Muscle Strains / hamstring strains

Muscle strains

Muscle strains are prevalent in sport and result when the muscle fails to withstand a certain force or strain (1) strains usually occur near the muscle-tendon junction (2), often during eccentric contraction (3).

Hamstring strains Hamstring strains are the most common of all muscle strains (4,5), accounting for 25% of all muscles strains in the body (6). Hamstring strains have a high recurrence rate (4, 7,8), and represent a significant source of lost time in competition (9). Studies by (10) and (11) found hamstring recurrence rates of 14% and 34% respectively. There is no consensus on optimal treatment and rehabilitation of hamstring strains, hence management tends to be based on anecdotal evidence and experience rather than evidence based practice (12). The cause of hamstring strains is considered multi-factorial (13). Various mechanisms have been hypothesised including; past history of posterior thigh injury, increasing age (8), race, past history of knee and groin injury (14), hamstring strength deficiency (15), lack of flexibility (16), strength imbalances between quadriceps and hamstrings, biarticular muscles (17), fatigue and incomplete rehabilitation (18). Recently, poor pelvic instability arising from excessive foot pronation has been hypothesised as a contributing factor to hamstring strains (12). Consequently, the management of hamstring strains is a challenge given the multi-factorial aetiology (19). The mechanism-of-injury often cited is ‘eccentric-deceleration’ involving biarticular muscles, therefore eccentric muscle strength training can play an important part in prevention of hamstring strains (20).

Hamstring tear in the muscle-tendon junction

References

1. Malliaropoulos N, Papalexandris S, Papalada A, Papacostas E, (2004). The role of stretching in rehabilitation of hamstring injuries: 80 athletes follow-up. Medicine Science in Sports & Exercise, 36, 756-759.
2. Taylor DC, Dalton JD, Seaber AV, Garrett WE, (1993). Experimental muscle strain. The American Journal of Sports Medicine, 21(2), 190-193.
3. Noonan TJ, Best TM, Seaber AV, Garrett WE, (1994). Identification of a threshold for skeletal muscle injury. The American Journal of Sports Medicine, 22(2), 257-261.
4. Askling C, Saartok T, Thostensson A, (2006). Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. British Journal of Sports Medicine, 40, 40-44.
5. Hoskins W, Pollard H, (2005a). The management of hamstring injury – part 1: Issues of diagnosis. Manual Therapy, 10, 96-107.
6. Brothers A, Alamin T, Pedowitz R, (2003). Basic clinical management of muscle strains and tears. The Journal of Musculoskeletal Medicine, 20, 303-307.
7. Mason DL, Dickens V, Vail A, (2004). Rehabilitation for hamstring injuries (Protocol). The Cochrane Database of Systematic Reviews. Art. No.: CD004575.
8. Sherry MA, Best MT, (2004). A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. The Journal of Orthopaedic and Sports Physical Therapy, 34, 116-125.
9. Slavotinek JP, Verrall GM, Fon GT, (2002). Hamstring injury in athletes: Using MR imaging measurements to compare muscle injury with amount of time lost from competition. American Journal of Roentgenology, 179, 1621-1628.
10. Dadebo B, White J, George KP, (2004). A survey of flexibility training protocols and hamstring strains in professional football clubs in England. British Journal of Sports Medicine, 38, 388-394.
11. Orchard J, Seward H, (2002). Epidemiology of injuries in the Australian Football League, seasons 1997-2000. British Journal of Sports Medicine, 36, 39-45.
12. Fleet, T., Edge, D. Catterall, K. (2008). Prevention of Hamstring Injuries in a Professional Football Club: using a multi-discipline sports medicine team approach. Journal of Sportex Dynamics, 15,10-14.
13. Koulouris G, Connell D, (2003). Evaluation of hamstring muscle complex following acute injury. Skeletal Radiol, 32, 582-589.
14. Verrall GM, Slavotinek JP, Barnes PG, Fon GT, Spriggins AJ, (2001). Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging. British Journal of Sports Medicine, 35, 435-440.
15. Askling C, Karlsson J, Thorstensson A, (2003). Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scandinavian Journal of Medicine & Science in Sport, 13, 244-250.
16. Bandy WD, Irion JM, Briggler M, (1998). The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles. Journal of Orthopaedic and Sports Physical Therapy, 27(4), 295-300.
17. French, D. N. (2008). Conditioning the hamstrings: Training considerations for performance and injury prevention. Journal of Sportex Dynamics, 15, 18-22.
18. Croisier JL, Forthomme B, Namurois MH, et. Al. (2002). Hamstring muscle strain recurrence and strength performance disorders. The American Journal of Sports Medicine, 30, 199-203.
19. Hoskins W, Pollard H, (2005b). Hamstring injury management – part 2: Treatment. Manual Therapy, 10, 180-190.
20. Roig Pull, M., Ranson, C. (2007). Eccentric muscle action: Implications for injury prevention and rehabilitation. Journal of Physical Therapy in Sport. 8(2), 88-97.