Return to Competitive Play After Hamstring Injuries Involving Disruption of the Central Tendon

2012 ◽  
Vol 41 (1) ◽  
pp. 111-115 ◽  
Author(s):  
Jules Comin ◽  
Peter Malliaras ◽  
Peter Baquie ◽  
Tim Barbour ◽  
David Connell
Keyword(s):  
Recovery Time ◽  
Biceps Femoris ◽  
Hamstring Tendon ◽  
Hamstring Injury ◽  
Level Of Evidence ◽  
Musculotendinous Junction ◽  
Sports Teams ◽  
Hamstring Injuries ◽  
Recurrent Injury ◽  
Recovery Times

Background: The hamstring muscles are the most commonly injured muscle group in many different sports. Recovery time is often unpredictable and prolonged, and recurrent injury is common. Hypothesis: Hamstring injuries that disrupt the central tendon enclosed within the muscle belly require a longer recovery time than do injuries involving only muscle, epimysial fascia, or the musculotendinous junction. Study Design: Cohort study; Level of evidence, 3. Methods: Injury records from professional sports teams were reviewed to determine the length of recovery from each hamstring injury that occurred over a 24-month period. The integrity of the central tendon on magnetic resonance imaging (MRI) was retrospectively reviewed for each case. The association between central tendon disruption on MRI and recovery time was determined. Results: There were 62 hamstring injuries included for analysis; 45 (72%) involved the biceps femoris, 11 (18%) involved the semimembranosus, and 6 (10%) involved the semitendinosus. Central tendon disruption was identified in 12 (45%) of the biceps femoris injuries and in none of the injuries to the other 2 muscles. Three of these injuries were treated surgically, with a median recovery time of 91 days. The median (interquartile range [IQR]) recovery times for those remaining biceps femoris injuries with and without central tendon disruption were 21 days (IQR, 9-28) and 72 days (IQR, 42-109), respectively ( P < .01). Conclusion: Disruption of the central tendon in injuries to the biceps femoris results in a significantly longer recovery time than injuries that do not disrupt the central tendon. This highlights the distinction between injury to the hamstring muscle and injury to the hamstring tendon, which is underappreciated as being a distinct entity when injury involves the enclosed central portion of the tendon.

Hamstring injury in futsal players: the effect of active range of motion (AROM) deficit on the full recovery time

2020 ◽  
Author(s):  
Lyudmila Smirnova ◽  
Aleksandr Derinov ◽  
Irina Glazkova
Keyword(s):  
Range Of Motion ◽  
Recovery Time ◽  
Full Recovery ◽  
Hamstring Injury ◽  
Control Group ◽  
Hamstring Muscle ◽  
Muscle Injuries ◽  
Musculotendinous Junction ◽  
Hamstring Injuries ◽  
Active Range Of Motion

Abstract Background Hamstring muscle injuries are one of the most common traumas occurring in athletes and football players. Thus, the recovery time is crucial for their return to full athlete activity. Objective This article examines cases of hamstring injury in futsal players and finds association between the active range of motion (AROM) deficit and the full recovery time. Methods For this study, 200 futsal players with acute, first-time, unilateral posterior hamstring injuries were recruited, all men. All patients underwent clinical examination and ultrasonography. In 74 of 200 patients, sonography revealed no abnormalities in the musculoligamentary structures. Thereby, they were excluded from further investigation. Only 126 futsal players underwent measurement of the active range of motion with a 30-cm clear plastic inclinometer. Injured areas were compared with the normal hamstrings in all athletes and with the control group, and the AROM deficit was evaluated. The association between the full recovery time and the AROM deficit was identified. A control group (100 men) underwent examination in the same series of steps as the study group. Results Biceps femoris was the most commonly injured muscle, making up 80% of injuries. The musculotendinous junction, proximal and distal, was involved in 91% of injury cases. Twelve athletes had an AROM deficit of 25 to 35 degrees and reached full recovery at 2.5 months and later. Seventy or 55.5% of athletes had an AROM deficit less than 15 degrees and felt fully recovered only in a month. Conclusions The classification system of hamstring muscle injuries that is offered here is based on an objective clinical marker (active knee ROM deficit), is easily applicable, and is indicative of recovery duration.

scholarly journals Platelet-Rich Plasma Shortens Return to Play in National Football League Players With Acute Hamstring Injuries

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091173 ◽  
Author(s):  
James P. Bradley ◽  
Tracye J. Lawyer ◽  
Sonia Ruef ◽  
Jeffrey D. Towers ◽  
Justin W. Arner
Keyword(s):  
National Football League ◽  
Platelet Rich Plasma ◽  
Nonoperative Treatment ◽  
Return To Play ◽  
Professional Athletes ◽  
Hamstring Injury ◽  
Level Of Evidence ◽  
Hamstring Injuries ◽  
Recurrent Injury ◽  
Significant Difference

Background: Hamstring injuries are prevalent in professional athletes and can lead to significant time loss, with recurrent injury being common. The efficacy of platelet-rich plasma (PRP) for augmentation of nonoperative treatment of partial musculotendinous hamstring injuries is not well established. Hypothesis: The addition of PRP injections to nonoperative treatment for acute partial musculotendinous hamstring injuries will lead to a shortened return to play in National Football League (NFL) players. Study Design: Cohort study; Level of evidence, 3. Methods: NFL players from a single team who sustained acute grade 2 hamstring injuries, as diagnosed on magnetic resonance imaging (MRI) by a musculoskeletal radiologist from 2009 to 2018, were retrospectively reviewed. Average days, practices, and games missed were recorded. Players who did and did not receive PRP (leukocyte-poor) injections were compared. Those who received PRP did so within 24 to 48 hours after injury. Results: A total of 108 NFL players had MRI evidence of a hamstring injury, and of those, 69 athletes sustained grade 2 injuries. Thirty players received augmented treatment with PRP injections and 39 players underwent nonoperative treatment alone. Average time missed in those treated with PRP injections was 22.5 days, 18.2 practices, and 1.3 games. In those who did not receive PRP injections, time missed was 25.7 days ( P = .81), 22.8 practices ( P = .68), and 2.9 games ( P < .05). Conclusion: Augmentation with PRP injections for acute grade 2 hamstring injuries in NFL players showed no significant difference in days missed or time to return to practice but did allow for faster return to play, with a 1 game overall difference. Owing to the possible large financial impact of returning to play 1 game sooner, PRP injections for treatment of grade 2 hamstring injuries may be advantageous in professional athletes.

Using Acute Performance on a Comprehensive Neurocognitive, Vestibular, and Ocular Motor Assessment Battery to Predict Recovery Duration After Sport-Related Concussions

2017 ◽  
Vol 45 (5) ◽  
pp. 1187-1194 ◽  
Author(s):  
Alicia M. Sufrinko ◽  
Gregory F. Marchetti ◽  
Paul E. Cohen ◽  
R.J. Elbin ◽  
Valentina Re ◽  
...  
Keyword(s):  
Recovery Time ◽  
Symptom Assessment ◽  
Cognitive Testing ◽  
Ocular Motor ◽  
Motor Speed ◽  
Multinomial Regression ◽  
Symptom Scale ◽  
Level Of Evidence ◽  
Recovery Times ◽  
Visual Motor

Background: A sport-related concussion (SRC) is a heterogeneous injury that requires a multifaceted and comprehensive approach for diagnosis and management, including symptom reports, vestibular/ocular motor assessments, and neurocognitive testing. Purpose: To determine which acute (eg, within 7 days) vestibular, ocular motor, neurocognitive, and symptom impairments predict the duration of recovery after an SRC. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Sixty-nine patients with a mean age of 15.3 ± 1.9 years completed a neurocognitive, vestibular/ocular motor, and symptom assessment within 7 days of a diagnosed concussion. Patients were grouped by recovery time: ≤14 days (n = 27, 39.1%), 15-29 days (n = 25, 36.2%), and 30-90 days (n = 17, 24.6%). Multinomial regression was used to identify the best subset of predictors associated with prolonged recovery relative to ≤14 days. Results: Acute visual motor speed and cognitive-migraine-fatigue symptoms were associated with an increased likelihood of recovery times of 30-90 days and 15-29 days relative to a recovery time of ≤14 days. A model with visual motor speed and cognitive-migraine-fatigue symptoms within the first 7 days of an SRC was 87% accurate at identifying patients with a recovery time of 30-90 days. Conclusion: The current study identified cognitive-migraine-fatigue symptoms and visual motor speed as the most robust predictors of protracted recovery after an SRC according to the Post-concussion Symptom Scale, Immediate Post-concussion Assessment and Cognitive Testing, and Vestibular/Ocular Motor Screening (VOMS). While VOMS components were sensitive in identifying a concussion, they were not robust predictors for recovery. Clinicians may consider particular patterns of performance on clinical measures when providing treatment recommendations and discussing anticipated recovery with patients.

Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men’s Soccer

2011 ◽  
Vol 39 (11) ◽  
pp. 2296-2303 ◽  
Author(s):  
Jesper Petersen ◽  
Kristian Thorborg ◽  
Michael Bachmann Nielsen ◽  
Esben Budtz-Jørgensen ◽  
Per Hölmich
Keyword(s):  
Training Program ◽  
Intervention Group ◽  
Soccer Players ◽  
Hamstring Injury ◽  
Control Group ◽  
Eccentric Training ◽  
Preventive Effect ◽  
Injury Rates ◽  
Hamstring Injuries ◽  
Recurrent Injury

Background: The incidence of acute hamstring injuries is high in several sports, including the different forms of football. Purpose: The authors investigated the preventive effect of eccentric strengthening of the hamstring muscles using the Nordic hamstring exercise compared with no additional hamstring exercise on the rate of acute hamstring injuries in male soccer players. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Fifty Danish male professional and amateur soccer teams (942 players) were allocated to an intervention group (461 players) or a control group (481 players). Players in the intervention group conducted a 10-week progressive eccentric training program followed by a weekly seasonal program, whereas players in the control group followed their usual training program. The main outcome measures were numbers of overall, new, and recurrent acute hamstring injuries during 1 full soccer season. Results: Fifty-two acute hamstring injuries in the control group compared with 15 injuries in the intervention group were registered. Comparing intervention versus the control group, overall acute hamstring injury rates per 100 player seasons were 3.8 versus 13.1 (adjusted rate ratio [RR], 0.293; 95% confidence interval [CI], 0.150-0.572; P < .001). New injury rates per 100 player seasons were 3.1 versus 8.1 (RR, 0.410; 95% CI, 0.180-0.933; P = .034), whereas recurrent injury rates per 100 player seasons were 7.1 versus 45.8 (RR, 0.137; 95% CI, 0.037-0.509; P = .003). Number needed to treat [NNT] to prevent 1 acute hamstring injury (new or recurrent) is 13 (95% CI, 9-23) players. The NNT to prevent 1 new injury is 25 (95% CI, 15-72) players, and NNT to prevent 1 recurrent injury is 3 (95% CI, 2-6) players. Conclusion: In male professional and amateur soccer players, additional eccentric hamstring exercise decreased the rate of overall, new, and recurrent acute hamstring injuries.

No Relationship Between Hamstring Flexibility and Hamstring Injuries in Male Amateur Soccer Players: A Prospective Study

2016 ◽  
Vol 45 (1) ◽  
pp. 121-126 ◽  
Author(s):  
Mitchell C.M. van Doormaal ◽  
Nick van der Horst ◽  
Frank J.G. Backx ◽  
Dirk-Wouter Smits ◽  
Bionka M.A. Huisstede
Keyword(s):  
Multivariate Logistic Regression Analysis ◽  
Soccer Players ◽  
Hamstring Injury ◽  
Level Of Evidence ◽  
Hamstring Injuries ◽  
Hamstring Flexibility ◽  
A Prospective Study ◽  
The Relationship ◽  
Control Study

Background: In soccer, although hamstring flexibility is thought to play a major role in preventing hamstring injuries, the relationship between hamstring flexibility and hamstring injuries remains unclear. Purpose: To investigate the relationship between hamstring flexibility and hamstring injuries in male amateur soccer players. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 450 male first-class amateur soccer players (mean age, 24.5 years). Hamstring flexibility was measured by performing the sit-and-reach test (SRT). The relationship between hamstring flexibility and the occurrence of hamstring injuries in the following year, while adjusting for the possible confounding effects of age and previous hamstring injuries, was determined with a multivariate logistic regression analysis. Results: Of the 450 soccer players, 21.8% reported a hamstring injury in the previous year. The mean (±SD) baseline score for the SRT was 21.2 ± 9.2 cm. During the 1-year follow-up period, 23 participants (5.1%) suffered a hamstring injury. In the multivariate analysis, while adjusting for age and previous injuries, no significant relationship was found between hamstring flexibility and hamstring injuries ( P = .493). Conclusion: In this group of soccer players, hamstring flexibility (measured with the SRT) was not related to hamstring injuries. Age and previous hamstring injuries as possible confounders did not appear to influence this relationship. Other etiological factors need to be examined to further elucidate the mechanism of hamstring injuries.

scholarly journals Relationship of Musculotendinous Junction Location to Harvested Semitendinosus and Gracilis Tendon Length

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770463 ◽  
Author(s):  
Omer A. Ilahi ◽  
Eugene F. Stautberg ◽  
David J. Mansfield ◽  
Ali A. Qadeer
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Musculotendinous Junction ◽  
Tendon Length ◽  
Total Length ◽  
Scant Attention

Background: Harvested hamstring tendon length has received scant attention in published anterior cruciate ligament (ACL) reconstruction literature, yet length can limit the ability to increase graft diameter by folding the tendon over more than once. Indeed, some ultrashort tendons may be too short to yield a clinically useful graft after being folded over just once. Ultimately, the total length of a harvested hamstring tendon may depend on the length of the tendon distal to its musculotendinous (MT) junction. Purpose: To compare the lengths of harvested hamstring tendons to the location of the MT junction to help predict abnormally short tendon harvest. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Eighty-four consecutive patients undergoing primary ACL reconstruction using hamstring tendon autografts underwent intraoperative measurement of the total length of each harvested semitendinosus (ST) and gracilis (G) tendon, as well as the distance from the MT junction to that tendon’s distal end (ie, the “tendon-only” length). Results: The ratio of the tendon-only portion to total harvested tendon length averaged 0.52 (range, 0.39-0.71) for the ST and 0.52 (range, 0.43-0.71) for the G, suggesting a 95% chance of harvesting a tendon <15 cm in length for the tendon-only portion is <6.45 cm for ST or <6.75 cm for G tendons. There was moderate correlation between the lengths of harvested ST and G tendons with patient height as well as with the diameter of the combined, quadruple-stranded graft. Conclusion: The ratio of the tendon-only length to total harvested length for both the ST and G appear to range from approximately 0.4 to 0.7. Patients with abnormally distal MT junctions of either their ST or G are likely to have an abnormally short harvest of that tendon, even in the absence of technical harvesting error.

scholarly journals Hamstring injuries in elite Gaelic football: an 8-year investigation to identify injury rates, time-loss patterns and players at increased risk

2016 ◽  
Vol 52 (15) ◽  
pp. 982-988 ◽  
Author(s):  
Mark Roe ◽  
John C Murphy ◽  
Conor Gissane ◽  
Catherine Blake
Keyword(s):  
Management Strategies ◽  
Fold Increase ◽  
Hamstring Injury ◽  
Time Loss ◽  
Match Play ◽  
Injury Rates ◽  
Musculotendinous Junction ◽  
Hamstring Injuries ◽  
Increased Risk ◽  
Prevention Programmes

BackgroundHamstring injuries occur frequently in field sports, yet longitudinal information to guide prevention programmes is missing.AimInvestigate longitudinal hamstring injury rates and associated time loss in elite Gaelic football, while identifying subgroups of players at increased risk.Methods38 data sets from 15 elite male Gaelic football teams were received by the National Gaelic Athletic Association (GAA) Injury Surveillance Database between 2008 and 2015. Injury and exposure data were provided by the team's medical staff via an online platform.Results391 hamstring injuries were sustained accounting for 21% (95% CI 20.0% to 21.7%) of all injuries. Prevalence was 21% (95% CI 19.2% to 23.4%). Incidences were 2.2 (95% CI 1.9 to 2.4) per 1000 exposure hours, and 7.0 (95% CI 6.5 to 7.1) times greater in match play than in training. Typically each team sustained 9.0 (95% CI 7.0 to 11.0) hamstring injuries per season affecting the: bicep femoris belly (44%; 95% CI 39.4% to 48.7%); proximal musculotendinous junction (13%; 95% CI 9.8% to 16.3%); distal musculotendinous junction (12%; 95% CI 8.6% to 14.9%) and semimembranosis/semitendinosis belly (9%; 95% CI 6.3% to 11.7%). ∼36% (95% CI 31.5% to 41.0%) were recurrent injuries. Mean time loss was 26.0 (95% CI 21.1 to 33.0) days, which varied with age, injury type and seasonal cycle. Hamstring injuries accounted for 31% (95% CI 25.8% to 38.2%) of injury-related time loss. Previously injured players (rate ratio (RR)=3.3), players aged 18–20 years (IRR=2.3) or >30 years (RR=2.3), as well as defensive (IRR=2.0) and midfield players (RR=1.5), were most at risk of sustaining a hamstring injury. Comparisons of 2008–2011 with 2012–2015 seasons revealed a 2-fold increase in hamstring injury incidences. Between 2008 and 2015 training incidence increased 2.3-fold and match-play incidences increased 1.3-fold.ConclusionsHamstring injuries are the most frequent injury in elite Gaelic football, with incidences increasing from 2008–2011 to 2012–2015. Tailoring risk management strategies to injury history, age and playing position may reduce the burden of hamstring injuries.

scholarly journals The mechanism of hamstring injuries – a systematic review

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Adam Danielsson ◽  
Alexandra Horvath ◽  
Carl Senorski ◽  
Eduard Alentorn-Geli ◽  
William E. Garrett ◽  
...  
Keyword(s):  
Systematic Review ◽  
Kinematic Analysis ◽  
Gait Cycle ◽  
Swing Phase ◽  
Injury Mechanism ◽  
Hamstring Injury ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Hamstring Injuries ◽  
Hip Flexion

Abstract Background Injuries to the hamstring muscles are among the most common in sports and account for significant time loss. Despite being so common, the injury mechanism of hamstring injuries remains to be determined. Purpose To investigate the hamstring injury mechanism by conducting a systematic review. Study design A systematic review following the PRISMA statement. Methods A systematic search was conducted using PubMed, EMBASE and the Cochrane Library. Studies 1) written in English and 2) deciding on the mechanism of hamstring injury were eligible for inclusion. Literature reviews, systematic reviews, meta-analyses, conference abstracts, book chapters and editorials were excluded, as well as studies where the full text could not be obtained. Results Twenty-six of 2372 screened original studies were included and stratified to the mechanism or methods used to determine hamstring injury: stretch-related injuries, kinematic analysis, electromyography-based kinematic analysis and strength-related injuries. All studies that reported the stretch-type injury mechanism concluded that injury occurs due to extensive hip flexion with a hyperextended knee. The vast majority of studies on injuries during running proposed that these injuries occur during the late swing phase of the running gait cycle. Conclusion A stretch-type injury to the hamstrings is caused by extensive hip flexion with an extended knee. Hamstring injuries during sprinting are most likely to occur due to excessive muscle strain caused by eccentric contraction during the late swing phase of the running gait cycle. Level of evidence Level IV

scholarly journals Reconsidering Return-to-Play Times: A Broader Perspective on Concussion Recovery

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876085 ◽  
Author(s):  
Christopher D’Lauro ◽  
Brian R. Johnson ◽  
Gerald McGinty ◽  
C. Dain Allred ◽  
Darren E. Campbell ◽  
...  
Keyword(s):  
Recovery Time ◽  
Time Window ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Sample Population ◽  
Intercollegiate Athletes ◽  
Level Of Evidence ◽  
Athletic Status ◽  
Recovery Times ◽  
Concussion Recovery

Background: Return-to-play protocols describe stepwise, graduated recoveries for safe return from concussion; however, studies that comprehensively track return-to-play time are expensive to administer and heavily sampled from elite male contact-sport athletes. Purpose: To retrospectively assess probable recovery time for collegiate patients to return to play after concussion, especially for understudied populations, such as women and nonelite athletes. Study Design: Cohort study; Level of evidence, 3. Methods: Medical staff at a military academy logged a total of 512 concussion medical records over 38 months. Of these, 414 records included complete return-to-play protocols with return-to-play time, sex, athletic status, cause, and other data. Results: Overall mean return to play was 29.4 days. Sex and athletic status both affected return-to-play time. Men showed significantly shorter return to play than women, taking 24.7 days (SEM, 1.5 days) versus 35.5 days (SEM, 2.7 days) ( P < .001). Intercollegiate athletes also reported quicker return-to-play times than nonintercollegiate athletes: 25.4 days (SEM, 2.6 days) versus 34.7 days (SEM, 1.6 days) ( P = .002). These variables did not significantly interact. Conclusion: Mean recovery time across all groups (29.4 days) showed considerably longer return to play than the most commonly cited concussion recovery time window (7-10 days) for collegiate athletes. Understudied groups, such as women and nonelite athletes, demonstrated notably longer recovery times. The diversity of this sample population was associated with longer return-to-play times; it is unclear how other population-specific factors may have contributed. These inclusive return-to-play windows may indicate longer recovery times outside the population of elite athletes.

scholarly journals Effects of Different Recovery Times on Internal and External Load During Small-Sided Games in Soccer

2021 ◽  
pp. 194173812199546
Author(s):  
Luis Branquinho ◽  
Ricardo Ferraz ◽  
Bruno Travassos ◽  
Daniel A. Marinho ◽  
Mário C. Marques
Keyword(s):  
External Load ◽  
Recovery Time ◽  
Total Duration ◽  
Training Load ◽  
Maximum Speed ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Internal Load ◽  
Exercise Load ◽  
Recovery Times

Background: The ability to maintain a high intensity of exercise over several repetitions depends on recovery from previous exercises. This study aimed to identify the effects of different recovery times on internal and external load during small-sided soccer games. Hypothesis: An increase in recovery time will increase the external training load and decrease the internal exercise load, which will result in a greater physical impact of the exercise. Study Design: Cross-sectional study. Level of Evidence: Level 2. Methods: Twenty male semiprofessional soccer players participated in the present study. They performed the same exercise (5-a-side game format) continuously (1 × 18 minutes) and repeatedly/fractionated (3 × 6 minutes) with different recovery times (30 seconds, 1 minute, 1.5 minutes, and 2 minutes). Their internal load (ie, average heart rate (HR) and maximum HR) and external load (ie, total distance, maximum speed, and ratio meters) were measured using an HR band and an inertial device equipped with a global positioning system, respectively. Results: The manipulation of recovery times induced differences in the internal and external load. For the same total duration, the external and internal load indicators exhibited higher values during the fractionated method, particularly with short recovery periods. Conclusion: The application of small-sided soccer games with different recovery times induced varying responses in training load. To maintain high physical performance and high training load, the fractional method with short recovery periods (ie, 30 seconds) should be used. In contrast, to carefully manage players’ efforts and decrease response to training load, continuous or fractional methods with longer recovery periods (ie, 1-2 minutes) should be used. Clinical Relevance: The proper prescription of recovery time between exercises facilitates enhanced training efficiency and optimized performance.

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