, P < .001) and MG (t = -8.98, d = 2.54, P < .001), muscle thickness (t = -6.71, d = 2.86, P < .001) and (t = -7.85, d = 2.22, P < .001), and the pennation angle (t = -10.21, d = 1.88, P < .05) and (t = -1.87, d = 0.53, P < .05), respectively. After the detraining period, fascicle length, muscle thickness, and pennation angle showed a significant decrease. In the CG, no significant changes were observed in any of the variables. CONCLUSIONS The heel drop exercise seems to generate adaptations in the architectural conditions of LG and MG, which are also reversible after a detraining period. These results may have practical implications for injury prevention and rehabilitation programs.
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Kraus K, Schütz E, Doyscher R. The Relationship Between a Jump-Landing Task and Functional Movement Screen Items : A Validation Study. J Strength Cond Res 2019; 33:1855-1863. [PMID: 28859011 DOI: 10.1519/jsc.0000000000002121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Kraus, K, Schütz, E, and Doyscher, R. The relationship between a jump-landing task and functional movement screen items : a validation study. J Strength Cond Res 33(7): 1855-1863, 2019-Sports injuries and athletic performance are complex areas, which are characterized by manifold interdependencies. The landing error scoring system (LESS) is a valid screening tool to examine bilateral jump-landing mechanics, whereas the Functional Movement Screen (FMS) items are thought to operationalize flexibility and motor behavior during low-intense bodyweight patterns. The aim of the study was to explore possible interdependency of the diagnostic information of these screening tools. Fifty-three athletes (age 23.3 ± 2.1 years) were tested in a sport scientific laboratory. In detail, 31 professional soccer players (third division) and 22 collegiate athletes were studied. Linear, partial correlational, and cluster analysis were performed to examine possible trends. Generally, the sportsmen achieved a LESS score of 6.6 ± 2 and a jumping height of 37 ± 7.8 cm. Partial correlational analysis indicates that trunk control (r = 0.4; p < 0.01) is moderately related to landing mechanics, which in turn was negatively related on LESS height (r = -0.67, p < 0.01). In addition, clustering showed by trend that a higher active straight leg raise (ASLR) score is related to better landing mechanics (ASLR score 1: LESS 6.9 ± 1.8; n = 15 vs. ASLR score 3: LESS 5.6 ± 2.1; n = 10). On the task-specific level, jump-landing mechanics were directly related to jumping performance in this cohort with poor mechanics. On unspecific analysis level, kinetic chain length (ASLR) and trunk control have been identified as potential moderator variables for landing mechanics, indicating that these parameters can limit landing mechanics and ought to be optimized within the individual's context. A potential cognitive strategy shift from internal (FMS) to external focus (LESS) and different muscle recruitment patterns are potential explanations for the nonsignificant linear relationship between the FMS and LESS data.
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Affiliation(s)
- Kornelius Kraus
- Department of Sports Science, Munich University of Federal Armed Forces, Neubiberg, Germany
| | | | - Ralf Doyscher
- Centrum for Orthopedics and Trauma Surgery, Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Neuromuscular changes in football players with previous hamstring injury. Clin Biomech (Bristol, Avon) 2019; 69:115-119. [PMID: 31330460 DOI: 10.1016/j.clinbiomech.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/17/2019] [Accepted: 07/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Impact of prior injury on myoelectrical activity of the hamstrings during isokinetic eccentric contractions has received increased literature attention. This cross-sectional study aimed to assess neuromuscular adaptations, namely proprioception, core stability, muscle strength, extensibility and activity, in football players with history of hamstring strain injury. METHODS Seventeen players, 10 with history of hamstring injury and 7 without prior injury underwent isokinetic strength testing, eccentric knee extension at 30 and 120°/s. Myoelectrical activity of bicep femoris and medial hamstrings was calculated at 30, 50 and 100 ms after onset of contraction. Functional tests included core stability, muscle strength, and knee proprioception tests. FINDING Differences were observed between Hamstring Group injured and uninjured and Control Group dominant limbs in the bicep femoris activity at almost all times in both velocities (p < 0.05). Joint position sense error was higher in the injured side compared to uninjured and control dominant limb; additionally there were also differences between injured and uninjured limb in the triple-hop test. INTERPRETATION Previously injured side showed deficits in bicep femoris myoelectrical activity after onset of contraction during eccentric testing, proprioceptive deficits, and functional asymmetry.
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61
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Kellis E, Galanis N, Kofotolis N. Hamstring-to-Quadriceps Ratio in Female Athletes with a Previous Hamstring Injury, Anterior Cruciate Ligament Reconstruction, and Controls. Sports (Basel) 2019; 7:sports7100214. [PMID: 31569442 PMCID: PMC6835705 DOI: 10.3390/sports7100214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/22/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022] Open
Abstract
Muscle strength imbalances around the knee are often observed in athletes after anterior cruciate ligament (ACL) surgery and hamstring muscle injury. This study examined three hamstrings-to-quadriceps (H:Q) strength ratio types (conventional, functional, and mixed) in thirteen female athletes with a history of hamstring injury, fourteen basketball players following ACL reconstruction and 34 controls. The conventional (concentric H:Q) peak torque ratio was evaluated at 120°·s−1 and 240°·s−1. The functional (eccentric hamstring to concentric quadriceps) torque ratio was evaluated at 120°·s−1. Finally, the mixed (eccentric hamstrings at 30°·s−1 to concentric quadriceps at 240°·s−1) torque ratio was calculated. Both ACL and the hamstring-injured groups showed a lower quadriceps and hamstrings strength compared with controls (p < 0.05). However, non-significant group differences in the H:Q ratio were found (p > 0.05). Isokinetic assessment of muscle strength may be useful for setting appropriate targets of training programs for athletes with a history of ACL surgery or hamstring strain. However, isokinetic evaluation of the H:Q ratio is not injury—specific and it does not vary between different methods of calculating the H:Q ratio.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, 62100 Thessaloniki, Greece.
| | - Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopaedics, General Hospital Papageorgiou, Aristotle University of Thessaloniki Medical School, 56403 Thessaloniki, Greece.
| | - Nikolaos Kofotolis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, 62100 Thessaloniki, Greece.
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Higashihara A, Ono T, Tokutake G, Kuramochi R, Kunita Y, Nagano Y, Hirose N. Hamstring muscles' function deficit during overground sprinting in track and field athletes with a history of strain injury. J Sports Sci 2019; 37:2744-2750. [PMID: 31608831 DOI: 10.1080/02640414.2019.1664030] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In this study, we aimed to clarify the characteristics of neuromuscular function, kinetics, and kinematics of the lower extremity during sprinting in track and field athletes with a history of strain injury. Ten male college sprinters with a history of unilateral hamstring injury performed maximum effort sprint on an athletic track. The electromyographic (EMG) activity of the long head of the biceps femoris (BFlh) and gluteus maximus (Gmax) muscles and three-dimensional kinematic data were recorded. Bilateral comparisons were performed for the EMG activities, pelvic anterior tilt angle, hip and knee joint angles and torques, and the musculotendon length of BFlh. The activity of BFlh in the previously injured limb was significantly lower than that in the uninjured limb during the late-swing phase of sprinting (p < 0.05). However, the EMG activity of Gmax was not significantly different between the previously injured and uninjured limbs. Furthermore, during the late-swing phase, a significantly more flexed knee angle (p < 0.05) and a decrease in BFlh muscle length (p < 0.05) were noted in the injured limb. It was concluded that previously injured hamstring muscles demonstrate functional deficits during the late swing phase of sprinting in comparison with the uninjured contralateral muscles.
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Affiliation(s)
| | - Takashi Ono
- Kitasato University College of Liberal Arts and Sciences, Center for Human and Social Sciences , Kanagawa , Japan
| | - Gaku Tokutake
- School of Health and Sport Sciences, Chukyo University , Aichi , Japan
| | - Rieko Kuramochi
- School of Health and Sport Sciences, Chukyo University , Aichi , Japan
| | - Yasuhiro Kunita
- Department of Rehabilitation, Nippon Koukan Hospital , Kanagawa , Japan
| | - Yasuharu Nagano
- Department of Sports Wellness Sciences, Japan Women's College of Physical Education , Tokyo , Japan
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University , Saitama , Japan
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Injury Incidence, Prevalence and Severity in High-Level Male Youth Football: A Systematic Review. Sports Med 2019; 49:1879-1899. [DOI: 10.1007/s40279-019-01169-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Impact of Hip Flexion Angle on Unilateral and Bilateral Nordic Hamstring Exercise Torque and High-Density Electromyography Activity. J Orthop Sports Phys Ther 2019; 49:584-592. [PMID: 30913969 DOI: 10.2519/jospt.2019.8801] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the bilateral Nordic hamstring exercise (NHE), hamstrings operate at relatively short lengths, which may limit the efficacy of the NHE in hamstring injury prevention. OBJECTIVES To examine knee flexion torque and biceps femoris long head (BFLH) and semitendinosus (ST) high-density electromyography (EMG) activity during the unilateral and bilateral NHE, performed with either neutral (NHE0) or 90°-flexed (NHE90) hips. METHODS In this laboratory study, exercises were performed on a novel device at the eccentric 1-repetition maximum load defined for 90° to 15° of knee range of motion. Torque and EMG signals normalized to maximal voluntary isometric activity were compared in different phases of the exercises with statistical parametric mapping. RESULTS The EMG levels were lower in NHE90 than in NHE0, mainly in the second half of the movement. Knee flexor eccentric torque was higher in NHE90 than in NHE0 from the beginning to 87% of the bilateral movement, and over the entire unilateral movement. In NHE0, ST activity compared to BFLH activity was higher during the initial movement phase and lower when the movement was close to knee extension. Torque and EMG activity were generally similar in the bilateral and unilateral modes. CONCLUSION If performed with neutral hips, the NHE selectively activates the BFLH near full knee extension. Performing the NHE with hips flexed to 90° is preferable when higher passive torque and ST selectivity are targeted at a longer muscle length. Performing these exercises unilaterally could help train each limb separately, with similar torque and EMG output to those of the bilateral conditions. J Orthop Sports Phys Ther 2019;49(8):584-592. Epub 26 Mar 2019. doi:10.2519/jospt.2019.8801.
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Hickey JT, Timmins RG, Maniar N, Rio E, Hickey PF, Pitcher CA, Williams MD, Opar DA. Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2019:1-35. [PMID: 31253060 DOI: 10.2519/jospt.2019.8895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized controlled trial. BACKGROUND Conventional guidelines recommend hamstring strain injury (HSI) rehabilitation should only be performed and progressed in complete absence of pain, despite lack of comparison to alternative approaches. OBJECTIVES The primary aim of this study was to compare the number of days from acute HSI to return to play (RTP) clearance following a standardised rehabilitation protocol performed within either pain-free or pain-threshold limits. The secondary aims were to compare isometric knee flexor strength, biceps femoris long head (BFlh) fascicle length, fear of movement and re-injury during a six-month follow-up between pain-free and pain-threshold groups. METHODS Forty-three men with acute HSIs were randomly allocated to either a pain-free (n=22) or pain-threshold (n=21) rehabilitation group. Days from HSI to RTP clearance, isometric knee flexor strength, BFlh fascicle length, fear of movement and re-injuries within six-month follow-up were reported. RESULTS The median time from HSI to RTP clearance was 15 days (95% CI = 13 to 17) in the pain-free group and 17 days (95% CI = 11 to 24) in the pain-threshold group, which was not significantly different (p = 0.37). Recovery of isometric knee flexor strength at 90/90 degrees of hip/knee flexion was greater in the pain-threshold group at RTP clearance by 15% (95% CI = 1 to 28) and by 15% (95% CI = 1 to 29) at two-month follow-up. BFlh fascicles were 0.91cm (95% CI = 0.34 to 1.48) longer at two-month follow-up in the pain-threshold group. Two re-injuries occurred in both the pain-free and pain-threshold group during six-month follow-up. CONCLUSION Pain-threshold rehabilitation did not accelerate RTP clearance but did result in greater recovery of isometric knee flexor strength and better maintenance of BFlh fascicle length improvements compared to pain-free rehabilitation. J Orthop Sports Phys Ther, Epub 28 Jun 2019. doi:10.2519/jospt.2019.8895.
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Affiliation(s)
- Jack T Hickey
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Ebonie Rio
- La Trobe Centre for Sports and Exercise Medicine Research, Melbourne, Australia
| | - Peter F Hickey
- Epigenetics and Development Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Christian A Pitcher
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Morgan D Williams
- School of Health, Sport and Professional Practice, University of South Wales, Pontypridd, Wales, UK
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
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Ruddy JD, Shield AJ, Maniar N, Williams MD, Duhig S, Timmins RG, Hickey J, Bourne MN, Opar DA. Predictive Modeling of Hamstring Strain Injuries in Elite Australian Footballers. Med Sci Sports Exerc 2019; 50:906-914. [PMID: 29266094 DOI: 10.1249/mss.0000000000001527] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Three of the most commonly identified hamstring strain injury (HSI) risk factors are age, previous HSI, and low levels of eccentric hamstring strength. However, no study has investigated the ability of these risk factors to predict the incidence of HSI in elite Australian footballers. Accordingly, the purpose of this prospective cohort study was to investigate the predictive ability of HSI risk factors using machine learning techniques. METHODS Eccentric hamstring strength, demographic and injury history data were collected at the start of preseason for 186 and 176 elite Australian footballers in 2013 and 2015, respectively. Any prospectively occurring HSI were reported to the research team. Using various machine learning techniques, predictive models were built for 2013 and 2015 within-year HSI prediction and between-year HSI prediction (2013 to 2015). The calculated probabilities of HSI were compared with the injury outcomes and area under the curve (AUC) was determined and used to assess the predictive performance of each model. RESULTS The minimum, maximum, and median AUC values for the 2013 models were 0.26, 0.91, and 0.58, respectively. For the 2015 models, the minimum, maximum and median AUC values were, correspondingly, 0.24, 0.92, and 0.57. For the between-year predictive models the minimum, maximum, and median AUC values were 0.37, 0.73, and 0.52, respectively. CONCLUSIONS Although some iterations of the models achieved near perfect prediction, the large ranges in AUC highlight the fragility of the data. The 2013 models performed slightly better than the 2015 models. The predictive performance of between-year HSI models was poor however. In conclusion, risk factor data cannot be used to identify athletes at an increased risk of HSI with any consistency.
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Affiliation(s)
- Joshua D Ruddy
- School of Exercise Science, Australian Catholic University, Melbourne, AUSTRALIA
| | - Anthony J Shield
- School of Exercise Science, Australian Catholic University, Melbourne, AUSTRALIA
| | - Nirav Maniar
- School of Exercise Science, Australian Catholic University, Melbourne, AUSTRALIA
| | - Morgan D Williams
- School of Exercise Science, Australian Catholic University, Melbourne, AUSTRALIA
| | - Steven Duhig
- School of Exercise Science, Australian Catholic University, Melbourne, AUSTRALIA
| | - Ryan G Timmins
- School of Exercise Science, Australian Catholic University, Melbourne, AUSTRALIA
| | - Jack Hickey
- School of Exercise Science, Australian Catholic University, Melbourne, AUSTRALIA
| | - Matthew N Bourne
- School of Exercise Science, Australian Catholic University, Melbourne, AUSTRALIA
| | - David A Opar
- School of Exercise Science, Australian Catholic University, Melbourne, AUSTRALIA
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McHugh MP, Tyler TF. Muscle strain injury vs muscle damage: Two mutually exclusive clinical entities. TRANSLATIONAL SPORTS MEDICINE 2019. [DOI: 10.1002/tsm2.66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Malachy P. McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma Lenox Hill Hospital New York City New York
| | - Timothy F. Tyler
- Nicholas Institute of Sports Medicine and Athletic Trauma Lenox Hill Hospital New York City New York
- PRO Sports Physical Therapy of Westchester Scarsdale New York
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Blandford L, Theis N, Charvet I, Mahaffey R. Is neuromuscular inhibition detectable in elite footballers during the Nordic hamstring exercise? Clin Biomech (Bristol, Avon) 2018; 58:39-43. [PMID: 30015204 DOI: 10.1016/j.clinbiomech.2018.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/10/2018] [Accepted: 07/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The presence of neuromuscular inhibition following injury may explain the high incidence of biceps femoris injury recurrence in elite (soccer) footballers. This phenomenon may be detectable in elite players during the Nordic hamstring exercise. Thus, the first purpose of this study was to assess biceps femoris muscle activation during this exercise in players with hamstring injury history. Additionally, following injury, observed increases in synergistic muscle activation may represent a protective mechanism to the presence of neuromuscular inhibition. Thus, the second purpose was to identify if the relative contributions of biceps femoris, and its synergists reflected a post-injury pattern of activation suggestive of these potentially compensatory neural mechanisms. METHODS Ten elite players with a history of hamstring injury and ten elite players without a history of hamstring injury, completed six repetitions of the Nordic hamstring exercise. During each trial, biceps femoris, semitendinosus and gluteus maximus muscle activations were collected at 90-30° and 30-0° of knee flexion. FINDINGS Biceps femoris activation was significantly higher at 90-30° of knee flexion compared to 30-0° (P < 0.001) but did not differ between the groups. In players with a history of injury, muscle activation ratios for the biceps femoris/semitendinosus (P = 0.001) and biceps femoris/gluteus maximus (P = 0.023) were significantly greater at 30-0° of knee flexion than in the control group. INTERPRETATION Neuromuscular inhibition of the biceps femoris was not detected during the exercise within elite footballers, yet the relative contributions of biceps femoris and its synergists appear to change following injury.
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Affiliation(s)
- Lincoln Blandford
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK.
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Ingrid Charvet
- Department of Civil, Environmental & Geomatic Engineering, University College London, UK
| | - Ryan Mahaffey
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK
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Hamstring Muscle Use in Women During Hip Extension and the Nordic Hamstring Exercise: A Functional Magnetic Resonance Imaging Study. J Orthop Sports Phys Ther 2018; 48:607-612. [PMID: 29685059 DOI: 10.2519/jospt.2018.7748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Understanding hamstring muscle activation patterns in resistance training exercises may have implications for the design of strength training and injury prevention programs. Unfortunately, surface electromyography studies have reported conflicting results regarding hamstring muscle activation patterns in women. Objectives To determine the spatial patterns of hamstring muscle activity during the 45° hip extension and Nordic hamstring exercises in women using functional magnetic resonance imaging (fMRI). Methods This was a cross-sectional study in which 6 recreationally active women with no history of lower-limb injury underwent fMRI on both thighs before and immediately after 5 sets of 6 bilateral eccentric contractions of the 45° hip extension exercise or the Nordic exercise. Using fMRI, the transverse (T2) relaxation times were measured from pre-exercise and postexercise scans, and the percentage increase in T2 was used as an index of muscle activation. Results The fMRI revealed a significantly higher biceps femoris long head-to-semitendinosus ratio during the 45° hip extension exercise than in the Nordic exercise (P = .028). The T2 increase after the 45° hip extension exercise was greater for the biceps femoris long head (P<.001), semitendinosus, and semimembranosus (P≤.001) than that for the biceps femoris short head. During the Nordic exercise, the T2 increase of the semitendinosus was greater than that of the biceps femoris short head (P<.001) and biceps femoris long head (P = .001). Conclusion While both exercises involve high levels of semitendinosus activation in women, the Nordic exercise preferentially recruits that muscle, while the hip extension exercise more evenly activates all the biarticular hamstrings. J Orthop Sports Phys Ther 2018;48(8):607-612. Epub 23 Apr 2018. doi:10.2519/jospt.2018.7748.
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Alonso-Fernandez D, Gutierrez-Sanchez Á, Garcia-Remeseiro T, Garganta R. Effects of the Nordic hamstring exercise on the architecture of the semitendinosus. ISOKINET EXERC SCI 2018. [DOI: 10.3233/ies-172196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Diego Alonso-Fernandez
- Faculty of Science Education and Sport, University of Vigo, Pontevedra, Spain
- Education, Physical Activity and Health Research Group (Gies10-DE3), Galicia Sur Health Research Institute, University of Vigo, Vigo, Spain
| | - Águeda Gutierrez-Sanchez
- Faculty of Science Education and Sport, University of Vigo, Pontevedra, Spain
- Education, Physical Activity and Health Research Group (Gies10-DE3), Galicia Sur Health Research Institute, University of Vigo, Vigo, Spain
| | - Tania Garcia-Remeseiro
- Faculty of Science Education and Sport, University of Vigo, Pontevedra, Spain
- Education, Physical Activity and Health Research Group (Gies10-DE3), Galicia Sur Health Research Institute, University of Vigo, Vigo, Spain
| | - Rui Garganta
- Faculty of Sport, University of Porto, Porto, Portugal
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Murphy SJ, Rennie DJ. Rehabilitation of the Surgically Repaired Intramuscular Hamstring Tendon - A Case Report. Curr Sports Med Rep 2018; 17:187-191. [PMID: 29889147 DOI: 10.1249/jsr.0000000000000490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Simon J Murphy
- Medical Department, Leicester City Football Club, Leicester, United Kingdom
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The Effects of Maturation on Measures of Asymmetry During Neuromuscular Control Tests in Elite Male Youth Soccer Players. Pediatr Exerc Sci 2018; 30:168-175. [PMID: 28787266 PMCID: PMC6538932 DOI: 10.1123/pes.2017-0081] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Asymmetry is a risk factor for male youth soccer players. There is a paucity of data confirming the presence of asymmetry using practically viable screening tasks in players at different stages of maturation. METHODS A cross-sectional sample (N = 347) of elite male youth soccer players who were either pre-, circa-, or post-peak height velocity (PHV) completed the following assessments: single-leg Y-Balance anterior reach, single-leg hop for distance, single-leg 75% hop and stick, and single-leg countermovement jumps. RESULTS Single-leg countermovement jumps landing force asymmetry was higher in both circa- and post-PHV groups (P < .001; d = 0.41-0.43). Single-leg 75% hop and stick landing force asymmetries were also highest in circa-PHV players, but between-group comparisons were not statistically significant and effect sizes were small. Single-leg hop for distance and single-leg Y-Balance anterior reach asymmetries reduced with maturation; however, no group differences were significant, with small to trivial effect sizes (d ≤ 0.25). CONCLUSION Stage of maturation did not have a profound effect on asymmetry. Between-limb differences in functional performance seem to be established in early childhood; thus, targeted interventions to reduce this injury risk factor should commence in pre-PHV athletes and be maintained throughout childhood and adolescence to ensure asymmetry does not increase.
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Effects of a Novel Neurodynamic Tension Technique on Muscle Extensibility and Stretch Tolerance: A Counterbalanced Crossover Study. J Sport Rehabil 2018; 27:55-65. [PMID: 27992294 DOI: 10.1123/jsr.2016-0171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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74
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Shield AJ, Bourne MN. Hamstring Injury Prevention Practices in Elite Sport: Evidence for Eccentric Strength vs. Lumbo-Pelvic Training. Sports Med 2017; 48:513-524. [DOI: 10.1007/s40279-017-0819-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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75
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Williams S, Trewartha G, Kemp SPT, Brooks JHM, Fuller CW, Taylor AE, Cross MJ, Shaddick G, Stokes KA. How Much Rugby is Too Much? A Seven-Season Prospective Cohort Study of Match Exposure and Injury Risk in Professional Rugby Union Players. Sports Med 2017; 47:2395-2402. [PMID: 28361327 PMCID: PMC5633632 DOI: 10.1007/s40279-017-0721-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Numerous studies have documented the incidence and nature of injuries in professional rugby union, but few have identified specific risk factors for injury in this population using appropriate statistical methods. In particular, little is known about the role of previous short-term or longer-term match exposures in current injury risk in this setting. OBJECTIVES Our objective was to investigate the influence that match exposure has upon injury risk in rugby union. METHOD We conducted a seven-season (2006/7-2012/13) prospective cohort study of time-loss injuries in 1253 English premiership professional players. Players' 12-month match exposure (number of matches a player was involved in for ≥20 min in the preceding 12 months) and 1-month match exposure (number of full-game equivalent [FGE] matches in preceding 30 days) were assessed as risk factors for injury using a nested frailty model and magnitude-based inferences. RESULTS The 12-month match exposure was associated with injury risk in a non-linear fashion; players who had been involved in fewer than ≈15 or more than ≈35 matches over the preceding 12-month period were more susceptible to injury. Monthly match exposure was linearly associated with injury risk (hazard ratio [HR]: 1.14 per 2 standard deviation [3.2 FGE] increase, 90% confidence interval [CI] 1.08-1.20; likely harmful), although this effect was substantially attenuated for players in the upper quartile for 12-month match exposures (>28 matches). CONCLUSION A player's accumulated (12-month) and recent (1-month) match exposure substantially influences their current injury risk. Careful attention should be paid to planning the workloads and monitoring the responses of players involved in: (1) a high (>≈35) number of matches in the previous year, (2) a low (<≈15) number of matches in the previous year, and (3) a low-moderate number of matches in previous year but who have played intensively in the recent past. These findings make a major contribution to evidence-based policy decisions regarding match workload limits in professional rugby union.
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Affiliation(s)
- Sean Williams
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Grant Trewartha
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | | | - John H M Brooks
- The Population Health Research Institute, St. George's University of London, London, UK
| | | | | | - Matthew J Cross
- Department for Health, University of Bath, Bath, BA2 7AY, UK
- Rugby Football Union, Twickenham, UK
| | - Gavin Shaddick
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, BA2 7AY, UK
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TIMMINS RYANG, BOURNE MATTHEWN, HICKEY JACKT, MANIAR NIRAV, TOFARI PAULJ, WILLIAMS MORGAND, OPAR DAVIDA. Effect of Prior Injury on Changes to Biceps Femoris Architecture across an Australian Football League Season. Med Sci Sports Exerc 2017; 49:2102-2109. [DOI: 10.1249/mss.0000000000001333] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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77
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Erickson LN, Sherry MA. Rehabilitation and return to sport after hamstring strain injury. JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:262-270. [PMID: 30356646 PMCID: PMC6189266 DOI: 10.1016/j.jshs.2017.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/25/2017] [Accepted: 02/24/2017] [Indexed: 06/01/2023]
Abstract
Hamstring strain injuries are common among sports that involve sprinting, kicking, and high-speed skilled movements or extensive muscle lengthening-type maneuvers with hip flexion and knee extension. These injuries present the challenge of significant recovery time and a lengthy period of increased susceptibility for recurrent injury. Nearly one third of hamstring strains recur within the first year following return to sport with subsequent injuries often being more severe than the original. This high re-injury rate suggests that athletes may be returning to sport prematurely due to inadequate return to sport criteria. In this review article, we describe the epidemiology, risk factors, differential diagnosis, and prognosis of an acute hamstring strain. Based on the current available evidence, we then propose a clinical guide for the rehabilitation of acute hamstring strains and an algorithm to assist clinicians in the decision-making process when assessing readiness of an athlete to return to sport.
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Schuermans J, Van Tiggelen D, Palmans T, Danneels L, Witvrouw E. Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence? Gait Posture 2017; 57:270-277. [PMID: 28683419 DOI: 10.1016/j.gaitpost.2017.06.268] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 06/16/2017] [Accepted: 06/26/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although the vast majority of hamstring injuries in male soccer are sustained during high speed running, the association between sprinting kinematics and hamstring injury vulnerability has never been investigated prospectively in a cohort at risk. PURPOSE This study aimed to objectify the importance of lower limb and trunk kinematics during full sprint in hamstring injury susceptibility. STUDY DESIGN Cohort study; level of evidence, 2. METHODS At the end of the 2013 soccer season, three-dimensional kinematic data of the lower limb and trunk were collected during sprinting in a cohort consisting of 30 soccer players with a recent history of hamstring injury and 30 matched controls. Subsequently, a 1.5 season follow up was conducted for (re)injury registry. Ultimately, joint and segment motion patterns were submitted to retro- and prospective statistical curve analyses for injury risk prediction. RESULTS Statistical analysis revealed that index injury occurrence was associated with higher levels of anterior pelvic tilting and thoracic side bending throughout the airborne (swing) phases of sprinting, whereas no kinematic differences during running were found when comparing players with a recent hamstring injury history with their matched controls. CONCLUSION Deficient core stability, enabling excessive pelvis and trunk motion during swing, probably increases the primary injury risk. Although sprinting encompasses a relative risk of hamstring muscle failure in every athlete, running coordination demonstrated to be essential in hamstring injury prevention.
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Affiliation(s)
- Joke Schuermans
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium.
| | - Damien Van Tiggelen
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
| | - Tanneke Palmans
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
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Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players. Sports Med 2017; 46:1059-66. [PMID: 26856339 DOI: 10.1007/s40279-016-0479-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Injuries reported in male youth soccer players most commonly occur in the lower extremities, and include a high proportion of ligament sprains at the ankle and knee with a lower proportion of overuse injuries. There is currently a paucity of available literature that examines age- and sex-specific injury risk factors for such injuries within youth soccer players. Epidemiological data have reported movements that lead to non-contact ligament injury include running, twisting and turning, over-reaching and landing. Altered neuromuscular control during these actions has been suggested as a key mechanism in females and adult populations; however, data available in male soccer players is sparse. The focus of this article is to review the available literature and elucidate prevalent risk factors pertaining to male youth soccer players which may contribute to their relative risk of injury.
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Schuermans J, Danneels L, Van Tiggelen D, Palmans T, Witvrouw E. Proximal Neuromuscular Control Protects Against Hamstring Injuries in Male Soccer Players: A Prospective Study With Electromyography Time-Series Analysis During Maximal Sprinting. Am J Sports Med 2017; 45:1315-1325. [PMID: 28263670 DOI: 10.1177/0363546516687750] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND With their unremittingly high incidence rate and detrimental functional repercussions, hamstring injuries remain a substantial problem in male soccer. Proximal neuromuscular control ("core stability") is considered to be of key importance in primary and secondary hamstring injury prevention, although scientific evidence and insights on the exact nature of the core-hamstring association are nonexistent at present. HYPOTHESIS The muscle activation pattern throughout the running cycle would not differ between participants based on injury occurrence during follow-up. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Sixty amateur soccer players participated in a multimuscle surface electromyography (sEMG) assessment during maximal acceleration to full-speed sprinting. Subsequently, hamstring injury occurrence was registered during a 1.5-season follow-up period. Hamstring, gluteal, and trunk muscle activity time series during the airborne and stance phases of acceleration were evaluated and statistically explored for a possible causal association with injury occurrence and absence from sport during follow-up. RESULTS Players who did not experience a hamstring injury during follow-up had significantly higher amounts of gluteal muscle activity during the front swing phase ( P = .027) and higher amounts of trunk muscle activity during the backswing phase of sprinting ( P = .042). In particular, the risk of sustaining a hamstring injury during follow-up lowered by 20% and 6%, with a 10% increment in normalized muscle activity of the gluteus maximus during the front swing and the trunk muscles during the backswing, respectively ( P < .024). CONCLUSION Muscle activity of the core unit during explosive running appeared to be associated with hamstring injury occurrence in male soccer players. Higher amounts of gluteal and trunk muscle activity during the airborne phases of sprinting were associated with a lower risk of hamstring injuries during follow-up. Hence, the present results provide a basis for improved, evidence-based rehabilitation and prevention, particularly focusing on increasing neuromuscular control of the gluteal and trunk muscles during sport-specific activities (eg, sprint drills, agility drills).
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Affiliation(s)
- Joke Schuermans
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Damien Van Tiggelen
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Tanneke Palmans
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Lee JW, Li C, Yung PS, Chan KM. The reliability and validity of a video-based method for assessing hamstring strength in football players. J Exerc Sci Fit 2017. [PMID: 29541126 PMCID: PMC5812858 DOI: 10.1016/j.jesf.2017.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background/Objective Evaluating hamstring strength by isokinetic dynamometry is limited by various practical issues such as time and cost. A video-based Nordic hamstring exercise is introduced as an alternative option. The aims of this study are to evaluate 1.) the between-session reliability and 2.) concurrent validity of the testing method compared to a standardized isokinetic dynamometry. Methods Thirty male elite footballers were recruited for the study. From the Nordic hamstring exercise, the video-analysis-determined Nordic break-point angles where the participant could no longer withstand the force of the fall (eccentric mode) and the number of seconds that the player could hold at 30° forward flexion angle (isometric mode) were measured. Intra-class correlation coefficients for between-session reliability, Pearson r correlations between the current method and isokinetic dynamometry were calculated. Results The reliability of the eccentric mode was moderate (ICC (2,1) = 0.82) while that of isometric mode was poor (ICC (2,1) = 0.57). The Nordic break-point angle of the eccentric mode significantly correlated with the concentric and eccentric hamstring peak torque (r = 0.48 and 0.58, p < 0.001), while the isometric was not (r = 0.02 - 0.07, p > 0.05). Conclusion The eccentric mode of the video-based hamstring strength test was a moderately reliable and valid method to measure the eccentric hamstring strength in elite football players.
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82
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Alonso-Fernandez D, Docampo-Blanco P, Martinez-Fernandez J. Changes in muscle architecture of biceps femoris induced by eccentric strength training with nordic hamstring exercise. Scand J Med Sci Sports 2017; 28:88-94. [DOI: 10.1111/sms.12877] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 12/25/2022]
Affiliation(s)
- D. Alonso-Fernandez
- Department of Physical Education and Sports; Faculty of Science Education and Sport; University of Vigo; Pontevedra Spain
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83
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Green B, Pizzari T. Calf muscle strain injuries in sport: a systematic review of risk factors for injury. Br J Sports Med 2017; 51:1189-1194. [PMID: 28259848 DOI: 10.1136/bjsports-2016-097177] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review the literature to identify risk factors for calf strain injury, and to direct future research into calf muscle injuries. DESIGN Systematic review DATA SOURCES: Database searches conducted for Medline, CINAHL, EMBASE, AMED, AUSPORT, SportDiscus, PEDro and Cochrane Library. Manual reference checks, ahead of press searches, citation tracking. From inception to June 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating and presenting data related to intrinsic or extrinsic risk factors for sustaining future calf injury. RESULTS Ten studies were obtained for review. Subjects across football, Australian football, rugby union, basketball and triathlon were reported on, representing 5397 athletes and 518 calf/ lower leg muscle injuries. Best evidence synthesis highlights chronological age and previous history of calf strain are the strongest risk factors for future calf muscle injury. Previous lower limb injuries (hamstring, quadriceps, adductor, knee) show some limited evidence for an association. Numerous factors lack evidence of an association, including height, weight, gender and side dominance. SUMMARY/CONCLUSION Increasing age and previous calf strain injury are the most predictive of future calf injury. The overall paucity of evidence and the trend for studies of a high risk of bias show that further research needs to be undertaken.
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Affiliation(s)
- Brady Green
- Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Tania Pizzari
- Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
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84
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Kirk EA, Rice CL. Contractile function and motor unit firing rates of the human hamstrings. J Neurophysiol 2017; 117:243-250. [PMID: 27784806 PMCID: PMC5220116 DOI: 10.1152/jn.00620.2016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/19/2016] [Indexed: 11/22/2022] Open
Abstract
Neuromuscular properties of the lower limb in health, aging, and disease are well described for major lower limb muscles comprising the quadriceps, triceps surae, and dorsiflexors, with the notable exception of the posterior thigh (hamstrings). The purpose of this study was to further characterize major muscles of the lower limb by comprehensively exploring contractile properties in relation to spinal motor neuron output expressed as motor unit firing rates (MUFRs) in the hamstrings of 11 (26.5 ± 3.8) young men. Maximal isometric voluntary contraction (MVC), voluntary activation, stimulated contractile properties including a force-frequency relationship, and MUFRs from submaximal to maximal voluntary contractile intensities were assessed in the hamstrings. Strength and MUFRs were assessed at two presumably different muscle lengths by varying the knee joint angles (90° and 160°). Knee flexion MVCs were 60-70% greater in the extended position (160°). The frequency required to elicit 50% of maximum tetanic torque was 16-17 Hz. Mean MUFRs at 25-50% MVC were 9-31% less in the biceps femoris compared with the semimembranosus-semitendinosus group. Knee joint angle (muscle length) influenced MUFRs such that mean MUFRs were greater in the shortened (90°) position at 50% and 100% MVC. Compared with previous reports, mean maximal MUFRs in the hamstrings are greater than those in the quadriceps and triceps surae and somewhat less than those in the tibialis anterior. Mean maximal MUFRs in the hamstrings are influenced by changes in knee joint angle, with lower firing rates in the biceps femoris compared with the semimembranosus-semitendinosus muscle group. NEW & NOTEWORTHY We studied motor unit firing rates (MUFRs) at various voluntary contraction intensities in the hamstrings, one of the only major lower limb muscles to have MUFRs affected by muscle length changes. Within the hamstrings muscle-specific differences have greater impact on MUFRs than length changes, with the biceps femoris having reduced neural drive compared with the semimembranosus-semimembranosus. Comparing our results to other lower limb muscles, flexors have inherently higher firing rate compared with extensors.
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Affiliation(s)
- Eric A Kirk
- Neuromuscular Laboratory, School of Kinesiology, The University of Western Ontario, London, Ontario, Canada; and
| | - Charles L Rice
- Neuromuscular Laboratory, School of Kinesiology, The University of Western Ontario, London, Ontario, Canada; and
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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85
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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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86
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Read PJ, Oliver JL, Croix MBDS, Myer GD, Lloyd RS. Consistency of Field-Based Measures of Neuromuscular Control Using Force-Plate Diagnostics in Elite Male Youth Soccer Players. J Strength Cond Res 2016; 30:3304-3311. [PMID: 27075641 PMCID: PMC5053830 DOI: 10.1519/jsc.0000000000001438] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Read, P, Oliver, JL, Croix, MD, Myer, GD, and Lloyd, RS. Consistency of field-based measures of neuromuscular control using force-plate diagnostics in elite male youth soccer players. J Strength Cond Res 30(12): 3304-3311, 2016-Deficits in neuromuscular control during movement patterns such as landing are suggested pathomechanics that underlie sport-related injury. A common mode of assessment is measurement of landing forces during jumping tasks; however, these measures have been used less frequently in male youth soccer players, and reliability data are sparse. The aim of this study was to examine the reliability of a field-based neuromuscular control screening battery using force-plate diagnostics in this cohort. Twenty-six pre-peak height velocity (PHV) and 25 post-PHV elite male youth soccer players completed a drop vertical jump (DVJ), single-leg 75% horizontal hop and stick (75%HOP), and single-leg countermovement jump (SLCMJ). Measures of peak landing vertical ground reaction force (pVGRF), time to stabilization, time to pVGRF, and pVGRF asymmetry were recorded. A test-retest design was used, and reliability statistics included change in mean, intraclass correlation coefficient, and coefficient of variation (CV). No significant differences in mean score were reported for any of the assessed variables between test sessions. In both groups, pVGRF and asymmetry during the 75%HOP and SLCMJ demonstrated largely acceptable reliability (CV ≤ 10%). Greater variability was evident in DVJ pVGRF and all other assessed variables, across the 3 protocols (CV range = 13.8-49.7%). Intraclass correlation coefficient values ranged from small to large and were generally higher in the post-PHV players. The results of this study suggest that pVGRF and asymmetry can be reliably assessed using a 75%HOP and SLCMJ in this cohort. These measures could be used to support a screening battery for elite male youth soccer players and for test-retest comparison.
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Affiliation(s)
- Paul J Read
- 1School of Sport, Health and Applied Science, St Mary's University, London, United Kingdom; 2Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; 3School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom; 4Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio; 5Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio; 6The Micheli Center for Sports Injury Prevention, Boston, Massachusetts; 7Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand; and 8Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
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87
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Ruddy JD, Pollard CW, Timmins RG, Williams MD, Shield AJ, Opar DA. Running exposure is associated with the risk of hamstring strain injury in elite Australian footballers. Br J Sports Med 2016; 52:919-928. [DOI: 10.1136/bjsports-2016-096777] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/03/2022]
Abstract
BackgroundTo investigate the association between running exposure and the risk of hamstring strain injury (HSI) in elite Australian footballers.MethodsElite Australian footballers (n=220) from 5 different teams participated. Global positioning system (GPS) data were provided for every athlete for each training session and match for the entire 2015 season. The occurrences of HSIs throughout the study period were reported. Receiver operator characteristic curve analyses were performed and the relative risk (RR) of subsequent HSI was calculated for absolute and relative running exposure variables related to distance covered above 10 and 24 km/hour in the preceding week/s.Results30 prospective HSIs occurred. For the absolute running exposure variables, weekly distance covered above 24 km/hour (>653 m, RR=3.4, 95% CI 1.6 to 7.2, sensitivity=0.52, specificity=0.76, area under the curve (AUC)=0.63) had the largest influence on the risk of HSI in the following week. For the relative running exposure variables, distance covered above 24 km/hour as a percentage of distance covered above 10 km/hour (>2.5%, RR=6.3, 95% CI 1.5 to 26.7, sensitivity=0.93, specificity=0.34, AUC=0.63) had the largest influence on the risk of HSI in the following week. Despite significant increases in the RR of HSI, the predictive capacity of these variables was limited.ConclusionsAn association exists between absolute and relative running exposure variables and elite Australian footballers' risk of subsequent HSI, with the association strongest when examining data within 7–14 days. Despite this, the use of running exposure variables displayed limited clinical utility to predict HSI at the individual level.
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88
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Roe M, Murphy JC, Gissane C, Blake C. Hamstring injuries in elite Gaelic football: an 8-year investigation to identify injury rates, time-loss patterns and players at increased risk. Br J Sports Med 2016; 52:982-988. [DOI: 10.1136/bjsports-2016-096401] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/03/2022]
Abstract
BackgroundHamstring injuries occur frequently in field sports, yet longitudinal information to guide prevention programmes is missing.AimInvestigate longitudinal hamstring injury rates and associated time loss in elite Gaelic football, while identifying subgroups of players at increased risk.Methods38 data sets from 15 elite male Gaelic football teams were received by the National Gaelic Athletic Association (GAA) Injury Surveillance Database between 2008 and 2015. Injury and exposure data were provided by the team's medical staff via an online platform.Results391 hamstring injuries were sustained accounting for 21% (95% CI 20.0% to 21.7%) of all injuries. Prevalence was 21% (95% CI 19.2% to 23.4%). Incidences were 2.2 (95% CI 1.9 to 2.4) per 1000 exposure hours, and 7.0 (95% CI 6.5 to 7.1) times greater in match play than in training. Typically each team sustained 9.0 (95% CI 7.0 to 11.0) hamstring injuries per season affecting the: bicep femoris belly (44%; 95% CI 39.4% to 48.7%); proximal musculotendinous junction (13%; 95% CI 9.8% to 16.3%); distal musculotendinous junction (12%; 95% CI 8.6% to 14.9%) and semimembranosis/semitendinosis belly (9%; 95% CI 6.3% to 11.7%). ∼36% (95% CI 31.5% to 41.0%) were recurrent injuries. Mean time loss was 26.0 (95% CI 21.1 to 33.0) days, which varied with age, injury type and seasonal cycle. Hamstring injuries accounted for 31% (95% CI 25.8% to 38.2%) of injury-related time loss. Previously injured players (rate ratio (RR)=3.3), players aged 18–20 years (IRR=2.3) or >30 years (RR=2.3), as well as defensive (IRR=2.0) and midfield players (RR=1.5), were most at risk of sustaining a hamstring injury. Comparisons of 2008–2011 with 2012–2015 seasons revealed a 2-fold increase in hamstring injury incidences. Between 2008 and 2015 training incidence increased 2.3-fold and match-play incidences increased 1.3-fold.ConclusionsHamstring injuries are the most frequent injury in elite Gaelic football, with incidences increasing from 2008–2011 to 2012–2015. Tailoring risk management strategies to injury history, age and playing position may reduce the burden of hamstring injuries.
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89
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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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90
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Bourne MN, Williams MD, Opar DA, Al Najjar A, Kerr GK, Shield AJ. Impact of exercise selection on hamstring muscle activation. Br J Sports Med 2016; 51:1021-1028. [PMID: 27467123 DOI: 10.1136/bjsports-2015-095739] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine which strength training exercises selectively activate the biceps femoris long head (BFLongHead) muscle. METHODS We recruited 24 recreationally active men for this two-part observational study. Part 1: We explored the amplitudes and the ratios of lateral (BF) to medial hamstring (MH) normalised electromyography (nEMG) during the concentric and eccentric phases of 10 common strength training exercises. Part 2: We used functional MRI (fMRI) to determine the spatial patterns of hamstring activation during two exercises which (1) most selectively and (2) least selectively activated the BF in part 1. RESULTS Eccentrically, the largest BF/MH nEMG ratio occurred in the 45° hip-extension exercise; the lowest was in the Nordic hamstring (Nordic) and bent-knee bridge exercises. Concentrically, the highest BF/MH nEMG ratio occurred during the lunge and 45° hip extension; the lowest was during the leg curl and bent-knee bridge. fMRI revealed a greater BF(LongHead) to semitendinosus activation ratio in the 45° hip extension than the Nordic (p<0.001). The T2 increase after hip extension for BFLongHead, semitendinosus and semimembranosus muscles was greater than that for BFShortHead (p<0.001). During the Nordic, the T2 increase was greater for the semitendinosus than for the other hamstring muscles (p≤0.002). SUMMARY We highlight the heterogeneity of hamstring activation patterns in different tasks. Hip-extension exercise selectively activates the long hamstrings, and the Nordic exercise preferentially recruits the semitendinosus. These findings have implications for strategies to prevent hamstring injury as well as potentially for clinicians targeting specific hamstring components for treatment (mechanotherapy).
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Affiliation(s)
- Matthew N Bourne
- Faculty of Health, School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Queensland Academy of Sport, Centre of Excellence for Applied Sport Science Research, Brisbane, Australia
| | - Morgan D Williams
- Faculty of Life Sciences and Education, School of Health, Sport and Professional Practice, University of South Wales, Wales, UK
| | - David A Opar
- School of Exercise Sciences, Australian Catholic University, Melbourne, Australia
| | - Aiman Al Najjar
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Graham K Kerr
- Faculty of Health, School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Anthony J Shield
- Faculty of Health, School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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91
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Schuermans J, Van Tiggelen D, Danneels L, Witvrouw E. Susceptibility to Hamstring Injuries in Soccer: A Prospective Study Using Muscle Functional Magnetic Resonance Imaging. Am J Sports Med 2016; 44:1276-85. [PMID: 26912281 DOI: 10.1177/0363546515626538] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Running-related hamstring strain injuries remain a delicate issue in several sports such as soccer. Their unremittingly high incidence and recurrence rates indicate that the underlying risk has not yet been fully identified. Among other factors, the importance of neuromuscular coordination and the quality of interplay between the different hamstring muscle bellies is thought to be a key determinant within the intrinsic injury risk. Muscle functional magnetic resonance imaging (mfMRI) is one of the tools that has been proven to be valid for evaluating intermuscular coordination. PURPOSE To investigate the risk of sustaining an index or recurring soccer-related hamstring injury by exploring metabolic muscle characteristics using mfMRI. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 27 healthy male soccer players and 27 soccer players with a history of hamstring injuries underwent standardized mfMRI. The mfMRI protocol consisted of a resting scan, a strenuous bilateral eccentric hamstring exercise, and a postexercise scan. The exercise-related T2 change, or the signal intensity shift between both scans, was used to detect differences in metabolic characteristics between (1) the different hamstring muscle bellies and (2) the prospective cohorts based on the (re)occurrence of hamstring injuries during a follow-up period of 18 months. RESULTS The risk of sustaining a first hamstring injury was associated with alterations in the intermuscular hierarchy in terms of the magnitude of the metabolic response after a heavy eccentric effort, with the dominant role of the semitendinosus set aside for a higher contribution of the biceps femoris (P = .017). Receiver operating characteristic (ROC) curve analysis demonstrated that this variable was significantly able to predict the occurrence of index injuries with a sensitivity of 100% and a specificity of 70% when the metabolic activity of the biceps femoris exceeded 10%. The risk of sustaining a reinjury was associated with a substantial deficit in hamstring strength endurance (P = .031). Soccer players who sustained a reinjury were only able to perform prone leg curls for a mean duration of 146.50 ± 76.16 seconds, whereas those with an injury history but no recurrence during follow-up were able to continue for a mean of 237.45 ± 110.76 seconds (95% CI, 11.9-230.5 seconds; P = .031). CONCLUSION This was the first study to assess the causal relation between the intramuscular recruitment pattern and the risk of sustaining an index or secondary hamstring strain. Changes in intermuscular interplay seem to significantly increase the risk of sustaining index hamstring injuries in male amateur soccer players. Inadequate eccentric muscle endurance could be associated with an increased risk of sustaining a recurring hamstring injury.
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Affiliation(s)
- Joke Schuermans
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Damien Van Tiggelen
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium Department of Physiotherapy, Aspetar, Doha, Qatar
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92
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TIMMINS RYANG, BOURNE MATTHEWN, SHIELD ANTHONYJ, WILLIAMS MORGAND, LORENZEN CHRISTIAN, OPAR DAVIDA. Biceps Femoris Architecture and Strength in Athletes with a Previous Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2016; 48:337-45. [DOI: 10.1249/mss.0000000000000783] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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93
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TIMMINS RYANG, RUDDY JOSHUAD, PRESLAND JOEL, MANIAR NIRAV, SHIELD ANTHONYJ, WILLIAMS MORGAND, OPAR DAVIDA. Architectural Changes of the Biceps Femoris Long Head after Concentric or Eccentric Training. Med Sci Sports Exerc 2016; 48:499-508. [DOI: 10.1249/mss.0000000000000795] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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94
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Timmins RG, Shield AJ, Williams MD, Lorenzen C, Opar DA. Architectural adaptations of muscle to training and injury: a narrative review outlining the contributions by fascicle length, pennation angle and muscle thickness. Br J Sports Med 2016; 50:1467-1472. [DOI: 10.1136/bjsports-2015-094881] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 01/06/2023]
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95
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Timmins RG, Bourne MN, Shield AJ, Williams MD, Lorenzen C, Opar DA. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study. Br J Sports Med 2015; 50:1524-1535. [PMID: 26675089 DOI: 10.1136/bjsports-2015-095362] [Citation(s) in RCA: 272] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM To investigate the role of eccentric knee flexor strength, between-limb imbalance and biceps femoris long head (BFlh) fascicle length on the risk of future hamstring strain injury (HSI). METHODS Elite soccer players (n=152) from eight different teams participated. Eccentric knee flexor strength during the Nordic hamstring exercise and BFlh fascicle length were assessed at the beginning of preseason. The occurrences of HSIs following this were recorded by the team medical staff. Relative risk (RR) was determined for univariate data, and logistic regression was employed for multivariate data. RESULTS Twenty seven new HSIs were reported. Eccentric knee flexor strength below 337 N (RR=4.4; 95% CI 1.1 to 17.5) and possessing BFlh fascicles shorter than 10.56 cm (RR=4.1; 95% CI 1.9 to 8.7) significantly increased the risk of a HSI. Multivariate logistic regression revealed significant effects when combinations of age, history of HSI, eccentric knee flexor strength and BFlh fascicle length were explored. From these analyses the likelihood of a future HSI in older athletes or those with a HSI history was reduced if high levels of eccentric knee flexor strength and longer BFlh fascicles were present. CONCLUSIONS The presence of short BFlh fascicles and low levels of eccentric knee flexor strength in elite soccer players increases the risk of future HSI. The greater risk of a future HSI in older players or those with a previous HSI is reduced when they have longer BFlh fascicles and high levels of eccentric strength.
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Affiliation(s)
- Ryan G Timmins
- School of Exercise Science, Australian Catholic University, Melbourne, Australia
| | - Matthew N Bourne
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Morgan D Williams
- School of Health, Sport and Professional Practice, University of South Wales, Pontypridd, Wales, UK
| | - Christian Lorenzen
- School of Exercise Science, Australian Catholic University, Melbourne, Australia
| | - David A Opar
- School of Exercise Science, Australian Catholic University, Melbourne, Australia
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96
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Valle X, L.Tol J, Hamilton B, Rodas G, Malliaras P, Malliaropoulos N, Rizo V, Moreno M, Jardi J. Hamstring Muscle Injuries, a Rehabilitation Protocol Purpose. Asian J Sports Med 2015; 6:e25411. [PMID: 26715969 PMCID: PMC4691307 DOI: 10.5812/asjsm.25411] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/28/2015] [Accepted: 02/06/2015] [Indexed: 11/22/2022] Open
Abstract
Context: Hamstring acute muscle injuries are prevalent in several sports including AFL football (Australian Football League), sprinting and soccer, and are often associated with prolonged time away from sport. Evidence Acquisition: In response to this, research into prevention and management of hamstring injury has increased, but epidemiological data shows no decline in injury and re-injury rates, suggesting that rehabilitation programs and return to play (RTP) criteria have to be improved. There continues to be a lack of consensus regarding how to assess performance, recovery and readiness to RTP, following hamstring strain injury. Results: The aim of this paper was to propose rehabilitation protocol for hamstring muscle injuries based on current basic science and research knowledge regarding injury demographics and management options. Conclusions: Criteria-based (subjective and objective) progression through the rehabilitation program will be outlined along with exercises for each phase, from initial injury to RTP.
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Affiliation(s)
- Xavier Valle
- Football Club Barcelona, Medical Department, Barcelona, Spain
- Corresponding author: Xavier Valle, Football Club Barcelona, Medical Department, Barcelona, Spain. Tel: +34-699416359, Fax: +34-934963664, E-mail:
| | | | - Bruce Hamilton
- Sports Medicine Department, Millenium Institute of Sport and Health, Auckland, New Zealand
| | - Gil Rodas
- Football Club Barcelona, Medical Department, Barcelona, Spain
| | - Peter Malliaras
- Sports Medicine Department, Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Nikos Malliaropoulos
- Sports Medicine Department, Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Musculoskeletal Department, Thessaloniki Sports Medicine Clinic, Thessaloniki, Greece
| | - Vicenc Rizo
- Football Club Barcelona, Medical Department, Barcelona, Spain
| | - Marcel Moreno
- Football Club Barcelona, Medical Department, Barcelona, Spain
| | - Jaume Jardi
- Football Club Barcelona, Medical Department, Barcelona, Spain
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97
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Read P, Oliver JL, De Ste Croix MBA, Myer GD, Lloyd RS. Injury Risk Factors in Male Youth Soccer Players. Strength Cond J 2015. [DOI: 10.1519/ssc.0000000000000171] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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98
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Abstract
Despite increased knowledge of hamstring muscle injuries, the incidence has not diminished. We now know that not all hamstring injuries are the same and that certain types of injuries require prolonged rehabilitation and return to play. The slow stretch type of injury and injuries involving the central tendon both require longer times to return to play. A number of factors have been proposed as being indicators of time taken to return to play, but the evidence for these is conflicting. Recurrence rates remain high and it is now thought that strength deficits may be an important factor. Strengthening exercise should be performed with the hamstrings in a lengthened position. There is conflicting evidence regarding the efficacy of platelet-rich plasma injection in the treatment of hamstring injuries so at this stage we cannot advise their use. Various tests have been proposed as predictors of hamstring injury and the use of the Nordboard is an interesting addition to the testing process. Prevention of these injuries is the ultimate aim and there is increasing evidence that Nordic hamstring exercises are effective in reducing the incidence.
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99
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Bourne MN, Opar DA, Williams MD, Al Najjar A, Shield AJ. Muscle activation patterns in the Nordic hamstring exercise: Impact of prior strain injury. Scand J Med Sci Sports 2015; 26:666-74. [DOI: 10.1111/sms.12494] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 12/19/2022]
Affiliation(s)
- M. N. Bourne
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Brisbane Queensland Australia
- Centre of Excellence for Applied Sport Science Research; Queensland Academy of Sport; Brisbane Queensland Australia
| | - D. A. Opar
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Brisbane Queensland Australia
- School of Health, Sport and Professional Practice; University of South Wales; Australian Catholic University; Melbourne Victoria Australia
| | - M. D. Williams
- School of Exercise Science; Australian Catholic University; University of South Wales; Wales UK
| | - A. Al Najjar
- Centre for Advanced Imaging; University of Queensland; Brisbane Queensland Australia
| | - A. J. Shield
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Brisbane Queensland Australia
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100
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Effects of external pelvic compression on electromyographic activity of the hamstring muscles during unipedal stance in sportsmen with and without hamstring injuries. ACTA ACUST UNITED AC 2015; 20:412-9. [DOI: 10.1016/j.math.2014.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/09/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022]
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