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      • Gaenslen Test
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      • Gower's Sign
      • Lumbar Quadrant Test
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      • Slump Test
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Go to Return to Sport Functional Tests

Hamstring strain injuries: Are we heading in the right direction?

10/5/2014

1 Comment

 
Picture
Lately I have been seeing more and more hamstring strains as football season is underway.  This brought me back to some of my old literature reviews from residency and my own personal research.  Interestingly enough, many of the hamstring studies are poorly designed and have conflicting evidence.  However, this review did a nice job breaking down some of the strengths and flaws of these studies.  Additionally, the authors gave their opinions on some of the findings which I found especially useful.  Below are some of the highlights....

Previous Injury:  

-  "In humans, MRI has shown evidence of scar tissue for up to 1 year after an athlete’s return to sport. The presence of scar tissue can alter muscle transmission pathway, decrease tendon/aponeurosis complex compliance, and consequently lead to a modification of deformation patterns in the muscle tissue adjacent to the fibrous scar."

Flexibility: 

-  "However, the evaluation methods used to measure hamstring flexibility have been criticized for their static approach and inability to differentiate from lumbopelvic flexibility, which in turn has not been shown to be related to injury rates.

- "During running, the psoas of the contralateral leg had a greater influence on hamstring length than the hamstring itself."

Strength:  

- "The fact that most studies assess isokinetic strength during single joint movements may be one of the reasons for the current controversy since the hamstrings’ moment arms at the hip are nearly twice the length of those at the knee during the end of swing phase running."

- "However, a recent Cochrane Systematic Review conducted by Goldman and Jones has concluded that there is insufficient evidence to state that the protocols of eccentric training have the capacity to reduce hamstring injuries."

- "We believe that one major limitation may be the generalized use of the Nordic hamstring exercise, which works the knee flexors eccentrically but with the hip in a fixed position. During any movement, such as the swing phase of a sprint, the hip is not fixed but instead moves and works in coordination with the rest of the segments of the body."


Core Stability:

- "There are many hypotheses that associate hamstring injuries with lumbopelvic stability."

Architecture of Hamstring Muscle:

-  "It's been reported that hamstring injuries related to sprint actions affected mainly the proximal part of the biceps femoris, whereas overstretching injuries mainly involved the free proximal portion of the semimembranosus muscle."

-  "It is well accepted that the prevalence of biceps femoris injury is much higher than the medial hamstrings."


Neural Tension: 

-  "Neural tension has not been shown to be a risk factor24 but it may indirectly have an affect through decreased ROM."


- Brian

1 Comment
Devin
10/5/2014 11:19:15 pm

Hello,
While that review has some really interesting information, I'd be hesitant to shy away from eccentric training as a lot of good stuff has come out about their preventative effects more recently.

http://www.ncbi.nlm.nih.gov/pubmed/25227125
http://m.bjsm.bmj.com/content/48/7/609.3.abstract

Also some from Peterson et al, arnason et al, opal et al that I don't have time to look up right now.

Compliance is an important factor in hamstring prevention just as much as in acl prevention it's starting to look like.

http://www.sportsmedres.org/2013/10/compliance-with-neuromuscular-warm-up-injury-prevention.html?m=1

Let me know what you think

Reply



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    • Cervical Spine >
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      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
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      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
    • HEP >
      • Neck and Shoulder >
        • Supine Chin Tuck
        • Supine DNF with Towel Assist
        • Supine DNF
        • Standing Chin Tuck Against Wall
        • Standing Chin Tuck Against Wall with Scaption
        • Seated Cervical Retraction Repeated
        • Seated Cervical Retraction with Extension Repeated
        • Seated Cervical Retraction with Sidebend Repeated
        • Seated Cervical Retraction with Rotation Repeated
        • Standing Wall Shrugs at 90 Degrees Flex
        • Seated Thoracic Whips
        • Standing Ballistic Shoulder Extensions
        • Standing Repeated Shoulder Extension with Squat
        • Standing Repetead Shoulder Horiz. Abd. with Ext. CKC
        • Seated with Arms on Pillows Cervical AROM (Flex/Ext/Rot/SB)
        • Seated with Arms on Pillows Shrugs
        • Seated with Arms on Pillows Shrug with Scapular Retraction
        • Supine Shoulder IR with GH Centralization
        • Supine Shoulder ER with GH Centralization
        • Holding Dumbbell at 180 Degrees Flexion for Time
        • Cat Camel
        • Prone T's
        • Prone Y's
        • Quad Chin Tuck w/ Shoulder Flexion
      • Low Back >
        • Supine TA Isometric
        • Standing TA Isometric Agains Wall with Squat
        • Supine BKFO
        • Quad Rock Back
        • Standing Hip Hinge
        • Sit to Stand with Hip Hinge
        • Repeated Lumbar Sideglides
        • Repeated Standing Lumbar Extension
        • Repeated Standing Lumbar Flexion
        • Repeated Prone Press-Ups
        • Repeated Supine DKC
        • Slump Sciatic Nerve Glides
        • Birddog Progression
      • Hip and Knee >
        • Clamshells with Progressions
        • Fire Hydrants with Progressions
        • Donkey Kicks
        • Bridge Variations
        • Repeated Hip Flexion
        • Squats
        • Seated Repeated Knee Extensions
        • CKC Seated Repeated Knee Extensions
        • Heel Slides
        • CKC DF with Tibial IR
      • Foot and Ankle >
        • Calf Raises
        • Calf Raises with Soccer Ball Between Medial Malleoli
        • Towel Scrunches with Foot in PF
        • Toe Flexion Using T-Band with Foot in PF
        • PF with Toes Flexed Using T-Band
        • DF with Toes Flexed Using T-Band
        • Forefoot Adduction
        • Gastroc Stretch
        • Repeated PF
      • Examination Templates