Strains
Conditions
Keywords
Hamstring, Muscle, Injury, Treatment, Rehabilitation
Brief summary
The purpose of the study is to compare the effect of two rehabilitation protocols with different emphasis on eccentric exercises after acute hamstring muscle strain injuries on the time to return to sports (RTS) and the rate of re-injuries in male athletes. The hypothesis is that the addition of early eccentric hamstring exercises being performed at longer muscle-tendon length towards end range of motion alter the outcomes RTS and re-injuries in a rehabilitation protocol after acute hamstring muscle strain injuries.
Detailed description
Background and rationale: Acute hamstring muscle strain injuries represent the most prevalent non-contact muscle injury reported in sports. Despite the high prevalence and a rapidly expanding body of literature investigating hamstring muscle strain injuries, \[1\] occurrence and re-injury rates have not improved over the last three decades \[2\]. Therefore, rehabilitation and secondary prevention are of particular concern, and the primary objective of all rehabilitation protocols is to return an athlete to pre-injury level as soon as possible with a minimal risk of injury recurrence.There is still a lack of consensus and clinical research regarding the effectiveness of various rehabilitation protocols for acute hamstring injuries in athletes participating in sports with high sprinting demands \[3,4\]. To our knowledge, there are no prospective, randomised trials investigating the effect of different rehabilitation protocols in a Middle-Eastern athletic population. Eccentric strength training has shown to reduce the risk of both new acute hamstring injuries as well as re-injuries \[5,6\], whereas hamstring exercises being performed at longer muscle-tendon length, preferentially mimicking movements occuring simultaneously at both the knee and hip are reported to be more effective than a protocol containing conventional exercises \[7\], and are suggested to be a key strategy in the management of hamstring injuries. However, the preventive effect related to the eccentric training remains unclear and is still debated and the optimal intensity of eccentric training in rehabilitation of acute hamstring strain injuries and prevention of re-injuries is yet unknown \[8\]. The primary objective in this study is therefore to compare the effect of two rehabilitation protocols after acute hamstring muscle strain injuries on the time to return to sports (RTS) and the rate of re-injuries in male athletes in a prospective single-site randomized controlled trial. The investigators aim to include 90 male athletes with clinical signs and MRI abnormalities consistent with an acute hamstring muscle strain injury. The injured athletes will be randomised into one of two different rehabilitation protocols with unlike emphasis on eccentric exercises.
Interventions
OTHERPhysiotherapy ASPETAR
Standardized physiotherapy protocol
OTHERPhysiotherapy ASPETAR+
Standardized physiotherapy protocol including early lengthening exercises
Sponsors
Aspetar
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Male athletes * Age 18-50 years * Acute onset posterior thigh pain when training or competing, identified as: 1. Patient reported sudden event 2. Patient reported pain in posterior thigh * Clinical diagnosis of an acute hamstring muscle strain injury, defined as: 1. Localised pain during palpation of hamstring muscle 2. Increasing pain during isometric contraction 3. Localised pain when performing a passive straight leg raise test * MRI confirmed isolated hamstring lesion (increased high signal intensity on fat saturated sequences) * MRI performed ≤5 days from injury * Available for ≥3 physiotherapy sessions per week at Aspetar * Available for follow-up
Exclusion criteria
* Patients with verified or suspected previous hamstring injury within the last 6 months in the same leg * Chronic hamstring complaints \>2 months * Grade III injury including complete hamstring disruption or avulsion of all tendons * Contraindications to MRI * Patients that do not have an intention to return to full sport activity * Patients that do not want to receive one of the two therapies
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Return to Sport (RTS) | After the initial injury, patients will be followed daily during working days for the duration of time until they return to RTS, with an expected average of 25 days up to 1 year | Number of days between initial injury and return to full unrestricted training and/or match play |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Re-injury within 2 months, 6 months and 12 months after RTS | The patients will be monitored by phone 2 months, 6 months and 12 months after RTS | In the event of a clinical suspicion of re-injury, the player will be advised to immediately call the primary investigator and consult a physician |
Other
| Measure | Time frame | Description |
|---|---|---|
| Pain and restriction during with trunk flexion | Measured initial at inclusion, daily up to 5 days a week throughout the rehabilitation period and at RTS with an expected average of 25 days up to 1 year | pain evaluation |
| Length and width of painful area with palpation | Measured initial at inclusion, daily up to 5 days a week throughout the rehabilitation period and at RTSwith an expected average of 25 days up to 1 year | palpation evaluation |
| Distance from tuber to maximal painful area identified with palpation | Measured initial at inclusion and at RTS with an expected average of 25 days up to 1 year | palpation evaluation |
| Hamstring force | Mid range, outer range measured initial at inclusion, daily up to 5 days/w throughout the rehab. period and at RTS with expected average 25 days - up to 1 year. Inner range measured at initial inclusion and RTS with expected 25 days up to 1 year | Inner range, mid range and outer range hamstring force measured with handheld dynamometry (HHD) \[9\] |
| Hamstring flexibility | SLR and MHFAKE measured initial at inclusion, daily up to 5 days a week throughout the rehabilitation period and at RTS with expected average 25 days up to 1 year. PKET measured initial at inclusion and at RTS with expected average 25 days up to 1 year | Hamstring flexibility measured as passive straight leg raise (SLR), passive knee extension (PKET) and maximal hip flexion active knee extension (MHFAKE) with inclinometer |
| Painful single leg bridge | Measured initial at inclusion, daily up to 5 days a week throughout the rehabilitation period and at RTS with an expected average of 25 days up to 1 year | functional pain evaluation |
| Patient prediction | Measured initial at inclusion | Patient prediction on time to RTS and performance after RTS |
| Subjective pain score assessed with visual analogue scale (VAS) | Measured initial at inclusion, daily up to 5 days a week throughout the rehabilitation period and at RTS with an expected average of 25 days up to 1 year | pain evaluation |
| Isokinetic knee flexor strength | Measured initial (uninjured leg) at inclusion and at RTS (both legs) with an expected average of 25 days up to 1 year | Isokinetic knee flexor strength assessed with BIODEX |
| Eccentric knee flexor strength during Nordic Hamstring Exercise | Measured at RTS with an expected average of 25 days up to 1 year | Eccentric knee flexor strength measured during Nordic Hamstring Exercise performed on a Novel Device |
| sEMG hamstring muscle activity | Measured initial at inclusion and at RTS with an expected average of 25 days up to 1 year | sEMG is measured during isokinetic knee flexor strength testing with BIODEX initial on uninjured leg and at RTS on both legs. sEMG is measured during eccentric knee flexor strength test performed (Nordic Hamstring Exercise) at RTS. |
| Insecurity with dynamic flexibility test (H-test) [10] | Measured at RTS with an expected average of 25 days up to 1 year | Htest evaluation |
| RTS questions | Measured at RTS with an expected average of 25 days up to 1 year | RTS questions including rate of recovery and fear of sustaining a new injury |
| Days between injury and 1st training with the club team and 1st match played | The patients are monitored by phone after RTS with an expected average of 25 days up to 1 year | evalaution number of days training |
| MRI parameters | Measured initial at inclusion | MRI evaluation |
| Pain during walking and jogging | Measured initial at inclusion, daily up to 5 days a week throughout the rehabilitation period and at RTS with an expected average of 25 days up to 1 year | pain evaluation |
Countries
Qatar
Outcome results
None listed