Hamstring Injury Treatments and Management in Athletes: A Systematic Review of the Current Literature.
Journal
JBJS reviews
ISSN: 2329-9185
Titre abrégé: JBJS Rev
Pays: United States
ID NLM: 101674872
Informations de publication
Date de publication:
01 Nov 2023
01 Nov 2023
Historique:
medline:
22
11
2023
pubmed:
20
11
2023
entrez:
20
11
2023
Statut:
epublish
Résumé
The field of sports medicine presents a varied landscape of research on hamstring injuries in athletes, characterized by inconclusive and sometimes conflicting findings on effective treatment and rehabilitation strategies. This discordance prompted the current systematic investigation. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for conducting the systematic review. Multiple international bibliometric databases (Scopus, PubMed, Web of Science, and Embase) were searched to identify studies evaluating any treatment option for the management of hamstring injuries in athletes. Eligible studies were appraised for quality using Joanna Briggs Institute and Risk of Bias 2 tools. A total of 30 studies with 1,195 participants were included. Of the reviewed studies, treatments varied from aggressive rehabilitation, platelet-rich plasma (PRP) injections, manual techniques, various exercise protocols to modalities like high-power laser and nonsteroidal anti-inflammatory drugs. Evidence suggested benefits from treatments like extensive muscle lengthening during eccentric actions, progressive agility, and trunk stabilization. PRP injections produced mixed results regarding return to sport and reinjury rates. Stretching exercises, sometimes combined with cryotherapy, showed benefits. Treatments for hamstring injuries exhibit varied efficacy. Although rest, ice, compression, and elevation remains essential for acute management, rehabilitation focusing on muscle strengthening and flexibility is crucial. The potential benefits of PRP injections, especially for chronic cases, require more conclusive research. A comprehensive approach, combining evidence-based practices and patient-centric factors, is vital for effective management and recovery. Level IV. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
BACKGROUND
The field of sports medicine presents a varied landscape of research on hamstring injuries in athletes, characterized by inconclusive and sometimes conflicting findings on effective treatment and rehabilitation strategies. This discordance prompted the current systematic investigation.
METHODS
METHODS
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for conducting the systematic review. Multiple international bibliometric databases (Scopus, PubMed, Web of Science, and Embase) were searched to identify studies evaluating any treatment option for the management of hamstring injuries in athletes. Eligible studies were appraised for quality using Joanna Briggs Institute and Risk of Bias 2 tools.
RESULTS
RESULTS
A total of 30 studies with 1,195 participants were included. Of the reviewed studies, treatments varied from aggressive rehabilitation, platelet-rich plasma (PRP) injections, manual techniques, various exercise protocols to modalities like high-power laser and nonsteroidal anti-inflammatory drugs. Evidence suggested benefits from treatments like extensive muscle lengthening during eccentric actions, progressive agility, and trunk stabilization. PRP injections produced mixed results regarding return to sport and reinjury rates. Stretching exercises, sometimes combined with cryotherapy, showed benefits.
CONCLUSION
CONCLUSIONS
Treatments for hamstring injuries exhibit varied efficacy. Although rest, ice, compression, and elevation remains essential for acute management, rehabilitation focusing on muscle strengthening and flexibility is crucial. The potential benefits of PRP injections, especially for chronic cases, require more conclusive research. A comprehensive approach, combining evidence-based practices and patient-centric factors, is vital for effective management and recovery.
LEVEL OF EVIDENCE
METHODS
Level IV. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 37983561
doi: 10.2106/JBJS.RVW.23.00161
pii: 01874474-202311000-00007
doi:
Types de publication
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B35).
Références
Verrall GM, Slavotinek JP, Barnes PG, Fon GT. Diagnostic and prognostic value of clinical findings in 83 athletes with posterior thigh injury: comparison of clinical findings with magnetic resonance imaging documentation of hamstring muscle strain. Am J Sports Med. 2003;31(6):969-73.
Malliaropoulos N, Papacostas E, Kiritsi O, Papalada A, Gougoulias N, Maffulli N. Posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med. 2010;38(9):1813-9.
Bahr R, Clarsen B, Ekstrand J. Why we should focus on the burden of injuries and illnesses, not just their incidence. Br J Sports Med. 2018;52(16):1018-21.
Hickey J, Shield AJ, Williams MD, Opar DA. The financial cost of hamstring strain injuries in the Australian Football League. Br J Sports Med. 2014;48(8):729-30.
Hägglund M, Waldén M, Magnusson H, Kristenson K, Bengtsson H, Ekstrand J. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 2013;47(12):738-42.
Reurink G, Goudswaard GJ, Tol JL, Verhaar JA, Weir A, Moen MH. Therapeutic interventions for acute hamstring injuries: a systematic review. Br J Sports Med. 2012;46(2):103-9.
Järvinen TA, Järvinen M, Kalimo H. Regeneration of injured skeletal muscle after the injury. Muscles Ligaments Tendons J. 2013;3(4):337-45.
Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40(2):67-81.
Guillodo Y, Bouttier R, Saraux A. Value of sonography combined with clinical assessment to evaluate muscle injury severity in athletes. J Athl Train. 2011;46(5):500-4.
Maffulli N, Oliva F, Frizziero A, Nanni G, Barazzuol M, Via AG, Ramponi C, Brancaccio P, Lisitano G, Rizzo D, Freschi M, Galletti S, Melegati G, Pasta G, Testa V, Valent A, Del Buono A. ISMuLT guidelines for muscle injuries. Muscles Ligaments Tendons J. 2013;3(4):241-9.
Malliaropoulos N, Isinkaye T, Tsitas K, Maffulli N. Reinjury after acute posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med. 2011;39(2):304-10.
Dohan Ehrenfest David M, Andia I, Zumstein MA, Zhang C-Q, Pinto NR, Bielecki T. Classification of platelet concentrates (Platelet-Rich Plasma-PRP, Platelet-Rich Fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscle Ligaments Tendons J. 2014;4(1):3.
Fader RR, Mitchell JJ, Traub S, Nichols R, Roper M, Mei Dan O, McCarty EC. Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population. Muscles Ligaments Tendons J. 2014;4(4):461-6.
Redler LH, Thompson SA, Hsu SH, Ahmad CS, Levine WN. Platelet-rich plasma therapy: a systematic literature review and evidence for clinical use. Phys Sportsmed. 2011;39(1):42-51.
Sánchez M, Anitua E, Orive G, Mujika I, Andia I. Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med. 2009;39(5):345-54.
Wright-Carpenter T, Klein P, Schäferhoff P, Appell H, Mir L, Wehling P. Treatment of muscle injuries by local administration of autologous conditioned serum: a pilot study on sportsmen with muscle strains. Int J Sports Med. 2004;25(8):588-93.
Cibulka MT, Rose SJ, Delitto A, Sinacore DR. Hamstring muscle strain treated by mobilizing the sacroiliac joint. Phys Ther. 1986;66(8):1220-3.
Kornberg C, Lew P. The effect of stretching neural structures on grade one hamstring injuries. J Orthop Sports Phys Ther. 1989;10(12):481-7.
Reynolds JF, Noakes TD, Schwellnus MP, Windt A, Bowerbank P. Non-steroidal anti-inflammatory drugs fail to enhance healing of acute hamstring injuries treated with physiotherapy. South Afr Med J. 1995;85(6):517-22.
Malliaropoulos N, Papalexandris S, Papalada A, Papacostas E. The role of stretching in rehabilitation of hamstring injuries: 80 athletes follow-up. Med Sci Sports Exerc. 2004;36(5):756-9.
Sherry MA, Best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther. 2004;34(3):116-25.
Zissen MH, Wallace G, Stevens KJ, Fredericson M, Beaulieu CF. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol. 2010;195(4):993-8.
Cacchio A, Rompe JD, Furia JP, Susi P, Santilli V, De Paulis F. Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes. Am J Sports Med. 2011;39(1):146-53.
Kilcoyne KG, Dickens JF, Keblish D, Rue JP, Chronister R. Outcome of grade I and II hamstring injuries in intercollegiate athletes: a novel rehabilitation protocol. Sports Health. 2011;3(6):528-33.
Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013;47(15):953-9.
Patel R, Joseph Wetzel R, Terry M. Platelet-rich plasma as an effective treatment for proximal hamstring injuries. Arthroscopy. 2013;29(10):e103.
Rettig AC, Meyer S, Bhadra AK. Platelet-rich plasma in addition to rehabilitation for acute hamstring injuries in NFL players: clinical effects and time to return to play. Orthop J Sports Med. 2013;1(1):2325967113494354.
Silder A, Sherry MA, Sanfilippo J, Tuite MJ, Hetzel SJ, Heiderscheit BC. Clinical and morphological changes following 2 rehabilitation programs for acute hamstring strain injuries: a randomized clinical trial. J Orthop Sports Phys Ther. 2013;43(5):284-99.
Wetzel RJ, Patel RM, Terry MA. Platelet-rich plasma as an effective treatment for proximal hamstring injuries. Orthopedics. 2013;36(1):e64-70.
A Hamid MS, Mohamed Ali MR, Yusof A, George J, Lee LP. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med. 2014;42(10):2410-8.
Askling CM, Tengvar M, Tarassova O, Thorstensson A. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2014;48(7):532-9.
Davenport KL, Campos JS, Nguyen J, Saboeiro G, Adler RS, Moley PJ. Ultrasound-guided intratendinous injections with platelet-rich plasma or autologous whole blood for treatment of proximal hamstring tendinopathy: a double-blind randomized controlled trial. J Ultrasound Med. 2015;34(8):1455-63.
Guillodo Y, Madouas G, Simon T, Le Dauphin H, Saraux A. Platelet-rich plasma (PRP) treatment of sports-related severe acute hamstring injuries. Muscles Ligaments Tendons J. 2015;5(4):284-8.
Hamilton B, Tol JL, Almusa E, Boukarroum S, Eirale C, Farooq A, Whiteley R, Chalabi H. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. Br J Sports Med. 2015;49(14):943-50.
Reurink G, Goudswaard GJ, Moen MH, Weir A, Verhaar JA, Bierma-Zeinstra SM, Maas M, Tol JL; Dutch HIT-study Investigators. Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study. Br J Sports Med. 2015;49(18):1206-12.
Zanon G, Combi F, Combi A, Perticarini L, Sammarchi L, Benazzo F. Platelet-rich plasma in the treatment of acute hamstring injuries in professional football players. Joints. 2016;4(1):17-23.
Tyler TF, Schmitt BM, Nicholas SJ, McHugh MP. Rehabilitation after hamstring-strain injury emphasizing eccentric strengthening at long muscle lengths: results of long-term follow-up. J Sport Rehabil. 2017;26(2):131-40.
Kim G, Kim H, Kim WK, Kim J. Effect of stretching-based rehabilitation on pain, flexibility and muscle strength in dancers with hamstring injury: a single-blind, prospective, randomized clinical trial. J Sports Med Phys Fitness. 2018;58(9):1287-95.
Sefiddashti L, Ghotbi N, Salavati M, Farhadi A, Mazaheri M. The effects of cryotherapy versus cryostretching on clinical and functional outcomes in athletes with acute hamstring strain. J Bodyw Mov Ther. 2018;22(3):805-9.
Whiteley R, van Dyk N, Wangensteen A, Hansen C. Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression. Br J Sports Med. 2018;52(5):303-10.
Levy GM, Lucas P, Hope N. Efficacy of a platelet-rich plasma injection for the treatment of proximal hamstring tendinopathy: a pilot study. J Sci Med Sport. 2019;22(3):247-52.
Park PYS, Cai C, Bawa P, Kumaravel M. Platelet-rich plasma vs. steroid injections for hamstring injury—is there really a choice? Skeletal Radiol. 2019;48(4):577-82.
Albertin ES, Walters M, May J, Baker RT, Nasypany A, Cheatham S. An exploratory case series analysis of the use of Primal Reflex Release Technique to improve signs and symptoms of hamstring strain. Int J Sports Phys Ther. 2020;15(2):263-73.
Auriemma MJ, Tenforde AS, Harris A, McInnis KC. Platelet-rich plasma for treatment of chronic proximal hamstring tendinopathy. Regen Med. 2020;15(4):1509-18.
Bradley JP, Lawyer TJ, Ruef S, Towers JD, Arner JW. Platelet-rich plasma shortens return to play in national football league players with acute hamstring injuries. Orthop J Sports Med. 2020;8(4).2325967120911731.
Hickey JT, Timmins RG, Maniar N, Rio E, Hickey PF, Pitcher CA, Williams MD, Opar DA. Pain-free versus pain-threshold rehabilitation following acute hamstring strain injury: a randomized controlled trial. J Orthop Sports Phys Ther. 2020;50(2):91-103.
Lee KY, Baker HP, Hanaoka CM, Tjong VK, Terry MA. Treatment of patellar and hamstring tendinopathy with platelet-rich plasma in varsity collegiate athletes: a case series. J Orthop. 2020;18:91-4.
Medeiros DM, Aimi M, Vaz MA, Baroni BM. Effects of low-level laser therapy on hamstring strain injury rehabilitation: a randomized controlled trial. Phys Ther Sport. 2020;42:124-30.
Hickey JT, Rio E, Best TM, Timmins RG, Maniar N, Hickey PF, Williams MD, Pitcher CA, Opar DA. Early introduction of high-intensity eccentric loading into hamstring strain injury rehabilitation. J Sci Med Sport. 2022;25(9):732-6.
Pollock N, Kelly S, Lee J, Stone B, Giakoumis M, Polglass G, Brown J, MacDonald B. A 4-year study of hamstring injury outcomes in elite track and field using the British Athletics rehabilitation approach. Br J Sports Med. 2022;56(5):257-63.
Trunz LM, Landy JE, Dodson CC, Cohen SB, Zoga AC, Roedl JB. Effectiveness of hematoma aspiration and platelet-rich plasma muscle injections for the treatment of hamstring strains in athletes. Med Sci Sports Exerc. 2022;54(1):12-7.
van der Made AD, Peters RW, Verheul C, Smithuis FF, Reurink G, Moen MH, Tol JL, Kerkhoffs GMMJ. Proximal hamstring tendon avulsions: comparable clinical outcomes of operative and non-operative treatment at 1-year follow-up using a shared decision-making model. Br J Sports Med. 2022;56(6):340-8.
Verma S, Esht V, Chahal A, Kapoor G, Sharma S, Alghadir AH, Khan M, Kashoo FZ, Shaphe MA. Effectiveness of high power laser therapy on pain and isokinetic peak torque in athletes with proximal hamstring tendinopathy: a randomized trial. Biomed Res Int. 2022;2022:4133883.
Vermeulen R, Whiteley R, van der Made AD, van Dyk N, Almusa E, Geertsema C, Targett S, Farooq A, Bahr R, Tol JL, Wangensteen A. Early versus delayed lengthening exercises for acute hamstring injury in male athletes: a randomised controlled clinical trial. Br J Sports Med. 2022;56(14):792-800.
Chocholáč T, Bühl L, Nüesch C, Bleichner N, Mündermann A, Stoffel K. Modified surgical anchor refixation in older patients with acute proximal hamstring rupture: clinical outcome, patient satisfaction and muscle strength. Arch Orthop Trauma Surg. 2023;143(8):4679-88.
Allison BM. The effect of sacroiliac joint manipulation, when combined with conventional treatment, in the management of chronic hamstring strains [dissertation]. Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2012.
Iacob GS, Vrabie D, Stegariu VI, Zelenović M, Božić D. The effects of modern radiofrequency therapies in the acute rehabilitation of hamstring strains. Bull Transilvania Univ Braşov Ser IX Sci Hum Kinet. 2021;14(63):209-16.
Pas HI, Reurink G, Tol JL, Weir A, Winters M, Moen MH. Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis. Br J Sports Med. 2015;49(18):1197-205.
Garrett WE Jr. Muscle strain injuries. Am J Sports Med. 1996;24(6_suppl):S2-S8.
Askling CM, Nilsson J, Thorstensson A. A new hamstring test to complement the common clinical examination before return to sport after injury. Knee Surg Sports Traumatol Arthrosc. 2010;18(12):1798-803.
Askling CM, Tengvar M, Saartok T, Thorstensson A. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med. 2008;36(9):1799-804.
Sallay PI, Friedman RL, Coogan PG, Garrett WE. Hamstring muscle injuries among water skiers: functional outcome and prevention. Am J Sports Med. 1996;24(2):130-6.
Carmichael J, Packham I, Trikha SP, Wood DG. Avulsion of the proximal hamstring origin: surgical technique. J Bone Joint Surg Am. 2009;91(suppl 2):249-56.
Järvinen TAH, Järvinen TLN, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol. 2007;21(2):317-31.