Assessment of player performance following return to sport after hamstring muscle strain injury

doi:10.1016/j.jsams.2006.03.007

Journal of Science and Medicine in Sport

Volume 9, Issues 1–2, May 2006, Pages 87-90

https://doi.org/10.1016/j.jsams.2006.03.007 Get rights and content

Summary

Objective

To determine if there is any decrease in playing performance of athletes following return to sport after recovery from hamstring muscle strain injury.

Design

Prospective cohort study.

Participants

One professional Australian football team over two playing seasons.

Methods

For every game, the team coach rated player performance proportional to time spent on the ground playing (an integer score out of a maximum of 10). Player performance ratings were compared pre- and post-hamstring muscle strain injury to assess player performance upon return to sport.

Results

Thirteen athletes had hamstring injuries and the required player ratings were available. The mean player performance rating for the entire playing season in which the player was injured was 6.9. The mean player performance rating for the two games prior to injury was 6.8 as opposed to 5.4 for the two games after return to sport. Athletes had a significantly lower player performance rating immediately upon return to sport when compared to ratings for the entire season (p < 0.001) and when compared to ratings from the two games prior to injury (p < 0.001).

Conclusions

Following return to sport from hamstring injury, player performance as assessed by the team coach is reduced. This suggests that some athletes may return to sport prior to complete resolution of the injury.

Introduction

Hamstring muscle strain injuries are common in many sports, including the various football codes.1, 2 In Australian football, hamstring injuries are responsible for the greatest quantity of competition time lost due to injury² and have a high recurrence rate.2, 3 Athletes in professional sports are aware of the troublesome nature and high recurrence rate of hamstring injuries.⁴ Despite this there is often an expectation from the team, coach and the athletes themselves to return to active competition as soon as practical following this injury. Although no data have been presented about player performance after return to sport from hamstring injury, evidence from magnetic resonance imaging (MRI) studies,⁵ laboratory studies of muscle stretch injury6, 7 and the observed high recurrence rate³ suggests that the injury in many cases has not fully resolved at the time of return to sport. Accordingly, the aim of this study was to determine if athlete performance is poorer following return to sport after recovery from hamstring injury.

Section snippets

Method

All athletes were male and played professional Australian football for an elite level team consisting of first and reserve grade teams. The study was conducted over two full playing seasons with the team playing weekly for 25 competition matches in each season.

Hamstring muscle strain injury was noted when a player developed pain localised to the posterior thigh during the course of playing or training and subsequent MRI scan detected focal intramuscular hyperintensity within the hamstring

Results

Across the two seasons, a total of 20 hamstring injuries were recorded. Thirteen of these injuries had relevant player ratings and were therefore included in the analyses. Seven athletes were excluded (three had insufficient pre-injury ratings, four had insufficient post-injury ratings). Three of the 13 returned to play in the reserve grade and played one match there, before being promoted to the first grade team, whereas the other 10 played in the first grade team for their return from injury

Discussion

This study demonstrates that player performance in Australian football is reduced in the immediate return to play period following hamstring injury. This is consistent with the hypothesis that athletes often return to sport prior to complete resolution, with respect to muscle healing, of injury.³ As obtaining direct histological evidence is difficult in the study of athletic hamstring injuries, indirect evidence, such as player performance or persistent MRI abnormalities may provide support for

Conclusions

This study demonstrates that player performance as assessed by the team coach is reduced following return to play after hamstring injury. This is consistent with the proposition from other studies that some athletes may return to sport prior to complete resolution of injury.

Practical implications

•
Player performance is reduced following return to play after hamstring injury.
•
Some athletes return to play prior to complete resolution of the hamstring injury.
•
Coaches, players and the medical team should be aware for the potential for player performance to be impaired when making decisions on the timing of return to play for hamstring injured athletes.

Acknowledgements

The authors wish to thank Dr. Adrian Esterman for his statistical analysis. The coach of the Norwood football club, Mr. Peter Rhode is also thanked.

References (10)

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Risk factors for injuries in football
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J. Orchard et al.
Epidemiology of injuries in the Australian Football League, seasons 1997–2000
Br J Sports Med
(2002)
J. Orchard et al.
The management of muscle strain injuries: an early return versus the risk of recurrence
Clin J Sports Med
(2002)
W.E. Garrett
Muscle strain injuries
Am J Sports Med
(1996)
D.A. Connell et al.
Longitudinal study comparing sonographic and MRI assessment of acute and healing hamstring injuries
Am J Roentgenol
(2004)

There are more references available in the full text version of this article.

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Notre objectif principal était de rechercher une éventuelle association entre les caractéristiques IRM initiales d’une lésion musculaire des ischio-jambiers et une récidive lésionnelle de lésion musculaire des ischio-jambiers. L’objectif secondaire était de rechercher d’éventuels facteurs de risque cliniques de récidive de lésion musculaire des ischio-jambiers.
Nous avons utilisé les données recueillies dans le cadre de l’étude HAMMER (HAMstring MEchanics and MRi), étude de cohorte prospective, multicentrique, non interventionnelle, qui consistait en la réalisation d’une IRM lors d’une suspicion clinique d’une lésion musculaire des ischio-jambiers. Nous avons recontacté les patients au moins 3 mois après leur lésion initiale des ischio-jambiers afin de les interroger sur une éventuelle récidive de lésion musculaire des ischio-jambiers ainsi que des éventuelles conséquences fonctionnelles. Ont aussi été inclus les patients de la cohorte HAMMER vus une seconde fois pour une récidive de lésion musculaire des ischio-jambiers.
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Notre étude cas-témoin était novatrice. Elle a permis de montrer que le plus faible volume lésionnel, le jeune âge , le sexe masculin, un IMC bas et la plus faible douleur initiale étaient des facteurs de risque de récidive. Ces résultats devraient aider à développer des stratégies pour gérer le risque de récidive.
Our main objective was to investigate a possible association between the initial MRI characteristics of hamstring muscle injury and recurrence of hamstring muscle injury. The secondary objective was to investigate possible clinical risk factors for recurrence of hamstring muscle injury.
We used the data collected in the HAMMER study (HAMstring MEchanics and MRi), a prospective, multicentre, non-interventional cohort study, which consisted of performing an MRI when a clinical suspicion hamstring muscle injury. We recontacted the patients at least 3 months after their initial hamstring injury in order to question them about a possible recurrence of hamstring muscle injury as well as possible functional consequences. Also included were patients from the HAMMER cohort seen a second time for a recurrence of hamstring muscle injury.
Out of 69 patients with a first hamstring muscle injury, 38 patients could be contacted by telephone. Twelve had presented a recurrence of muscular lesion of the hamstrings. Three unreachable patients had a recurrence included in HAMMER. A link was found between recurrence of hamstring muscle lesion and low lesion volume, with no other remnographic characteristic associated with recurrence. Younger age, male sex, lower BMI and less pain at the time of injury were significant risk factors for recurrence of hamstring muscle injury.
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Hamstring injuries in the national football league: An epidemiological study
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Citation Excerpt :
Repeated HSI may be consequential for a players time in the game and performance upon RTP. In other sports such as rugby and Australian football, player performance has been negatively affected after HSI, however, there is a paucity of literature describing performance outcomes following HSIs in NFL players.4,9,27 HSIs in NFL players have been shown to have a distribution of 88% strains, 11.3% partial tears, and 0.63% complete tears.5
While numerous studies have evaluated National Football League injuries, there is limited literature evaluating hamstring injuries sustained in games. Our primary aim is to analyze the effect of player position on the relative incidence of hamstring injuries in the National Football League. Our secondary aims are to analyze the effects of field surface, week of the season, and short rest weeks.
Official National Football League game books containing injury data from the 2013–2016 regular seasons were used. Data were analyzed to determine the incidence of hamstring injuries by field surface, rest, and week of the season. Field surface was considered either turf or grass. Short rest was considered four days. Relative incidence of hamstring injuries by position was performed with standardized incidence ratios. P values < 0.05 were considered statistically significant.
Seventy-eight qualifying hamstring injuries were identified and included in our analysis. Linebackers had the highest relative incidence per play with a standardized incidence ratio of 2.02 (CI: 1.14–2.91), followed by Defensive Backs (1.62; 95% CI: 1.14–1.62). Offensive linemen and defensive linemen had standardized incidence ratios significantly less than 1. Fifty-seven percent of hamstring injuries occurred on turf fields (p = 0.082). There was no significant difference between the proportion of hamstring injuries that occurred on short rest and the proportion of games played on short rest (p = 0.959). Hamstring injuries were not more likely to occur than the pooled group of all other types of injuries on short rest (p = 0.861). With a 17-week season, the mean week of hamstring injury was 8.05 (95% CI: 7.06–9.04), while the median week was 7.5.
Linebackers and Defensive Backs have the highest relative incidence of hamstring injuries compared to other position groups, while offensive and defensive linemen have the lowest. Field surface and a short rest period did not show significance.
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Hamstring muscle strain injury (hamstring injury) is one of the most common non-contact injuries with both short- and long-term consequences in sports that involve sprinting and kicking.1–3 This injury often causes significant time loss from competition and training,4,5 which not only impairs athletes’ sports performance6,7 but also results in tremendous financial burdens to sports organizations and to society.4 Some studies have found that the hamstring injury rate is increasing or remains unchanged,8 indicating a need for increasing efforts in research into prevention and rehabilitation.
Hamstring injury is one of the most common injuries in sports involving sprinting. Hamstring flexibility and strength are often considered to be modifiable risk factors in hamstring injury. Understanding the effects of hamstring flexibility or strength training on the biomechanics of the hamstring muscles during sprinting could assist in improving prevention strategies and rehabilitation related to these injuries. The purpose of this study was to determine the effects of altering hamstring flexibility or strength on peak hamstring musculotendinous strain during sprinting.
A total of 20 male college students (aged 18–24 years) participated and were randomly assigned to either a flexibility intervention group or a strength intervention group. Each participant executed exercise training 3 times a week for 8 weeks. Flexibility, sprinting, and isokinetic strength testing were performed before and after the 2 interventions. Paired t tests were performed to determine hamstring flexibility or strength intervention effects on optimal hamstring musculotendinous lengths and peak hamstring musculotendinous strains during sprinting.
Participants in the flexibility intervention group significantly increased the optimal musculotendinous lengths of the semimembranosus and biceps long head (p ≤ 0.026) and decreased peak musculotendinous strains in all 3 bi-articulate hamstring muscles (p ≤ 0.004). Participants in the strength-intervention group significantly increased the optimal musculotendinous lengths of all 3 hamstring muscles (p ≤ 0.041) and significantly decreased their peak musculotendinous strain during sprinting (p ≤ 0.017).
Increasing hamstring flexibility or strength through exercise training may assist in reducing the risk of hamstring injury during sprinting for recreational male athletes.
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Some of the sport are important that considered to have a certain physique for it is necessary to recognize that experts that may damage these players are similar. Found and inertia, the moment of a larger mass of previous injuries, has been closely linked to the occurrence of a sprain of new employees' ankle [13]. The researchers concluded the body around the ankle joint rotation in complex ways in the standing phase of walking.
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Hamstring strain injuries (HSI) are the most common non-contact lower limb injuries in team sports that involve sprinting, kicking, jumping and high-speed movements.1 Increases in overall injury rates negatively influence team7 and individual performances,27 which have negative financial consequences for sporting organizations and athletes.9 As such, identifying factors associated with HSI have important applications in team sport.
Investigate the determinants of hamstring fascicle length in professional rugby league players.
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Thirty-three elite male athletes underwent testing in the pre-season and in-season periods. Fascicle length measurements of the biceps femoris long head, 3D kinematics and elapsed time-periods at thigh angular velocities between 20 °/s to peak velocity during a single-leg Nordic hamstring strength test, GPS-derived running loads, age and previous injury history were all recorded. Fixed effect determinants for fascicle length were analyzed using multiple linear regression.
Significant determinants of hamstring fascicle length were observed. Multivariate regression analysis showed modifiable factors including chronic (56 days) running volumes >80% of measured peak velocity and maximum velocity itself collectively explained 43% of the variability in the fascicle length data, whilst peak eccentric strength and elapsed time under load from 20 °/s to peak thigh angular velocity collectively contributed an additional 44%. Chronic running volumes >90% of individually measured peak velocity and the ‘break angle’ during a Nordic eccentric contraction were not significant contributors to the final model. Non-modifiable risk factors (age and previous injury) contributed the remaining 13%.
Managing high velocity running exposure as well as eccentric strength allows for ˜90% of the controllable determinants in fascicle length within elite athlete populations. An important contributor to the explained variability within fascicle length (superseded only by chronic velocity exposure and peak eccentric strength) was an athletes ability to achieve a prolonged contraction at long lengths during eccentric strength training rather than the angle of failure during the contraction in itself.
Hamstring muscle-tendon unit lengthening and activation in instep and cut-off kicking
2020, Journal of Biomechanics
Hamstring muscle strain injury is one of the most common injuries in sports involving sprinting and kicking. Studies examining hamstring kinematics and activations are rich for sprinting but lacking for kicking. The purpose of this study was to examine kinematics and activations of hamstring muscles in instep and cut-off kicking tasks frequently performed in soccer. Videographic and electromyographic (EMG) data were collected for 11 male soccer-majored college students performing the two kicking tasks. Peak hamstring muscle-tendon unit lengths, elongation velocities, and maximum linear envelop EMG data were identified and compared among hamstring muscles and between kicking tasks. Hamstring muscles exhibited activated elongations before and after the contact of the kicking foot with the ball. The muscle-tendon unit lengths peaked in the follow-through phase. The peak elongation velocity of the semimembranosus was significantly greater than that of the semitendinosus and biceps femoris (p = 0.001). The maximum linear envelop EMG of the biceps femoris was significantly greater than that of the semimembranosus (p = 0.026). The potential for hamstring injury exists in the follow-through phase of each kicking task. The increased hamstring muscle-tendon unit elongation velocities in kicking tasks may explain the more severe hamstring injuries in kicking compared to sprinting.

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Original paperAssessment of player performance following return to sport after hamstring muscle strain injury

Summary

Objective

Design

Participants

Methods

Results

Conclusions

Introduction

Section snippets

Method

Results

Discussion

Conclusions

Practical implications

Acknowledgements

Risk factors for injuries in football

Am J Sports Med

Epidemiology of injuries in the Australian Football League, seasons 1997–2000

Br J Sports Med

The management of muscle strain injuries: an early return versus the risk of recurrence

Clin J Sports Med

Muscle strain injuries

Am J Sports Med

Longitudinal study comparing sonographic and MRI assessment of acute and healing hamstring injuries

Am J Roentgenol

Original paper
Assessment of player performance following return to sport after hamstring muscle strain injury