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PubMed2005

Evidence based prevention of hamstring injuries in sport.

A common soft tissue injury in sports involving sprinting and jumping is the hamstring strain. A major problem with hamstring strains is the high incidence of reinjury. Muscle injuries can be classified as direct or indirect and are typically grouped into three categories according to severity. A number of potential risk factors have been proposed for hamstring strains. Only a few are evidence based and some are mainly based on theoretical assumptions. There is a lack of clinical research on the effectiveness of rehabilitation programmes for hamstring strains. Although the initial treatment of rest, ice, compression, and elevation is accepted for muscle strains, no consensus exists for their rehabilitation. Not much evidence based research has been carried out on prevention of hamstring strain. To our knowledge only two prospective studies have so far been published. As the injuries are common in football and other sports involving sprinting and jumping, there is a need for further research preferably in the form of randomised controlled trials.

Athletic Injuries↗
PubMedDate not supplied

Histochemical correlates of hamstring injuries.

This study reports the histochemical fiber type composition of the human hamstring muscles. Muscle specimens from necropsy specimens were obtained from seven locations in the hamstring, four locations in the quadriceps, and one location in the adductor magnus. The hamstring muscles are shown to have a relatively high proportion of Type II fibers. Type II fibers are more involved with exercise of higher intensity and force production and it is postulated that the hamstrings are capable of high intrinsic force production. The hamstrings are two-joint muscles and are, therefore, subject to increased stretch and force production extrinsically by motion at the hip and knee. It is proposed that high levels of tension in the hamstrings produced by intrinsic force production and extrinsic stretch may make them prone to injury in periods of intense muscular activity. This proposal is also relevant to other frequent athletic muscle injuries.

Adenosine Triphosphatases↗
PubMed1995

Non-steroidal anti-inflammatory drugs fail to enhance healing of acute hamstring injuries treated with physiotherapy.

The effects of two non-steroidal anti-inflammatory drugs (NSAIDs), meclofenamate and diclofenac, in combination with physiotherapy modalities on the rate of healing of acute hamstring muscle tears were studied in a double-blind, placebo-controlled trial. Fourty-four of the 75 patients with this injury recruited were assessed and randomly allocated to one of three treatment groups: meclofenamate (100 mg 3 times a day), diclofenac (50 mg 3 times a day) and placebo. All patients received the same intensive physiotherapy treatment over the 7-day treatment period. Patient assessments were performed on days 1, 3 and 7 of the 7-day study period and included pain assessment (visual analogue scale), swelling measurement (thigh circumference measurement at the site of the muscle tear) and isokinetic muscle performance testing. Treatment produced a significant improvement in all measurements in all groups, but there was no difference in any measurement between groups. However, when only the more severe injuries were analysed, the reported pain score at day 7 was significantly lower in the placebo group than in either the meclofenamate group or the diclofenac group (P < 0.05). Hence this study did not find any additive effect on the healing of acute muscle injuries when meclofenamate or diclofenac was added to standard physiotherapeutic modalities. The study therefore does not support the use of NSAIDs in the treatment of acute hamstring muscle injuries.

Adult↗
PubMed1988

Hamstring injuries.

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Athletic Injuries↗
PubMed1996

Hamstring injuries.

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Athletic Injuries↗
PubMed2004

Sciatic nerve injury following hamstring harvest.

Injury to the sciatic nerve following harvesting of the medial hamstring tendons is a complication that has not been described. I report a unique case of sciatic nerve injury above the level of its bifurcation into its terminal branches following hamstring graft harvest for use in ACL reconstruction. The sciatic nerve anatomy and technique of graft harvest is briefly described.

Adult↗
PubMedDate not supplied

Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers.

Hamstring muscle strain is the most prevalent injury in Australian Rules Football, accounting for 16% of playing time missed as a result of injury. Thirty-seven professional footballers from an Australian Football League team had preseason measurements of hamstring and quadriceps muscle concentric peak torque at 60, 180, and 300 deg/sec measured on a Cybex 340 dynamometer. Players were studied prospectively throughout the 1995 season. During that time, six players sustained clinically diagnosed hamstring muscle injuries that caused them to miss match-playing time. The injured hamstring muscles were all weaker than in the opposite leg in absolute values and hamstring-to-quadriceps muscle ratios. According to our t-test results, hamstring muscle injury was significantly associated with a low hamstring-to-quadriceps muscle peak torque ratio at 60 deg/sec on the injured side and a low hamstring muscle side-to-side peak torque ratio at 60 deg/sec. Flexibility (as measured by the sit-and-reach test) did not correlate with injury. Discriminant-function analysis using the two significant ratio variables resulted in a canonical correlation with injury of 0.4594 and correctly classified legs into injury groups with 77.4% success. These results indicate that preseason isokinetic testing of professional Australian Rules footballers can identify players at risk of developing hamstring muscle strains.

Adult↗
PubMed2003

[Consequences and prediction of hamstring muscle injury with concentric and eccentric isokinetic parameters in elite soccer players].

OBJECTIVE: To know if isokinetic parameters identify previous hamstring (H) injury and predict a new muscle injury in high-level soccer player. METHOD: Concentric (con) and eccentric (ecc) isokinetic torque was measured at the angular speed of 60 degrees /s in 28 elite soccer players (23 years +/- 3.3; 74 kg +/- 7.5; 178 cm +/- 6.5). First, 11 players, victims of 15 moderate or major hamstring injuries in the preceding 2 years, were compared with 17 players without previous hamstring injury. Comparisons were carried out from isokinetic knee flexors-extensors ratios [Hcon/Qcon and Hecc/Qcon] and bilateral knee flexors ratios [Hcon/Hcon and Hecc/Hecc]. Secondly, all the population was followed during 12 months and the isokinetic muscular profile of players who presented a recurrence or a new hamstring muscle injury was analysed. RESULTS: A concentric ratio hamstring-to-quadriceps lower than 0.6 and a hamstring asymmetry of more than 10% do not allow to identify previous hamstring injury. On the other hand, the mixed ratio eccentric hamstring-to-concentric quadriceps lower than 0.6 represents the best indicator (probability: 77.5%). The rate of recurrence is 30% (three cases of 10) and the rate of new hamstring muscle injury is 31% (five cases of 16) (P > 0.05). One of the five injured soccer players presented a concentric ratio hamstring-to-quadriceps lower than 0.6 and no player presented a mixed ratio lower than 0.6. However, four of the five injured players presented a concentric and an eccentric asymmetry. But, it is the strongest side, which presented a new hamstring muscle injury. CONCLUSION: The mixed ratio eccentric hamstring-to-concentric quadriceps lower than 0.6 identify a previous hamstring injury despite the resumption of competitive soccer. However, this ratio and the others isokinetic studied parameters do not predict a recurrence or a new hamstring muscle injury.

Adult↗
PubMed2006

Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union.

BACKGROUND: The incidence of hamstring muscle injuries in professional rugby union is high, but evidence-based information on risk factors and injury-prevention strategies in this sport is limited. PURPOSE: To define the incidence, severity, and risk factors associated with hamstring muscle injuries in professional rugby union and to determine whether the use of hamstring strengthening and stretching exercises reduces the incidence and severity of these injuries. STUDY DESIGN: Cohort study (prevention); Level of evidence, 3. METHODS: Team clinicians reported all hamstring muscle injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury; loss of time from training and match play was used as the definition of an injury. Players' match and training exposures were recorded on a weekly basis. RESULTS: The incidence of hamstring muscle injuries was 0.27 per 1000 player training hours and 5.6 per 1000 player match hours. Injuries, on average, resulted in 17 days of lost time, with recurrent injuries (23%) significantly more severe (25 days lost) than new injuries (14 days lost). Second-row forwards sustained the fewest (2.4 injuries/1000 player hours) and the least severe (7 days lost) match injuries. Running activities accounted for 68% of hamstring muscle injuries, but injuries resulting from kicking were the most severe (36 days lost). Players undertaking Nordic hamstring exercises in addition to conventional stretching and strengthening exercises had lower incidences and severities of injury during training and competition. CONCLUSION: The Nordic hamstring strengthening exercise may reduce the incidence and severity of hamstring muscle injuries sustained during training and competition.

Adult↗
PubMedDate not supplied

Hamstring muscle injuries among water skiers. Functional outcome and prevention.

Water skiing is associated with severe injuries to the proximal hamstring muscles. We wanted to define the mechanism of injury, describe the associated pathologic changes, determine the functional limitations of patients, and suggest measures to prevent injury. Twelve patients with water skiing-related hamstring injuries were included. Six patients were experienced skiers and six were novices. The mechanism of injury was identical in five of six novice skiers. Each sustained the injury while attempting to get up on one or two skis from a submerged position. In contrast, the expert skiers all sustained injury secondary to a fall while skiing. Physical examination documented evidence of complete or partial avulsion of the proximal hamstring muscle origins in all patients. In addition, six patients had magnetic resonance imaging or computed tomography scans that confirmed the location and extent of the tear. Convalescence ranged from 3 months to 1.5 years before the patient could return to vigorous activities. Seven patients (58%) returned to most of their preinjury sports, albeit at a lower level. Five patients (42%), all with complete disruptions, were unable to run or participate in sports requiring agility. Two of these patients required delayed surgical repairs because of persistent functional limitations.

Adolescent↗
PubMedDate not supplied

Prophylaxis and management of hamstring muscle injuries in intercollegiate football players.

Hamstring muscle strains were responsible for the loss of playing time of a significant number of football players at the University of Nebraska in the early 1970s. After the acquisition of a Cybex II isokinetic dynamometer, the number of injuries was noted to decrease. A retrospective study was performed over the period 1973 to 1982. Players in Group I, from 1973 to 1977, underwent a training program consisting of a supervised winter running program and self-designed year-long stretching, running, and weight lifting. Hamstring injuries were managed with rest, ice, and elevation initially and, by the third day, mild running was instituted. On the average, by the 14th day the athlete had demonstrated adequate speed and agility and was allowed to return to action. Group II consisted of players from the 1978 to 1982 period. These players received supervised winter running programs and staff-designed year-long stretching, running, and weight lifting programs. In addition, all athletes had baseline testing of hamstrings and quadriceps. Deficits were corrected to a desired ratio of 0.60. Injured players in Group II were treated with rest, ice, and elevation initially. High speed isokinetic workouts were begun on the third day with testing on the fifth day. They were allowed to begin jogging when the peak torque of hamstrings equaled 70% of baseline. Players returned to action when peak-torque reached a level of 95% of the baseline score or a hamstrings:quadriceps ratio of 0.55 or greater. Average time out of action was 2 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Identifying the time of occurrence of a hamstring strain injury during treadmill running: a case study.

BACKGROUND: While hamstring strain injuries are common during sprinting, the mechanisms of injury are not well understood. In this study, we analyzed the running kinematics of an athlete obtained at the time of an acute hamstring strain injury. The purpose was to identify the period of the gait cycle during which the hamstring was likely injured, as well as to characterize the biomechanical conditions associated with the injury. METHODS: A male professional skier injured his right biceps femoris long head while running at 5.36 m/s on a treadmill with a 15% incline. Whole body kinematics were recorded at the time of injury. A linear periodic prediction model was used to determine when individual marker trajectories deviated from a cyclic periodic pattern, indicating the mechanical response to injury. A three-dimensional musculoskeletal model was used to compute joint angles and hamstring musculotendon lengths during the injurious running trial. These data were used with estimates of neuromuscular latencies and electromechanical delays to identify the most likely time period of injury. FINDINGS: Based upon the earliest indications in marker trajectories, a 130 ms period during the late swing phase of the gait cycle was identified as the period of injury. During this period, the biceps femoris reached a peak musculotendon length that was estimated to be 12% beyond the length seen in an upright posture and exceeded the normalized peak length of the medial hamstrings. INTERPRETATION: This case provides quantitative data suggesting that the biceps femoris muscle is susceptible to an lengthening contraction injury during the late swing phase of the running gait cycle.

Adult↗
PubMed2026

Intervention components, training dose, and adherence in exercise-based prevention of hamstring strain injury in football: a systematic review and meta-analysis.

OBJECTIVE: To quantify associations between exercise-based prevention programmes and hamstring strain injury (HSI) risk in football participants, and whether training dose and adherence modify effects. METHODS: Six databases were searched to 1 October 2025. Randomised and cluster-randomised trials comparing HSI prevention programmes with usual practice or warm-up in football participants were included. Random-effects meta-analysis pooled risk ratios (RRs); subgroup analyses and meta-regression assessed effect modification. RESULTS: Fifteen trials (n = 7,465) were analysed. Programmes reduced HSI risk (RR = 0.51, 95% CI 0.36-0.71), with I&#xb2;=57% and a prediction interval crossing the null (0.18-1.40). Based on a control event rate of 7.8%, absolute risk reduction was 3.8% (38 fewer HSIs per 1000 participants; 95% CI 23-50 fewer). Effects were stronger for shorter interventions (1-6 months; RR = 0.43) than longer interventions (7-10 months; RR = 0.77; P for interaction=0.04), and for elite/semi-professional players (RR = 0.38) than amateur players (RR = 0.77; P for interaction = 0.02). Training frequency and weekly volume did not modify effects, whereas adherence did. High adherence (&#x2265;75%) was associated with lower HSI risk (RR = 0.36, 95% CI 0.28-0.48), whereas low adherence (<75%) showed no clear benefit (RR = 0.92, 95% CI 0.68-1.23; P for interaction <0.00001). Each 10% increase in adherence corresponded to an RR multiplier of 0.83 (approximately 17% lower RR). Certainty of evidence was low. CONCLUSION: Exercise-based programmes reduce HSI risk in football when implementation supports sustained adherence. Effects may be stronger in shorter interventions and elite populations, but evidence remains insufficient to differentiate programme types or components.

Humans↗
PubMed1997

Lower extremity alignment and risk of overuse injuries in runners.

A group of 304 runners enrolling in a marathon training program had alignment measurements performed and completed a questionnaire on training practices and injuries over the previous 12 months. The alignment measures consisted of arch index (AI), heel valgus (HV), knee tubercle-sulcus angle (TSA), knee varus (KV), and leg-length difference (LLD). Results indicated few consistent statistical associations between these alignment measures and risk of injuries, either bivariately or multivariately: left AI with hamstring injuries; right AI with shin injuries; right HV with back injuries; left TSA with ankle injuries; KV with hip injuries; and LLD with back, ankle, and foot injuries. A few statistically significant relationships were also found between other training and anthropometric factors and injuries: mileage with hamstring injuries; interval training with shin injuries; hard surfaces with back and thigh injuries; shoe use patterns with foot and overall injuries; and body mass index with heel injuries. We conclude that lower-extremity alignment is not a major risk factor for running injuries in our relatively low mileage cohort; however, prospective studies are necessary to confirm or refute these findings.

Adult↗