Hamstring Injuries in Sports
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Questions and Answers

What is the primary cause of hamstring strain injuries?

  • Inadequate warm-up
  • Weak quadriceps
  • Direct impact to the thigh
  • Forceful contraction or intense stretching of the hamstrings (correct)

    • Hamstring strain injuries typically do not result in significant time loss from competition.

    False

    What is the role of the hamstrings during high-speed running?

    They control hip flexion and knee extension while absorbing energy.

    A professional soccer team of 25 players can expect about ___ hamstring strains per season.

    <p>7</p> Signup and view all the answers

    Match the phase of movement with its role in hamstring injury susceptibility:

    <p>Terminal swing phase = Prone to injury due to rapid lengthening Concentric contraction = Produces hip extension and knee flexion Eccentric contraction = Controls hip flexion and knee extension Force development in elongated position = Compromised after injury</p> Signup and view all the answers

    Which factor increases the risk of hamstring injury?

    <p>Inability to produce sufficient force in a lengthening position</p> Signup and view all the answers

    The biceps femoris short head is biarticular and crosses both hip and knee joints.

    <p>False</p> Signup and view all the answers

    Hamstring strain injuries frequently cause a loss of time from competition, generally ranging from ___ to ___ days or more.

    <p>3, 28</p> Signup and view all the answers

    Which of the following factors is NOT considered a prognostic factor for injury recovery?

    <p>Time of day of the injury</p> Signup and view all the answers

    Hamstring tightness is indicated if the hip joint angle is less than 80° during the passive straight leg raise test.

    <p>True</p> Signup and view all the answers

    What position should hamstring strength testing be conducted in?

    <p>Prone position</p> Signup and view all the answers

    The active knee extension test is a reliable measure of hamstring __________.

    <p>flexibility</p> Signup and view all the answers

    What is the primary goal of early rehabilitation after a hamstring injury?

    <p>Normalizing gait</p> Signup and view all the answers

    Match the following hamstring assessment tests with their function:

    <p>Passive Straight Leg Raise = Measures hamstring tightness Active Knee Extension Test = Measures hamstring flexibility Hamstring Strength Testing = Evaluates muscle strength</p> Signup and view all the answers

    Early hip and knee range of motion contributes to disorganized scar formation.

    <p>False</p> Signup and view all the answers

    What is one of the interventions introduced to enhance lumbopelvic control during recovery?

    <p>Progressive agility and trunk stabilization exercises</p> Signup and view all the answers

    What is a benefit of the PATS program for athletes recovering from hamstring injuries?

    <p>Promotes controlled early loading through frontal-plane movements</p> Signup and view all the answers

    Eccentric strengthening should start when athletes can perform pain-free, maximal isometric contractions.

    <p>False</p> Signup and view all the answers

    At what angle of knee flexion should an athlete achieve 5/5 strength before advancing to end-range strengthening?

    <p>90°</p> Signup and view all the answers

    The PATS program significantly decreased injury recurrence during the first _____ and _____ following return to sport.

    <p>2 weeks, 1 year</p> Signup and view all the answers

    Match the exercises with their description in the PATS program:

    <p>Sidestepping = 3 sets of 1 minute Cariocas = 3 sets of 1 minute Boxer Shuffle = 3 sets of 1 minute Rotating Side Planks = 3 sets of 20 repetitions</p> Signup and view all the answers

    Which of the following is a component of the rehabilitation for hamstring injuries?

    <p>Controlled submaximal isometric contractions</p> Signup and view all the answers

    Athletes can return to full participation after completing any rehabilitation exercise.

    <p>False</p> Signup and view all the answers

    What is the primary focus during the final phase of rehabilitation for hamstring injuries?

    <p>Sport-specific drills and return-to-sport testing</p> Signup and view all the answers

    What is the primary muscle involved in injuries during high-speed running?

    <p>Biceps femoris long head</p> Signup and view all the answers

    Injuries to the intramuscular tendon of the biceps femoris long head heal slower than injuries to the proximal free tendon of the semimembranosus.

    <p>False</p> Signup and view all the answers

    What is one nonmodifiable risk factor for developing recurrent hamstring strain?

    <p>Previous hamstring strain</p> Signup and view all the answers

    During high-speed running, hamstrings are actively lengthening to decelerate the limb for _____ contact with the ground.

    <p>initial</p> Signup and view all the answers

    Match the following risk factors with their types:

    <p>Previous hamstring strain = Nonmodifiable Age over 23 = Nonmodifiable Hamstring weakness = Modifiable Hamstring to quadriceps strength imbalance = Modifiable</p> Signup and view all the answers

    Which symptom is NOT commonly associated with hamstring injuries?

    <p>Increased flexibility</p> Signup and view all the answers

    Hamstring injuries caused by kick activities primarily affect the biceps femoris long head.

    <p>False</p> Signup and view all the answers

    What is one sign that may appear during the physical examination of a hamstring injury?

    <p>Pain with resisted knee flexion</p> Signup and view all the answers

    What is the primary focus of Stage 1 in hamstring rehabilitation?

    <p>Slow jogging with minimal pain</p> Signup and view all the answers

    Eccentric exercises are less effective in hamstring injury prevention than concentric training.

    <p>False</p> Signup and view all the answers

    What is one example of an end-range eccentric strengthening exercise?

    <p>Single-limb windmill</p> Signup and view all the answers

    The combination of clinical assessment, performance tests, and isokinetic dynamometry tests assists in return to sport (RTP) decision making after a hamstring injury. The isokinetic testing should show less than __________ deficit in the eccentric hamstring to concentric quadriceps ratio.

    <p>5%</p> Signup and view all the answers

    Match the stages of rehabilitation with their key characteristics:

    <p>Stage 1 = Slow jogging, about 25% maximum speed Stage 2 = Moderate-speed running, pain-free Stage 3 = Gradual progression to sprinting, up to 100% maximum speed Return to Sport = Combination of clinical assessment and performance tests</p> Signup and view all the answers

    What percentage of athletes risk reinjury when only performing stretching and strengthening exercises after a hamstring injury?

    <p>70%</p> Signup and view all the answers

    Maximal isometric strength testing is not necessary for return to sport criteria.

    <p>False</p> Signup and view all the answers

    What type of exercises are recommended to lower the risk of hamstring strain reinjury?

    <p>Agility and stabilization exercises</p> Signup and view all the answers

    What percentage of athletes felt insecure during the active hamstring test post-injury?

    <p>95%</p> Signup and view all the answers

    Standard hops are effective criteria for athletes returning to sport after a hamstring injury.

    <p>False</p> Signup and view all the answers

    What type of exercises should be implemented post-return to help athletes reduce the risk of re-injury?

    <p>Ongoing progressive eccentric and lumbopelvic strengthening exercises</p> Signup and view all the answers

    The active hamstring test is a _______ flexibility test.

    <p>ballistic</p> Signup and view all the answers

    Match the findings with their implications regarding hamstring injuries:

    <p>26% ongoing muscle injury = Evidence of muscle damage at return Persistent edema on MRI = Indicates ongoing healing Reduction in knee flexor torque = Weakness that may lead to re-injury Eccentric training = Enhances stability and reduces re-injury risk</p> Signup and view all the answers

    What aspect did Silder et al. report about the hamstring muscle complex during MRI scans?

    <p>Evidence of ongoing muscle injury</p> Signup and view all the answers

    Physical therapists should only focus on pain control during early rehabilitation.

    <p>False</p> Signup and view all the answers

    Athletes must meet criteria like full _______ of motion and passing strength tests.

    <p>range</p> Signup and view all the answers

    Study Notes

    Hamstring Strain Injury in Athletes

    • Hamstring strains occur due to sudden forceful contraction or intense stretching of the hamstring muscles. High mechanical stress leads to this
    • Characterized by sharp pain in the back of the thigh, caused by hamstring muscle fiber disruption, without direct external impact.
    • High-speed running, jumping, kicking, and explosive movements with rapid directional changes (lifting objects from the ground) frequently cause hamstring strains.
    • A professional soccer team of 25 players can expect approximately 7 hamstring strains per season
    • Hamstring strains can result in a significant loss of competition time, ranging from 3 to 28 days or more, depending on injury severity.

    Relevant Anatomy and Biomechanics

    • The hamstring complex, except for the biceps femoris short head, is a biarticular structure that crosses both the hip and knee joints.
    • Concentric contractions in the complex cause hip extension and knee flexion, while eccentric contractions control hip flexion and knee extension.
    • During many sports activities, the hamstring muscles produce high levels of force eccentrically for stabilization across the hip and knee joints.
    • The inability to produce sufficient force during lengthening positions increases muscle susceptibility to injury.
    • Following a hamstring injury, peak knee flexion torque shifts to a shorter musculotendon length (increased knee flexion angle), potentially increasing recurrence due to compromised force development within elongated positions.
    • High-speed running is a common cause of hamstring strains due to the high activity and rapid lengthening of the hamstrings during the terminal swing phase before foot contact.
    • Hamstring muscle force increases by about 1.3 times as running speed increases from 80% to 100% maximum, with the greatest stretch experienced in the long head of the biceps femoris.
    • Injury location within the hamstring complex (intramuscular tendon of the biceps femoris long head versus proximal tendon of the semimembranosus) affects recovery time. Injuries to the intramuscular portion heal faster than those involving the proximal free tendon.

    Risk Factors

    • Non-modifiable: Previous hamstring strain is the most significant risk factor, with a 2-6 times higher recurrence rate post-injury. Age is also a factor, where athletes older than 23/25 years show a higher risk.
    • Modifiable: Hamstring weakness during eccentric contraction, lumbopelvic weakness, and an imbalance between hamstring and quadriceps strength

    Examination

    • Sudden onset of posterior thigh pain is a characteristic symptom.
    • Other symptoms may include audible popping sounds, antalgic gait (shortened stride length), bruising (ecchymosis), posterior thigh swelling, and pain with sitting or direct pressure.
    • Physical examination reveals pain and weakness during resisted knee flexion/hip extension and pain during passive hip flexion/knee extension. Palpation of injury site, tenderness, mechanism of injury, and the time to return to pain-free walking.

    Muscle Strength Measurements

    • Hamstring strength testing is done in the prone position, with hip stabilization at 0° extension. Medical and lateral hamstring muscles can be assessed using internal/external tibial rotation at different knee flexion angles (90° and 15°).
    • Hip Extension strength is evaluated with the knee at 90° and 0°, applying manual resistance to the distal posterior thigh and heel.

    ROM Measurements

    • Range of motion is assessed through the passive straight leg raise test and active knee extension test.
    • Hamstring tightness is indicated if hip joint angle is <80° during passive straight leg raise and knee flexion angle >20° during active knee extension test.
    • Acute hamstring injury (<5 days) can be assessed reliably using the active knee extension test.
    • Significant increase in ROM on injured side compared to uninjured side suggests avulsion injury.

    Prognostic Factors

    • Injury proximity to the ischial tuberosity correlates with recovery time, with more proximal injuries needing longer rehabilitation.
    • Excessive stretching injuries require longer rehab compared to high-speed running injuries.
    • Injuries to the proximal free tendon of the hamstring take longer to recover than injuries to the musculotendon junction
    • Athletes taking >1 day to walk pain free post- injury are more likely to need >3 weeks rehab before returning to 100% sport functions
    • Active knee extension test doesn't determine return-to-sport time

    Rehabilitation Goals and Intervention

    • Early rehabilitation focuses on pain management, gait normalization, and gentle strengthening.
    • Progressive agility and trunk stabilization exercises (PATS) enhance lumbopelvic control, reduce risk of re-injury.
    • Controlled early loading through frontal plane movements, while avoiding end-range hamstring lengthening, promote PATS benefits.
    • Eccentric strengthening, following acute injury, promotes better muscle function. Initiating eccentric strengthening early can reduce injury recurrence risk. Focus on concentric contractions (initially) in the mid-range, and move to end-range with increased load as strength improves.
    • The final step involves sport-specific drills and return-to-sport testing, prioritizing re-injury risk mitigation.

    Progressive Agility and Trunk Stabilization (PATS) Program

    • A PATS program within the first week of a hamstring injury significantly reduces injury recurrence rates in the first 2 weeks and 1 year after returning to sports.
    • Exercises like sidestepping, caroticas, boxer shuffle, and rotating side planks (3 sets of 20 repetitions each) are involved.

    Progressive Running Program

    • A three-stage protocol for a gradual return to high-speed running and sprinting and involves minimal pain, starting with slow jogging (25% of max speed), progressing to moderate-speed running (50% of max speed), and culminating in progressively increasing intensity toward maximum speed (up to 100% of max speed). Increment of 5-10% to reduce the risk of re-injury.

    Eccentric Exercises

    • Eccentric hamstring exercises are a common intervention to prepare athletes for high-speed running, address strength and muscle structure deficits, and prevent re-injury (research supports this over concentric training).
    • Progressive exercises are done when full ROM is achieved with a pain rating ≤4/10

    End Range Eccentric Strengthening Examples

    • Single-limb windmill, single-limb chair bridge, single-leg deadlift, and supine bent knee walk-out.

    Clinical Practice Guidelines

    • Guidelines recommend using eccentric training with stretching, strengthening, stabilization and progressive running programs to improve return-to-play (RTP) time.

    Interventions after Injury

    • The systematic review noted that agility/stabilization exercises done after injury were associated with a lower risk of re-injury compared to only stretching/strengthening.

    Injury Prevention of First-Time Injury

    • Include components like warm-up exercises, stretching, stability training, strengthening and specific sport-related functional movements (Agility, high-speed running) as part of an injury prevention program.

    Return to Sport

    • A combination of clinical assessments, performance testing, (sprinting, agility, hopping), and isokinetic dynamometry informs RTP decision-making.

    Return to Sport Criteria

    • Full pain-free hip and knee range of motion;
    • Maximal isometric strength;
    • Negative hamstring test;
    • Normal isokinetic ratio for hamstring on concentric to quadriceps eccentric;
    • No pain during functional/sport-specific activities;
    • No pain with active hamstring tests.
    • No palpable tenderness along the posterior thigh;
    • No pain or apprehension during functional/sport-specific activities.

    Return to Sport Implications

    • Imaging studies indicate ongoing muscle injury, even after athletes meet criteria.
    • Morphologic/strength deficits may remain for athletes who followed return to sport protocols.
    • Post-return progressive eccentric and lumbopelvic strengthening is vital to reach pre-injury performance levels and reduce risk of re-injury.

    Summary

    • Initial rehab focuses on pain, gait normalization, and mild strengthening.
    • PATS, eccentric exercises enhance stability and lower re-injury risk.
    • Athletes need to meet criteria like full range of motion and pass strength tests.
    • Continued eccentric and core strengthening prevent future injuries.

    References

    • Specific research articles are cited in the provided text, however, these references are not included in this summary, as requested.

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    Hamstring Strain Injury in Athletes PDF

    Description

    This quiz covers the essential aspects of hamstring strain injuries, including causes, risk factors, and their impact on athletic performance. Evaluate your understanding of the role of hamstrings during high-speed running and the implications of injury recovery. Ideal for sports medicine and physiotherapy students.

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