None listed
Conditions
Brief summary
The aims of this research project are to determine how hamstring muscle function and structure change over time during rehabilitation for hamstring strain injury and whether exercising completely pain-free or to a pain-threshold effects the time course of these changes. The research project is split into two parts, part A is a cohort study to determine presence of acute hamstring strain injury and part B is a randomised control trial. We will recruit recreationally active males and females who suspect they have suffered an acute hamstring strain injury for part A of the study until we have recruited forty participants with clinically confirmed acute hamstring strain injury within seven days of initial suspected injury for part B of the study. Part A of the study involves a one off initial clinical assessment including a subjective interview, inspection of the injury site, assessments of muscle structure, strength and flexibility to determine presence of acute hamstring strain injury. If acute hamstring strain injury is confirmed within seven days of initial suspected injury, participants will be eligible to participate in part B of the study and randomised to either a pain-free or pain-threshold exercise group. Both groups in part B of the study will complete identical follow-up clinical assessments and rehabilitation including progressive running and resistance exercise twice per week until pre-determined return to play criteria is met. Participants in the pain-free group must complete all exercises and running within the rehabilitation protocol completely pain-free and if any level of pain in caused during rehabilitation, exercises will be altered appropriately. Participants in the pain-threshold group will be allowed to exercise and run to a pain-threshold of 4/10 on a visual analogue scale (VAS) and if any level of pain greater than this is experienced during rehabilitation, exercises will be adjusted accordingly. Once these criteria have been met, participants will be free to resume their previous level of activity and invited to attend ACU on a weekly basis for follow-up clinical assessment as above for a period of 3 months. During this period and the subsequent 24 months following return to play clearance, participants will be contacted on a weekly basis to enquire whether any suspected re-injury has occurred. In this event participants will be required to attend a follow-up clinical assessment to confirm presence of re-injury and if confirmed they may be eligible for additional rehabilitation services.
Interventions
Part A of this research project refers to the initial clinical assessment to confirm presence of acute hamstring strain injury. Once this is complete part B of the research study refers to the twice weekly clinical assessment and rehabilitation sessions. These sessions will last from 60 to 90 minutes in duration and last until the return to play criteria are successfully met. This criteria includes pain-free palpation of the injury site, pain-free range of motion assessment, pain-free isometric
Part A of this research project refers to the initial clinical assessment to confirm presence of acute hamstring strain injury. Once this is complete part B of the research study refers to the twice weekly clinical assessment and rehabilitation sessions. These sessions will last from 60 to 90 minutes in duration and last until the return to play criteria are successfully met. This criteria includes pain-free palpation of the injury site, pain-free range of motion assessment, pain-free isometric knee flexor strength assessment and pain-free sprinting. The rehabilitation includes resistance exercise and progressive running up to a limit of participant rated pain-threshold of 4/10 on a visual analogue scale (VAS). Rehabilitation sessions will be fully supervised by an accredited exercise physiologist on an individual basis. Rehabilitation sessions will consist of progressive running protocol which includes 3 stages, walk-jog-walk, jog-run-jog and run-sprint-run. These intensities are rated by the participant's perception of running intensity based on the following jog = less than 50% intensity, run = 70% intensity and sprint = 100% intensity. Each of these stages contains 3 levels starting with 20m acceleration, 10m constant speed, 20m deceleration with these levels progressing to 15m-20m-15m and finally 10m-30m-10m. Participants will progress to the next level once they have completed 3 repetitions at the previous level within the limits of 4/10 pain on the VAS. Participants are permitted to complete a maximum of 9 repetitions per session. Following the progressive running protocol participants will complete resistance exercises including a supine hamstring bridge 3*10-15 repetitions, 45 degree hip extension 3*8-10 repetitions, eccentric sliding hamstring curl 3*4-6 repetitions and the Nordic hamstring exercise 3*4-6 repetitions. Each exercise will be progressed on an individual basis within the limits of 4/10 pain on the VAS. The Nordic hamstring exercise will only commence once the eccentric sliding hamstring curl can be completed with the limits of 4/10 pain on the VAS. These sessions will take place twice per week with a minimum of one days rest in between sessions for recovery. Adherence will be essential as completing rehabilitation sessions twice per week is required for participation in this research project. This will be monitored during each session as the participant will be attending ACU twice per week so the date and session number will be recorded on a spreadsheet at the start of each visit and everything they do during that session recorded on the same spreadsheet.
Sponsors
Australian Catholic University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
Individuals with an acute hamstring strain injury defined as the acute onset of posterior thigh pain during activity causing the individual to stop what they are doing. This injury must confirmed by clinical assessment within seven days of the initial injury incident.
Exclusion criteria
Individuals presenting with posterior thigh pain with no acute mechanism or onset. Other causes of posterior thigh pain such as proximal hamstring tendinopathy, referred pain due to lumbar spine pathology will be excluded. Individuals with complete hamstring muscle ruptures (grade 3) or avulsion fracture injuries requiring surgery will also be excluded from participation.
Outcome results
None listed