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Gendron P, Lamontagne M, Fournier-Farley C, Gagnon DH. Prognosticating Return-To-Play Time Following a Hamstring Strain Injury Using Early Flexibility Asymmetry and Musculoskeletal Ultrasound Imaging Outcomes: An Exploratory Study Among Canadian University Football Players. Clin J Sport Med 2024:00042752-990000000-00199. [PMID: 38996441 DOI: 10.1097/jsm.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 04/28/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE Identify key flexibility and point-of-care musculoskeletal ultrasound (POCUS) measures for prognosticating return-to-play (RTP) following a first hamstring strain injury (HSI) and informing the clinical decision-making process. DESIGN Exploratory prospective cohort study. SETTING Sport medicine and rehabilitation clinic of a Canadian university. PARTICIPANTS One hundred and sixty-seven elite Canadian university football athletes followed over 5 seasons. INTERVENTIONS Clinical and POCUS measures collected within 7 days after HSI and preseason clinical measures. MAIN OUTCOME MEASURES Active knee extension (AKE) and Straight Leg Raise (SLR) to quantify hamstring flexibility, POCUS-related outcomes to characterize tissue alteration, and RTP until full sport resumption were documented (categorized as Early [1-40 days] or Late [>40 days] RTP). RESULTS A total of 19 and 14 athletes were included in the Early RTP (mean RTP = 28.84 ± 8.62 days) and Late RTP groups (mean 51.93 ± 10.54 days), respectively, after having been diagnosed with a first HSI. For the clinical results, height and a greater flexibility asymmetry measure with the AKE or SLR when compared with both ipsilateral preseason and acute contralateral values significantly increases the chance of facing a long delay before returning to play (ie, RTP). For the POCUS-related results, the Peetrons severity score, extent of the longitudinal fibrillary alteration, and novel score lead to similar results. CONCLUSIONS Early hamstring flexibility asymmetry following acute HSI, particularly the AKE, along with some POCUS-related measures are valuable in prognosticating late RTP following among Canadian university football athletes.
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Affiliation(s)
- Patrick Gendron
- Sports Medicine Clinic, Université de Montréal, Montreal, QC, Canada
| | - Martin Lamontagne
- Sports Medicine Clinic, Université de Montréal, Montreal, QC, Canada
- Department of Physiatry, Université de Montréal Hospital Center (CHUM), Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; and
| | - Camille Fournier-Farley
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; and
- Center of Interdisciplinary Rehabilitation Research of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Dany H Gagnon
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; and
- Center of Interdisciplinary Rehabilitation Research of Greater Montreal (CRIR), Montreal, QC, Canada
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Hardaker NJ, Hume PA, Sims ST. Differences in Injury Profiles Between Female and Male Athletes Across the Participant Classification Framework: A Systematic Review and Meta-Analysis. Sports Med 2024; 54:1595-1665. [PMID: 38536647 DOI: 10.1007/s40279-024-02010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries. OBJECTIVE The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science'(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist. RESULTS Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4-5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17-1.34), bone stress injury (RR 3.4; 95% CI 2.1-5.4) and concussion (RR 8.46; 95% CI 1.04-68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31-3.88) and hamstring injuries (RR 2.4; 95% CI 1.8-3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37-2.7) to 2.8 (2.45-3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition. DISCUSSION Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14-20], tier-4: 16.9 ± 1.9 [11-21], tier-3: 16.9 ± 1.5 [11-20], tier-2: 16.3 ± 2.2 [11-20], tier-1 studies: 15.6 ± 1.3 [14-17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes' propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes. CONCLUSIONS Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury. TRIAL REGISTRY PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).
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Affiliation(s)
- Natalie J Hardaker
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.
- Accident Compensation Corporation, Wellington, New Zealand.
| | - Patria A Hume
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Tech & Policy Lab, Law School, The University of Western Australia, Perth, Australia
| | - Stacy T Sims
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
- Stanford Lifestyle Medicine, Stanford University, Palo Alto, CA, USA
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Hoy MK, Stache S, Roedl JB. Hamstring Injuries: A Paradigm for Return to Play. Semin Musculoskelet Radiol 2024; 28:119-129. [PMID: 38484764 DOI: 10.1055/s-0043-1778027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Muscle injuries are the most common sports-related injuries, with hamstring involvement most common in professional athletes. These injuries can lead to significant time lost from play and have a high risk of reinjury. We review the anatomy, mechanisms of injury, diagnostic imaging modalities, and treatment techniques for hamstring injuries. We also present the latest evidence related to return to play (RTP) after hamstring injuries, including a review of articles targeted to RTP in European soccer (Union of European Football Associations), American football (National Football League), and other professional sports. Review of imaging findings in hamstring injury, grading systems for injuries, considerations for RTP, as well as advances in injury prevention, are discussed.
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Affiliation(s)
- Michael K Hoy
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stephen Stache
- Departments of Orthopaedics and Family and Community Medicine, Rothman Orthopaedic Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Johannes B Roedl
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Gurchiek RD, Teplin Z, Falisse A, Hicks JL, Delp SL. Hamstrings are stretched more and faster during accelerative running compared to speed-matched constant speed running. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.25.586659. [PMID: 38585841 PMCID: PMC10996654 DOI: 10.1101/2024.03.25.586659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Hamstring strain injuries are associated with significant time away from sport and high reinjury rates. Recent evidence suggests that hamstring injuries often occur during accelerative running, but investigations of hamstring mechanics have primarily examined constant speed running on a treadmill. To help fill this gap in knowledge, this study compares hamstring lengths and lengthening velocities between accelerative running and constant speed overground running. Methods We recorded 2 synchronized videos of 10 participants (5 female, 5 male) during 6 accelerative running trials and 6 constant speed running trials. We used OpenCap (a markerless motion capture system) to estimate body segment kinematics for each trial and a 3-dimensional musculoskeletal model to compute peak length and step-average lengthening velocity of the biceps femoris (long head) muscle-tendon unit. To compare running conditions, we used linear mixed regression models with running speed (normalized by the subject-specific maximum) as the independent variable. Results At running speeds below 75% of top speed accelerative running resulted in greater peak lengths than constant speed running. For example, the peak hamstring muscle-tendon length when a person accelerated from running at only 50% of top speed was equivalent to running at a constant 88% of top speed. Lengthening velocities were greater during accelerative running at all running speeds. Differences in hip flexion kinematics primarily drove the greater peak muscle-tendon lengths and lengthening velocities observed in accelerative running. Conclusion Hamstrings are subjected to longer muscle-tendon lengths and faster lengthening velocities in accelerative running compared to constant speed running. This provides a biomechanical explanation for the observation that hamstring strain injuries often occur during acceleration. Our results suggest coaches who monitor exposure to high-risk circumstances (long lengths, fast lengthening velocities) should consider the accelerative nature of running in addition to running speed.
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Affiliation(s)
- Reed D. Gurchiek
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Zachary Teplin
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Antoine Falisse
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Jennifer L. Hicks
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Scott L. Delp
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
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Martin RL, Takla A, Disantis A, Kohlrieser D, Enseki K, Lifshitz L, Grant L, Bizzini M, Voight M, Ryan M, McGovern R, Tyler T, Steinfeld-Mass Y, Campbell A, Zhang Y. Evaluating Functional Performance Tests in those with Non-arthritic Intra-articular Hip Pain: An International Consensus Statement. Int J Sports Phys Ther 2023; 18:1346-1355. [PMID: 38050542 PMCID: PMC10693491 DOI: 10.26603/001c.89269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 12/06/2023] Open
Abstract
Background Non-arthritic intra-articular hip pain, caused by various pathologies, leads to impairments in range of motion, strength, balance, and neuromuscular control. Although functional performance tests offer valuable insights in evaluating these patients, no clear consensus exists regarding the optimal tests for this patient population. Purpose This study aimed to establish expert consensus on the application and selection of functional performance tests in individuals presenting with non-arthritic intra-articular hip pain. Study Design A modified Delphi technique was used with fourteen physical therapy experts, all members of the International Society for Hip Arthroscopy (ISHA). The panelists participated in three rounds of questions and related discussions to reach full consensus on the application and selection of functional performance tests. Results The panel agreed that functional performance tests should be utilized at initial evaluation, re-evaluations, and discharge, as well as criterion for assessing readiness for returning to sports. Tests should be as part of a multimodal assessment of neuromuscular control, strength, range of motion, and balance, applied in a graded fashion depending on the patient's characteristics. Clinicians should select functional performance tests with objective scoring criteria and prioritize the use of tests with supporting psychometric evidence. A list of recommended functional performance tests with varying intensity levels is provided. Low-intensity functional performance tests encompass controlled speed in a single plane with no impact. Medium-intensity functional performance tests involve controlled speed in multiple planes with low impact. High-intensity functional performance tests include higher speeds in multiple planes with higher impact and agility requirements. Sport-specific movement tests should mimic the patient's particular activity or sport. Conclusion This international consensus statement provides recommendations for clinicians regarding selection and utilization of functional performance tests for those with non-arthritic intra-articular hip pain. These recommendations will encourage greater consistency and standardization among clinicians during a physical therapy assessment.
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Affiliation(s)
| | - Amir Takla
- Swinburne University of Technology
- Australian Sports Physiotherapy
- Hip Arthroscopy Australia
| | | | | | | | | | | | | | - Mike Voight
- Nashville Hip Institute at TOA
- School of Physical Therapy Belmont University
| | - Mark Ryan
- The Steadman Clinic Steadman Philippon Research Institute
| | | | | | | | - Ashley Campbell
- Nashville Hip Institute at TOA
- School of Physical Therapy Belmont University
| | - Yongni Zhang
- Duquesne University
- Duquesne - China Health Institute
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Robaina BDQ, Medeiros DM, Roberti LDS, Franke RDA, Baroni BM. The Single Leg Bridge Test does not replace handheld dynamometer hamstring tests in a clinical setting. Phys Ther Sport 2023; 63:126-131. [PMID: 37573852 DOI: 10.1016/j.ptsp.2023.08.001] [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: 05/11/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To examine the correlation of Single Leg Bridge Test (SLBT) scores with maximum isometric strength values obtained in handheld dynamometer (HHD) hamstring tests performed in a clinical setting. DESIGN Cross-sectional study. SETTING Physical therapy clinic. PARTICIPANTS Fifty healthy and physically active men. MAIN OUTCOME MEASURES Correlation between SLBT scores and force values found in three HHD hamstring tests: test 'A', volunteer in prone with hip in neutral position and the knee flexed at ∼90°; test 'B', volunteer in supine with hip and knee flexed at ∼90°; and test 'C', volunteer in the same position used to perform the SLBT. RESULTS The volunteers' SLBT score was 27.55 ± 7.81 repetitions. The SLBT scores were poorly associated with mean (r = 0.246) and peak (r = 0.321) results provided by HHD test 'A'. There were no significant correlations between the SLBT scores and mean or peak values obtained in tests 'B' and 'C' (p > 0.05). Similarly, the SLBT between-limb asymmetry was not associated with asymmetries found in HHD hamstring tests (p > 0.05). CONCLUSIONS HHD hamstring tests should not be replaced by the SLBT. We recommend for clinicians to applying such tests in a complementary way to assess the hamstring's functional status.
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Miccinilli S, Bravi M, Conti G, Bressi F, Sterzi S, Santacaterina F, Ciccozzi M. SARS-CoV-2 Infection Increases the Risk of Muscle Injury in Professional Male Soccer Players-A Retrospective Analysis of the Italian and Spanish Major Leagues. Infect Dis Rep 2023; 15:425-435. [PMID: 37623047 PMCID: PMC10454539 DOI: 10.3390/idr15040043] [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: 05/16/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
A retrospective cohort study on professional soccer players from the Serie A and LaLiga was conducted to investigate the correlation between SARS-CoV-2 infection and muscle injuries. Players were divided into two groups based on whether they contracted the SARS-CoV-2 infection (C+) or not (C-) during the 2020/2021 season. In the 2019-2020 season, both championships showed a similar number of muscular injuries (MI) between C+ and C- (Serie A: p = 0.194; 95% CI: -0.044 to 0.215, LaLiga p = 0.915; 95% CI: -0.123 to 0.137). In the 2020-2021 season, C+ had a significantly higher number of MI compared to C- in both championships (Serie A: p < 0.05; 95% CI 0.731 to 1.038; LaLiga: p < 0.05; 95% CI: 0.773 to 1.054). Multiple linear regression analysis confirmed that belonging to C+ in the season 2020/2021 was the variable that most strongly influenced the probability of having a muscle injury. Survival analysis revealed a hazard ratio of 3.73 (95% CI 3.018 to 4.628) and of 5.14 (95% CI 3.200 to 8.254) for Serie A and LaLiga respectively. We found an association between SARS-CoV-2 infection and increased risk of muscle injury, emphasizing the importance of carefully considering the infection in the decision-making process for returning to sport. Therefore, SARS-CoV-2 infection should be judged as a real injury requiring specific assessment and training programs.
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Affiliation(s)
- Sandra Miccinilli
- Department of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.M.); (M.B.); (G.C.); (F.B.); (S.S.)
- Research Unit of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Marco Bravi
- Department of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.M.); (M.B.); (G.C.); (F.B.); (S.S.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Giorgio Conti
- Department of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.M.); (M.B.); (G.C.); (F.B.); (S.S.)
| | - Federica Bressi
- Department of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.M.); (M.B.); (G.C.); (F.B.); (S.S.)
- Research Unit of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Silvia Sterzi
- Department of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.M.); (M.B.); (G.C.); (F.B.); (S.S.)
- Research Unit of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Fabio Santacaterina
- Department of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.M.); (M.B.); (G.C.); (F.B.); (S.S.)
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy;
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Augustsson J, Alt T, Andersson H. Speed Matters in Nordic Hamstring Exercise: Higher Peak Knee Flexor Force during Fast Stretch-Shortening Variant Compared to Standard Slow Eccentric Execution in Elite Athletes. Sports (Basel) 2023; 11:130. [PMID: 37505617 PMCID: PMC10383276 DOI: 10.3390/sports11070130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
Hamstring strain injuries are prevalent in many sports. Research has demonstrated that the Nordic hamstring exercise (NHE), a knee-dominant exercise addressing the posterior chain muscles, can aid in reducing the risk of hamstring injuries in athletes. However, most research on hamstring injury prevention has focused on performing the eccentric version of the NHE (NHEECC). In contrast, in sports, it is quite frequent for athletes to use an eccentric-concentric version of the NHE. Additionally, eccentric NHE is typically performed using a slow, controlled tempo. The effect of a fast stretch-shortening cycle NHE (NHESSC) compared to standard slow NHEECC on peak knee flexor force has not been investigated. The aim of the study was therefore to investigate fast NHESSC vs. standard slow NHEECC. Our hypothesis posited that peak knee flexor force would be greater for fast NHESSC compared with standard slow NHEECC. The study involved 22 elite athletes (actively competing in both national and international events) consisting of female (n = 10) and male (n = 7) track and field athletes and male football players (n = 5), aged 17-31 years. The participants performed maximum trials of slow NHEECC and fast NHESSC repetitions in which measurement of bilateral peak knee flexor force was conducted at the ankle with the use of a load cell. During the NHEs, a linear encoder was used to measure both the position where the peak knee flexor force was recorded and the average eccentric velocity. SSC contributed to an enhanced NHE performance, where bilateral absolute peak knee flexor force was 13% higher for fast NHESSC vs. standard slow NHEECC (822 vs. 726 N, p < 0.01, ES = 0.54). Participants achieved a 32% greater forward distance at the breakpoint stage during NHEECC compared to the coupling phase for NHESSC (54 vs. 41 cm, p < 0.001, ES = 1.37). Eccentric average velocity was more than three times higher for NHESSC compared with NHEECC (0.38 vs. 0.12 m/s, p < 0.001, ES = 3.25). The key findings of this study were that SSC contributed to an enhanced NHE performance, where absolute peak knee flexor force was 13% greater for fast NHESSC compared to standard slow NHEECC. The fast NHESSC could therefore be an interesting alternative to the standard slow NHEECC execution, as it may offer potential advantages for sprint performance, as well as hamstring injury prevention and rehabilitation.
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Affiliation(s)
- Jesper Augustsson
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, 39182 Kalmar, Sweden
| | - Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength & Conditioning, Olympic Training and Testing Centre Westphalia, 44139 Dortmund, Germany
| | - Håkan Andersson
- High Performance Center, Strength and Conditioning Institute, 35246 Vaxjo, Sweden
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Prince C, Latella S, Gachon B, Picot B. Reliability and validity of 2D-video analysis to objectively assess hamstring performance during the H-test. Sports Biomech 2023:1-14. [PMID: 37154270 DOI: 10.1080/14763141.2023.2203132] [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] [Indexed: 05/10/2023]
Abstract
The H-test is commonly used during return-to-sport decisions after hamstring muscle injury. The primary aim was to evaluate the reliability of two-dimensional (2D) video analysis for the H-Test. The second aim was to assess its validity compared to an electronic gyroscope (gold standard), and the third aim was to establish normative values. We conducted a cross-sectional study including 30 healthy individuals. Mean, maximal velocities (VMean and Vmax) and range of motion (ROM) of hip flexion were captured during the H-test to evaluate inter-rater and test-retest reliability using intraclass correlation coefficient (ICC2,1) and standard error of measurement (SEM). Correlation analysis (r) and as typical error of estimate (TEE) were used to assess the validity between the video and the gyroscope. Reliability was excellent for ROM (ICC:0.91, [95% CI:0.83-0.95]), moderate for VMean (ICC:0.57; [95% CI:0.32-0.74]) and VMax (ICC:0.64, [95% CI:0.43-0.79]). Strong positive correlations were found between video and gyroscope for VMean (r = 0.79, [95% CI:0.71-0.86]) and VMax (r = 0.84, [95% CI:0.77-0.89]) and very strong for ROM (r = 0.89, [95% CI:0.85-0.93]). Males exhibited a higher VMax (p < 0.001) than females, while females had a higher ROM (p < 0.001). 2D-video analysis is a valid and reliable method to assess ROM during the H-Test and could easily be implemented in clinical practice.
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Affiliation(s)
- Caroline Prince
- Univ Savoie Mont Blanc, Interuniversity Laboratory of Human Movement Sciences, Chambéry, France
- Physiotherapy Department and Motion Analysis Lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
- Société Française des Masseurs Kinésithérapeute du Sport, SFMKS-Lab, Pierrefitte-sur-Seine, France
| | - Sébastien Latella
- Univ Savoie Mont Blanc, Interuniversity Laboratory of Human Movement Sciences, Chambéry, France
| | - Benoit Gachon
- Univ Savoie Mont Blanc, Interuniversity Laboratory of Human Movement Sciences, Chambéry, France
| | - Brice Picot
- Univ Savoie Mont Blanc, Interuniversity Laboratory of Human Movement Sciences, Chambéry, France
- Société Française des Masseurs Kinésithérapeute du Sport, SFMKS-Lab, Pierrefitte-sur-Seine, France
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Zadro JR. Appraisal of Clinical Practice Guideline: Clinical Practice Guideline for hamstring strain injury in athletes. J Physiother 2023; 69:128. [PMID: 36914523 DOI: 10.1016/j.jphys.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
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Valente HG, Oliveira RRD, Baroni BM. How are hamstring strain injuries managed in elite men's football clubs? A survey with 62 Brazilian physical therapists. Phys Ther Sport 2023; 61:73-81. [PMID: 36940549 DOI: 10.1016/j.ptsp.2023.03.001] [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: 01/19/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE To describe perceptions and practices of physical therapists from elite men's football clubs on the management of athletes with hamstring strain injury (HSI). DESIGN Cross-sectional study. SETTING Online survey. PARTICIPANTS Physical therapists from clubs engaged in the two main divisions of Brazilian men's football. MAIN OUTCOME MEASURES Practices for assessment and rehabilitation of athletes with HSI. RESULTS This survey had 62 physical therapists from 35 of the 40 eligible clubs (87.5% representativeness). Despite heterogeneity on assessment practices, all respondents use imaging exams, adopt injury classification scales, and evaluate aspects related to pain, range of motion, muscle strength, and functional status of athletes with HSI. Rehabilitation programs are usually divided into 3 to 4 phases. All respondents usually apply electrophysical agents and stretching in HSI rehabilitation programs, 98.4% apply strengthening exercises (93.5% include eccentrics), 96.8% manual therapy, 95.2% exercises that mimic the functional demands of football, and 93.5% lumbopelvic stabilization exercises. Muscle strength was the most reported return to play criterion (71% of respondents). CONCLUSION The present study allowed the sports physical therapy community to become aware of the approaches usually adopted for management of athletes with HSI who play in the highest level of Brazilian men's football.
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Affiliation(s)
- Henrique Gonçalves Valente
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil; Department of Science, Health and Performance, Grêmio Foot-Ball Porto Alegrense, Porto Alegre, RS, Brazil
| | | | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.
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Paton BM, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Pollock N, Read P, Stirling B, Tulloch L, van Dyk N, Wilson MG, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 1: classification. Br J Sports Med 2023; 57:254-265. [PMID: 36650035 DOI: 10.1136/bjsports-2021-105371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Muscle injury classification systems for hamstring injuries have evolved to use anatomy and imaging information to aid management and prognosis. However, classification systems lack reliability and validity data and are not specific to individual hamstring muscles, potentially missing parameters vital for sport-specific and activity-specific decision making. A narrative evidence review was conducted followed by a modified Delphi study to build an international consensus on best-practice decision-making for the classification of hamstring injuries. This comprised a digital information gathering survey to a cohort of 46 international hamstring experts (sports medicine physicians, physiotherapists, surgeons, trainers and sports scientists) who were also invited to a face-to-face consensus group meeting in London . Fifteen of these expert clinicians attended to synthesise and refine statements around the management of hamstring injury. A second digital survey was sent to a wider group of 112 international experts. Acceptance was set at 70% agreement. Rounds 1 and 2 survey response rates were 35/46 (76%) and 99/112 (88.4%) of experts responding. Most commonly, experts used the British Athletics Muscle Injury Classification (BAMIC) (58%), Munich (12%) and Barcelona (6%) classification systems for hamstring injury. Issues identified to advance imaging classifications systems include: detailing individual hamstring muscles, establishing optimal use of imaging in diagnosis and classification, and testing the validity and reliability of classification systems. The most used hamstring injury classification system is the BAMIC. This consensus panel recommends hamstring injury classification systems evolve to integrate imaging and clinical parameters around: individual muscles, injury mechanism, sporting demand, functional criteria and patient-reported outcome measures. More research is needed on surgical referral and effectiveness criteria, and validity and reliability of classification systems to guide management.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health, University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ricci Plastow
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health, University College London, London, UK.,British Athletics, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Goucester, Gloucester, UK
| | | | | | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK.,Princess Grace Hospital, London, UK
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13
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Afonso J, Olivares-Jabalera J, Fernandes RJ, Clemente FM, Rocha-Rodrigues S, Claudino JG, Ramirez-Campillo R, Valente C, Andrade R, Espregueira-Mendes J. Effectiveness of Conservative Interventions After Acute Hamstrings Injuries in Athletes: A Living Systematic Review. Sports Med 2023; 53:615-635. [PMID: 36622557 DOI: 10.1007/s40279-022-01783-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hamstrings injuries are common in sports and the reinjury risk is high. Despite the extensive literature on hamstrings injuries, the effectiveness of the different conservative (i.e., non-surgical) interventions (i.e., modalities and doses) for the rehabilitation of athletes with acute hamstrings injuries is unclear. OBJECTIVE We aimed to compare the effects of different conservative interventions in time to return to sport (TRTS) and/or time to return to full training (TRFT) and reinjury-related outcomes after acute hamstrings injuries in athletes. DATA SOURCES We searched CINAHL, Cochrane Library, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science databases up to 1 January, 2022, complemented with manual searches, prospective citation tracking, and consultation of external experts. ELIGIBILITY CRITERIA The eligibility criteria were multi-arm studies (randomized and non-randomized) that compared conservative treatments of acute hamstrings injuries in athletes. DATA ANALYSIS We summarized the characteristics of included studies and conservative interventions and analyzed data for main outcomes (TRTS, TRFT, and rate of reinjuries). The risk of bias was judged using the Cochrane tools. Quality and completeness of reporting of therapeutic exercise programs were appraised with the i-CONTENT tool and the certainty of evidence was judged using the GRADE framework. TRTS and TRFT were analyzed using mean differences and the risk of reinjury with relative risks. RESULTS Fourteen studies (12 randomized and two non-randomized) comprising 730 athletes (mostly men with ages between 14 and 49 years) from different sports were included. Nine randomized studies were judged at high risk and three at low risk of bias, and the two non-randomized studies were judged at critical risk of bias. Seven randomized studies compared exercise-based interventions (e.g., L-protocol vs C-protocol), one randomized study compared the use of low-level laser therapy, and three randomized and two non-randomized studies compared injections of platelet-rich plasma to placebo or no injection. These low-level laser therapy and platelet-rich plasma studies complemented their interventions with an exercise program. Only three studies were judged at low overall risk of ineffectiveness (i-CONTENT). No single intervention or combination of interventions proved superior in achieving a faster TRTS/TRFT or reducing the risk of reinjury. Only eccentric lengthening exercises showed limited evidence in allowing a shorter TRFT. The platelet-rich plasma treatment did not consistently reduce the TRFT or have any effect on the risk of new hamstrings injuries. The certainty of evidence was very low for all outcomes and comparisons. CONCLUSIONS Available evidence precludes the prioritization of a particular exercise-based intervention for athletes with acute hamstrings injuries, as different exercise-based interventions showed comparable effects on TRTS/TRFT and the risk of reinjuries. Available evidence also does not support the use of platelet-rich plasma or low-level laser therapy in clinical practice. The currently available literature is limited because of the risk of bias, risk of ineffectiveness of exercise protocols (as assessed with the i-CONTENT), and the lack of comparability across existing studies. CLINICAL TRIAL REGISTRATION PROSPERO CRD42021268499 and OSF ( https://osf.io/3k4u2/ ).
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Affiliation(s)
- José Afonso
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, R. Dr. Plácido da Costa 91, 4200-450, Porto, Portugal.
| | - Jesús Olivares-Jabalera
- Sport Research Lab, Football Science Institute, Granada, Spain
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Ricardo J Fernandes
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, R. Dr. Plácido da Costa 91, 4200-450, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - Filipe Manuel Clemente
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Delegação da Covilhã, Instituto de Telecomunicações, Covilhã, Portugal
| | - Sílvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Tumor & Microenvironment Interactions Group, INEB-Institute of Biomedical Engineering, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Research Center in Sports Performance, Recreation, Innovation and Technology (SPRINT), Melgaço, Portugal
| | - João Gustavo Claudino
- Group of Research, Innovation and Technology Applied to Sport (GSporTech), Multi-user Laboratory of the Department of Physical Education (MultiLab of the DPE), Department of Physical Education, Center for Health Sciences, Federal University of Piauí, Teresina, Piauí, Brazil
- Department of Physical Education, Center for Health Sciences, Federal University of Piauí, Teresina, Piauí, Brazil
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Cristina Valente
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
| | - Renato Andrade
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal.
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal.
- Dom Henrique Research Centre, Porto, Portugal.
| | - João Espregueira-Mendes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805 017, Guimarães, Portugal
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Comparison of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation. Sports (Basel) 2023; 11:sports11030053. [PMID: 36976939 PMCID: PMC10053564 DOI: 10.3390/sports11030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating the effectiveness of the current conservative management of proximal hamstring tendinopathy (PHT) and outcomes are lacking. The purpose of this review is to provide insights into the efficacy of conservative therapeutic interventions in the management of PHT. In January 2022, databases including PubMed, Web of Science, CINAHL, and Embase were searched for studies assessing the effectiveness of conservative intervention compared with that of a placebo or combination of treatments on functional outcomes and pain. Studies that performed conservative management (exercise therapy and/or physical therapy modalities) in adults 18–65 years were included. Studies that performed surgical interventions or whose subjects had complete hamstring rupture/avulsion greater than a 2 cm displacement were excluded. A total of 13 studies were included: five studies compared exercise interventions, while eight studies investigated a multimodal approach of either shockwave therapy and exercise or a hybrid model incorporating exercise, shockwave therapy, and other modalities, such as ultrasound, trigger point needling, or instrument-assisted soft tissue mobilization. This review supports the notion that the conservative management of PHT may best be optimized through a multimodal approach incorporating a combination of tendon-specific loading at an increased length, lumbopelvic stabilization exercises, and extracorporeal shockwave therapy. With regard to hamstring-specific exercise selection, PHT may be optimally managed by including a progressive loading program at combined angles of the hip flexion at 110 degrees and the knee flexion between 45 and 90 degrees.
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Differences in Peak Knee Flexor Force between Eccentric-Only and Combined Eccentric-Concentric Nordic Hamstring Exercise. Sports (Basel) 2023; 11:sports11020041. [PMID: 36828326 PMCID: PMC9961423 DOI: 10.3390/sports11020041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
In many sports, the hamstring strain injury is a common injury. There is evidence that the Nordic hamstring exercise (NHE), a knee flexor exercise, can reduce hamstring injury risk in athletes. In research on hamstring injury prevention, eccentric-only NHE is typically performed, whereas in sports, it is relatively common for athletes to perform NHE eccentrically-concentrically. Further, NHE strength is generally assessed by measuring knee flexor force through an ankle brace, attached atop of a load cell. An alternative method might be to assess knee flexor force about the knee joint using a force plate. The aim of the study was to investigate differences in peak knee flexor force between eccentric-only and combined eccentric-concentric NHE. The purpose was also to determine the correlation between hamstring force measured at the ankle using a load cell (current gold standard) and force assessed about the knee joint using a force plate during NHE. Fifteen junior and senior elite soccer and track and field athletes (3 women and 12 men aged 17-27 years) performed eccentric NHE (ENHE) in which they leaned forward as far as possible until breakpoint and eccentric-concentric NHE (ECNHE) where they returned to the starting position. A linear encoder measured the position at which peak force occurred during the NHEs. Force assessed at the ankle differed significantly (678 vs. 600 N, p < 0.05), whereas force about the knee joint did not (640 vs. 607 N, p > 0.05) between ENHE and ECNHE (12 and 5% difference, respectively). The forward distance achieved by the participants in cm at breakpoint for ENHE was 37% higher than at the coupling phase for ECNHE (74 vs. 54 cm, p < 0.001). Very strong significant (p < 0.01) correlations were noted between peak force assessed at the ankle and about the knee joint for ENHE and ECNHE, r = 0.96 and r = 0.99, respectively. Our results suggest that ECNHE, where peak knee flexor force was reached with 37% less forward movement, may complement ENHE, i.e., during hamstring injury rehabilitation, where a position of great knee extension may not be well tolerated by the athlete. Further, assessing knee flexor force about the knee joint using a force plate may provide an alternative to measuring force at the ankle using a load cell when testing NHE strength.
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Does an Adjusted Kinematic Model Predict the Relative Eccentric Force During Nordic Curl? J Sport Rehabil 2023; 32:151-157. [PMID: 35894874 DOI: 10.1123/jsr.2022-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023]
Abstract
This study aimed to assess the combination of video-based kinematic variables adjusted by intrinsic covariates to predict the relative eccentric force (RelF) during the Nordic curl. The participants (n = 21) performed Nordic curls (3 trials; 3-min rest) on a device measuring the eccentric force. The peaks were normalized by body weight. Kinovea software was used to track angular and linear velocity and acceleration from recorded videos. Two prediction models with multiple linear regression equations associated kinematic, anthropometric, and age variables to adjust the actual RelF. The equations obtained the predicted RelF. The actual RelF was inversely correlated with height (r = -.52), tangential (r = -.50) and centripetal accelerations (r = -.715), and angular velocity (r = -.70). The best prediction models combined angular velocity with age (F2,18 = 15.1, P = .001, r = .792, r2 = .627) and with height (F2,18 = 14.5, P = .001, r = .785, r2 = .616). No differences were observed between actual and predicted values (P = .993-.994), with good levels of agreement and consistency (intraclass correlation coefficient = .77-.78; Cronbach α = .86-.87). Bland-Altman results showed high levels of agreement and low biases. The standard error of measurement and minimal detectable change ranges were 0.46 to 0.49 N/kg and 1.28 to 1.36 N/kg, respectively. Also, the percentage of standard error of measurement was below 10% (7.92%-8.35%). The coefficient of variation analysis returned a 14.54% and 15.13% for each model, respectively. Kinematic analysis offers portability and low cost to current expensive or technical impaired dynamometry-based techniques to assess the RelF.
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Trummer G, Stephens R, Washmuth NB. A PHYSICAL THERAPIST WHO SWEARS: A CASE SERIES. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2023; 6:10277. [PMID: 37152116 PMCID: PMC10161436 DOI: 10.2340/jrmcc.v6.10277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/09/2023]
Abstract
Objective Swearing deserves attention in the physical therapy setting due to its potential positive psychological, physiological, and social effects. The purpose of this case series is to describe 2 cases in which a physical therapist swears in the clinical setting and its effect on therapeutic alliance. Patients Case 1 is a 19-year-old male treated for a hamstring strain, and case 2 is a 23-year-old male treated post-operatively for anterior cruciate ligament reconstruction. The physical therapist utilized social swearing in the clinic with the goal of motivating the patient and enhancing the social connection with the patient, to improve therapeutic alliance. Results The patient in case 1 reported a decrease in therapeutic alliance after the physical therapist began swearing during physical therapy treatments, whereas the patient in case 2 reported an increase in therapeutic alliance. Both patients disagreed that physical therapist swearing is unprofessional and disagreed that swearing is offensive, and both patients agreed physical therapists should be able to swear around their patients. Conclusion Physical therapist swearing may have positive and negative influences in the clinic setting and may not be considered unprofessional. These are, to our knowledge, the first published cases of a physical therapist swearing in the clinical setting.
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Affiliation(s)
| | - Richard Stephens
- School of Psychology, Keele University, Keele, Staffordshire, United Kingdom
| | - Nicholas B Washmuth
- Department of Physical Therapy, Samford University, Birmingham, AL, United States
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Widodo AF, Tien CW, Chen CW, Lai SC. Isotonic and Isometric Exercise Interventions Improve the Hamstring Muscles’ Strength and Flexibility: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10050811. [PMID: 35627948 PMCID: PMC9140507 DOI: 10.3390/healthcare10050811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Hamstring weakness has been associated with an increased risk of hamstring strain, a common sports injury that occurs when athletes perform actions such as quick sprints. The hamstring complex comprises three distinct muscles: the long and short heads of the bicep femoris, the semimembranosus, and the semitendinosus. Methods: The researchers collected the data from different electronic databases: PubMed, Google Scholar, and the Web of Science. Results: Many studies have been conducted on the numerous benefits of hamstring strength, in terms of athletic performance and injury prevention. Isotonic and isometric exercises are commonly used to improve hamstring strength, with each exercise type having a unique effect on the hamstring muscles. Isotonic exercise improves the muscles’ strength, increasing their ability to resist any force, while isometric training increases strength and the muscles’ ability to produce power by changing the muscle length. Conclusions: These exercises, when performed at low intensity, but with high repetition, can be used by the healthy general population to prepare for training and daily exercise. This can improve hamstring muscle strength and flexibility, leading to enhanced performance and reduced injury risk.
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Affiliation(s)
- Akhmad Fajri Widodo
- International Sport Science Master’s Program, College of Human Development and Health, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
| | - Cheng-Wen Tien
- Physical Education Office, General Education Centre, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
| | - Chien-Wei Chen
- International Sport Science Master’s Program, College of Human Development and Health, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
- Department of Exercise and Health Science, College of Human Development and Health, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
- Correspondence:
| | - Shih-Chiung Lai
- Department of Exercise and Health Science, College of Human Development and Health, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
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Hamstring Strain Injury in Athletes: A Summary of Clinical Practice Guideline Recommendations: Using the Evidence to Guide Physical Therapist Practice. J Orthop Sports Phys Ther 2022; 52:127-128. [PMID: 35227082 DOI: 10.2519/jospt.2022.0501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hamstring strain injuries (HSIs) are common in sports that involve high-speed running, jumping, kicking, explosive lower extremity movements, or lifting objects from the ground. HSIs may result in considerable impairment, activity limitation, and participation restriction, including time lost from competitive sports. The high reinjury rate is also a challenge. Improving reinjury risk assessment and decision making for safe return to play is a high priority for all stakeholders. J Orthop Sports Phys Ther 2022;52(3):127-128. doi:10.2519/jospt.2022.0501.
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