Hamstring injury patterns in professional male football (soccer): a systematic video analysis of 52 cas

ObjectiveTo closely describe the injury inciting events of acute hamstring injuries in professional male football (soccer) using systematic video analysis.MethodsVideo footage from four seasons (2014–2019) of the two highest divisions in German male football was searched for moderate and severe (ie, time loss of >7 days) acute non-contact and indirect contact match hamstring injuries. Two raters independently categorised inciting events using a standardised procedure to determine specific injury patterns and kinematics.Results52 cases of hamstring injuries were included for specific pattern analysis. The pattern analysis revealed 25 sprint-related (48%) and 27 stretch-related hamstring injuries (52%). All sprint-related hamstring injuries occured during linear acceleration or high-speed running. Stretch-related hamstring injuries were connected with closed chain movements like braking or stopping with a lunging or landing action and open chain movements like kicking. The kinematic analysis of stretch-related injuries revealed a change of movement involving knee flexion to knee extension and a knee angle of <45° at the assumed injury frame in all open and closed chain movements. Biceps femoris was the most affected muscle (79%) of all included cases.ConclusionDespite the variety of inciting events, rapid movements with high eccentric demands of the posterior thigh are likely the main hamstring injury mechanism. This study provides important data about how hamstring injuries occur in professional male football and supports the need for demand-specific multicomponent risk reduction programmes.

Surveillance of Injury Types, Locations, and Intensities in Male and Female Tennis Players: A Content Analysis of Online Newspaper Reports

The popularity of modern tennis has contributed to the increasing number of participants at both recreational and competitive levels. The influx of numerous tennis participants has resulted in a wave of injury occurrences of different types and magnitudes across both male and female players. Since tennis injury harms both players’ economic and career development, a better understanding of its epidemiology could potentially curtail its prevalence and occurrences. We used online-based tennis-related injury reports to study the prevalence, location types, and injury intensities in both male and female tennis players for the past five years. It is demonstrated from the chi-square analysis that injury occurrences are significantly associated with a specific gender (χ2(18) = 50.773; p = 0.001), with male players having a higher risk of injury manifestation (68.10%) as compared with female players (31.90%). Nonetheless, knee, hip, ankle, and shoulder injuries are highly prevalent in both male and female players. Moreover, the injury intensities are distributed across gender (χ2(2) = 0.398; p = 0.820), with major injuries being dominant, followed by minor injuries, whilst a few cases of career-threatening injuries were also reported. It was similarly observed that male players recorded a higher degree of both major, minor, and career-threatening injuries than female players. In addition, male players sustained more elbow, hip, knee, shoulder, and thigh injuries than female players. Whereas, female players mostly suffered from Achilles and back injuries, ankle and hamstring injuries affected both genders. The usage of online newspaper reports is pivotal in characterizing the epidemiology of tennis-related injuries based on locations and gender to better understand the pattern and localization of injuries, which could be used to address the problem of modern tennis-related injuries.

Intratendinous hamstring injuries: sequential MRIs as a tool to reduce the risk of reinjury in elite sport

Hamstring injuries are the most common muscle injuries in elite football. Injuries involving the intramuscular tendon are considered more significant, with longer return to play (RTP) times and an increased risk of reinjury. MRI is the gold standard investigation for muscle injuries, but initial findings cannot accurately determine RTP times. The role of MRI in monitoring muscle and tendon healing is not well described. We present three cases of hamstring injuries with intramuscular tendon involvement, illustrating the changes seen on MRI during progressive tendon healing and describing how we utilised this information to inform safe rehabilitation progression. We conclude that intramuscular hamstring tendon healing can be accurately seen on sequential MRI scans and that this information, when combined with traditional rehabilitation markers in and elite sport environment, can be utilised by clinicians to determine the earliest but safe RTP.

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

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.