Samuel S Rudisill1,2, Nathan H Varady1,3, Michael P Kucharik1, Christopher T Eberlin1, Scott D Martin1. 1. Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA. 2. Rush Medical College of Rush University, Chicago, Illinois, USA. 3. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Abstract
BACKGROUND: Hamstring injuries are common among athletes. Considering the potentially prolonged recovery and high rate of recurrence, effective methods of prevention and risk factor management are of great interest to athletes, trainers, coaches, and therapists, with substantial competitive and financial implications. PURPOSE: To systematically review the literature concerning evidence-based hamstring training and quantitatively assess the effectiveness of training programs in (1) reducing injury incidence and (2) managing injury risk factors. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 1. METHODS: A computerized search of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus with manual screening of selected reference lists was performed in October 2020. Randomized controlled trials investigating methods of hamstring injury prevention and risk factor management in recreational, semiprofessional, and professional adult athletes were included. RESULTS: Of 2602 articles identified, 108 were included. Eccentric training reduced the incidence of hamstring injury by 56.8% to 70.0%. Concentric hamstring strength increased with eccentric (mean difference [MD], 14.29 N·m; 95% CI, 8.53-20.05 N·m), concentric, blood flow-restricted, whole-body vibration, heavy back squat, FIFA 11+ (Fédération Internationale de Football Association), and plyometric training methods, whereas eccentric strength benefited from eccentric (MD, 26.94 N·m; 95% CI, 15.59-38.30 N·m), concentric, and plyometric training. Static stretching produced greater flexibility gains (MD, 10.89°; 95% CI, 8.92°-12.86°) than proprioceptive neuromuscular facilitation (MD, 9.73°; 95% CI, 6.53°-12.93°) and dynamic stretching (MD, 6.25°; 95% CI, 2.84°-9.66°), although the effects of static techniques were more transient. Fascicle length increased with eccentric (MD, 0.90 cm; 95% CI, 0.53-1.27 cm) and sprint training and decreased with concentric training. Although the conventional hamstring/quadriceps (H/Q) ratio was unchanged (MD, 0.03; 95% CI, -0.01 to 0.06), the functional H/Q ratio significantly improved with eccentric training (MD, 0.10; 95% CI, 0.03-0.16). In addition, eccentric training reduced limb strength asymmetry, while H/Q ratio and flexibility imbalances were normalized via resistance training and static stretching. CONCLUSION: Several strategies exist to prevent hamstring injury and address known risk factors. Eccentric strengthening reduces injury incidence and improves hamstring strength, fascicle length, H/Q ratio, and limb asymmetry, while stretching-based interventions can be implemented to improve flexibility. These results provide valuable insights to athletes, trainers, coaches, and therapists seeking to optimize hamstring training and prevent injury.
BACKGROUND: Hamstring injuries are common among athletes. Considering the potentially prolonged recovery and high rate of recurrence, effective methods of prevention and risk factor management are of great interest to athletes, trainers, coaches, and therapists, with substantial competitive and financial implications. PURPOSE: To systematically review the literature concerning evidence-based hamstring training and quantitatively assess the effectiveness of training programs in (1) reducing injury incidence and (2) managing injury risk factors. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 1. METHODS: A computerized search of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus with manual screening of selected reference lists was performed in October 2020. Randomized controlled trials investigating methods of hamstring injury prevention and risk factor management in recreational, semiprofessional, and professional adult athletes were included. RESULTS: Of 2602 articles identified, 108 were included. Eccentric training reduced the incidence of hamstring injury by 56.8% to 70.0%. Concentric hamstring strength increased with eccentric (mean difference [MD], 14.29 N·m; 95% CI, 8.53-20.05 N·m), concentric, blood flow-restricted, whole-body vibration, heavy back squat, FIFA 11+ (Fédération Internationale de Football Association), and plyometric training methods, whereas eccentric strength benefited from eccentric (MD, 26.94 N·m; 95% CI, 15.59-38.30 N·m), concentric, and plyometric training. Static stretching produced greater flexibility gains (MD, 10.89°; 95% CI, 8.92°-12.86°) than proprioceptive neuromuscular facilitation (MD, 9.73°; 95% CI, 6.53°-12.93°) and dynamic stretching (MD, 6.25°; 95% CI, 2.84°-9.66°), although the effects of static techniques were more transient. Fascicle length increased with eccentric (MD, 0.90 cm; 95% CI, 0.53-1.27 cm) and sprint training and decreased with concentric training. Although the conventional hamstring/quadriceps (H/Q) ratio was unchanged (MD, 0.03; 95% CI, -0.01 to 0.06), the functional H/Q ratio significantly improved with eccentric training (MD, 0.10; 95% CI, 0.03-0.16). In addition, eccentric training reduced limb strength asymmetry, while H/Q ratio and flexibility imbalances were normalized via resistance training and static stretching. CONCLUSION: Several strategies exist to prevent hamstring injury and address known risk factors. Eccentric strengthening reduces injury incidence and improves hamstring strength, fascicle length, H/Q ratio, and limb asymmetry, while stretching-based interventions can be implemented to improve flexibility. These results provide valuable insights to athletes, trainers, coaches, and therapists seeking to optimize hamstring training and prevent injury.
Authors: José C Ponce-Bordón; David Lobo-Triviño; Ana Rubio-Morales; Roberto López Del Campo; Ricardo Resta; Miguel A López-Gajardo Journal: Int J Environ Res Public Health Date: 2022-04-22 Impact factor: 4.614
Authors: Pascal Edouard; Noel Pollock; Kenny Guex; Shane Kelly; Caroline Prince; Laurent Navarro; Pedro Branco; Frédéric Depiesse; Vincent Gremeaux; Karsten Hollander Journal: Int J Environ Res Public Health Date: 2022-09-02 Impact factor: 4.614