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Yetter TR, Halvorson RT, Wong SE, Harris JD, Allahabadi S. Management of Proximal Hamstring Injuries: Non-operative and Operative Treatment. Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09911-0. [PMID: 39009901 DOI: 10.1007/s12178-024-09911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW To evaluate the current evidence and literature on treatment options for proximal hamstring injuries. RECENT FINDINGS Patients with 3-tendon complete tears with greater than 2 cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up. Proximal hamstring repair in patients who are male, with isolated semimembranosus injury, and have proximal hamstring free tendon rupture are more likely to have earlier return to sports. The Parisian Hamstring Avulsion Score (PHAS) is a validated patient-reported outcome measure to predict return to sports. Proximal hamstring injuries may occur in both elite and recreational athletes and may present with varying degrees of chronicity and severity. Injuries occur most commonly during forceful eccentric contraction of the hamstrings and often present with ischial tuberosity tenderness, ecchymosis, and hamstring weakness. Treatment decision-making is dictated by the tendons involved and chronicity. Many proximal hamstring injuries can be successfully treated with non-surgical measures. However, operative treatment of appropriately indicated proximal hamstring tendon injuries can result in significantly better functional outcomes and faster and more reliable return to sports compared to nonoperative treatment. Both endoscopic and open surgical repair techniques show high satisfaction levels and excellent patient-reported outcomes at short- and mid-term follow-up. Postoperative rehabilitation protocols vary across the literature and ongoing study is needed to clarify the optimal program, though emphasis on eccentric hamstring strengthening may be beneficial.
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Sadeghi M, Alizadeh MH, Minoonejad H. Acute effects of Nordic hamstring exercise on hip and knee joints proprioception. J Bodyw Mov Ther 2024; 39:382-389. [PMID: 38876656 DOI: 10.1016/j.jbmt.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/27/2023] [Accepted: 03/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND AND OBJECTIVES Nordic Hamstring Exercise (NHE) is one of the best exercises proposed for injury prevention of hamstring muscles. However, its effects on lower extremity proprioception are unclear. The aim of this study was to investigate the immediate effects of a single bout of NHE on hip and knee joints' proprioception. METHODS Forty collegiate male soccer players participated in this study with a mean age of 22.85 ± 1.82 years and were randomized into either control (n = 20) or experimental (n = 20) groups. Each subject participated in pre-test measurements in which hip and knee active joints position sense (JPS) were assessed in standing and lying tasks using the image-capturing method. The experimental group then performed three sets of NHE with 10 repetitions in each set, while the control group rested for 10 min. Paired and independent t-tests were used for calculating the differences within and between groups on SPSS software, respectively. The level of significance was P ≤ 0.05. RESULTS Hip JPS in the lying task and knee JPS in both of the standing and lying tasks were impaired significantly after performing a single bout of NHE (P ≤ 0.05). However, the effects of this exercise on hip JPS in the standing task were not significant (P ≥ 0.05). CONCLUSIONS NHE performing with three sets of 10 repetitions can significantly impair hip and knee JPS immediately after exercise and reduce the proprioception acuity of the lower limbs. It is recommended to perform this exercise at a time rather than before training or match sessions.
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Affiliation(s)
- Mohsen Sadeghi
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
| | - Mohammad H Alizadeh
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Hooman Minoonejad
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
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Della Villa F, Buckthorpe M, Pellegrini A, Ranzini A, Esposito F, Crescenzo C, Nanni G, Zago M. A comparative video analysis of hamstring injuries mechanism and situational pattern in men's and women's football (soccer). Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38881374 DOI: 10.1002/ksa.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/03/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE To describe the injury mechanism and situational patterns of severe (absence >28 days) hamstring muscle injuries in professional male and female football (soccer) players. METHODS The data for males were sourced from Serie A clubs participating in both national and international competitions from 2018 to 2021. For the female cohort, hamstring injuries were identified during matches of the top national/international competitions from 2017 to 2023. Video footage was obtained, and three raters categorised injury mechanisms and situational patterns. Injuries were also examined according to the month, minute and location. RESULTS A total of 129 severe hamstring injuries were identified, with 64 occurring in females and 65 in males. Video analysis was possible for 29 (45%) female cases and 61 (94%) male cases. Female injuries had longer lay-off times (97.8 ± 77.1 days) than males (39.6 ± 20.9 days). Females had a higher proportion of indirect contact injuries (34%) than males (13%) and a lower proportion of non-contact injuries (66% vs. 87%). Four situational patterns were identified: running was the most common for both sexes, representing 59% of female injuries and 41% of male injuries. Over-stretching injuries were split across open and CKC scenarios but collectively explained nearly half (48%) of male injuries but only one in five (21%) female injuries. Kicking injuries had a higher proportion in females (17%) than males (10%). Injuries were more common in the second half for females and the first half for males. CONCLUSION Females had a higher proportion of indirect contact, running and kicking injuries and a lower proportion of non-contact and stretch-type injuries than males. Understanding injury patterns can inform tailored prevention programs, considering sex-specific differences. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
- Faculty of Sport, Technology and Health Sciences, St Mary's University, Twickenham, London, UK
| | - Alessandro Pellegrini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Alice Ranzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | - Gianni Nanni
- Medical Area, Bologna Football Club 1909, Bologna, Italy
| | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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Sprouse B, Chandran A, Rao N, Boltz AJ, Johnson M, Hennis P, Varley I. Injury and illness surveillance monitoring in team sports: a framework for all. Inj Epidemiol 2024; 11:23. [PMID: 38858694 PMCID: PMC11163858 DOI: 10.1186/s40621-024-00504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Sport-related injuries and illnesses can negatively impact athlete welfare at all standards of participation in team sports. Injury and illness surveillance (IIS), and the development of monitoring systems, initiates the sequence of injury and illness prevention. Operational IIS monitoring systems help to appraise epidemiological estimates of injury and illness incidence and burden in various athlete populations. However, the methodological underpinnings of various monitoring systems are not harmonized or widely documented, with the presence of efficient and successful programmes rarely showcased at non-elite levels. The aim is to provide a framework that guides the development of IIS, which will enhance overall surveillance, to indirectly inform injury prevention strategies. METHODS The process involved all members of the research group initially discussing the research gaps, scope of the project, and the aims of the article. Unique experiences were shared, and specific and global challenges and barriers to IIS at all standards of team sport participation were identified. A tiered system of data collection with corresponding content were produced, with experiences and guidance provided throughout the article. RESULTS The literature has been reviewed and using first-hand experience in conducting IIS programmes in complex and diverse sport settings, the authors have identified key enablers and barriers for best practise as time, technological and human resources, reporter/practitioner training, and medical expertise. Areas of greatest importance regarding the conducting of IIS have been outlined, providing guidance and recommendations across all levels of team sport participation. These areas include definitions, data context, collection procedures, handling, security, ethics, storage, dissemination, quality, compliance, and analysis. Given the barriers to IIS, 3-tiered levels of data collection and content have been proposed. The levels indicate data collection variables, with a focus on sufficiency and achievability, aiming to support the successful conducting of IIS in team sports across all standards of participation. Future opportunities in IIS have been discussed, with several predictive measures and analytical techniques expanded upon. CONCLUSIONS The framework provides universal guidance for implementing IIS monitoring systems, facilitating athletes, coaches, parents/guardians, governing bodies and practitioners to implement IIS processes, identify challenges, complete analysis, and interpret outcomes at all standards of participation.
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Affiliation(s)
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Neel Rao
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Ian Varley
- Nottingham Trent University, Nottingham, UK
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Bellosta-López P, Giner-Nicolás R, Molina-Molina A, Rubio-Peirotén A, Roche-Seruendo LE, Doménech-García V. Recovery of spatio-temporal gait and functional parameters following unilateral eccentric exercise-induced muscle damage in the hamstrings. J Sci Med Sport 2024; 27:387-393. [PMID: 38644066 DOI: 10.1016/j.jsams.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES This study aimed to analyze how spatiotemporal gait parameters, active knee extension range of motion, muscle activity, and self-perceived function change over a seven-day period in healthy individuals after exercise-induced muscle damage (EIMD) in the hamstrings. DESIGN Longitudinal cohort study. METHODS Twenty-four healthy males participated in four sessions before and after EIMD (pre-EIMD, 48 h, 96 h, and 168 h post-EIMD). A single-leg deadlift exercise was performed to provoke EIMD in the hamstrings of the dominant leg. Lower limb function perception, spatiotemporal gait parameters, active knee extension range of motion, and electromyographic (EMG) activity of the semitendinosus and biceps femoris muscles during gait and maximal isometric contraction were assessed bilaterally. RESULTS At 48 h, the EIMD-side showed reduced step length, active knee extension range of motion, maximal strength and EMG activity compared to baseline (P < 0.042), while increased relative EMG activity in the biceps femoris during gait (P = 0.001). At 96 h, step length and EMG activity on the EIMD-side reached similar values to those at baseline, whereas lower limb function perception and active knee extension range of motion returned to baseline state at 168 h post-EIMD. No changes over time were observed on the control-side. CONCLUSIONS Recovery from EIMD requires a multimodal assessment since the different parameters affected by EIMD recover at different paces. Active range of motion appears to be the last variable to fully recover. Self-perceived function should not be considered in isolation as it does not represent complete functional recovery.
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Affiliation(s)
- Pablo Bellosta-López
- Universidad San Jorge, Autov A23 km 299, 50830 Villanueva de Gállego, Zaragoza, Spain
| | - Rafael Giner-Nicolás
- Universidad San Jorge, Autov A23 km 299, 50830 Villanueva de Gállego, Zaragoza, Spain
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Suhood AY, Summers SJ, Opar DA, Astill T, An WW, Rio E, Cavaleri R. Bilateral Corticomotor Reorganization and Symptom Development in Response to Acute Unilateral Hamstring Pain: A Randomized, Controlled Study. THE JOURNAL OF PAIN 2024; 25:1000-1011. [PMID: 37907112 DOI: 10.1016/j.jpain.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/08/2023] [Accepted: 10/21/2023] [Indexed: 11/02/2023]
Abstract
Accumulating evidence demonstrates that pain induces adaptations in the corticomotor representations of affected muscles. However, previous work has primarily investigated the upper limb, with few studies examining corticomotor reorganization in response to lower limb pain. This is important to consider, given the significant functional, anatomical, and neurophysiological differences between upper and lower limb musculature. Previous work has also focused on unilateral corticomotor changes in response to muscle pain, despite an abundance of literature demonstrating that unilateral pain conditions are commonly associated with bilateral motor dysfunction. For the first time, this study investigated the effect of unilateral acute hamstring pain on bilateral corticomotor organization using transcranial magnetic stimulation (TMS) mapping. Corticomotor outcomes (TMS maps), pain, mechanical sensitivity (pressure pain thresholds), and function (maximal voluntary contractions) were recorded from 28 healthy participants at baseline. An injection of pain-inducing hypertonic (n = 14) or pain-free isotonic (n = 14) saline was then administered to the right hamstring muscle, and pain ratings were collected every 30 seconds until pain resolution. Follow-up measures were taken immediately following pain resolution and at 25, 50, and 75 minutes post-pain resolution. Unilateral acute hamstring pain induced bilateral symptom development and changes in corticomotor reorganization. Two patterns of reorganization were observed-corticomotor facilitation and corticomotor depression. Corticomotor facilitation was associated with increased mechanical sensitivity and decreased function bilaterally (all P < .05). These effects persisted for at least 75 minutes after pain resolution. PERSPECTIVE: These findings suggest that individual patterns of corticomotor reorganization may contribute to ongoing functional deficits of either limb following acute unilateral lower limb pain. Further research is required to assess these adaptations and the possible long-term implications for rehabilitation and reinjury risk in cohorts with acute hamstring injury.
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Affiliation(s)
- Ariane Y Suhood
- Brain Stimulation and Rehabilitation Lab, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Simon J Summers
- Brain Stimulation and Rehabilitation Lab, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia; School of Biomedical Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David A Opar
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia; School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Tom Astill
- Brain Stimulation and Rehabilitation Lab, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Winko W An
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Ebonie Rio
- School of Allied Health, La Trobe University Melbourne, Melbourne, Victoria, Australia; The Victorian Institute of Sport, Albert Park, Victoria, Australia
| | - Rocco Cavaleri
- Brain Stimulation and Rehabilitation Lab, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia; School of Biomedical Science, Queensland University of Technology, Brisbane, Queensland, Australia; Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Bramah C, Mendiguchia J, Dos'Santos T, Morin JB. Exploring the Role of Sprint Biomechanics in Hamstring Strain Injuries: A Current Opinion on Existing Concepts and Evidence. Sports Med 2024; 54:783-793. [PMID: 37725240 PMCID: PMC11052868 DOI: 10.1007/s40279-023-01925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied mechanical strain and the capacity of the muscle to tolerate strain. To date, injury prevention and rehabilitation strategies have frequently focused on enhancing the capacity of the hamstrings to tolerate strain, with little consideration of factors directly influencing mechanical strain. Sprint running biomechanics are one factor proposed to influence the mechanical strain applied to the hamstrings that may be modified (towards reduced strain) within rehabilitation and injury prevention programs. This article aims to explore the theoretical mechanistic link between sprint running mechanics and hamstring strain injury, along with the available supporting evidence. In doing so, it hopes to provide practitioners with an understanding of mechanical parameters that may influence hamstring strain injury whilst also identifying areas for further research exploration.
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Affiliation(s)
- Christopher Bramah
- School of Health and Society, University of Salford, Allerton Building, Frederick Road Campus, Salford, M6 6PU, UK.
- Manchester Institute of Health and Performance, Manchester, UK.
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Centre, Barañain, Spain
| | - Thomas Dos'Santos
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
- Manchester Institute of Sport, Metropolitan University, Manchester, UK
| | - Jean-Benoȋt Morin
- University Jean Monnet Saint-Etienne, Lyon 1, University Savoie Mont-Blanc, Inter-University Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
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8
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Gurchiek RD, Teplin Z, Falisse A, Hicks JL, Delp SL. Hamstrings are stretched more and faster during accelerative running compared to speed-matched constant speed running. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.25.586659. [PMID: 38585841 PMCID: PMC10996654 DOI: 10.1101/2024.03.25.586659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Hamstring strain injuries are associated with significant time away from sport and high reinjury rates. Recent evidence suggests that hamstring injuries often occur during accelerative running, but investigations of hamstring mechanics have primarily examined constant speed running on a treadmill. To help fill this gap in knowledge, this study compares hamstring lengths and lengthening velocities between accelerative running and constant speed overground running. Methods We recorded 2 synchronized videos of 10 participants (5 female, 5 male) during 6 accelerative running trials and 6 constant speed running trials. We used OpenCap (a markerless motion capture system) to estimate body segment kinematics for each trial and a 3-dimensional musculoskeletal model to compute peak length and step-average lengthening velocity of the biceps femoris (long head) muscle-tendon unit. To compare running conditions, we used linear mixed regression models with running speed (normalized by the subject-specific maximum) as the independent variable. Results At running speeds below 75% of top speed accelerative running resulted in greater peak lengths than constant speed running. For example, the peak hamstring muscle-tendon length when a person accelerated from running at only 50% of top speed was equivalent to running at a constant 88% of top speed. Lengthening velocities were greater during accelerative running at all running speeds. Differences in hip flexion kinematics primarily drove the greater peak muscle-tendon lengths and lengthening velocities observed in accelerative running. Conclusion Hamstrings are subjected to longer muscle-tendon lengths and faster lengthening velocities in accelerative running compared to constant speed running. This provides a biomechanical explanation for the observation that hamstring strain injuries often occur during acceleration. Our results suggest coaches who monitor exposure to high-risk circumstances (long lengths, fast lengthening velocities) should consider the accelerative nature of running in addition to running speed.
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Affiliation(s)
- Reed D. Gurchiek
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Zachary Teplin
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Antoine Falisse
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Jennifer L. Hicks
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Scott L. Delp
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
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Timmins RG, Filopoulos D, Giannakis J, Nguyen V, Ruddy JD, Hickey JT, Maniar N, Pollard CW, Morgan N, Weakley J, Opar DA. The Effect of Eccentric or Isometric Training on Strength, Architecture, and Sprinting across an Australian Football Season. Med Sci Sports Exerc 2024; 56:564-574. [PMID: 38051129 DOI: 10.1249/mss.0000000000003326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE This study aimed to investigate the effect of an isometric (ISO) or Nordic hamstring exercise (NHE) intervention, alongside a sprint training program on hamstring strength, architecture, and sprinting performance in Australian footballers. METHODS Twenty-five male athletes undertook NHE ( n = 13) or ISO ( n = 12) training across a 38-wk period (including preseason and in season). Biceps femoris long head (BFlh) architecture, ISO, and eccentric knee flexor strength were assessed at baseline, at the end of preseason (14 wk), and at the conclusion of the intervention. Sprint times and force-velocity profiles were determined at baseline and at the end of preseason. RESULTS After the intervention, both groups had significant improvements in BFlh fascicle length (NHE: 1.16 cm, 95% CI = 0.68 to 1.63 cm, d = 1.88, P < 0.001; ISO: 0.82 cm, 95% CI = 0.57 to 1.06 cm, d = 1.70, P < 0.001), muscle thickness (NHE: 0.11 cm, 95% CI = 0.01 to 0.21 cm, d = 0.51, P = 0.032; ISO: 0.21 cm, 95% CI = 0.10 to 0.32 cm, d = 0.86, P = 0.002), and eccentric strength (NHE: 83 N, 95% CI = 53 to 114 N, d = 1.79, P < 0.001; ISO: 83 N, 95% CI = 17 to 151 N, d = 1.17, P = 0.018). Both groups also finished the intervention weaker isometrically than they started (NHE: -45 N, 95% CI = -81 to -8 N, d = -1.03, P = 0.022; ISO: -80 N, 95% CI = -104 to -56 N, d = -3.35, P < 0.001). At the end of preseason, the NHE group had improved their 5-m sprint time by 3.3% ± 2.0%), and their maximum horizontal velocity was 3% ± 2.1% greater than the ISO group who saw no changes. CONCLUSIONS Both ISO and NHE training with a periodized sprinting program can increase BFlh fascicle length, thickness, and eccentric strength in Australian footballers. NHE training also improves 5-m sprint time and maximum velocity. However, both interventions reduced ISO strength. These findings provide unique, contextually relevant insights into the adaptations possible in semiprofessional athletes.
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Affiliation(s)
| | - Dean Filopoulos
- Strength and Conditioning Department, Collingwood Football Club, Melbourne, Victoria, AUSTRALIA
| | - Jake Giannakis
- Strength and Conditioning Department, Collingwood Football Club, Melbourne, Victoria, AUSTRALIA
| | - Victor Nguyen
- Strength and Conditioning Department, Collingwood Football Club, Melbourne, Victoria, AUSTRALIA
| | - Joshua D Ruddy
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, AUSTRALIA
| | | | | | - Christopher W Pollard
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, AUSTRALIA
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Frouin A, Le Sant G, Barbier L, Jacquemin E, McNair PJ, Ellis R, Nordez A, Lacourpaille L. Individual distribution of muscle hypertrophy among hamstring muscle heads: Adding muscle volume where you need is not so simple. Scand J Med Sci Sports 2024; 34:e14608. [PMID: 38515303 DOI: 10.1111/sms.14608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The aim of this study was to determine whether a 9-week resistance training program based on high load (HL) versus low load combined with blood flow restriction (LL-BFR) induced a similar (i) distribution of muscle hypertrophy among hamstring heads (semimembranosus, SM; semitendinosus, ST; and biceps femoris long head, BF) and (ii) magnitude of tendon hypertrophy of ST, using a parallel randomized controlled trial. METHODS A total of 45 participants were randomly allocated to one of three groups: HL, LL-BFR, and control (CON). Both HL and LL-BFR performed a 9-week resistance training program composed of seated leg curl and stiff-leg deadlift exercises. Freehand 3D ultrasound was used to assess the changes in muscle and tendon volume. RESULTS The increase in ST volume was greater in HL (26.5 ± 25.5%) compared to CON (p = 0.004). No difference was found between CON and LL-BFR for the ST muscle volume (p = 0.627). The change in SM muscle volume was greater for LL-BFR (21.6 ± 27.8%) compared to CON (p = 0.025). No difference was found between HL and CON for the SM muscle volume (p = 0.178).There was no change in BF muscle volume in LL-BFR (14.0 ± 16.5%; p = 0.436) compared to CON group. No difference was found between HL and CON for the BF muscle volume (p = 1.0). Regarding ST tendon volume, we did not report an effect of training regimens (p = 0.411). CONCLUSION These results provide evidence that the HL program induced a selective hypertrophy of the ST while LL-BFR induced hypertrophy of SM. The magnitude of the selective hypertrophy observed within each group varied greatly between individuals. This finding suggests that it is very difficult to early determine the location of the hypertrophy among a muscle group.
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Affiliation(s)
- A Frouin
- Nantes Université, Movement - Interactions - Performance, MIP, Nantes, France
- Institut Sport Atlantique, ISA, Nantes, France
| | - G Le Sant
- Nantes Université, Movement - Interactions - Performance, MIP, Nantes, France
- School of Physiotherapy, IFM3R, Nantes, France
| | - L Barbier
- Nantes Université, Movement - Interactions - Performance, MIP, Nantes, France
- School of Physiotherapy, IFM3R, Nantes, France
| | - E Jacquemin
- Nantes Université, Movement - Interactions - Performance, MIP, Nantes, France
- School of Physiotherapy, IFM3R, Nantes, France
| | - P J McNair
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - R Ellis
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Active Living and Rehabilitation: Aotearoa, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - A Nordez
- Nantes Université, Movement - Interactions - Performance, MIP, Nantes, France
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Institut Universitaire de France (IUF), Paris, France
| | - L Lacourpaille
- Nantes Université, Movement - Interactions - Performance, MIP, Nantes, France
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11
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Behan FP, van Dyk N, Rane L, Thorne E, Banaghan A, Gilsenan K, Whyte EF. Implementing hamstring injury prevention programmes remotely: a randomised proof of concept trial. BMJ Open Sport Exerc Med 2024; 10:e001728. [PMID: 38288272 PMCID: PMC10824055 DOI: 10.1136/bmjsem-2023-001728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/31/2024] Open
Abstract
Objectives This study aimed to (1) compare the effectiveness of a Nordic hamstring exercise (NHE) versus single-leg Romanian deadlift (SLRDL) exercise programme on a hamstring injury risk surrogate; (2) compare the muscle soreness experienced by both exercise programmes; and (3) assess compliance to remote injury prevention exercise protocols through video software. Methods Twenty participants (10 women and 10 men: 21.45±1.6 years; 176±23 cm; 70±10 kg) were randomised into an NHE or SLRDL programme for 6 weeks. Single-leg hamstring bridge (SLHB), a hamstring injury surrogate, was the primary outcome for exercise efficacy. Muscle soreness and exercise adherence were also assessed. Significance was set at p<0.05. Results Both exercises increased SLHB performance resulting in an overall effect (p=0.013) with no effect for group (p=0.470) and no interaction effect (p=0.709), indicating both groups improved but there was no difference in improvement between interventions. There was no difference in muscle soreness between groups (p=0.087). Finally, both groups had 100% adherence to the programme. Conclusions Both the NHE and SLRDL are equally effective in increasing SLHB performance and demonstrate a similar level of muscle soreness. This suggests that SLRDL may be a viable option as a preventative exercise to mitigate the risk of hamstring injury. Finally, implementing injury prevention programmes remotely has the potential to enhance adherence.
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Affiliation(s)
- Fearghal P Behan
- Department of Bioengineering, Imperial College London, London, UK
- Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
- Faculty of Health Science, University of Pretoria, Section Sports Medicine, Pretoria, Gauteng, South Africa
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Lance Rane
- Department of Bioengineering, Imperial College London, London, UK
| | - Emma Thorne
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Alexa Banaghan
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Kevin Gilsenan
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Enda Francis Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
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12
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Pietsch S, Green B, Schache AG, Pizzari T. Epidemiology of quadriceps muscle strain injuries in elite male Australian football players. Scand J Med Sci Sports 2024; 34:e14542. [PMID: 37994173 DOI: 10.1111/sms.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To describe the epidemiology of quadriceps muscle strain injury (QMSI) in elite Australian Football League (AFL) players, explore recovery milestones and determine whether recovery is impacted by factors such as injury type (index vs. re-injury), the primary muscle injured and the mechanism of injury. MEASURES All QMSI data reported to the Soft Tissue Injury Registry of the AFL from the 2014 to 2020 seasons were evaluated. Player demographic data, circumstances of injury, MRI reports and recovery outcomes following injury were extracted. Descriptive statistics and frequency distributions are presented. Recovery outcomes for injury type, primary muscle injured and the mechanism of injury were compared using univariate analyses. RESULTS There were 164 QMSIs from 122 players reported (134 index; 30 re-injuries). Almost all (91.3%) QMSIs involved the rectus femoris. Half (48.4%) of the QMSIs occurred during kicking and most commonly affected the dominant kicking leg (72%). The majority occurred at training (64.6%). All re-injuries involved the rectus femoris, most occurred from kicking (63.0%) and within 6 months of the preceding injury (70%). The mean return to play (RTP) time was 25.4 days (95%CI = 22.6-28.2) and rectus femoris injuries took around 14 days longer to RTP than vastii injuries (p = 0.001). QMSIs with a kicking mechanism took the longest to RTP of all injury mechanisms. CONCLUSION In AFL players, QMSIs occur mostly in the dominant leg from a kicking mechanism. Rectus femoris injuries are more prevalent and result in longer RTP time frames. Re-injuries exclusively involved the rectus femoris, primarily from kicking.
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Affiliation(s)
- Samuel Pietsch
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Brady Green
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Palermi S, Vittadini F, Vecchiato M, Corsini A, Demeco A, Massa B, Pedret C, Dorigo A, Gallo M, Pasta G, Nanni G, Vascellari A, Marchini A, Lempainen L, Sirico F. Managing Lower Limb Muscle Reinjuries in Athletes: From Risk Factors to Return-to-Play Strategies. J Funct Morphol Kinesiol 2023; 8:155. [PMID: 37987491 PMCID: PMC10660751 DOI: 10.3390/jfmk8040155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
Muscle injuries and subsequent reinjuries significantly impact athletes, especially in football. These injuries lead to time loss, performance impairment, and long-term health concerns. This review aims to provide a comprehensive overview of the current understanding of muscle reinjuries, delving into their epidemiology, risk factors, clinical management, and prevention strategies. Despite advancements in rehabilitation programs and return-to-play criteria, reinjury rates remain alarmingly high. Age and previous muscle injuries are nonmodifiable risk factors contributing to a high reinjury rate. Clinical management, which involves accurate diagnosis, individualized rehabilitation plans, and the establishment of return-to-training and return-to-play criteria, plays a pivotal role during the sports season. Eccentric exercises, optimal loading, and training load monitoring are key elements in preventing reinjuries. The potential of artificial intelligence (AI) in predicting and preventing reinjuries offers a promising avenue, emphasizing the need for a multidisciplinary approach to managing these injuries. While current strategies offer some mitigation, there is a pressing need for innovative solutions, possibly leveraging AI, to reduce the incidence of muscle reinjuries in football players. Future research should focus on this direction, aiming to enhance athletes' well-being and performance.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | | | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | | | - Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Bruno Massa
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Diagonal, 08950 Barcelona, Spain;
| | - Alberto Dorigo
- Radiology Unit, Casa di Cura Giovanni XXIII, 31050 Monastier, Italy
| | - Mauro Gallo
- Radiology Unit, Casa di Cura Giovanni XXIII, 31050 Monastier, Italy
| | | | | | | | | | - Lasse Lempainen
- FinnOrthopaedics, Hospital Pihlajalinna, 20520 Turku, Finland;
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
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Gattringer M, Schalamon G, Pichler H, Breulmann FL, Buerger H, Mattiassich G, Bischofreiter M. Sciatic Nerve Compression after a Chronic Proximal Hamstring Tear: A Report of Two Cases and a Narrative Review of the Literature. Life (Basel) 2023; 13:1762. [PMID: 37629619 PMCID: PMC10455575 DOI: 10.3390/life13081762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Proximal hamstring tears are among the most common injuries afflicting athletes and middle-aged individuals. Sciatic nerve compression after a proximal hamstring injury, which can occur due to scar formation and subsequent irritation or compression of the nerve, is an infrequent but severe complication with few cases documented in the literature. No evidence is available about the optimal treatment for sciatic nerve symptoms after proximal hamstring injuries. In this case report, we present two cases involving patients primarily treated conservatively at another institution after suffering from a proximal hamstring injury and developing sciatic nerve symptoms over the course of a few months. Both were treated with open neurolysis at our institution without reattachment of the ruptured muscles to the ischial tuberosity due to the chronicity of the injuries. Both patients exhibited neurological symptoms over two years, which recovered after surgery. These two cases show that neurolysis of the sciatic nerve without reattachment of the proximal hamstring muscles is an applicable option for the treatment of chronic proximal hamstring tears with sciatic nerve compression. Further studies will be needed to validate this hypothesis.
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Affiliation(s)
- Michael Gattringer
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Georg Schalamon
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Hannes Pichler
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Franziska Lioba Breulmann
- Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Heinz Buerger
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Georg Mattiassich
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Martin Bischofreiter
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
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15
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Augustsson J, Alt T, Andersson H. Speed Matters in Nordic Hamstring Exercise: Higher Peak Knee Flexor Force during Fast Stretch-Shortening Variant Compared to Standard Slow Eccentric Execution in Elite Athletes. Sports (Basel) 2023; 11:130. [PMID: 37505617 PMCID: PMC10383276 DOI: 10.3390/sports11070130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
Hamstring strain injuries are prevalent in many sports. Research has demonstrated that the Nordic hamstring exercise (NHE), a knee-dominant exercise addressing the posterior chain muscles, can aid in reducing the risk of hamstring injuries in athletes. However, most research on hamstring injury prevention has focused on performing the eccentric version of the NHE (NHEECC). In contrast, in sports, it is quite frequent for athletes to use an eccentric-concentric version of the NHE. Additionally, eccentric NHE is typically performed using a slow, controlled tempo. The effect of a fast stretch-shortening cycle NHE (NHESSC) compared to standard slow NHEECC on peak knee flexor force has not been investigated. The aim of the study was therefore to investigate fast NHESSC vs. standard slow NHEECC. Our hypothesis posited that peak knee flexor force would be greater for fast NHESSC compared with standard slow NHEECC. The study involved 22 elite athletes (actively competing in both national and international events) consisting of female (n = 10) and male (n = 7) track and field athletes and male football players (n = 5), aged 17-31 years. The participants performed maximum trials of slow NHEECC and fast NHESSC repetitions in which measurement of bilateral peak knee flexor force was conducted at the ankle with the use of a load cell. During the NHEs, a linear encoder was used to measure both the position where the peak knee flexor force was recorded and the average eccentric velocity. SSC contributed to an enhanced NHE performance, where bilateral absolute peak knee flexor force was 13% higher for fast NHESSC vs. standard slow NHEECC (822 vs. 726 N, p < 0.01, ES = 0.54). Participants achieved a 32% greater forward distance at the breakpoint stage during NHEECC compared to the coupling phase for NHESSC (54 vs. 41 cm, p < 0.001, ES = 1.37). Eccentric average velocity was more than three times higher for NHESSC compared with NHEECC (0.38 vs. 0.12 m/s, p < 0.001, ES = 3.25). The key findings of this study were that SSC contributed to an enhanced NHE performance, where absolute peak knee flexor force was 13% greater for fast NHESSC compared to standard slow NHEECC. The fast NHESSC could therefore be an interesting alternative to the standard slow NHEECC execution, as it may offer potential advantages for sprint performance, as well as hamstring injury prevention and rehabilitation.
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Affiliation(s)
- Jesper Augustsson
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, 39182 Kalmar, Sweden
| | - Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength & Conditioning, Olympic Training and Testing Centre Westphalia, 44139 Dortmund, Germany
| | - Håkan Andersson
- High Performance Center, Strength and Conditioning Institute, 35246 Vaxjo, Sweden
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Kuitunen I, Immonen V, Pakarinen O, Mattila VM, Ponkilainen VT. Incidence of football injuries sustained on artificial turf compared to grass and other playing surfaces: a systematic review and meta-analysis. EClinicalMedicine 2023; 59:101956. [PMID: 37125402 PMCID: PMC10139885 DOI: 10.1016/j.eclinm.2023.101956] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Background Prior reviews have not conducted statistical synthesis of injury incidence on artificial turf in football. To analyse and compare the incidence of injuries sustained playing football (soccer) on artificial turf compared to grass and other playing surfaces. Methods This was a systematic review and meta-analysis. We searched PubMed, Scopus, SPORTDiscus, and Web of Science databases in October 2022 without filters. All observational studies (prospective or retrospective) that analysed injuries sustained playing football on artificial turf and which included a control group that played on grass or other surface were included. Studies were included if they reported the number of injuries and the exposure time for the playing surfaces. Risk of bias was assessed by Newcastle-Ottawa Scale. A random effects model was used to calculate the pooled incidence rate ratios (IRR) with 95% confidence intervals. Protocol was registered with PROSPERO on October 30th, 2022. Registration number: CRD42022371414. Findings We screened 1447 studies, and evaluated 67 full reports, and finally included 22 studies. Risk of bias was a notable issue, as only 5 of the 22 studies adjusted their analysis for potential confounders. Men (11 studies: IRR 0.82, CI 0.72-0.94) and women (5 studies: IRR 0.83, CI 0.76-0.91) had lower injury incidence on artificial turf. Professional players had a lower incidence of injury (8 studies: IRR 0.79, CI 0.70-0.90) on artificial turf, whereas there was no evidence of differences in the incidence of injury in amateur players (8 studies: IRR 0.91, CI 0.77-1.09). The incidence of pelvis/thigh (10 studies: IRR 0.72, CI 0.57-0.90), and knee injuries (14 studies: IRR 0.77, CI 0.64-0.92) were lower on artificial turf. Interpretation The overall incidence of football injuries is lower on artificial turf than on grass. Based on these findings, the risk of injury can't be used as an argument against artificial turf when considering the optimal playing surface for football. Funding No specific funding was received for this study.
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Affiliation(s)
- Ilari Kuitunen
- Institute of Clinical Medicine and Department of Paediatrics, University of Eastern Finland, Kuopio, Finland
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
- Boys National Teams, The Finnish Football Association, Helsinki, Finland
- Corresponding author. Department of Pediatrics, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70029, Kuopio, Finland.
| | - Ville Immonen
- Boys National Teams, The Finnish Football Association, Helsinki, Finland
| | - Oskari Pakarinen
- Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Ville M. Mattila
- Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
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Differences in Peak Knee Flexor Force between Eccentric-Only and Combined Eccentric-Concentric Nordic Hamstring Exercise. Sports (Basel) 2023; 11:sports11020041. [PMID: 36828326 PMCID: PMC9961423 DOI: 10.3390/sports11020041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
In many sports, the hamstring strain injury is a common injury. There is evidence that the Nordic hamstring exercise (NHE), a knee flexor exercise, can reduce hamstring injury risk in athletes. In research on hamstring injury prevention, eccentric-only NHE is typically performed, whereas in sports, it is relatively common for athletes to perform NHE eccentrically-concentrically. Further, NHE strength is generally assessed by measuring knee flexor force through an ankle brace, attached atop of a load cell. An alternative method might be to assess knee flexor force about the knee joint using a force plate. The aim of the study was to investigate differences in peak knee flexor force between eccentric-only and combined eccentric-concentric NHE. The purpose was also to determine the correlation between hamstring force measured at the ankle using a load cell (current gold standard) and force assessed about the knee joint using a force plate during NHE. Fifteen junior and senior elite soccer and track and field athletes (3 women and 12 men aged 17-27 years) performed eccentric NHE (ENHE) in which they leaned forward as far as possible until breakpoint and eccentric-concentric NHE (ECNHE) where they returned to the starting position. A linear encoder measured the position at which peak force occurred during the NHEs. Force assessed at the ankle differed significantly (678 vs. 600 N, p < 0.05), whereas force about the knee joint did not (640 vs. 607 N, p > 0.05) between ENHE and ECNHE (12 and 5% difference, respectively). The forward distance achieved by the participants in cm at breakpoint for ENHE was 37% higher than at the coupling phase for ECNHE (74 vs. 54 cm, p < 0.001). Very strong significant (p < 0.01) correlations were noted between peak force assessed at the ankle and about the knee joint for ENHE and ECNHE, r = 0.96 and r = 0.99, respectively. Our results suggest that ECNHE, where peak knee flexor force was reached with 37% less forward movement, may complement ENHE, i.e., during hamstring injury rehabilitation, where a position of great knee extension may not be well tolerated by the athlete. Further, assessing knee flexor force about the knee joint using a force plate may provide an alternative to measuring force at the ankle using a load cell when testing NHE strength.
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