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At least 19 recordsLinked to original sources

PubMed2004

The Football Association Medical Research Programme: an audit of injuries in professional football--analysis of hamstring injuries.

OBJECTIVE: To conduct a detailed analysis of hamstring injuries sustained in English professional football over two competitive seasons. METHODS: Club medical staff at 91 professional football clubs annotated player injuries over two seasons. A specific injury audit questionnaire was used together with a weekly form that documented each clubs' current injury status. RESULTS: Completed injury records for the two competitive seasons were obtained from 87% and 76% of the participating clubs respectively. Hamstring strains accounted for 12% of the total injuries over the two seasons with nearly half (53%) involving the biceps femoris. An average of five hamstring strains per club per season was observed. A total of 13 116 days and 2029 matches were missed because of hamstring strains, giving an average of 90 days and 15 matches missed per club per season. In 57% of cases, the injury occurred during running. Hamstring strains were most often observed during matches (62%) with an increase at the end of each half (p<0.01). Groups of players sustaining higher than expected rates of hamstring injury were Premiership (p<0.01) and outfield players (p<0.01), players of black ethnic origin (p<0.05), and players in the older age groups (p<0.01). Only 5% of hamstring strains underwent some form of diagnostic investigation. The reinjury rate for hamstring injury was 12%. CONCLUSION: Hamstring strains are common in football. In trying to reduce the number of initial and recurrent hamstring strains in football, prevention of initial injury is paramount. If injury does occur, the importance of differential diagnosis followed by the management of all causes of posterior thigh pain is emphasised. Clinical reasoning with treatment based on best available evidence is recommended.

Adolescent↗

PubMed2000

MR imaging of the distribution and location of acute hamstring injuries in athletes.

OBJECTIVE: Although hamstring injuries are common in athletes, the distribution and location of such injuries have not been well defined. We used MR imaging to determine the frequency of injury by muscle, involvement of one or more muscles, and location of injuries within the musculotendinous unit. SUBJECTS AND METHODS: We performed MR imaging on 15 consecutive college athletes with clinically diagnosed acute hamstring injuries. A hamstring injury was diagnosed and located on MR imaging by identifying high signal intensity within the muscle on T2-weighted images. RESULTS: We found that 10 athletes had injuries of a single muscle with six injuries of the biceps femoris, three of the semitendinosus, and one of the semimembranosus. In an additional five athletes, we found primary injuries of the biceps femoris and secondary injuries of the semitendinosus. The injuries occurred in diverse locations within the muscles including five injuries at the proximal musculotendinous junction, two at the distal musculotendinous junction, four within the proximal half of the muscle belly, and four in the distal half. All eight intramuscular injuries were located at the musculotendinous junction within the muscle. CONCLUSION: The biceps femoris is the most commonly injured hamstring muscle and the semitendinosus is the second most commonly injured. Although hamstring injuries often involve one muscle injured proximally, multiple muscles were involved in 33% of athletes (5/15) and the injuries were distal in 40% of athletes (6/15). All intramuscular injuries occurred at the musculotendinous junction, either at the ends of the muscle or within the muscle belly.

Adult↗

PubMed2005

The management of hamstring injury--Part 1: Issues in diagnosis.

Hamstring injuries are the most prevalent muscle injury in sports involving rapid acceleration and maximum speed running. Injury typically occurs in an acute manner through an eccentric mechanism at the terminal stages of the swing phase of gait. Biceps femoris is most commonly injured. Re-injury rates are high and management is a challenge given the complex multi-factorial aetiology. The high rates of hamstring injury and re-injury may result from a lack of high-quality research into the aetiological factors underlying injury. Re-injury may also result from inaccuracy in diagnosis that results from the potential multi-factorial causes of these conditions. Inaccuracy in diagnosis could lead to multiple potential diagnoses that may result in the implementation of variable management protocols. Whilst potentially useful, such variability may also lead to the implementation of sub-optimal management strategies. Previous hamstring injury is the most recognized risk factor for injury, which indicates that future research should be directed at preventative measures. Much anecdotal and indirect evidence exists to suggest that several non-local factors contribute to injury, which may be addressed through the application of manual therapy. However, this connection has been neglected in previous research and literature. This paper will explore and speculate on this potential connection and offer some new contributive factors for hamstring injury management. This first paper of a two part series on hamstring injury will explore diagnostic issues relevant to hamstring injury and the second will investigate various established and speculative management approaches.

Athletic Injuries↗

PubMed2005

Hamstring injuries of the hip.

Hamstring injuries can be classified with regard to the site of involvement. Traumatic disorders at the proximal bone-tendon origin are best defined as avulsion injuries, such as ischial tuberosity fractures and hamstring tendon tears. Musculotendinous lesions include muscle strains and muscle contusions. Most hamstring injuries occur after in-direct trauma from excessive stretching or forceful contraction, leading to avulsion injuries or muscle strains and tears. Insufficient warm-up, lack of flexibility, inadequate muscle strength and endurance, or abnormal contraction and running may predispose to such injuries. In the event of blunt direct trauma, a muscle contusion, intramuscular hematoma, myositis ossificans, or compartment syndrome may develop.

Athletic Injuries↗

PubMedDate not supplied

Hamstring injuries in sprinters. The role of concentric and eccentric hamstring muscle strength and flexibility.

Eleven sprinters with recent hamstring injuries were compared with nine uninjured runners. The flexibility of the hamstrings and the eccentric and concentric muscle torque were measured in the hamstrings and quadriceps muscles at different angular velocities. Sprinters with a previous hamstring injury had significantly tighter hamstrings than uninjured sprinters had. The uninjured sprinters had significantly higher eccentric hamstring torques at all angular velocities. They also had significantly higher concentric quadriceps and hamstring torques at 30 deg/sec but not at higher velocities. Sprinters with a history of hamstring injury thus differed from uninjured runners, being weaker in eccentric contractions and in concentric contractions at low velocities.

Adolescent↗

PubMed2006

Predictors of hamstring injury at the elite level of Australian football.

BACKGROUND: Hamstring injuries are the most common injury sustained by elite Australian football players and result in substantial costs because of missed training time, unavailability for matches and lost player payments. Evidence to support proposed risk factors for hamstring injury is generally lacking, limiting the development of appropriate prevention strategies. AIM: To identify intrinsic risk factors for hamstring injury at the elite level of Australian football. METHODS: A prospective cohort of 222 players underwent baseline measurement in the form of a self-report questionnaire and a musculo-skeletal screen during the pre-season period of the 2002 Australian football season. Injury surveillance and exposure data were collected for the full season. Logistic regression analyses were used to identify independent predictors of hamstring injury in this group of players. RESULTS: Thirty-one players sustained a hamstring injury. A past history (previous 12 months) of hamstring injury and increasing age were found to be independent predictors of hamstring injury. CONCLUSIONS: Older players and those with a previous history of hamstring injury are target groups for further research and implementation of injury prevention strategies. Restricted ankle dorsiflexion range of movement warrants consideration in the development of prevention programs for hamstring injury.

Adolescent↗

PubMed2006

A pilot randomised controlled trial of eccentric exercise to prevent hamstring injuries in community-level Australian Football.

Hamstring injuries are the most common injury sustained by Australian Football players. Eccentric training has been proposed as a potential preventative strategy. This pilot randomised controlled trial (RCT) evaluated the effectiveness of a pre-season eccentric training program for preventing hamstring injuries at the community level of Australian Football. Seven amateur clubs (n=220 players) were recruited. Players were randomised within clubs to the intervention (eccentric exercise) or control (stretching) groups and randomisation was stratified according to previous history of hamstring injury. Five exercise sessions were completed over a 12-week period, three during the pre-season and two during the first 6 weeks of the season. Compliance was recorded and players were monitored for the season to collect injury and participation data. There was no difference between the control (n=106) or intervention (n=114) groups with respect to baseline characteristics. Only 46.8% of all players completed at least two program sessions. Compliance was poorest for the intervention group. Intention-to-treat analysis suggested that players in the intervention group were not at reduced risk of hamstring injury (RR 1.2, 95% CI: 0.5, 2.8). When only control and intervention group players who participated in at least the first two sessions were analysed, 4.0% of intervention and 13.2% of control group players sustained a hamstring injury (RR 0.3, 95% CI: 0.1, 1.4; p=0.098). The findings suggest that a simple program of eccentric exercise could reduce the incidence of hamstring injuries in Australian Football but widespread implementation of this program is not likely because of poor compliance.

Adolescent↗

PubMed2005

Risk factors for hamstring injuries in community level Australian football.

OBJECTIVES: To identify risk factors for hamstring injury at the community level of Australian football. METHODS: A total of 126 community level Australian football players participated in this prospective cohort study. To provide baseline measurements, they completed a questionnaire and had a musculoskeletal screen during the 2000 preseason. All were monitored over the season. Injury surveillance and exposure data were collected for the full season. Survival analysis was used to identify independent predictors of hamstring injury. RESULTS: A hamstring injury was the first injury of the season in 20 players (16%). After adjustment for exposure, increasing age and decreased quadriceps flexibility were identified as significant independent predictors of the time to sustaining a hamstring injury. Older age (> or =23 years) was associated with an increased risk of hamstring injury (RR 3.8; 95% confidence interval (CI) 1.1 to 14.0; p = 0.044). Players with increased quadriceps flexibility (as measured by the modified Thomas test) were less likely to sustain a hamstring injury (RR 0.3; 95% CI 0.1 to 0.8; p = 0.022). CONCLUSIONS: The findings of this study can be used in the development of hamstring injury prevention strategies and to identify Australian football players at increased risk of hamstring injury.

Adult↗

PubMed2006

Why are older Australian football players at greater risk of hamstring injury?

INTRODUCTION: Increasing age is a commonly identified predictor of hamstring injury but is not modifiable to reduce injury risk. Why increasing age is a risk factor for hamstring injuries in athletes has not been studied to date. This study aimed to identify potentially modifiable age-related changes that predict hamstring injury in a population of Australian football players. METHODS: One hundred and one young (< or =20 years), and 73 older (> or =25 years), Australian football players, without a history of hamstring injury in the past 12 months were studied prospectively. Players underwent screening of anthropometric, flexibility and lower extremity range of movement tests during the pre-season period and were followed-up for a full season with respect to injury and match participation. Comparisons of the age groups were performed to identify differences related to age. Logistic regression analysis was undertaken to determine whether the observed differences were predictors of hamstring injury. RESULTS: There were significant differences between the age groups with respect to body weight, body mass index, hip flexor flexibility, hip internal rotation and ankle dorsiflexion range of movement. Body weight and hip flexor flexibility were significant independent predictors of hamstring injury in players aged > or =25 years. None of the observed differences were predictors of injury in the younger age group. CONCLUSIONS: There are age-related changes that are potentially modifiable to reduce injury risk in older athletes and these factors should be considered in the development of hamstring injury prevention programs for this high risk group.

Adolescent↗

PubMed1989

Biomechanical assessment of the effects of significant hamstring injury: an isokinetic study.

Soccer players may develop recurrent hamstring injuries. This may be due to inadequate rehabilitation or to recurrent injury. In addition, following injury, the hamstring muscular complex may be permanently damaged, resulting in decreased strength, and increased likelihood of recurrent injury. Fourteen professional soccer players were assessed by clinical examination and by isokinetic testing with a Cybex II machine. Seven had suffered moderate or major hamstring injuries in the past year. There were seven controls. None of the hamstring group were currently suffering from an acute hamstring injury. The results of the two groups were compared. There were no differences in the mean results. This pilot study suggests that no permanent functional damage occurs to the muscular complex after moderate or major hamstring injuries after correct treatment. However, further research is required to confirm this.

Adolescent↗

PubMed2005

Successful management of hamstring injuries in Australian Rules footballers: two case reports.

Hamstring injuries are the most prevalent injury in Australian Rules football. There is a lack of evidence based literature on the treatment, prevention and management of hamstring injuries, although it is agreed that the etiology is complicated and multi-factorial. We present two cases of hamstring injury that had full resolution after spinal manipulation and correction of lumbar-pelvic biomechanics. There was no recurrence through preventative treatment over a twelve and sixteen week period. The use of spinal manipulation for treatment or prevention of hamstring injury has not been documented in sports medicine literature and should be further investigated in prospective randomized controlled trials.

Journal Article↗

PubMed1997

Hamstring injuries. Current trends in treatment and prevention.

Pre-exercise stretching and adequate warm-up are important in the prevention of hamstring injuries. A previous mild injury or fatigue may increase the risk of injury. Hamstring muscle tear is typically partial and takes place during eccentric exercise when the muscle develops tension while lengthening, but variation in injury mechanisms is possible. Diagnosis of typical hamstring muscle injury is usually based on typical injury mechanism and clinical findings of local pain and loss of function. Diagnosis of avulsion in the ischial tuberosity, with the need for longer immobilisation, and a complete rupture of the hamstring origin, in which immediate operative treatment is necessary, poses a challenge to the treating physician. X-rays, ultrasonography or magnetic resonance imaging (MRI) may be helpful in differential diagnostics. After first aid with rest, compression, cold and elevation, the treatment of hamstring muscle injury must be tailored to the grade of injury. Conservative treatment is based on a knowledge of the biological background of the healing process of the muscle. Experimental studies have shown that a short period of immobilisation is needed to accelerate formation of the granulation tissue matrix following injury. The length of the immobilisation is, however, dependent on the grade of injury and should be optimised so that the scar can bear the pulling forces operating on it without re-rupture. Mobilisation, on the other hand, is required in order to regain the original strength of the muscle and to achieve good final results in resorption of the connective tissue scar and re-capillarisation of the damaged area. Another important aim of mobilisation--especially in sports medical practice--is to avoid muscle atrophy and loss of strength and extensibility, which rapidly result from prolonged immobilisation. Complete ruptures with loss of function should be operated on, as should cases resistant to conservative therapy in which, in the late phase of repair, the scar and adhesions prevent the normal function of the hamstring muscle.

Athletic Injuries↗

PubMedDate not supplied

Hamstring injuries. Proposed aetiological factors, prevention, and treatment.

Injuries to the hamstring muscles can be devastating to the athlete because these injuries frequently heal slowly and have a tendency to recur. It is thought that many of the recurrent injuries to the hamstring musculotendinous unit are the result of inadequate rehabilitation following the initial injury. The severity of hamstring injuries is usually of first or second degree, but occasionally third-degree injuries (complete rupture of the musculotendinous unit) do occur. Most hamstring strain injuries occur while running or sprinting. Several aetiological factors have been proposed as being related to injury of the hamstring musculotendinous unit. They include: poor flexibility, inadequate muscle strength and/or endurance, dyssynergic muscle contraction during running, insufficient warm-up and stretching prior to exercise, awkward running style, and a return to activity before complete rehabilitation following injury. Treatment for hamstring injuries includes rest and immobilisation immediately following injury and then a gradually increasing programme of mobilisation, strengthening, and activity. Permission to return to athletic competition should be withheld until full rehabilitation has been achieved (complete return of muscle strength, endurance, and flexibility in addition to a return of co-ordination and athletic agility). Failure to achieve full rehabilitation will only predispose the athlete to recurrent injury. The best treatment for hamstring injuries is prevention, which should include training to maintain and/or improve strength, flexibility, endurance, co-ordination, and agility.

Athletic Injuries↗

PubMed2005

Hamstring injury management--Part 2: Treatment.

The management of hamstring injuries can be described as vexed at best. One reason for this may be because of a lack of high-quality research into the methods of treatment, rehabilitation and prevention. As a result, an evidence-based approach to injury management does not exist. Management is based on clinical experience, anecdotal evidence and the knowledge of the biological basis of tissue repair. Previous hamstring injury is the most recognized risk factor for injury, which indicates that treatment approaches may be suboptimal under certain conditions. The identification of these risk factors and the methods best designed to manage them should be addressed with future research efforts. Much anecdotal and indirect evidence exists to suggest that several non-local factors contribute to injury. Despite the knowledge that these factors may exist, the literature appears almost devoid of research investigating their possible identification and treatment. Treatment has traditionally been in the form of altering the muscle repair process through the application of electrophysical therapy and various soft-tissue-based and exercise-based techniques. Little research has investigated the role of other forms of manual therapy particularly when directed at non-local structures. This paper will explore and speculate on this potential connection and offer some new contributive factors for hamstring injury management.

Animals↗

PubMed1996

Thermal pants may reduce the risk of recurrent hamstring injuries in rugby players.

OBJECTIVE: To determine whether the use of thermal pants might reduce the risk of hamstring injury in rugby players. METHODS: 44 male rugby players from the Cape Province, South Africa, who had previously suffered a hamstring injury were given the choice of wearing thermal warming pants or not, and were then monitored for the development of hamstring injuries during the 1992 season. RESULTS: In the group who wore warmers some of the time, the injury rate was significantly lower when using the warmers (3 injuries/1000 playing hours) than when not (57/1000 playing hours). There was no difference in injury rates between groups who either wore warmers all the time or none of the time, probably because the number who wore the warmers all the time was small (n = 5). Eighteen percent of the injuries recurred at exactly the same site in the muscle and within 12 d of returning to rugby after the initial injury. The incidence of injury was high in the first three weeks of the season and again in the same period after the mid-season break. More than 80% of all match and practice time lost by these players during the study was a direct result of their hamstring injuries. CONCLUSIONS: Thermal pants may have a role in preventing recurrent hamstring injuries but other factors such as inadequate preseason training and incomplete rehabilitation after injury are likely to be more significant risk factors for injury.

Adult↗

PubMed2005

Hamstring injuries in Australian football.

OBJECTIVE: To identify risk factors for hamstring injury in community-level Australian football players. DESIGN: Cohort study. SETTING: The preseason and 2000 season of 4 adult Victorian Amateur Football Association clubs. PARTICIPANTS: All players in the clubs who were training at the time of the baseline assessment were invited to participate (n = 148). Players who were injured and unable to participate in the baseline assessment were excluded (22 players; 15%). ASSESSMENT OF RISK FACTORS: During 3 weeks before preseason practice, each player had a series of musculoskeletal tests and completed a questionnaire. The musculoskeletal screening included flexibility tests of the hamstrings, lower extremities, quadriceps, and iliopsoas; range of motion assessments of the lumbar spine and hip rotation; and the active slump test of neural mobility. Testing was done after a brief warm up by 4 trained screeners. A questionnaire with pre-established validity and reliability included information on playing experience, injury history, and training habits. MAIN OUTCOME MEASURES: The main outcome measure was a first hamstring injury that resulted in missed participation time and/or treatment from a health professional in relation to predictive factors. Criteria defining a hamstring injury were sudden onset of posterior thigh pain, and tenderness on palpation with or without pain on stretching or contracting the hamstring muscle group. Through the season, the clubs' coaching staff collected information on exposure (hours of match and training participation). MAIN RESULTS: A total of 26 hamstring injuries occurred (incidence, 4 injuries per 1000 player hours). More injuries were sustained during competition (77%) than training. Rapid acceleration during running or sprinting was the primary mechanism of injury (81%), with the remainder occurring as the player kicked the ball. After adjustment for exposure, younger age was associated with a lower relative risk (RR) of injury (RR for age > or =23 years, 3.8; 95% CI, 1.1-14.0), as were quadriceps flexibility (RR for >51 degree knee flexion, 0.3; CI, 0.1-0.8) and active knee extension range of motion (RR for >27 degree knee flexion, 2.8; CI, 0.9-8.5; not significant). Frequency of off-season running, body height, and neural mobility were not significantly associated with hamstring injury. CONCLUSIONS: Hamstring injuries in amateur Australian football players most commonly occurred with sprinting and were more frequent in players older than 23 years or with lesser quadriceps flexibility.

Journal Article↗

PubMed1998

Isokinetic strength testing does not predict hamstring injury in Australian Rules footballers.

OBJECTIVE: To determine the relation of hamstring and quadriceps muscle strength and imbalance to hamstring injury using a prospective observational cohort study METHOD: A total of 102 senior male Australian Rules footballers aged 22.2 (3.6) years were tested at the start of a football season. Maximum voluntary concentric and eccentric torque of the hamstring and quadriceps muscles of both legs was assessed using a Kin-Com isokinetic dynamometer at angular velocities of 60 and 180 degrees/second. Twelve (11.8%) players sustained clinically diagnosed hamstring strains which caused them to miss one or more matches over the ensuing season. RESULTS: There were no significant differences for any of the isokinetic variables comparing the injured and non-injured legs in players with unilateral hamstring strains (n=9). Neither the injured nor the non-injured leg of injured players differed from the mean of left and right legs in non-injured players for any isokinetic variable. The hamstring to opposite hamstring ratios also did not differ between injured and non-injured players. A hamstring to opposite hamstring ratio of less than 0.90 and a hamstring to quadriceps ratio of less than 0.60 were not associated with an increased risk of hamstring injury. A significantly greater percentage of players who sustained a hamstring strain reported a history of hamstring strain compared with non-injured players (p=0.02). However, this was not related to muscle weakness or imbalance. CONCLUSIONS: Isokinetic muscle strength testing was not able to directly discriminate Australian Rules football players at risk for a hamstring injury.

Adult↗

PubMed2006

A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries.

BACKGROUND: Physicians evaluating hamstring strains in professional football players are increasingly turning to magnetic resonance imaging to support the clinical diagnosis and management of the injury. However, little information is available to assess how magnetic resonance imaging compares with the clinical evaluation in establishing the duration of rehabilitation required. HYPOTHESIS: Magnetic resonance imaging of hamstring strains can be useful in determining duration of rehabilitation. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 1. METHODS: Fifty-eight professional football players with a diagnosis of hamstring injury made by the team physician were enrolled in the study. All players underwent magnetic resonance imaging and a clinical evaluation by an independent physical therapist within 3 days of the injury. Presence, type, and location of injury were recorded in each examination. The physical therapist estimated the time required until return to competition, and the radiologist used the length of the injury (coronal view) to establish rehabilitation duration. Both clinicians were blinded to the other modality. RESULTS: Clinical and magnetic resonance imaging assessments were in agreement in 38 of 58 cases (65.5%). In 18 cases (31.0%), a clinically positive diagnosis was made, but no abnormalities were evident on magnetic resonance imaging. In 2 cases (3.4%), magnetic resonance imaging detected an injury, whereas the clinical examination had negative or equivocal findings. Both clinical examination and magnetic resonance imaging findings were strongly correlated with the actual time required to return to competition (r = .69, P < .001 and r = .58, P < .001, respectively). The correlation coefficient between clinical predictions and magnetic resonance imaging findings was moderate (r = .36, P = .006). CONCLUSION: This study shows that magnetic resonance imaging is not required for estimating the duration of rehabilitation of an acute minor or moderate hamstring injury in professional football players.

Adult↗