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Lin N, Cavaleri R, Rio E, Stanton TR, Imam J, Moukhaiber N, Thomson D, Williamson C, Andary T, Summers SJ. The relationship between sustained hamstring pain and reorganisation of somatosensory representations: a randomised, controlled study. Pain 2024:00006396-990000000-00639. [PMID: 38968398 DOI: 10.1097/j.pain.0000000000003312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/21/2024] [Indexed: 07/07/2024]
Abstract
ABSTRACT Recurrent hamstring injuries are highly prevalent amongst sporting populations. It has been hypothesised that pain from an initial hamstring injury may induce reorganisation of somatosensory representations that could contribute to reinjury. However, because of the cross-sectional nature of existing research, it remains unknown whether somatosensory changes are a cause or effect of pain or if they are driven by other potentially confounding factors. Here, we explored the effect of experimentally induced sustained hamstring pain on tasks that interrogate somatosensory and spatial representations. Fifty healthy participants were randomly allocated to an experimental group that performed an eccentric exercise protocol on the right hamstring to induce delayed onset muscle soreness or a control group performing a repetition-matched concentric exercise protocol. The tactile cortical representation was assessed using two-point discrimination and tactile localisation, whereas the proprioceptive representation was assessed using a left-right judgement task. Peripersonal spatial representations were assessed using an auditory localisation task. Assessments were performed at baseline and day 2. No between-group differences in tactile acuity were observed. However, improvements in left-right judgments and worsening of auditory localisation occurred in the experimental group compared with the control group. This study provides preliminary evidence showing that somatosensory changes occur in response to sustained hamstring pain. Experimentally induced, sustained hamstring pain elicited enhancements in proprioceptive processing and deficits in peripersonal spatial processing, suggesting a shift in the allocation of attentional resources from the external (peripersonal) to internal (body) environment. These findings may hold important implications for reinjury risk and rehabilitation following hamstring pain.
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Affiliation(s)
- Natalie Lin
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
| | - Rocco Cavaleri
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
- Queensland University of Technology, School of Biomedical Sciences, Queensland, Australia
| | - Ebonie Rio
- La Trobe University Melbourne, School of Allied Health, Victoria, Australia
| | - Tasha R Stanton
- University of South Australia, IIMPACT in Health, South Australia, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), South Australia, Australia
| | - Jawwad Imam
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
| | - Nadia Moukhaiber
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
| | - Daniel Thomson
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
| | - Cody Williamson
- Macarthur Football Club, A-League, New South Wales, Australia
| | - Toni Andary
- South Western Sydney Local Health District, New South Wales, Australia
| | - Simon J Summers
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
- Queensland University of Technology, School of Biomedical Sciences, Queensland, Australia
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Hannay WM, Sliepka JM, Parker K, Sammons K, Gee AO, Kweon CY, Hagen MS. Limited Return to Preinjury Performance in NCAA Division I American Football Players With Hamstring Injuries. Orthop J Sports Med 2024; 12:23259671241243345. [PMID: 38708007 PMCID: PMC11070146 DOI: 10.1177/23259671241243345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 05/07/2024] Open
Abstract
Background Hamstring strains are common among elite athletes, but their effect on return to the same level of play in American football has been incompletely characterized. Purpose Data on National Collegiate Athletics Association Division I college football players with acute hamstring strains were gathered to identify the effects these injuries have on both return to play and athletic performance regarding velocity, workload, and acceleration. Study Design Case Series; Level of evidence, 4. Methods Injury data for a single Division I football team were prospectively recorded over a 4-year period. Players wore global navigation satellite system and local positioning system (GNSS/LPS) devices to record movement data in practices and games. The practice and game data were cross-referenced to evaluate players with isolated acute hamstring strains. Comparisons were made regarding players' pre- and postinjury ability to maintain high velocity (>12 mph [19.3 kph]), maximal velocity, triaxial acceleration, and inertial movement analysis (IMA). There were 58 hamstring injuries in 44 players, of which 25 injuries from 20 players had GNSS/LPS data. Results Players were able to return to play from all 25 injury incidences at a mean of 9.2 days. At the final mean follow-up of 425 days, only 4 players had reached preinjury function in all measurements; 12 players were able to return in 2 of the 4 metrics; and only 8 players reached their preinjury ability to maintain high velocity. For those who did not achieve this metric, there was a significant difference between pre- and postinjury values (722 vs 442 m; P = .016). A total of 14 players were able to regain their IMA. Players who returned to prior velocity or acceleration metrics did so at a mean of 163 days across all metrics. Conclusion While players may be able to return to play after hamstring strain, many players do not reach preinjury levels of acceleration or velocity, even after 13.5 months. Further studies are needed to confirm these findings, assess clinical relevance on imaging performance, and improve hamstring injury prevention and rehabilitation.
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Affiliation(s)
- William M. Hannay
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Joseph M. Sliepka
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Kate Parker
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kyle Sammons
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Albert O. Gee
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Christopher Y. Kweon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Mia S. Hagen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
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Yagiz G, Fredianto M, Ulfa M, Ariani I, Agustin AD, Shida N, Moore EWG, Kubis HP. A retrospective comparison of the biceps femoris long head muscle structure in athletes with and without hamstring strain injury history. PLoS One 2024; 19:e0298146. [PMID: 38408057 PMCID: PMC10896514 DOI: 10.1371/journal.pone.0298146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/17/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION Hamstring strain injuries (HSI) and re-injuries are endemic in high-speed running sports. The biceps femoris long head (BFlh) is the most frequently injured muscle among the hamstrings. Structural parameters of the hamstring muscle are stated to be susceptible to strain injuries at this location. This retrospective study targeted comparing the BFlh's structural parameters between previously injured and uninjured athletes. METHODS Nineteen male athletes with previous BFlh strain injury history and nineteen athletes without former lower extremity injury history were included in this study. Fascicle length, mid-muscle belly and distal musculotendinous (MTJ) passive stiffnesses of the biceps femoris long head (BFlh) were examined via b-mode panoramic ultrasound scanning and ultrasound-based shear-wave elastography. Parameter comparisons of both legs within and between athletes with and without injury history were performed. RESULTS Comparison of the BFlh fascicle length between the injured leg of the injured group and the legs of the controls revealed a trend to shorter fascicle lengths in the injured leg (p = 0.067, d = -0.62). However, the mid-muscle belly passive stiffness of the BFlh was significantly higher in the injured legs (p = 0.009, d = 0.7) compared with the controls. Additionally, the distal MTJ stiffness was much higher in the previously injured legs compared with controls (p < 0.001, d = 1.6). CONCLUSIONS Outcomes support the importance of BFlh properties related to stiffness, and fascicle length for injury susceptibility in athletes. Future prospective studies should determine whether the higher stiffness in the injured athletes is a cause or consequence of the HSI. Physical therapy and rehabilitation programmes after HSI should focus on BFlh muscle properties i.e., elasticity and fascicle length for reducing re-injury and increasing sports performance.
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Affiliation(s)
- Gokhan Yagiz
- Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC, United States of America
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Amasya University, Amasya, Republic of Türkiye
| | - Meiky Fredianto
- Faculty of Medicine and Health Sciences, Orthopaedics and Traumatology Division, Surgery Department, School of Medicine, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
- Department of Orthopaedic Surgery, Siloam Hospitals Yogyakarta, Yogyakarta, Indonesia
| | - Maria Ulfa
- Faculty of Medicine and Health Sciences, School of Medicine, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
- Master of Hospital Administration, Postgraduate Program, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Indira Ariani
- Department of Radiology, Siloam Hospitals Yogyakarta, Yogyakarta, Indonesia
| | | | - Nami Shida
- Faculty of Health Sciences, Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - E Whitney G Moore
- Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC, United States of America
| | - Hans-Peter Kubis
- Institute for Applied Human Physiology, School of Human and Behavioural Sciences, Bangor University, Bangor, Wales, United Kingdom
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Seidi F, Izadi M, Thomas AC, Bellafiore M. Lower limb muscle activation pattern in male soccer players with lumbar hyperlordosis. J Bodyw Mov Ther 2023; 36:263-269. [PMID: 37949570 DOI: 10.1016/j.jbmt.2023.03.004] [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: 01/27/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE the aim of the current study was to compare the lower limb muscle activation pattern in soccer players with and without lumbar hyperlordosis during single-leg squat performance. METHODS thirty male collegiate soccer players (15 with and 15 without lumbar hyperlordosis) performed the SLS task. Surface EMG was used to record the activation of eleven lower limb muscles. The activation of these muscles reduces to 100 points during the SLS cycle, where 50% demonstrates the maximum knee flexion, and 0% and 99% demonstrate the maximum knee extension. RESULTS soccer players with lumbar hyperlordosis had higher muscle activation than those with normal lumbar lordosis in gluteus maximus, biceps femoris, and medial gastrocnemius. By contrast, they had lower gluteus medius, vastus medialis oblique, rectus femoris, soleus, and medial gastrocnemius (only in the final ascent phase of the SLS) muscle activity than the normal group during the SLS. CONCLUSION this alteration may negatively affect targeted muscle performance during the SLS. Subsequent study is required to specify whether such an alteration in the lower limb muscle could be accompanied by injury in soccer players and change in their athletic performance.
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Affiliation(s)
- Foad Seidi
- Department of Health and Sports Medicine, Faculty of Physical Education and Sport Science, University of Tehran, Iran
| | - Mohammad Izadi
- Department of Health and Sports Medicine, Faculty of Physical Education and Sport Science, University of Tehran, Iran; Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy.
| | - Abbey C Thomas
- Department of Kinesiology at University of North Carolina at Charlotte, USA
| | - Marianna Bellafiore
- Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
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Ekstrand J, Hallén A, Marin V, Gauffin H. Most modifiable risk factors for hamstring muscle injury in women's elite football are extrinsic and associated with the club, the team, and the coaching staff and not the players themselves: the UEFA Women's Elite Club Injury Study. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07429-5. [PMID: 37121935 DOI: 10.1007/s00167-023-07429-5] [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: 02/21/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE To describe the perceived importance of suggested hamstring injury risk factors according to chief medical officers (CMOs) of European women's professional football clubs. A secondary objective was to compare if these perceptions differed between teams with a lower-than-average and higher-than-average hamstring injury burden. METHODS The CMOs of eleven European professional women's football clubs were initially asked to suggest modifiable risk factors for hamstring injury. These risk factors were rated in according with their perceived importance on a 5-graded Likert scale. Participating teams were divided in two groups depending on their hamstring injury burden during the 2020/21 season. The LOW group consisted of six teams that had a lower-than-average hamstring injury burden. The HIGH group consisted of five teams that had a higher-than-average hamstring injury burden. RESULTS Twenty-one risk factors were suggested, most of which were extrinsic in nature, hence associated with the coaching staff, the team or the club organization rather than with the players themselves. The risk factors with the highest average importance were: "lack of communication between medical staff and coaching staff" and "load on players" (each with a weighted average of 3.9), followed by "lack of regular exposure to high-speed football actions during training" and "playing matches 2-3 times a week" (weighted average of 3.8 and 3.7). Differently from the LOW group, the HIGH group perceived the coaching factors (style of coach leadership, training/exercise surveillance by coaching staff) as more important. CONCLUSION In accordance to the eleven CMOs recruited in this study, most risk factors for hamstring injuries are extrinsic in nature and associated with the club, the team, and the coaching staff, and not the players themselves. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jan Ekstrand
- Unit of Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Platensgatan 19, S-582 20, Linköping, Sweden.
- Football Research Group, Linköping, Sweden.
| | - Anna Hallén
- Unit of Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Platensgatan 19, S-582 20, Linköping, Sweden
- Football Research Group, Linköping, Sweden
| | - Vittoria Marin
- Isokinetic Medical Group, FIFA Medical Centre of Excellence, London, UK
| | - Håkan Gauffin
- Department of Orthopedics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Alt T, Roos T, Nolte K, Modenbach D, Knicker AJ, Jaitner T. Modulating the Nordic Hamstring Exercise From "Zero to Hero": A Stepwise Progression Explored in a High-Performance Athlete. J Athl Train 2023; 58:329-337. [PMID: 35984720 PMCID: PMC11215643 DOI: 10.4085/1062-6050-0010.22] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Nordic hamstring exercise (NHE) is commonly implemented to selectively improve eccentric knee-flexor strength. However, the standard version of the exercise (leveled shanks, extended hip joint) is too strenuous for most individuals, whose muscle activity rapidly decreases at extended knee angles. Hitherto, a gradual approach to the exercise has been missing. In this exploratory case study, we investigated elite performance to introduce a stepwise progression to the NHE. OBJECTIVE To determine the extent to which exercise modifications (shank inclination, additional load, hip flexion) altered NHE mechanics. DATA COLLECTION AND ANALYSIS One male long jumper (age = 33 years, height = 171 cm, mass = 69 kg) with high-level expertise in the NHE performed 20 exercise variations. The corresponding kinematics, kinetics, and electromyographic activity of the biceps femoris long head (BFlh) and semitendinosus (ST) muscles were evaluated. RESULTS Exercise variations demonstrated gradually increased peak moments from 69% (zigzag pose) to 154% (inclined bent single-legged version) versus a standard NHE. Shank inclination and additional load elicited small to moderate effects on peak moments, BFlh, and ST (0.24 ≤ d ≤ 0.72), whereas hip flexion largely affected all tested variables (2.80 ≤ d ≤ 6.66), especially muscle activity (BFlh = -63%; ST = -55% of maximal voluntary isometric contraction). COMMENTARY These insights will help practitioners and scientists design multifaceted stepwise NHE progressions by creating differentiated stimuli that best match the strength capacities of individuals and address their specific needs.
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Affiliation(s)
- Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength & Conditioning, Olympic Training and Testing Centre Westphalia, Dortmund, Germany
| | - Tilman Roos
- Institute of Sport Science, Otto-von-Guericke University, Magdeburg, Germany
| | - Kevin Nolte
- Department for Sport and Sport Science, TU Dortmund University, Germany
| | - Dominik Modenbach
- Department for Sport and Sport Science, TU Dortmund University, Germany
| | - Axel J. Knicker
- Institute of Movement & Neuroscience, German Sport University, Cologne
- Research Centre of Elite Sport (Momentum), Cologne, Germany
| | - Thomas Jaitner
- Department for Sport and Sport Science, TU Dortmund University, Germany
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Ekstrand J, Ueblacker P, Van Zoest W, Verheijen R, Vanhecke B, van Wijk M, Bengtsson H. Risk factors for hamstring muscle injury in male elite football: medical expert experience and conclusions from 15 European Champions League clubs. BMJ Open Sport Exerc Med 2023; 9:e001461. [PMID: 36726776 PMCID: PMC9884908 DOI: 10.1136/bmjsem-2022-001461] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives To describe the perceived importance of suggested hamstring injury risk factors according to chief medical officers (CMOs) of European male professional football clubs. A secondary objective was to compare if these perceptions differed between teams with a lower-than-average hamstring injury burden and teams with a higher than average hamstring injury burden. Methods First, CMOs of 15 European professional male football clubs were asked to suggest risk factors for hamstring injury in their club. The perceived importance of the suggested risk factors was then rated by all participants on a 5-graded Likert scale. Participating teams were divided in two groups depending on their hamstring injury burden during the 2019/2020 and 2020/2021 seasons. The LOW group consisted of seven teams that had a lower than average hamstring injury burden. The HIGH group consisted of eight teams that had a higher-than-average hamstring injury burden. Results Twenty-one risk factors were suggested. The majority were extrinsic in nature, associated with coaching staff, team or club rather than players themselves. 'Lack of communication between medical staff and coaching staff' had the highest average importance (weighted average=3.7) followed by 'Lack of regular exposure to high-speed football during training sessions' (weighted average=3.6). The HIGH group perceived the player factors fatigue and wellness as more important than the LOW group. Conclusion According to CMOs recruited in this study, most risk factors for hamstring injuries are extrinsic and associated with the club and coaching staff, and not the players themselves.
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Affiliation(s)
- Jan Ekstrand
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | | | - Wart Van Zoest
- PSV Eindhoven, Eindhoven, The Netherlands,Department of Sports and Orthopaedic Surgery, Anna Hospital, Eindhoven, The Netherlands
| | | | - Bruno Vanhecke
- Football Club Brugge, Brugge, Belgium,Department of Physical and Rehabilitation Medicine, AZ Delta Hospitals, Brugge, Belgium
| | | | - Håkan Bengtsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden,Football Research Group, Linköping, Sweden
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Activity Distribution Among the Hamstring Muscles During the Nordic Hamstring Exercise: A Multichannel Surface Electromyography Study. J Appl Biomech 2023; 39:69-79. [PMID: 36791725 DOI: 10.1123/jab.2022-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 02/17/2023]
Abstract
This study assessed activity distribution among the hamstring muscles during the Nordic hamstring exercise (NHE). The objective was to compare muscle activity between and within muscles during the NHE to add insights in its underlying protective mechanism. Through multichannel electromyography, we measured muscle activity in male basketball players during the NHE. Electromyography was assessed at 15 locations: 5 for biceps femoris long head, 4 for semitendinosus, and 6 for semimembranosus. For each percent of the eccentric phase of the NHE, muscle activity was calculated for each electrode location within each hamstring muscle individually. To quantify whole muscle head activity, means and variances across electrodes within each muscle were calculated. Thirty-five noninjured participants were included (mean age, 18 [2] y; mass, 87 [12] kg; height, 192 [9] cm). Heterogeneous muscle activity was found between 38% and 62% and over the whole eccentric contraction phase within the semitendinosus and the semimembranosus, respectively. Muscle activity of the semitendinosus was significantly higher than that of the biceps femoris long head. During the NHE, the relative contribution of the semitendinosus is the highest among hamstring muscles. Its strong contribution may compensate for the biceps femoris long head, the most commonly injured hamstring muscle head.
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Ritzmann R, Strütt S, Torreno I, Riesterer J, Centner C, Suarez-Arrones L. Neuromuscular characteristics of agonists and antagonists during maximal eccentric knee flexion in soccer players with a history of hamstring muscle injuries. PLoS One 2022; 17:e0277949. [PMID: 36455059 PMCID: PMC9714924 DOI: 10.1371/journal.pone.0277949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Muscle strain injuries (MSIs) in the hamstrings are among the most prevalent injuries in elite soccer. We aimed to examine the relation between biomechanical maladaptation in eccentric strength and neuromuscular factors separated by their time and frequency domains. METHODS 20 elite soccer players with a previous history of unilateral MSI in the M. biceps femoris (BF) long head and 20 without MSI participated. Knee flexion torques, rate of torque development (RTD) and electromyographic signals (EMG) of the BF, the M. semitendinosus (SMT) and knee extensors were obtained during unilateral maximal eccentric knee flexions performed at slow (30°/s) and fast (120°/s) angular speeds. Root mean squares and mean power frequency (MF) was calculated. RESULTS In the group with a history of MSI, reduced maximal eccentric flexion torque (slow eccentrics -8±11, p<0.05; fast eccentrics -18±13 N*m, p<0.05) and RTD (-33±28 N*m/s, p<0.05; -95±47 N*m/s, p<0.05) concomitantly occurred with diminished agonistic myoelectrical activities (-4±5% of MVC, p<0.05; -10±7% of MVC, p<0.05) and MFs (-24±13 Hz, p<0.05; -24±18 Hz, p<0.05) in the BF. Simultaneously, antagonistic myoelectric activity was elevated (+4±3% of MVC, p<0.05; +3±3% of MVC, p<0.05) in MSI affected legs as compared to unaffected legs for both eccentric contractions. Deficits in myoelectrical activity (r2 = 0.715, p<0.05; r2 = 0.601, p<0.05) and MF (r2 = 0.484, p<0.05; r2 = 0.622, p<0.05) correlated with deficits in maximal torque in the affected leg in the MSI group. Analysis of SMT demonstrated no significant differences. CONCLUSION Positive relationships between neuromuscular deficits and the reduced eccentric strength profile underpin neuronal inhibition after MSI. This persistent involvement of dysfunctional synergist and antagonist neural hamstring function in strength weakness is of clinical relevance in sports medicine for prevention and rehabilitation.
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Affiliation(s)
- Ramona Ritzmann
- Department of Sports and Sport Science, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Sarah Strütt
- Praxisklinik Rennbahn AG, Muttenz, Switzerland
- FC Basel, Basel, Switzerland
| | | | | | | | - Luis Suarez-Arrones
- FC Lugano, Lugano, Switzerland
- Department of Sports and Computer Science, Section of Physical Education and Sports, Universidad Pablo de Olavide, Seville, Spain
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Kellis E, Blazevich AJ. Hamstrings force-length relationships and their implications for angle-specific joint torques: a narrative review. BMC Sports Sci Med Rehabil 2022; 14:166. [PMID: 36064431 PMCID: PMC9446565 DOI: 10.1186/s13102-022-00555-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022]
Abstract
Temporal biomechanical and physiological responses to physical activity vary between individual hamstrings components as well as between exercises, suggesting that hamstring muscles operate differently, and over different lengths, between tasks. Nevertheless, the force-length properties of these muscles have not been thoroughly investigated. The present review examines the factors influencing the hamstrings’ force-length properties and relates them to in vivo function. A search in four databases was performed for studies that examined relations between muscle length and force, torque, activation, or moment arm of hamstring muscles. Evidence was collated in relation to force-length relationships at a sarcomere/fiber level and then moment arm-length, activation-length, and torque-joint angle relations. Five forward simulation models were also used to predict force-length and torque-length relations of hamstring muscles. The results show that, due to architectural differences alone, semitendinosus (ST) produces less peak force and has a flatter active (contractile) fiber force-length relation than both biceps femoris long head (BFlh) and semimembranosus (SM), however BFlh and SM contribute greater forces through much of the hip and knee joint ranges of motion. The hamstrings’ maximum moment arms are greater at the hip than knee, so the muscles tend to act more as force producers at the hip but generate greater joint rotation and angular velocity at the knee for a given muscle shortening length and speed. However, SM moment arm is longer than SM and BFlh, partially alleviating its reduced force capacity but also reducing its otherwise substantial excursion potential. The current evidence, bound by the limitations of electromyography techniques, suggests that joint angle-dependent activation variations have minimal impact on force-length or torque-angle relations. During daily activities such as walking or sitting down, the hamstrings appear to operate on the ascending limbs of their force-length relations while knee flexion exercises performed with hip angles 45–90° promote more optimal force generation. Exercises requiring hip flexion at 45–120° and knee extension 45–0° (e.g. sprint running) may therefore evoke greater muscle forces and, speculatively, provide a more optimum adaptive stimulus. Finally, increases in resistance to stretch during hip flexion beyond 45° result mainly from SM and BFlh muscles.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, TEFAA Serres, 62100, Serres, Greece.
| | - Anthony J Blazevich
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, 6027, Australia
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Martin RL, Cibulka MT, Bolgla LA, Koc TA, Loudon JK, Manske RC, Weiss L, Christoforetti JJ, Heiderscheit BC. Hamstring Strain Injury in Athletes. J Orthop Sports Phys Ther 2022; 52:CPG1-CPG44. [PMID: 35164536 DOI: 10.2519/jospt.2022.0301] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hamstring strain injury (HSI) may result in considerable impairment, activity limitation, and participation restriction, including time lost from competitive sports. This CPG includes sports-related overloading and overstretching injuries to myofascial or musculotendinous structures in any combination of the 3 hamstring muscles (the semitendinosus, semimembranosus, and biceps femoris). J Orthop Sports Phys Ther 2022;52(3):CPG1-CPG44. doi:10.2519/jospt.2022.0301.
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Is Muscle Architecture Different in Athletes with a Previous Hamstring Strain? A Systematic Review and Meta-Analysis. J Funct Morphol Kinesiol 2022; 7:jfmk7010016. [PMID: 35225902 PMCID: PMC8884017 DOI: 10.3390/jfmk7010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Hamstring strains are a frequent injury in sports and are characterized by a high recurrence rate. The aim of this review was to examine the muscle and tendon architecture in individuals with hamstring injury. A systematic literature search in four databases yielded eleven studies on architecture following injury. Differences in the fascicle length (FL), pennation angle (PA) and muscle size measures (volume, thickness and physiological cross-sectional area) at rest were not significantly different between the previously injured limb and the contralateral limb (p > 0.05). There was moderate evidence that biceps femoris long head (BFlh) FL shortening was greater during contraction in the injured compared to the contralateral limb. The BFlh FL was smaller in athletes with a previous injury compared to uninjured individuals (p = 0.0015) but no differences in the FL and PA of other muscles as well as in the aponeurosis/tendon size were observed (p > 0.05). An examination of the FL of both leg muscles in individuals with a previous hamstring strain may be necessary before and after return to sport. Exercises that promote fascicle lengthening of both injured and uninjured leg muscles may be beneficial for athletes who recover from a hamstring injury.
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13
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Changes in Amplitude of Hamstring Electromyographic Activity and Its Peak Location During Nordic Hamstring Exercise by Adding External Load. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2022. [DOI: 10.1123/ijatt.2021-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This crossover trial aimed to investigate whether additional loading of unilateral Nordic hamstring exercise on a sloped platform would increase the biceps femoris long head electromyographic activity. Participants were randomly allocated to unilateral Nordic hamstring exercise under three conditions: bodyweight only (BW) or BW with an added weighted ball of 3 kg (BW + 3 kg) or 6 kg (BW + 6 kg), respectively. The biceps femoris long head electromyographic activity was significantly higher for BW + 6 kg (p < .001) than for BW and BW + 3 kg (p < .01). Therefore, adding a load to unilateral Nordic hamstring exercise on a sloped platform might be effective for rehabilitation and prevention of hamstring strain injury recurrence.
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14
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Alizadeh S, Sarvestan J, Svoboda Z, Alaei F, Linduška P, Ataabadi PA. Hamstring and ACL injuries impacts on hamstring-to-quadriceps ratio of the elite soccer players: A retrospective study. Phys Ther Sport 2021; 53:97-104. [PMID: 34894617 DOI: 10.1016/j.ptsp.2021.12.001] [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: 07/17/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to compare the angle-specific (AS) and non-angle-specific (NAS) hamstring to quadriceps conventional and functional ratios between healthy, hamstring- and ACL-injured elite soccer players. One hundred and eleven players (27.42 ± 8.01 years, 182.11 ± 6.79 cm, 75.93 ± 7.25 kg) completed a series of concentric knee flexor and extensor strength in addition to eccentric knee flexor strength was measured at an angular velocity of 60°.s-1. Normalized and raw peak torque values, and the torque-angle profiles were extracted for analysis. Conventional and functional NAS (peak values) and AS (waveform ratios) hamstring to quadriceps ratios were calculated and compared between the groups. Healthy players produced greater functional and conventional ratios compared to players with either ACL or hamstring injury. Players with hamstring injury produced a lower AS functional ratios between 46° and 54° of knee flexion. Players suffering from ACL injury depicted a lower value for the AS functional ratio between 33° and 56° of knee flexion. Although NAS can identify soccer players with previous hamstring or ACL injury, the range where there is a strength deficiency is eluded. With the use of AS the range where the deficiency is present can be identified, and clinicians can benefit from this analysis to design robust rehabilitation protocols.
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Affiliation(s)
- Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Javad Sarvestan
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic.
| | - Zdeněk Svoboda
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Fatemeh Alaei
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Petr Linduška
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Peyman Aghaie Ataabadi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
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15
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Nara G, Samukawa M, Oba K, Koshino Y, Ishida T, Kasahara S, Tohyama H. The deficits of isometric knee flexor strength in lengthened hamstring position after hamstring strain injury. Phys Ther Sport 2021; 53:91-96. [PMID: 34890906 DOI: 10.1016/j.ptsp.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the effects of knee flexion angle on peak torque, rate of torque development (RTD) during isometric contraction and hamstring flexibility after hamstring strain injury (HSI). DESIGN Cross-sectional. SETTING Controlled laboratory research. PARTICIPANTS Fourteen male athletes with a history of HSI and 14 athletes without HSI (controls). MAIN OUTCOME MEASURES Hamstring flexibility was evaluated using active knee extension test. Isometric knee flexion peak torque and RTD were determined at 30°, 60°, and 90° of knee flexion measured by an isokinetic dynamometer. RESULTS Individuals with a history of HSI had statistically significant, moderate deficits in isometric peak torque at 30° of knee flexion (P = 0.037; effect size = 0.55) in the HSI limb than in the uninjured limb, but not at 60° and 90° of knee flexion. In the control group, no significant differences in isometric peak torque at any angle were found between limbs. No differences in peak RTD and flexibility were found between limbs in both groups. CONCLUSIONS Isometric peak torque at 30° of knee flexion was lower in the injured limb than in the uninjured limb. Isometric strength deficits after HSI tended to be affected by lengthened hamstring angles.
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Affiliation(s)
- Ginji Nara
- Rehabilitation Center, NTT Medical Center Sapporo, Sapporo, Japan; Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Kensuke Oba
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan; Department of Rehabilitation, Hitsujigaoka Hospital, Sapporo, Japan
| | - Yuta Koshino
- Rehabilitation Center, NTT Medical Center Sapporo, Sapporo, Japan; Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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16
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Mikami K, Samukawa M, Oba K, Nakamura K, Suzumori Y, Ishida Y, Matsumoto H, Aoki Y, Ishida T, Yamanaka M, Tohyama H. Torque-angle curve of the knee flexors in athletes with a prior history of hamstring strain. Phys Ther Sport 2021; 54:29-35. [PMID: 34929533 DOI: 10.1016/j.ptsp.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To investigate the knee flexor torque-angle curve after hamstring strain injury using different muscle action types and angular velocities. DESIGN Cross-sectional. SETTING Controlled laboratory. PARTICIPANTS Thirteen collegiate athletes injured hamstring strain (21.0 ± 0.8 years; 173.9 ± 6.5 cm; 70.1 ± 10.5 kg). MAIN OUTCOME MEASURES Concentric and eccentric knee flexor torque was measured at 60 & 300°/sec. Peak torque and average torque every 10° were determined from torque-angle curve and injured side was compared with non-injured side. RESULTS No significant differences were found in the concentric muscle actions. However, the eccentric peak torque was significantly lower on the injured side at 60°/sec (p = 0.048) and at 300°/sec (p = 0.002). The average eccentric torque was significantly lower on the injured side at 60°/sec from 10° to 20° of knee flexion (p = 0.012-0.018) and at 300°/sec from 10° to 60° of knee flexion (p = 0.005-0.049). CONCLUSION The knee flexor torque-angle curve changes with eccentric muscle action after hamstring injury. Eccentric torque declines were close to full knee extension at 60°/sec and a wide range of knee flexion at 300°/sec. The assessment and rehabilitation of eccentric hamstring strength may be important to consider the effect of the angular velocity after hamstring strain injury.
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Affiliation(s)
- Kentaro Mikami
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Kensuke Oba
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan; Department of Rehabilitation, Hitsujigaoka Hospital, Sapporo, Japan
| | - Kentaro Nakamura
- Department of Rehabilitation, Sapporo Spine Clinic, Sapporo, Japan
| | - Yuki Suzumori
- Department of Rehabilitation, Hitsujigaoka Hospital, Sapporo, Japan
| | - Yuko Ishida
- Sports Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Hisashi Matsumoto
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Yoshimitsu Aoki
- Department of Orthopedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Tomoya Ishida
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan; Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masanori Yamanaka
- Faculty of Health Sciences, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
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17
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Buhmann R, Trajano GS, Kerr GK, Shield AJ. Lower knee flexion and hip extension rate of torque development in athletes with previous hamstring strain injury. J Sports Sci 2021; 40:534-541. [PMID: 34787048 DOI: 10.1080/02640414.2021.2003981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Persistent deficits in strength and voluntary activation have been observed in athletes with a history of hamstring strain injury. The mechanisms contributing to these deficits are poorly understood and consequently may not be appropriately addressed during rehabilitation. This study aimed to investigate the impact of intended knee flexor contraction mode (concentric, eccentric or isometric) on the rate of torque development and surface electromyography (sEMG) rise in athletes with and without a history of unilateral hamstring strain injury. The impact of the previous injury on hip extensor rate of torque development was also investigated. Previously injured limbs exhibited a slower rate of torque development (mean difference = -31%, p = 0.02, Cohen's d = 0.62) and biceps femoris rate of sEMG rise (mean difference = -181% · s-1, p = 0.003, Cohen's d = 1.10) during intended eccentric knee flexor contractions compared with control limbs. Previously injured (mean difference = -29%, p = 0.01, Cohen's d = 0.85) and contralateral uninjured limbs (mean difference = -31%, p = 0.007, Cohen's d = 0.73) exhibited a slower rate of torque development during isometric hip extensor contractions compared with control limbs. These findings may highlight lower levels of descending input to hamstring motoneurons in previously injured athletes.
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Affiliation(s)
- Robert Buhmann
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Graham K Kerr
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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18
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Martínez-Rodríguez R, Galán-Del-Río F, Cantalapiedra JA, Flórez-García MT, Martínez-Martín J, Álvaro-Meca A, Koppenhaver SL, Fernández-de-Las-Peñas C. Reliability and discriminative validity of real-time ultrasound elastography in the assessment of tissue stiffness after calf muscle injury. J Bodyw Mov Ther 2021; 28:463-469. [PMID: 34776179 DOI: 10.1016/j.jbmt.2021.06.019] [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: 10/09/2020] [Revised: 04/18/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the reliability and discriminative validity of real-time ultrasound elastography (RTE) measures of soft-tissue elasticity after calf muscle tear. DESIGN Cross-sectional, intra/inter-examiner reliability and comparative validity study. SETTING Department of Physical Therapy. PARTICIPANTS Twenty-one recreational athletes were included and examined 6 weeks after sustaining a grade I-II calf musculature tear. MAIN OUTCOME MEASURES Soft-tissue elasticity was measured by two experienced assessors using RTE assessments in both the longitudinal and transverse planes of the athletes' injured and uninjured calf muscles. Elasticity was estimated by using the strain ratio (SR), which was calculated by dividing the strain (displacement) value taken at the medial gastrocnemius-soleus myotendinous junction (reference) by the strain value taken at the centre of the injury (index) as visualized on B-mode sonogram. Intra- and inter-observer reliability was estimated calculating intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). Differences in elasticity between injured and healthy legs were assessed using t-tests or Wilcoxon tests for repeated measures. RESULTS All RTE assessments in both planes showed ICC values ranging from 0.77 to 0.95 and SEM values ranging from 0.72 to 0.99. Additionally, RTE enabled both assessors to determine differences in elastic properties between injured and control legs (p < 0.001). CONCLUSION RTE measures of calf muscles demonstrated good reliability and were able to differentiate injured from non-injured muscle tissue. RTE may provide a fast and objective measure in sports medicine to improve the detection of risk factors for muscle injury related to alterations of the mechanical behaviour of soft tissues during healing process.
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Affiliation(s)
| | - Fernando Galán-Del-Río
- Spanish Football Federation, Physiotherapy Team, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain.
| | - Juan Aboítiz Cantalapiedra
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; Orthopaedic Surgery, Traumatology and Rehabilitation Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Mariano T Flórez-García
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; Orthopaedic Surgery, Traumatology and Rehabilitation Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Javier Martínez-Martín
- Orthopaedic Surgery, Traumatology and Rehabilitation Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Alejandro Álvaro-Meca
- Department of Preventive Medicine & Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
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19
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Increased short interval intracortical inhibition in participants with previous hamstring strain injury. Eur J Appl Physiol 2021; 122:357-369. [PMID: 34729636 DOI: 10.1007/s00421-021-04839-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Cortical mechanisms may contribute to weakness in participants with previous hamstring strain injury. This study aims to examine intra-cortical inhibition (SICI) and corticospinal excitability in previously injured participants. METHODS In this cross-sectional study, TMS was used to examine SICI, silent period, silent period: MEP ratios and area under the stimulus response curve in the biceps femoris and medial hamstrings. Comparisons were made between participants with (n = 10) and without (n = 10) previous hamstring strain injury. Motor threshold and isometric knee flexor strength were also compared between participants and the relationship between strength and SICI in control and previously injured participants was examined. RESULTS Isometric knee flexor strength was lower in previously injured limbs compared with control limbs (mean difference = - 41 Nm (- 26%) [95% CI = - 80 to - 2 Nm], p = 0.04, Cohen's d = - 1.27) and contralateral uninjured limbs (mean difference = - 23 Nm (- 17%), [95% CI = - 40 to - 6 Nm], p = 0.01, Cohen's d = - 0.57). Previously injured limbs exhibited smaller responses to paired pulse stimulation (i.e. greater levels of SICI) in the biceps femoris compared with control limbs (mean difference = - 19%, [95% CI = - 34 to - 5%], p = 0.007, Cohen's d = - 1.33). Isometric knee flexor strength was associated with the level of SICI recorded in the biceps femoris in previously injured participants (coefficient = 23 Nm [95% CI = 7-40 Nm], adjusted R2 = 0.31, p = 0.01). There were no differences in markers of corticospinal excitability between previously injured and control limbs (all p > 0.24, all Cohen's d < 0.40). CONCLUSION Athletes with previous injury in the biceps femoris exhibit increased SICI in this muscle compared with control participants. Increased SICI is related to lower levels of hamstring strength, and rehabilitation programs targeting the removal of intra-cortical inhibition should be considered.
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20
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Presland JD, Timmins RG, Maniar N, Tofari PJ, Kidgell DJ, Shield AJ, Dickson J, Opar DA. Muscle Activity and Activation in Previously Strain-Injured Lower Limbs: A Systematic Review. Sports Med 2021; 51:2311-2327. [PMID: 34309803 DOI: 10.1007/s40279-021-01487-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lower limb muscle strain injury is highly prevalent in running-based sports and is considered a risk factor for recurrent injury. It is possible that differences in muscle activity and activation in previously strain-injured limbs may contribute to the elevated risk of reinjury. OBJECTIVES To systematically review available literature investigating whether muscle activity and/or activation is different in previously strain-injured muscles compared to contralateral uninjured muscles or uninjured controls. METHODS A systematic review of literature in SPORTDiscus, MEDLINE Complete, CINAHL and Web of Science was conducted. Full-text English articles which compared indicators of neuromuscular function between injured and uninjured contralateral limbs or control groups in those with a history of muscle strain injury were included. RESULTS Twelve studies were included in the review after eligibility criteria were applied. A best evidence synthesis revealed moderate to limited evidence suggesting differences in surface electromyography (sEMG) amplitude, integrated sEMG amplitude, inter-muscle sEMG ratios and voluntary activation in injured limbs, most often during eccentric contractions. Studies utilising sprinting assessments demonstrated conflicting evidence when comparing late swing phase biceps femoris sEMG amplitude between limbs with a history of hamstring strain injury and uninjured contralateral limbs. CONCLUSIONS Differences in muscle activity and activation were observed between injured and uninjured limbs across a variety of strength assessments. The evidence supporting these differences was most often moderate or limited and was generally observed during eccentric contractions. Mostly conflicting or limited evidence was found to suggest that participants with previous hamstring strain injury demonstrate no differences in muscle activity during running tasks when compared with their uninjured counterparts or contralateral limbs. TRIAL REGISTRY PROSPERO (ID, CRD42019135681).
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Affiliation(s)
- Joel D Presland
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia.
| | - Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Paul J Tofari
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Dawson J Kidgell
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jessica Dickson
- Library and Academic Research Services, Australian Catholic University, Melbourne, VIC, Australia
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
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21
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Mühlenfeld N, Steendahl IB, Berthold DP, Meyer T, Hauser T, Wagner N, Sander AL, Marzi I, Kaltenbach B, Yel I, Vogl T, Eichler K. Assessment of muscle volume using magnetic resonance imaging (MRI) in football players after hamstring injuries. Eur J Sport Sci 2021; 22:1436-1444. [PMID: 34110980 DOI: 10.1080/17461391.2021.1942226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Muscle injuries of the hamstrings are among the most frequent in football and a main cause for significant time away from training and competition. The purpose of this study was to prospectively evaluate the loss of muscle volume in recreational football players three and six weeks after initial trauma. We hypothesized that significant muscle volume loss occurs within 6 weeks after the initial injury event. Twenty recreational football players (mean-age=25 ± 4years; mean-height=181 ± 8cm; mean-weight=81 ± 10kg) with type3a (minor partial muscle tear) and type3b (moderate partial muscle tear) injuries were included. Muscle volume was determined using established methods for the hamstrings and the quadriceps femoris muscle within 3 days and after 3 and 6 weeks following the initial injury. The injured hamstrings lost 6.5% (mean=64 cm3(95%CI=31-98 cm3), p<0.001), the healthy hamstrings lost 2.1% (mean=21 cm3(3-44 cm3),p=0.096) of muscle volume after six weeks. The quadriceps in the injured leg lost 3.8% (mean=78 cm3(51-104 cm3), p<0.001) and 4.5% (83 cm3 (45-121 cm3), p<0.001) in the healthy leg. Muscle volume loss inversely correlated with activity levels in the healthy leg for the quadriceps (r=0.96 (0.90-0.98); R2=0.92; p<0.001) and the hamstrings (r=0.72 (0.40-0.88); R2=0.51; p<0.001), as well as the quadriceps in the injured leg (r=0.70 (0.37-0.87); R2=0.49; p<0.001), but not the injured hamstrings. Muscle volume ratio of hamstrings to quadriceps in the control limb was 0.52 ± 0.06 and 0.53 ± 0.06 in the injured leg. The rehabilitation period of six weeks did not have a relevant negative or a positive effect on ratios. Significant muscle volume loss in the upper thigh occurs in recreational soccer players within three, and within six weeks after a hamstring injury and lies between 2% and 7%.Highlights This study found that significant muscle volume loss occurs within six weeks after sustaining hamstring muscle group injuries.Additionally, most of the non-professional football players in the present study demonstrated low hamstring-to-quadriceps volume ratios in both the injured, as well as the heathy leg. Low hamstring-to-quadriceps volume ratios may provide an opportunity to focus on muscle hypertrophy strategies to help reduce the risk for muscle imbalances and thus future injury.After three weeks of resting, reduced training activity, compared to the training activity before the injury, seems to be sufficient to preserve 99% of the remaining muscle volume in the quadriceps and as well as the healthy hamstrings. The number of training-minutes correlates statistically significant inversely with the muscle volume lost in a rehabilitation period.
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Affiliation(s)
- Nils Mühlenfeld
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ida Bo Steendahl
- Institute of Sports and Preventive Medicine, Saarland University, Saarbruecken, Germany.,Deutscher Fußball-Bund (DFB), Frankfurt, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbruecken, Germany
| | | | - Nils Wagner
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anna-Lena Sander
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Benjamin Kaltenbach
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Vogl
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
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22
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Soga T, Nishiumi D, Furusho A, Akiyama K, Hirose N. Effect of Different Slopes of the Lower Leg during the Nordic Hamstring Exercise on Hamstring Electromyography Activity. JOURNAL OF SPORTS SCIENCE AND MEDICINE 2021; 20:216-221. [PMID: 33948099 DOI: 10.52082/jssm.2021.216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to examine whether the NHE with an increased lower leg slope angle would enhance hamstring EMG activity in the final phase of the descend. The hamstring EMG activity was measured, the biceps femoris long head (BFlh) and the semitendinosus (ST). Fifteen male volunteers participated in this study. Subjects performed a prone leg curl with maximal voluntary isometric contraction to normalize the hamstring EMG activity. Subsequently, subjects performed the NHE, with the help of a certified strength and conditioning specialist, while the lower leg slope angle were randomly set at 0° (NH), 20° (N20), and 40° (N40). To compare hamstring EMG activity during the NHE variations, the knee flexion angle was set in the range from 0° to 50°, divided into five phases (0-10°, 10-20°, 20-30°, 30-40° and 40-50°), where 0° indicated that the knee was fully extended. To calculate the knee extension angular velocity, the knee flexion angle divided by time, and break point angle (BPA) was the angle at which 10°/s was exceeded. In the statistical analysis, a two-way repeated measures ANOVA was used for the hamstring EMG activity and a one-way repeated measures ANOVA was used for the BPA. The EMG activity of the BFlh and the ST in N20 and N40 was significantly higher than in NH at knee flexion angle of 0-20° (p < 0.05). For the BPA, NH (57.75° ± 13.28°), N20 (36.27° ± 9.89°) and N40 (16.26° ± 9.58°) were significantly higher in that order (p < 0.05). The results of this study revealed that the NHE with an increased lower leg slope angle shifted the BPA to the lower knee flexion angle and enhanced the hamstring EMG activity in the final phase of the descent.
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Affiliation(s)
- Toshiaki Soga
- Graduate School of Sport Sciences, Waseda University, Tokyo, Japan
| | - Daichi Nishiumi
- Graduate School of Sport Sciences, Waseda University, Tokyo, Japan
| | - Atsuya Furusho
- Graduate School of Sport Sciences, Waseda University, Tokyo, Japan
| | - Kei Akiyama
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| | - Norikazu Hirose
- Graduate School of Sport Sciences, Waseda University, Tokyo, Japan.,Faculty of Sport Sciences, Waseda University, Tokyo, Japan
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23
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NIN DARRENZ, PAIN MATTHEWTG, LIM YIIH, KONG PUIW. HAMSTRING MUSCLE ARCHITECTURE AND VISCOELASTIC PROPERTIES: RELIABILITY AND RETROSPECTIVE COMPARISON BETWEEN PREVIOUSLY INJURED AND UNINJURED ATHLETES. J MECH MED BIOL 2021. [DOI: 10.1142/s021951942150007x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The architecture of the biceps femoris (BF) and stiffness of the hamstrings have been found to be associated with injury risk. However, less is known about the architecture of the equally voluminous semitendinosus (ST) and viscoelastic properties of both muscles in individuals with a prior injury. Methods: BF and ST of 15 athletes (previously injured, [Formula: see text]; control, [Formula: see text]) were assessed using ultrasonography and myotonometry. Mean architecture (muscle thickness (MT), pennation angle (PA) and fascicle length (FL)) and viscoelastic measures (stiffness, oscillation frequency and decrement) were compared between the previously injured and contralateral uninjured limb, and between the previously injured and control limbs (mean of both limbs of the control group). Control group participants returned for a duplicate measurement. Findings: Both muscles exhibited high reliability between sessions (intraclass correlation coefficient [Formula: see text]) for architecture. BF PA was larger in the previously injured than both uninjured [Formula: see text] and control [Formula: see text]. BF fascicles were shorter in the previously injured limb compared to the uninjured [Formula: see text] and control [Formula: see text]. BF was stiffer in the previously injured compared to uninjured [Formula: see text]. ST architecture and viscoelasticity were similar across limbs. Conclusion: A prior hamstring strain injury is associated with a stiffer BF characterized by larger PAs and shorter fascicles.
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Affiliation(s)
- DARREN Z. NIN
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, 50 Nanyang Ave, Singapore 639798, Singapore
- Institute for Sports Research, Nanyang Technological University, 50 Nanyang Ave, Singapore 639798, Singapore
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire LE11 3TU United Kingdom
| | - MATTHEW T. G. PAIN
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire LE11 3TU United Kingdom
| | - YII H. LIM
- Sports & Preventive Medicine Branch, Parkway Shenton 1 Raffles Quay North Tower, #09-02, Singapore 048583, Singapore
| | - PUI W. KONG
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, 50 Nanyang Ave, Singapore 639798, Singapore
- Institute for Sports Research, Nanyang Technological University, 50 Nanyang Ave, Singapore 639798, Singapore
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24
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Ehiogu UD, Stephens G, Jones G, Schöffl V. Acute Hamstring Muscle Tears in Climbers-Current Rehabilitation Concepts. Wilderness Environ Med 2020; 31:441-453. [PMID: 33189522 DOI: 10.1016/j.wem.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
Acute hamstring injuries are often caused by the heel hook technique. This technique is unique to climbing and causes injury to muscular and inert tissues of the posterior thigh. The heel hook is used by climbers during strenuous ascent on overhanging walls and when crossing difficult terrain. The technique reduces the amount of upper body strength required during strenuous climbing because the climber's center of mass is retained within the base of support. The heel hook is stressful collectively for the hamstring muscle group and musculotendinous junction. Depending on injury severity, both conservative and surgical methods exist for the management of hamstring injuries. Contemporary approaches to rehabilitation primarily advocate the use of eccentric muscle strengthening strategies because of high rates of elongation stress associated with sprinting and team sports. However, there is reason to doubt whether this alone is sufficient to rehabilitate the climbing athlete in light of the high degree of concentric muscle strength required in the heel hook maneuver. This review examines the contemporary rehabilitation and strength and conditioning literature in relation to the management of acute hamstring musculotendinous injuries for the climbing athlete. The review provides a comprehensive approach for the rehabilitation and athletic preparation of the climbing athlete from the initial injury to full return to sports participation.
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Affiliation(s)
- Uzo Dimma Ehiogu
- Birmingham Royal Orthopaedic Hospital, Research and Training Department, Birmingham, United Kingdom; Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.
| | - Gareth Stephens
- Birmingham Royal Orthopaedic Hospital, Research and Training Department, Birmingham, United Kingdom
| | - Gareth Jones
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Volker Schöffl
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom; Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany; Section of Sports Medicine, Department of Orthopedic Surgery, Klinikum Bamberg, Germany; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
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25
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Zongxing L, Xiangwen W, Shengxian Y. The effect of sitting position changes from pedaling rehabilitation on muscle activity. Comput Methods Biomech Biomed Engin 2020; 24:260-269. [PMID: 32969744 DOI: 10.1080/10255842.2020.1823377] [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] [Indexed: 12/15/2022]
Abstract
Sports injuries or traffic accidents make the individuals bedridden for a long duration, easily causing the disuse of lower limb muscles. Exercise rehabilitation is an effective method to improve muscle activity; however, currently, exercise therapy mainly relies on the experience of rehabilitation physicians for determining the rehabilitation parameters. In this paper, we establish a human-machine coupling system model for disuse atrophy of lower limb muscles. We analyze the influence of sitting position on pedaling rehabilitation. The relationship between the sitting position and muscle effect of lower limb muscle is calculated. We optimized the parameters to analyze muscle force and activity distribution in the muscle group during different sitting positions, and the rehabilitation risk area and the invalid area were identified from the distribution map, which helps quantify the maximal exercise of muscles without causing secondary muscle damage. The mapping relationship between sitting position and muscle force was established in this study. Further, muscle activity mapping is performed for overall assessment. Muscle activity assessment considered the training intensity of small muscles and avoids secondary injury of small muscle. The corresponding designated sitting posture improved the intensity of muscle training and shortened the rehabilitation cycle. Systematic distribution areas for different rehabilitation effects in pedal exercises are presented and provide the sitting position distribution areas for patients in the early, middle, and late stages. The proposed model provides theoretical guidance for rehabilitation physicians.
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Affiliation(s)
- Lu Zongxing
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian, China
| | - Wei Xiangwen
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian, China
| | - You Shengxian
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian, China
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26
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Page RM, Greig M. The cumulative and residual changes in eccentric knee flexor strength indices following soccer-specific treadmill running: Novel considerations of angle specific torque. J Sports Sci 2020; 38:1877-1885. [PMID: 32508286 DOI: 10.1080/02640414.2020.1763053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
With potential implications for recovery and conditioning practices, the aim of this study was to assess the cumulative and residual response of angle specific eccentric knee flexor (eccKF) strength indices following soccer-specific activity. Thirteen semi-professional soccer players were therefore required to complete a 90-minute soccer-specific treadmill running. with eccKF isokinetic strength assessments completed pre-trial, immediately post-trial, and 48 hours post-trial. The strength assessments comprised the completion of 5 repetitions at angular velocities of 60 and 300 deg·s-1. Isokinetic data was analysed for measures of peak torque (PT), angle of peak torque (APT), functional range (FR), and angle specific torque (AST). Significant post-trial impairments were observed for measures of slow velocity PT60 (6.6%) and AST300 (12.5%). Further significant differences were observed 48 hours post-trial for PT300 (10.7%) and PT60 (12.8%) PT, APT60 (~15°), and AST300 (>13.6%). These data have implications for post exercise recovery monitoring and the prescription of recovery modalities and conditioning practices in the 2 days following match-play. The AST and APT responses highlight the importance of analysis of the entire strength-angle curve and at a range of angular velocities.
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Affiliation(s)
- Richard Michael Page
- Sports Injuries Research Group, Dept. Of Sport & Physical Activity, Edge Hill University , Lancashire, UK
| | - Matt Greig
- Sports Injuries Research Group, Dept. Of Sport & Physical Activity, Edge Hill University , Lancashire, UK
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27
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Stronska K, Golas A, Wilk M, Zajac A, Maszczyk A, Stastny P. The effect of targeted resistance training on bench press performance and the alternation of prime mover muscle activation patterns. Sports Biomech 2020; 21:1262-1276. [PMID: 32460639 DOI: 10.1080/14763141.2020.1752790] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Targeted muscle strengthening might improve performance or help overcome training stagnation; therefore, the aim of the present study was to investigate changes in muscle activity patterns before and after six weeks of targeted resistance training. Twenty-seven resistance-trained men were divided into three groups according to their prime mover activity, as measured by surface electromyography during a bench press (BP). Each group underwent a six-week block of targeted exercises for one of the following muscles: anterior deltoid (AD), pectoralis major (PM) or triceps brachii (TB). ANOVA showed that each group increased their 1 repetition maximum (1RM) (p < 0.05) and the activity of the exercised muscle group during an isometric bench press (p < 0.01) and during a dynamic bench press (p < 0.01) at 85% of the 1RM. During the isometric BP, the TB training group had an increase in TB activity in comparison to the other groups. Targeted muscle training is a useful method for muscle activity increase and increasing the maximum strength in complex exercise, when applied in activity-deficient muscle groups. Strengthening the TB elicits changes in all prime movers and results in TB activity domination during a bench press.
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Affiliation(s)
- Katarzyna Stronska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Artur Golas
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Michal Wilk
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Adam Zajac
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Adam Maszczyk
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Petr Stastny
- Department of Sport Games, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
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28
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Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH. Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J 2020; 102-B:556-567. [PMID: 32349600 DOI: 10.1302/0301-620x.102b5.bjj-2019-1212.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: Bone Joint J 2020;102-B(5):556-567.
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Affiliation(s)
- Jung Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea Seongnam, South Korea
| | - Seunghwan Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Department of Orthopedic Surgery, Seoul National University College of Medicine Seongnam, South Korea
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29
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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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30
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de Lima-E-Silva FX, Oliveira GS, Medeiros TM, Dornelles MP, Ribeiro-Alvares JBA, Baroni BM. Flexibility, strength, and fascicle length of football players with and without history of hamstring strain injury in the prior season. SCI MED FOOTBALL 2020. [DOI: 10.1080/24733938.2020.1751871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Felipe Xavier de Lima-E-Silva
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Gabriel Santos Oliveira
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Thales Menezes Medeiros
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Maurício Pinto Dornelles
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - João Breno Araujo Ribeiro-Alvares
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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31
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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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32
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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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33
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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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34
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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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35
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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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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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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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Heer ST, Callander JW, Kraeutler MJ, Mei-Dan O, Mulcahey MK. Hamstring Injuries: Risk Factors, Treatment, and Rehabilitation. J Bone Joint Surg Am 2019; 101:843-853. [PMID: 31045674 DOI: 10.2106/jbjs.18.00261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Steven T Heer
- Tulane University School of Medicine, New Orleans, Louisiana
| | | | | | - Omer Mei-Dan
- University of Colorado School of Medicine, Aurora, Colorado
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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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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Blandford L, McNeill W, Charvet I. Can we spread the risk? A demand-share perspective to sustained hamstring health. J Bodyw Mov Ther 2018; 22:766-779. [PMID: 30100311 DOI: 10.1016/j.jbmt.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lincoln Blandford
- Movement Performance Solutions Ltd, The Quorum, Bond Street South, Bristol, BS1 3AE, UK.
| | | | - Ingrid Charvet
- Department of Civil, Environmental & Geomatic Engineering, University College London, WC1E 6BT, UK.
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van Dyk N, Bahr R, Burnett AF, Verhagen E, von Tiggelen D, Witvrouw E. No association between rate of torque development and onset of muscle activity with increased risk of hamstring injury in elite football. Scand J Med Sci Sports 2018; 28:2153-2163. [DOI: 10.1111/sms.13224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2018] [Indexed: 01/02/2023]
Affiliation(s)
- N. van Dyk
- Rehabilitation Department; Aspetar Orthopaedic and Sports Medicine Hospital, Aspire Zone Foundation; Doha Qatar
| | - R. Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital; Doha Qatar
- Oslo Sports Trauma Research Center; Norwegian School of Sport Sciences; Oslo Norway
| | - A. F. Burnett
- Aspetar Orthopaedic and Sports Medicine Hospital; Doha Qatar
| | - E. Verhagen
- Amsterdam Collaboration on Health and Safety in Sports; Department of Public and Occupational Health; Amsterdam Movement Science; VU University Medical Center; Amsterdam The Netherlands
- Australian Centre for Research into Injury in Sport and its Prevention; Federation University; Ballarat Australia
- UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM); Department of Human Biology; Faculty of Health Sciences; University of Cape Town; Cape Town South-Africa
| | - D. von Tiggelen
- Department of Rehabilitation Sciences and Physiotherapy; Ghent University; Ghent Belgium
| | - E. Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy; Ghent University; Ghent Belgium
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WITHDRAWN: Can we spread the risk? A demand-share perspective to sustained hamstring health. Biomaterials 2018. [DOI: 10.1016/j.biomaterials.2018.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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A Novel Apparatus to Measure Knee Flexor Strength During Various Hamstring Exercises: A Reliability and Retrospective Injury Study. J Orthop Sports Phys Ther 2018; 48:72-80. [PMID: 29073840 DOI: 10.2519/jospt.2018.7634] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Reliability and case-control injury study. Background Knee flexor strength is a key variable when dealing with hamstring strain injury (HSI), and methodologies of objective measurement of strength are often limited to single exercises. Objectives To establish test-retest reliability of a novel apparatus to measure knee flexor strength during various hamstring exercises, and to investigate whether the measure can detect between-leg differences in male participants with and without history of unilateral HSI. Methods Twenty male participants without and 10 male participants with previous unilateral HSI participated. Isometric knee flexor strength and peak rate of force development (RFD) at 0°/0°, 45°/45°, and 90°/90° of hip/knee flexion were measured, as well as force impulse during bilateral and unilateral variations of an eccentric slider and hamstring bridge, using a novel apparatus. Intraclass correlation coefficient (ICC), typical error, and typical error as a coefficient of variation were calculated for all measures. The magnitudes of between-leg differences within each group were calculated using estimates of effect sizes, reported as Cohen's d and 90% confidence interval (CI). Results Moderate to high test-retest reliability was observed for isometric knee flexor strength (ICC = 0.87-0.92) and peak RFD (ICC = 0.88-0.95) across 3 positions and for mean force impulse during the eccentric slider (ICC = 0.83-0.90). In those with prior HSI, large deficits were observed in the previously injured leg compared to the contralateral uninjured leg for mean force impulse during the unilateral eccentric slider (d = -1.09; 90% CI: -0.20, -1.97), isometric strength at 0°/0° (d = -1.06; 90% CI: -0.18, -1.93) and 45°/45° (d = -0.88; 90% CI: -0.02, -1.74), and peak RFD at 45°/45° (d = -0.88; 90% CI: -0.02, -1.74). Conclusion The novel apparatus provides a reliable measure of isometric knee flexor strength, peak RFD, and force impulse during an eccentric slider, with deficits seen in previously injured hamstrings for these measures. J Orthop Sports Phys Ther 2018;48(2):72-80. Epub 26 Oct 2017. doi:10.2519/jospt.2018.7634.
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Navandar A, Veiga S, Torres G, Chorro D, Navarro E. A previous hamstring injury affects kicking mechanics in soccer players. J Sports Med Phys Fitness 2018; 58:1815-1822. [PMID: 29327823 DOI: 10.23736/s0022-4707.18.07852-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although the kicking skill is influenced by limb dominance and sex, how a previous hamstring injury affects kicking has not been studied in detail. Thus, the objective of this study was to evaluate the effect of sex and limb dominance on kicking in limbs with and without a previous hamstring injury. METHODS Forty-five professional players (males: N.=19, previously injured players=4, age=21.16±2.00 years; females: N.=19, previously injured players =10, age= 22.15±4.50 years) performed 5 kicks each with their preferred and non-preferred limb at a target 7m away, which were recorded with a three-dimensional motion capture system. Kinematic and kinetic variables were extracted for the backswing, leg cocking, leg acceleration and follow through phases. RESULTS A shorter backswing (20.20±3.49% vs. 25.64±4.57%), and differences in knee flexion angle (58±10º vs. 72±14º) and hip flexion velocity (8±0 rad/s vs. 10±2 rad/s) were observed in previously injured, non-preferred limb kicks for females. A lower peak hip linear velocity (3.50±0.84 m/s vs. 4.10±0.45 m/s) was observed in previously injured, preferred limb kicks of females. These differences occurred in the backswing and leg-cocking phases where the hamstring muscles were the most active. A variation in the functioning of the hamstring muscles and that of the gluteus maximus and iliopsoas in the case of a previous injury could account for the differences observed in the kicking pattern. CONCLUSIONS Therefore, the effects of a previous hamstring injury must be considered while designing rehabilitation programs to re-educate kicking movement.
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Affiliation(s)
- Archit Navandar
- Faculty of Sports Sciences, Universidad Politécnica de Madrid, Madrid, Spain -
| | - Santiago Veiga
- Faculty of Sports Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | - Gonzalo Torres
- Faculty of Sports Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | - David Chorro
- Faculty of Sports Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | - Enrique Navarro
- Faculty of Sports Sciences, Universidad Politécnica de Madrid, Madrid, Spain
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Whiteley R, van Dyk N, Wangensteen A, Hansen C. Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression. Br J Sports Med 2017; 52:303-310. [DOI: 10.1136/bjsports-2017-097616] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/08/2017] [Accepted: 10/04/2017] [Indexed: 11/03/2022]
Abstract
AimTo investigate the association of daily clinical measures and the progression of rehabilitation and perceived running effort.MethodsA cohort of 131 athletes with an MRI-confirmed acute hamstring injury underwent a standardised criteria-based rehabilitation protocol. Descriptive and inferential statistics were used to investigate the association between daily clinical subjective and objective measures and both the progression of rehabilitation and perceived running effort. These measures included different strength, palpation, flexibility and functional tests. Inter-rater and intrarater reliability and minimal detectable change were established for the clinical measures of strength and flexibility by examining measures taken on consecutive days for the uninjured leg.ResultsThe progression of the daily measures was seen to be non-linear and varied according to the measure. Intra-rater reliability for the strength and flexibility measures were excellent (95% CI ≥0.85 for all measures). Strength (in the outer range position) and flexibility (in maximum hip flexion with active knee extension (MHFAKE) in supine) were best associated with rehabilitation progression and perceived running effort. Additionally, length of pain on palpation was usefully associated with rehabilitation progression. At lower perceived running effort there was a large variation in actual running speed.ConclusionDaily physical measures of palpation pain, outer range strength, MHFAKE and reported pain during daily activity are useful to inform the progression of rehabilitation.Trial registration numberNCT01812564 and NCT02104258.
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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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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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Lovell R, Knox M, Weston M, Siegler JC, Brennan S, Marshall PWM. Hamstring injury prevention in soccer: Before or after training? Scand J Med Sci Sports 2017; 28:658-666. [DOI: 10.1111/sms.12925] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- R. Lovell
- School of Science and Health; Western Sydney University; Penrith NSW Australia
| | - M. Knox
- School of Science and Health; Western Sydney University; Penrith NSW Australia
| | - M. Weston
- School of Social Sciences; Business & Law; Teesside University; Middlesbrough UK
| | - J. C. Siegler
- School of Science and Health; Western Sydney University; Penrith NSW Australia
| | - S. Brennan
- School of Science and Health; Western Sydney University; Penrith NSW Australia
| | - P. W. M. Marshall
- School of Science and Health; Western Sydney University; Penrith NSW Australia
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Electrodiagnostic Evaluation of Individuals Implanted With Extracellular Matrix for the Treatment of Volumetric Muscle Injury: Case Series. Phys Ther 2016; 96:540-9. [PMID: 26564252 PMCID: PMC4817212 DOI: 10.2522/ptj.20150133] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Electrodiagnosis can reveal the nerve and muscle changes following surgical placement of an extracellular matrix (ECM) bioscaffold for treatment of volumetric muscle loss (VML). OBJECTIVE The purpose of this study was to characterize nerve conduction study (NCS) and electromyography (EMG) changes following ECM bioscaffold placement in individuals with VML. The ability of presurgical NCS and EMG to be used as a tool to help identify candidates who are likely to display improvements postsurgically also was explored. DESIGN A longitudinal case series design was used. METHODS The study was conducted at the McGowan Institute for Regenerative Medicine at the University of Pittsburgh. Eight individuals with a history of chronic VML participated. The intervention was surgical placement of an ECM bioscaffold at the site of VML. The strength of the affected region was measured using a handheld dynamometer, and electrophysiologic evaluation was conducted on the affected limb with standard method of NCS and EMG. All measurements were obtained the day before surgery and repeated 6 months after surgery. RESULTS Seven of the 8 participants had a preoperative electrodiagnosis of incomplete mononeuropathy within the site of VML. After ECM treatment, 5 of the 8 participants showed improvements in NCS amplitude or needle EMG parameters. The presence of electrical activity within the scaffold remodeling site was concomitant with clinical improvement in muscle strength. LIMITATIONS This study had a small sample size, and participants served as their own controls. The electromyographers and physical therapists performing the evaluation were not blinded. CONCLUSIONS Electrodiagnostic data provide objective evidence of physiological improvements in muscle function following ECM placement at sites of VML. Future studies are warranted to further investigate the potential of needle EMG as a predictor of successful outcomes following ECM treatment for VML.
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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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