A 4-year study of hamstring injury outcomes in elite track and field using the British Athletics rehabilitation approach

2021 ◽  
pp. bjsports-2020-103791
Author(s):  
Noel Pollock ◽  
Shane Kelly ◽  
Justin Lee ◽  
Ben Stone ◽  
Michael Giakoumis ◽  
...  
Keyword(s):  
Muscle Injury ◽  
Tendon Injury ◽  
Track And Field ◽  
Return To Play ◽  
Hamstring Injury ◽  
Cross Sectional ◽  
Entire Cohort ◽  
Hamstring Injuries ◽  
Longitudinal Length ◽  
Tendon Tension

ObjectivesThe British Athletics Muscle Injury Classification (BAMIC) correlates with return to play in muscle injury. The aim of this study was to examine hamstring injury diagnoses and outcomes within elite track and field athletes following implementation of the British Athletics hamstring rehabilitation approach.MethodsAll hamstring injuries sustained by elite track and field athletes on the British Athletics World Class Programme between December 2015 and November 2019 that underwent an MRI and had British Athletics medical team prescribed rehabilitation were included. Athlete demographics and specific injury details, including mechanism of injury, self-reported gait phase, MRI characteristics and time to return to full training (TRFT) were contemporaneously recorded.Results70 hamstring injuries in 46 athletes (24 women and 22 men, 24.6±3.7 years) were included. BAMIC grade and the intratendon c classification correlated with increased TRFT. Mean TRFT was 18.6 days for the entire cohort. Mean TRFT for intratendon classifications was 34±7 days (2c) and 48±17 days (3c). The overall reinjury rate was 2.9% and no reinjuries were sustained in the intratendon classifications. MRI variables of length and cross-sectional (CSA) area of muscle oedema, CSA of tendon injury and loss of tendon tension were associated with TRFT. Longitudinal length of tendon injury, in the intratendon classes, was not associated with TRFT.ConclusionThe application of BAMIC to inform hamstring rehabilitation in British Athletics results in low reinjury rates and favourable TRFT following hamstring injury. The key MRI variables associated with longer recovery are length and CSA of muscle oedema, CSA of tendon injury and loss of tendon tension.

Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice

2019 ◽  
Vol 53 (23) ◽  
pp. 1464-1473 ◽  
Author(s):  
Ben Macdonald ◽  
Stephen McAleer ◽  
Shane Kelly ◽  
Robin Chakraverty ◽  
Michael Johnston ◽  
...  
Keyword(s):  
Muscle Injury ◽  
Clinical Presentation ◽  
Classification Systems ◽  
Track And Field ◽  
Hamstring Injury ◽  
Shared Decision ◽  
Injury Rehabilitation ◽  
Hamstring Injuries ◽  
Elite Sports ◽  
Injury Classification

RationaleHamstring injuries are common in elite sports. Muscle injury classification systems aim to provide a framework for diagnosis. The British Athletics Muscle Injury Classification (BAMIC) describes an MRI classification system with clearly defined, anatomically focused classes based on the site of injury: (a) myofascial, (b) muscle–tendon junction or (c) intratendinous; and the extent of the injury, graded from 0 to 4. However, there are no clinical guidelines that link the specific diagnosis (as above) with a focused rehabilitation plan.ObjectiveWe present an overview of the general principles of, and rationale for, exercise-based hamstring injury rehabilitation in British Athletics. We describe how British Athletics clinicians use the BAMIC to help manage elite track and field athletes with hamstring injury. Within each class of injury, we discuss four topics: clinical presentation, healing physiology, how we prescribe and progress rehabilitation and how we make the shared decision to return to full training. We recommend a structured and targeted diagnostic and rehabilitation approach to improve outcomes after hamstring injury.

scholarly journals Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making

2017 ◽  
Vol 51 (22) ◽  
pp. 1583-1591 ◽  
Author(s):  
Nick van der Horst ◽  
FJG Backx ◽  
Edwin A Goedhart ◽  
Bionka MA Huisstede
Keyword(s):  
Decision Making ◽  
Field Testing ◽  
Return To Play ◽  
Hamstring Injury ◽  
Feedback Report ◽  
Hamstring Injuries ◽  
Starting Point ◽  
Delphi Procedure ◽  
Hamstring Flexibility ◽  
The Moment

There are three major questions about return to play (RTP) after hamstring injuries: How should RTP be defined? Which medical criteria should support the RTP decision? And who should make the RTP decision? The study aimed to provide a clear RTP definition and medical criteria for RTP and to clarify RTP consultation and responsibilities after hamstring injury. The study used the Delphi procedure. The results of a systematic review were used as a starting point for the Delphi procedure. Fifty-eight experts in the field of hamstring injury management selected by 28 FIFA Medical Centres of Excellence worldwide participated. Each Delphi round consisted of a questionnaire, an analysis and an anonymised feedback report. After four Delphi rounds, with more than 83% response for each round, consensus was achieved that RTP should be defined as ‘the moment a player has received criteria-based medical clearance and is mentally ready for full availability for match selection and/or full training’. The experts reached consensus on the following criteria to support the RTP decision: medical staff clearance, absence of pain on palpation, absence of pain during strength and flexibility testing, absence of pain during/after functional testing, similar hamstring flexibility, performance on field testing, and psychological readiness. It was also agreed that RTP decisions should be based on shared decision-making, primarily via consultation with the athlete, sports physician, physiotherapist, fitness trainer and team coach. The consensus regarding aspects of RTP should provide clarity and facilitate the assessment of when RTP is appropriate after hamstring injury, so as to avoid or reduce the risk of injury recurrence because of a premature RTP.

scholarly journals Evidence-Based Management and Factors Associated With Return to Play After Acute Hamstring Injury in Athletes: A Systematic Review

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110538
Author(s):  
Samuel S. Rudisill ◽  
Michael P. Kucharik ◽  
Nathan H. Varady ◽  
Scott D. Martin
Keyword(s):  
Knee Extension ◽  
Risk Of Bias ◽  
Return To Play ◽  
Hamstring Injury ◽  
Controlled Trials ◽  
Factors Associated ◽  
Randomized Controlled ◽  
Hamstring Injuries ◽  
Muscular Injury ◽  
Proximal Hamstring

Background: Considering the lengthy recovery and high recurrence risk after a hamstring injury, effective rehabilitation and accurate prognosis are fundamental to timely and safe return to play (RTP) for athletes. Purpose: To analyze methods of rehabilitation for acute proximal and muscular hamstring injuries and summarize prognostic factors associated with RTP. Study Design: Systematic review; Level of evidence, 4. Methods: In August 2020, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus were queried for studies examining management and factors affecting RTP after acute hamstring injury. Included were randomized controlled trials, cohort studies, case-control studies, and case series appraising treatment effects on RTP, reinjury rate, strength, flexibility, hamstrings-to-quadriceps ratio, or functional assessment, as well as studies associating clinical and magnetic resonance imaging factors with RTP. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials or the Methodological Index for Non-Randomized Studies (MINORS). Results: Of 1289 identified articles, 75 were included. The comparative and noncomparative studies earned MINORS scores of 18.8 ± 1.3 and 11.4 ± 3.4, respectively, and 12 of the 17 randomized controlled trials exhibited low risk of bias. Collectively, studies of muscular injury included younger patients and a greater proportion of male athletes compared with studies of proximal injury. Surgery for proximal hamstring ruptures achieved superior outcomes to nonoperative treatment, whereas physiotherapy incorporating eccentric training, progressive agility, and trunk stabilization restored function and hastened RTP after muscular injuries. Platelet-rich plasma injection for muscular injury yielded inconsistent results. The following initial clinical findings were associated with delayed RTP: greater passive knee extension of the uninjured leg, greater knee extension peak torque angle, biceps femoris injury, greater pain at injury and initial examination, “popping” sound, bruising, and pain on resisted knee flexion. Imaging factors associated with delayed RTP included magnetic resonance imaging-positive injury, longer lesion relative to patient height, greater muscle/tendon involvement, complete central tendon or myotendinous junction rupture, and greater number of muscles injured. Conclusion: Surgery enabled earlier RTP and improved strength and flexibility for proximal hamstring injuries, while muscular injuries were effectively managed nonoperatively. Rehabilitation and athlete expectations may be managed by considering several suitable prognostic factors derived from initial clinical and imaging examination.

scholarly journals Hamstring Injuries Prevention in Soccer: A Narrative Review of Current Literature

Joints ◽  
2020 ◽  
Author(s):  
Gian Nicola Bisciotti ◽  
Karim Chamari ◽  
Emanuele Cena ◽  
Giulia Carimati ◽  
Alessandro Bisciotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Risk ◽  
Epidemiological Data ◽  
Return To Play ◽  
Hamstring Injury ◽  
Apparent Paradox ◽  
Hamstring Injuries ◽  
High Incidence ◽  
Sport Activities ◽  
Injury Risk Factors

AbstractHamstring injuries and reinjuries are one of the most important sport lesions in several sport activities including soccer, Australian football, track and field, rugby, and in general in all sport activities requiring sprinting and acceleration. However, it is important to distinguish between the lesions of the biceps femoris and semitendinosus and semimembranosus. Indeed, three muscles representing the hamstring complex have a very different injury etiology and consequently require different prevention strategies. This fact may explain, at least in part, the high incidence of reinjuries. In soccer, hamstring injuries cause an important rate of time loss (i.e., in average 15–21 matches missed per club per season). The hamstring injury risk factors may be subdivided in three categories: “primary injury risk factors” (i.e., the risk factors mainly causing a first lesion), “recurrent injury risk factors” (i.e., the risk that can cause a reinjury), and bivalent injury risk factors” (i.e., the risk factors that can cause both primary injuries and reinjuries). The high incidence of hamstring lesions caused consequently an important increase in hamstring injury research. However, although the prevention has increased paradoxically, epidemiological data do not show a loss in injuries and/or reinjuries but, on the contrary, they show an increase in hamstring injuries. This apparent paradox highlights the importance both of the improvement in the prevention programs quality and the criteria for return to play after hamstring injury.

scholarly journals A Longitudinal Investigation of Muscle Injuries in an Elite Spanish Male Academy Soccer Club: A Hamstring Injuries Approach

2020 ◽  
Vol 10 (5) ◽  
pp. 1610 ◽  
Author(s):  
Javier Raya-González ◽  
Mark de Ste Croix ◽  
Paul Read ◽  
Daniel Castillo
Keyword(s):  
Muscle Injury ◽  
Injury Rate ◽  
Hamstring Injury ◽  
Anatomical Site ◽  
Injury Incidence ◽  
Age Group ◽  
Muscle Injuries ◽  
Match Play ◽  
Youth Soccer ◽  
Hamstring Injuries

The aims of this study were to analyze the muscle injury incidence in an elite Spanish soccer academy during three consecutive seasons attending to different chronological age groups (i.e., U14, U16, U19 and senior) and to examine the hamstring injury incidence in this elite soccer academy. Elite male youth soccer players (227) participated in this study. A total of 207 time-loss injuries (i.e., injuries that involve at least one absence day) were observed during this study period. The overall incidence rate of muscle injury was 1.74 muscle injuries/1000 h. In addition, higher muscle injury incidence was observed during match play in comparison to training sessions (6.78 vs. 3.20 muscle injuries/1000 h, p < 0.05). The oldest age group presented the highest injury rate (2.73 muscle injuries/1000 h, p < 0.05), with the burden (i.e., number of absence days per 1000 h of exposure) peak values recorded in the U16 age group (26.45 absence days/1000 h). In addition, muscle tears accounted for the greatest percentage of muscle injuries (43.5%), and the most frequent anatomical site of injury was the hamstring (30.4%). Muscle tear was the most common type of hamstring injury (49.2%), with the biceps femoris the most commonly injured muscle of the hamstring complex (39.7%). Fullbacks (FB), wide midfielders (WM) and forwards (F) suffered a greater number of hamstring injuries. Hamstring injury incidence showed a seasonal variation, as indicated by peaks in August and October. Specifically, the highest injury incidence was observed in the final part of each period during match play. These results reinforce the necessity to implement individual preventive strategies according to each specific injury profile across the youth soccer development phase.

scholarly journals Intramuscular tendon injury is not associated with an increased hamstring reinjury rate within 12 months after return to play

2018 ◽  
Vol 52 (19) ◽  
pp. 1261-1266 ◽  
Author(s):  
Anne D van der Made ◽  
Emad Almusa ◽  
Gustaaf Reurink ◽  
Rod Whiteley ◽  
Adam Weir ◽  
...  
Keyword(s):  
Hamstring Tendon ◽  
Tendon Injury ◽  
Acute Onset ◽  
Rehabilitation Programme ◽  
Thigh Pain ◽  
Return To Play ◽  
Hamstring Injury ◽  
Football Players ◽  
Significant Difference ◽  
Injury Treatment

BackgroundAcute hamstring injury that includes intramuscular tendon injury has been suggested to be associated with increased reinjury risk. These observations were based on a relatively small number of retrospectively analysed cases.ObjectiveTo determine whether intramuscular tendon injury is associated with higher reinjury rates in acute hamstring injury.MethodsMRIs of 165 athletes with an acute hamstring injury were obtained within 5 days of injury. Treatment consisted of a standardised criteria-based rehabilitation programme. Standardised MRI parameters and intramuscular tendon injury, the latter subdivided into tendon disruption and waviness, were scored. We prospectively recorded reinjuries, defined as acute onset of posterior thigh pain in the same leg within 12 months after return to play.ResultsParticipants were predominantly football players (72%). Sixty-four of 165 (39%) participants had an index injury with intramuscular hamstring tendon disruption, and waviness was present in 37 (22%). In total, there were 32 (19%) reinjuries. There was no significant difference (HR: 1.05, 95% CI 0.52 to 2.12, P=0.898) in reinjury rate between index injuries with intramuscular tendon disruption (n=13, 20%) and without tendon disruption (n=19, 20%). There was no significant difference in reinjury rate (X²(1)=0.031, P=0.861) between index injuries with presence of waviness (n=7, 19%) and without presence of waviness (n=25, 20%).ConclusionIn athletes with an acute hamstring injury, intramuscular tendon injury was not associated with an increased reinjury rate within 12 months after return to play.

scholarly journals Platelet-rich plasma (PRP) Shortens Return to Play in National Football League (NFL) Players with Acute Hamstring Injuries

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0042
Author(s):  
Justin W. Arner ◽  
Tracye J. Lawyer ◽  
Craig Stephen Mauro ◽  
James P. Bradley
Keyword(s):  
Operative Treatment ◽  
National Football League ◽  
Platelet Rich Plasma ◽  
Financial Impact ◽  
Return To Play ◽  
Professional Athletes ◽  
Hamstring Injury ◽  
Hamstring Injuries ◽  
Injection Treatment ◽  
Musculoskeletal Radiologist

Objectives: Hamstring injuries are common in professional athletes and subsequent delays in healing are common, costly, and even career ending. The efficacy of platelet-rich plasma (PRP) for augmentation of non-operative treatment of partial musculotendinous hamstring injuries has not yet been established. Methods: NFL players from a single team who sustained acute grade 2 hamstring injuries as diagnosed on MRI by a musculoskeletal radiologist from 2009 to 2017 were retrospectively reviewed. Average days, practices, and games missed were recorded. Players that did and did not receive PRP injections were compared. Those who received PRP did so within 24 to 48 hours after injury. Results: Ninety-four NFL players had MRI evidence of a hamstring injury, while 61 athletes sustained grade 2 injuries. Thirty-one were treated with PRP injections and 30 were not. Average time missed in those treated with PRP injections was 22.4 days, 18.5 practices, and 1.7 games. In those who did not receive PRP injections, time missed was 25.8 days (p = 0.81), 22.2 practices (p = 0.68), and 2.7 games (p < 0.05). Conclusion: PRP injection treatment for acute grade 2 hamstring injuries in NFL players allows for faster return to play with a 1 game overall difference. Due to the possible large financial impact of return to play 1 game sooner, PRP injections for treatment of grade 2 hamstring injuries may be advantageous in professional athletes. Additional evaluation of PRP treatment of acute hamstring injuries in a larger cohort is necessary.

scholarly journals Hamstring Injuries in Professional Soccer Players: Extent of MRI-Detected Edema and the Time to Return to Play

2017 ◽  
Vol 10 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Michel D. Crema ◽  
Ivan R. B. Godoy ◽  
Rene J. Abdalla ◽  
Jose Sanchez de Aquino ◽  
Sheila J. McNeill Ingham ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Negative Binomial ◽  
Cross Sectional Area ◽  
Return To Play ◽  
Soccer Players ◽  
Sectional Area ◽  
Cross Sectional ◽  
Professional Soccer ◽  
Hamstring Injuries ◽  
The Mean

Background: Discrepancies exist in the literature regarding the association of the extent of injuries assessed on magnetic resonance imaging (MRI) with recovery times. Hypothesis: MRI-detected edema in grade 1 hamstring injuries does not affect the return to play (RTP). Study Design: Retrospective cohort study. Level of Evidence: Level 4. Methods: Grade 1 hamstring injuries from 22 professional soccer players were retrospectively reviewed. The extent of edema-like changes on fluid-sensitive sequences from 1.5-T MRI were evaluated using craniocaudal length, percentage of cross-sectional area, and volume. The time needed to RTP was the outcome. Negative binomial regression analysis tested the measurements of MRI-detected edema-like changes as prognostic factors. Results: The mean craniocaudal length was 7.6 cm (SD, 4.9 cm; range, 0.9-19.1 cm), the mean percentage of cross-sectional area was 23.6% (SD, 20%; range, 4.4%-89.6%), and the mean volume was 33.1 cm3 (SD, 42.6 cm3; range, 1.1-161.3 cm3). The mean time needed to RTP was 13.6 days (SD, 8.9 days; range, 3-32 days). None of the parameters of extent was associated with RTP. Conclusion: The extent of MRI edema in hamstring injuries does not have prognostic value. Clinical Relevance: Measuring the extent of edema in hamstring injuries using MRI does not add prognostic value in clinical practice.

scholarly journals Validity of an On-Field Readaptation Program Following a Hamstring Injury in Professional Soccer

2019 ◽  
Vol 28 (6) ◽  
Author(s):  
Sergio Jiménez-Rubio ◽  
Archit Navandar ◽  
Jesús Rivilla-García ◽  
Victor Paredes-Hernández
Keyword(s):  
Neuromuscular Control ◽  
Rehabilitation Program ◽  
Lower Limbs ◽  
Return To Play ◽  
Soccer Players ◽  
Hamstring Injury ◽  
Strength And Conditioning ◽  
Hamstring Strain ◽  
Professional Soccer ◽  
Hamstring Injuries

Context: Despite the presence of various injury prevention programs, the rate of hamstring injuries and reinjuries is increasing in soccer, warranting the need for a soccer-specific rehabilitation program. Objective: To develop and validate a new, functional on-field program for the rehabilitation and readaptation of soccer players after a hamstring strain injury through a panel of experts; and determine the usefulness of the program through its application in professional soccer players. Design: A 13-item program was developed, which was validated by a panel of experts and later applied to professional soccer players. Setting: Soccer training ground. Participants: Fifteen strength and conditioning and rehabilitation fitness coaches with a professional experience of 15.40 (1.57) years in elite clubs and national teams in Europe validated the program. The program was later applied to 19 professional soccer players of the Spanish First Division (La Liga). Interventions: Once a player sustained a clinically diagnosed injury, the player would first be subject to mobilization and strengthening exercises in the gym after undergoing treatment by percutaneous needle electrolysis. The player would then complete an on-field readaptation program consisting of 13 drills arranged in a progressive manner in terms of complexity. The drills integrated various aspects of repeated sprint abilities, retraining and reeducation of biomechanical patterns, and neuromuscular control of the core and lower limbs. Main Outcome Measures: Aiken’s V for each item of the program and number of days taken by the players to return to play. Results: The experts evaluated all items of the program very highly, as seen from Aiken’s V values between 0.78 and 0.98 (0.63–0.99) for all drills, while the return to play was in 22.42 (2.32) days. Conclusion: This program has the potential to help a player suffering from a hamstring strain injury to adapt to real-match conditions in the readaptation phase through the application of sports-specific drills that were very similar to the different injury mechanisms.

Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury

2017 ◽  
Vol 52 (2) ◽  
pp. 83-88 ◽  
Author(s):  
Anne D van der Made ◽  
Emad Almusa ◽  
Rod Whiteley ◽  
Bruce Hamilton ◽  
Cristiano Eirale ◽  
...  
Keyword(s):  
Case Series ◽  
Return To Play ◽  
Hamstring Injury ◽  
Full Thickness ◽  
Retrospective Case ◽  
Cross Sectional ◽  
Male Athletes ◽  
Serious Injury ◽  
The Individual ◽  
Mean Time

BackgroundHamstring injury with intramuscular tendon involvement is regarded as a serious injury with a delay in return to play (RTP) of more than 50 days and reinjury rates up to 63%. However, this reputation is based on retrospective case series with high risk of bias.ObjectiveDetermine whether intramuscular tendon involvement is associated with delayed RTP and elevated rates of reinjury.MethodsMRI of male athletes with an acute hamstring injury was obtained within 5 days of injury. Evaluation included standardised MRI scoring and scoring of intramuscular tendon involvement. Time to RTP and reinjury rate were prospectively recorded.ResultsOut of 70 included participants, intramuscular tendon disruption was present in 29 (41.4%) injuries. Injuries without intramuscular tendon disruption had a mean time to RTP of 22.2±7.4 days. Injuries with <50%, 50%–99% and 100% disruption of tendon cross-sectional area had a mean time to RTP of 24.0±9.7, 25.3±8.6 and 31.6±10.9 days, respectively. Injuries with full-thickness disruption took longer to RTP compared with injuries without disruption (p=0.025). Longitudinal intramuscular tendon disruption was not significantly associated with time to RTP. Waviness was present in 17 (24.3%) injuries. Mean time to RTP for injuries without and with waviness was 22.6±7.5 and 30.2±10.8 days (p=0.014). There were 11 (15.7%) reinjuries within 12 months, five (17.2%) in the group with intramuscular tendon disruption and six (14.6%) in the group without intramuscular tendon disruption.ConclusionTime to RTP for injuries with full-thickness disruption of the intramuscular tendon and waviness is significantly longer (by slightly more than 1 week) compared with injuries without intramuscular tendon involvement. However, due to the considerable overlap in time to RTP between groups with and without intramuscular tendon involvement, its clinical significance for the individual athlete is limited.

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