Factors associated with recurrent hamstring injuries

However, these numbers differ in other studies and are complicated by the fact that more than one muscle often is injured ( 5, 13). Grade ii strains are more complete partial tears, with definite loss of strength and pain. Whilst the multifactoral nature of hsis is. See full list on journals. The usual mechanism for proximal hamstring avulsion is forceful eccentric contraction with knee extension and hip flexion, and it is seen most commonly seen in waterskiing. 001) were significant risk factors for hsi. Who stated that 12% of injuries classed as severe ( time loss > 28 days) were seen to be hamstring injuries. Of hamstring strain injury ( 24, 26, 27). Background: although recurrent hamstring injury is a frequent problem with a significant impact on athletes, data on factors determining the risk for a recurrent hamstring injury are scarce. Sherry and best performed a prospective randomized comparison study of 24 athletes with acute hamstring strain into two groups: static stretching, isolated progressive hamstring resistance exercise, and icing ( stst group) or progressive agility and trunk stabilization exercises and icing ( pats group). A cochrane review included three randomized controlled or comparative trials dealing with hamstring rehabilitation ( 29).

Hamstring muscle injuries are common in both recreational and elite athletes. Factors associated with recurrent hamstring injuries sports medicine, vol. Most occurred in the musculotendinous junction, which is really a 10- to 12- cm transition zone in which myofibrils contribute to form the tendon. This may lead to repeatedly unsuccessful efforts to return to sports, resulting in re- injuries or a development of chronicity of the injury and symptoms, even longer rehabilitation times, and, in worst cases, the end of an athletic career. Most studies found rates of reinjury for the ensuing sporting season higher than 30% and some up to 60% - 70% ( 29, 31, 35, 41). The biceps femoris tendon is found easily on the lateral knee where it should be palpated to its insertion on the fibular head. Nonmodifiable factors include age, previous hamstring and lower extremity muscle injuries, and being of black or aboriginal ethnic origin ( 9, 11, 30, 31). Player match hours. The risk of recurrent hsi is best evaluated using clinical data and not the mri characteristics of the index injury.

There is only one published study examining the role of nsaid in hamstring strain healing. Any swelling, ecchymosis, atrophy, and scars should be noted during the inspection. Hamstring tears: causes and risk factors. Playing positions that required more running also correlated with hamstring injury rates.

The risk factors for hamstring injuries include: 1- 6 previous hamstring injury. The hamstring injury risk factors may be subdivided in three categories: “ primary injury risk factors” ( i. Get a printable copy ( pdf file) of the complete article ( 847k), or click on a page image below to browse page by page. Muscle strain injuries are common in sports that involve high- intensity sprinting efforts such as the various forms of football and track and field. Grade iii tears are complete ruptures of the musculotendinous unit with a complete loss of muscle function, and they typically develop a large hematoma. Predicting return to play after hamstring injuries. In the majority of studies, the biceps femoris was the most commonly injured hamstring. Modifiable risk factors include fatigue, low hamstring strength, lack of warm- up, greater training volume, poor muscle flexibility, cross- pelvic posture, poor lumbo- pelvic strength, and biomechanical problems. Hamstring injuries are more common with age and affect african americans more frequently.

Best and david tietze, usa. The selected prospective, full- text studies in humans, published in the english language, could include either first- time or recurrent hamstring muscle injuries that were sport- related. Grade i injuries signify a small tear of the muscle or tendon, minor swelling, and pain with no or minimal strength loss. J sports sci ; 32:. 17 the majority of hamstring injuries occur abruptly during activity, with a tearing feeling accompanied by significant pain. The use of corticosteroid for muscle or tendon injury is controversial, and many physicians have a clinical concern that corticosteroid may incr.

The key identifiable risk factor for hamstring strain is a previous injury. A randomized controlled trial by malliaropoulos et al. 11, 20, 25, 38 to our knowledge, this is the first study investigating the surgical treatment of recurrent musculotendinous injuries to the hamstring muscle group in professional athletes. Risk factors of recurrent hamstring injuries: a systematic review.

This methodological and statistical approach to evaluating sports injury evidence and its specific relationship to hamstring injury seems sound and points out the limitations of our ability to analyze hamstring injury risks and treatment interve. This may reflect the increased physical burden in the higher leagues where the tempo of the games may be faster and training more demanding. Outfield players exhibited a higher incidence ( 22% to 37% ) of hamstring strain compared with goalkeepers in english soccer and australian rules football ( 32, 48). Most subsequent strains occurred within the first 2 months after return to sport, although the risk continued over time ( 2, 8, 15). Results: the incidence of hamstring muscle injuries was 0. Return to play following muscle injuries in professional footballers. Several risk factors have been attributed to hamstring injury and can be divided into modifiable and nonmodifiable factors and their interplay. None of the features examined were associated with increased recurrent injury risk within the same playing season. Prevalence rates range from 8% to 25%, with return to sport occurring from 2 wk to never, with large variability based on severity. Study design prospective studies on risk factors for re- injury.

Rates of hamstring muscle injury vary by differing injury definitions and sporting populations. When someone is dehydrated, the muscles can be more prone to cramping and therefore more prone to injury. Hamstring strain injury incidence ( 31, 79, 114 ) and rate ( 26 ) is reported to be more prevalent during competition than in training. It is important to note that 31% of the individuals with a recurrent hamstring injury in that study displayed normal hamstring strength, suggesting that strength imbalances alone cannot ex- plain the. The influence and interaction of hamstring strength, flexibility, warm- up and fatigue are aetiological factors that should be addressed in the rehabilitation and prevention of hamstring. 003) and at 1 yr ( 8% vs 70% ; p = 0.

In english professional soccer, hamstring strain injury reoccurred in between 12% and 48% of the players. Existing lower limb injury. Most studies involved australian rules football and noted that athletes with a previous history of hamstring strain were two to six times more likely to suffer subsequent strains during their lifetime ( 2, 8, 18, 31, 45). One study reports a single- season prevalence rate greater than 50% in elite soccer players ( 3). Results of 687 players isokinetically tested in preseason, a complete follow- up was obtained in 462 players, for whom 35 hamstring injuries were recorded. 9 10 both reviews identifi ed. 10 motor control and strength as predictors of hamstring injury in elite players of australian football.

001) and unrestricted activity ( 13. Players with a hamstring injury will report sudden onset of pain localised to the hamstring region with a clear mechanism or incident. The groups of factors associated with hamstring muscle strains. Objective: to systematically review the literature and provide an overview of risk factors for re- injury of acute hamstring muscle injuries. De visser hm, reijman m, heijboer mp, bos pk. , the risk factors mainly causing a first lesion), “ recurrent injury risk factors. Similarly, a study performed on australian rules football demonstrated a significantly higher prevalence ( > 20% ) in the australian football league ( afl) versus the lower division south australian national football league ( sanfl) ( 45). Data collected from the united states’ national collegiate athletic association indicates that the three highest risk sports are american football and men’ s and women’ s soccer [ 12 ]. The physiological impact of cox- 1 and cox- 2 inhibition and impaired prostaglandin function by nonsteroidal antiinflammatories ( nsaid) and subsequent decrease in inflammatory cells and pain perception is well- established. Bahr, in his recent and well- constructed review of risk factors for sports injuries in general, makes several observations with specific regard to hamstring injuries.

In some reports, athletes were three times more likely to suffer ano. Poor flexibility. Hamstring strain injury has a very high recurrence rate. In soccer, australian rules football, and in the rugby union, the players who ran more, kicked more, and covered more of the fiel. Hallén a, ekstrand j. The semimembranosis inserts deep to the pes anserinus on the posterior tibia and can be felt through the semitendinosus and gracili.

Out of all these risk factors, a previous hamstring injury is the most significant risk factor for a recurrent hamstring injury. In this study, there was no difference in pain, swelling, strength, or endurance among the three groups. Even when randomized controlled trials have been conducted, most have low total numbers of injured athletes, which potentially explains the variability among study results. Other factors recurrent hamstring injuries may also develop after a number of removed causes. Found that static stretching started 48 h from injury in grade ii hamstring tears four times daily compared with once daily decreased athlete' s time to normal range of motion ( 5. A history of muscle injury represents a predominant risk factor for future insult in that muscle group. If a muscle is weak or fatigued it can alter a person’ s biomechanics and may increase risk of injury. Additionally, the high rate of recurrent injuries suggests that our current. In the setting of hamstring injuries, ultrasonography and magnetic resonance imaging ( mri) are the modalities of choice. The subjective assessment is key to correctly diagnose an injury.

The length of the hamstring should be palpated for tenderness or any muscle defects from the popliteal fossa to the ischial tuberosity, where the semitendinosus, semimembranosis, and the long head of the biceps femoris originate. This was further investigated hamstring muscle strain in speed and. What causes hamstring tears? What are the risk factors for a hamstring injury?

Many partial avulsions do well with nonoperative treatment, but in limited case series, complete ruptures treated nonoperatively did poorly with the great majority ultimately seeking surgery. Many interventions commonly are done, but limited randomized controlled trials and quality prospective studies guide the medical, surgical, and rehabilitation treatments prescribed by clinicians. Muscle weakness and fatigue. 3 vs 15 d; p < 0. Recording subsequent hamstring injuries allowed us to define injury frequencies and relative risks between groups. Muscle imbalance. Br j sports med ; 48:. Sports that require sprinting or running, or other activities such as dancing that might require extreme stretching, make a hamstring injury more likely. Some of the risk factors associated with the possible recurrence of the injury are, in all probability, already implicated in the initial injury.

Hamstring injury evaluation follows a pattern similar to evaluation of other musculoskeletal injury: inspection, palpation, range of motion, strength testing, and special maneuvers. The high incidence of hamstring muscle strain- type injuries and potential associated costs has resulted in a substantial amount of research into the factors related to such injuries. Due to the relative rarity of hamstring rupture, published evidence on hamstring surgery outcomes are all based on case series and expert opinion, and to our knowledge, there are no randomized controlled trials or prospective surgical outcome studies. Twelve ( 40% ) of 30 athletes had recurrent injury within the same season, with an additional 7 athletes having recurrent injury in the subsequent season. What is the past history of hamstring injury? Conclusionsgiven the prevalence of hamstring injuries, rates of recurrence and costs involved, future research should investigate treatment efficacy, prevention and return to play outcomes in an evidence- based paradigm. Many rehabilitation programs exist for hamstring tears, but only a few are based on randomized controlled trials.

15, 16 a study of college soccer players suggests that hamstring injuries are more common in males. A hamstring rehabilitation model is proposed that is based on our current understanding of the aetiological factors that contribute to hamstring muscle strain. In a double- blind, randomized controlled trial ( n = 75), patients were given either one of two nsaid or placebo, and all completed the same physical therapy course including rice ( rest, ice, compression, elevation), ultrasound therapy, deep transverse friction massage, stretching, and strengthening. Proximal injuries including tendon avulsion ( based on their relationship to the origin of the short head of the biceps femoris) were more common than distal injuries, regardless of which muscle was involved. Particular attention also should be placed on gait analysis, including motion at the hips, knees, and feet. This may occur due to disc bulges at the l4/ 5 or l5/ s1 levels, or due to joint stiffness of the lumbar spine or sacro- iliac joints, which may result in nerve root irritation. Additionally, the high rate of recurrent injuries suggests that our current understanding of hsi and re- injury risk is incomplete. Objective to systematically review the literature and provide an overview of risk factors for re- injury of acute hamstring muscle injuries.

There is no consensus regarding treatment for hamstring tears. Hamstring injuries are common at all levels of sport, however recurrence rates are disproportionate compared to other soft tissue injuries. Depending on the severity of the injury, the athlete may require considerable time off from sport ( 9, 11, 14, 29, 31, 33, 35, 41). Previous injury history, particularly previous hamstring injury is also important, as this is one of the major risk factors for future hamstring injuries ( freckleton, et al. Consideration of the aetiological factors that are relevant to hamstring injuries is particularly important in formulating a plan to avoid recurrence of the injury. Recurrent hamstring injuries develop in more than 30 percent of athletes, with most occurring during the ensuing sporting season. Background although recurrent hamstring injury is a frequent problem with a significant impact on athletes, data on factors determining the risk for a recurrent hamstring injury are scarce. 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). Reinjury was less likely in the pats group at 2 wk after return to sport ( rts) ( 0% vs 54.

More images for factors associated with recurrent hamstring injuries ». Some of the risk factors associated with the possible recurrence of the injury are, in all probability, already implicated in the. Bony avulsion of the ischium was rare in adults and usually occurred in the skeletally immature ( 4, 5, 13, 23, 47). Acute hamstring injuries occur particularly. That’ s where avoiding or at least minimizing exposure to hamstring injury risk factors is so important. Factors in recurrent hamstring injuries 683 extrinsic factors intrinsic factors modifications from initial strain questionable options in treatment first injury recurrent injuries fig. Abnormal q angle, flat foot and history of previous injuries were found as associated intrinsic risk factors, while not engaging in stretching exercises by holding a stretch > 20 seconds, training at hard intensity and sudden alterations in training pattern were found as associated extrinsic risk factors for injuries in runners. Proximal avulsions can be divided into complete, partial, and bony apophyseal injury, typically seen in the skeletally immature, where classically, surgery is reserved for retraction greater than 2 cm ( 39, 47).

Injury to the semimembranosis was less common, followed by the semitendinosus ( 4, 13, 23, 45). The severity of hamstring injuries was further displayed by ekstrand et al. Hamstring strain injuries ( hsis) are common in a number of sports and incidence rates have not declined in recent times. Medicine clinicians. Based on this information, various researches have proposed different training protocols targeting to reduce the risk of hamstring injuries with varying success. Thirty athletes met criteria for hamstring injury. What is the recurrence rate of hamstring strain injury? The high frequency of re- injury and persistent complaints after a hamstring strain comprise major difficulties for the athlete on return to athletic activities.

Two recent systematic reviews have been completed in an attempt to collate the evidence around risk factors for hamstring injuries. Recent high- quality studies have postulated various evidence- based causes and risk factors for hamstring injuries. Risk factors for hamstring injuries: a current view of the literature – written by thomas m. Both provide detailed information about the injury with respect to localization and characterization. Clinical examination for determining hamstring injury is considered to be reliable and accurate ( schneider- kolsky, et al.

Hamstring tears traditionally have been classified as mild ( grade i), moderate ( grade ii), and severe ( grade iii). The semitendinosus can be followed to its insertion at the pes anserinus, where it is felt as the most posterior and inferior tendon. If the body is compensating for another lower- limb injury, it can increase the chances of another injury somewhere else in the same or opposite limb. Recurrent hamstring injury rates generally are higher than initial injuries. Ways to prevent hamstring strain. 31 muckle 32 pointed out that recurrent hamstring injuries may cause lumbar spine abnormalities, meniscal. Moreover, many of the published risk factor studies are retrospective or assess only a small number of injured athletes. Past history of hamstring injury as factors associated with increased risk of hamstring muscle strain injuries.

These causes may include: referral of pain from the lumbar spine. Hamstring injury, risk factors, research, hamstring mobility. People who have suffered a hamstring injury in the past are at the greatest risk of future hamstring injuries. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with hsi risk. When compared to healthy individuals, people who have had a previous hamstring injury are 2 to 6 times more likely to suffer a hamstring injury. Sports participation. A higher level of competition was a risk factor of hamstring injury. Age and previous injury are supported in the literature as risk factors for hamstring injury; nonetheless, debate exists regarding modifiable risk factors.

Prior hamstring injury. One study found that hamstring- to- quadriceps strength imbalances can be a risk factor for reinjury ( 18). When conservative treatment fails in partial proximal avulsions, surgical treatment has allowed 87% - 100% of patients return to sport ( 24, 47). Full text full text is available as a scanned copy of the original print version. A comprehensive analytical review by bahr from the oslo sports trauma research center provides invaluable insight into the methodological deficits of the majority of published hamstring studies ( 6). The role of psychological rehabilitation, particularly in the case of recurrent hamstring strain, requires further research. Hamstring injuries can occur at either the proximal or distal “ free” ends, the musculotendinous junctions, or at the central intramuscular tendon. Interestingly hamstring: quadriceps ratio is not associated with hamstring injury. Player training hours and 5. 7, 8 because of this added risk, proper initial management and rehabilitation of an acute hamstring injury may be.

In their severe injury subgroups, the placebo group had significantly better pain scores compared with the nsaid groups at day 7 ( 37). One study involving soccer in the english premier league ( epl) showed a significantly higher prevalence of hamstring strain in the premier division versus division 2 ( 48). However, healing from your initial hamstring injury doesn’ t mean that you should not ever anticipate a second or recurrent injury. Surgical outcomes from repai.

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