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Mechó S, Palomar-Garcia A, Wong M, Gallego JC, López F, Valle X, Ruperez F, Pruna R, González JR, Rodas G. Characterization of acute effects of football competition on hamstring muscles by muscle functional MRI techniques. PLoS One 2024; 19:e0308328. [PMID: 39190697 DOI: 10.1371/journal.pone.0308328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024] Open
Abstract
Muscle functional MRI identifies changes in metabolic activity in each muscle and provides a quantitative index of muscle activation and damage. No previous studies have analyzed the hamstrings activation over a football match. This study aimed at detecting different patterns of hamstring muscles activation after a football game, and to examine inter- and intramuscular differences (proximal-middle-distal) in hamstring muscles activation using transverse relaxation time (T2)-weighted magnetic resonance images. Eleven healthy football players were recruited for this study. T2 relaxation time mapping-MRI was performed before (2 hours) and immediately after a match (on average 13 min). The T2 values of each hamstring muscle at the distal, middle, and proximal portions were measured. The primary outcome measure was the increase in T2 relaxation time value after a match. Linear mixed models were used to detect differences pre and postmatch. MRI examination showed that there was no obvious abnormality in the shape and the conventional T2 weighted signal of the hamstring muscles after a match. On the other hand, muscle functional MRI T2 analysis revealed that T2 relaxation time significantly increased at distal and middle portions of the semitendinosus muscle (p = 0.0003 in both cases). By employing T2 relaxation time mapping, we have identified alterations within the hamstring muscles being the semitendinosus as the most engaged muscle, particularly within its middle and distal thirds. This investigation underscores the utility of T2 relaxation time mapping in evaluating muscle activation patterns during football matches, facilitating the detection of anomalous activation patterns that may warrant injury reduction interventions.
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Affiliation(s)
- Sandra Mechó
- Department of Radiology Hospital de Barcelona, SCIAS, Barcelona, Spain
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation Hub, Barcelona, Spain
| | | | - Manuel Wong
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation Hub, Barcelona, Spain
| | - Juan C Gallego
- Department of Radiology Hospital de Barcelona, SCIAS, Barcelona, Spain
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation Hub, Barcelona, Spain
| | - Francesc López
- Department of Radiology Hospital de Barcelona, SCIAS, Barcelona, Spain
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation Hub, Barcelona, Spain
| | - Xavier Valle
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation Hub, Barcelona, Spain
| | - Ferran Ruperez
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation Hub, Barcelona, Spain
| | - Ricard Pruna
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation Hub, Barcelona, Spain
| | - Juan R González
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gil Rodas
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation Hub, Barcelona, Spain
- Sports Medicine Unit, Hospital Clinic and Sant Joan de Déu, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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2
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Kellis E, Kekelekis A, Drakonaki EE. Thoracolumbar Fascia and Lumbar Muscle Stiffness in Athletes with A History of Hamstring Injury. J Sports Sci Med 2024; 23:436-444. [PMID: 38841644 PMCID: PMC11149066 DOI: 10.52082/jssm.2024.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
The purpose of this study was to examine the differences in thoracolumbar fascia (TLF) and lumbar muscle modulus in individuals with and without hamstring injury using shear wave elastography (SWE). Thirteen male soccer players without a previous hamstring injury and eleven players with a history of hamstring injury performed passive and active (submaximal) knee flexion efforts from 0°, 45° and 90° angle of knee flexion as well as an active prone trunk extension test. The elastic modulus of the TLF, the erector spinae (ES) and the multifidus (MF) was measured using ultrasound SWE simultaneously with the surface electromyography (EMG) signal of the ES and MF. The TLF SWE modulus was significantly (p < 0.05) higher in the injured group (range: 29.86 ± 8.58 to 66.57 ± 11.71 kPa) than in the uninjured group (range: 17.47 ± 9.37 to 47.03 ± 16.04 kPa). The ES and MF modulus ranged from 14.97 ± 4.10 to 66.57 ± 11.71 kPa in the injured group and it was significantly (p < .05) greater compared to the uninjured group (range: 11.65 ± 5.99 to 40.49 ± 12.35 kPa). TLF modulus was greater than ES and MF modulus (p < 0.05). Active modulus was greater during the prone trunk extension test compared to the knee flexion tests and it was greater in the knee flexion test at 0° than at 90° (p < 0.05). The muscle EMG was greater in the injured compared to the uninjured group in the passive tests only (p < 0.05). SWE modulus of the TLF and ES and MF was greater in soccer players with previous hamstring injury than uninjured players. Further research could establish whether exercises that target the paraspinal muscles and the lumbar fascia can assist in preventing individuals with a history of hamstring injury from sustaining a new injury.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Afxentios Kekelekis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Eleni E Drakonaki
- Department of Anatomy, Medical School, University of Crete, Heraklion Crete, Greece
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3
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Hooijmans MT, Veeger TTJ, Mazzoli V, van Assen HC, de Groot JH, Gottwald LM, Nederveen AJ, Strijkers GJ, Kan HE. Muscle fiber strain rates in the lower leg during ankle dorsi-/plantarflexion exercise. NMR IN BIOMEDICINE 2024; 37:e5064. [PMID: 38062865 DOI: 10.1002/nbm.5064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 02/17/2024]
Abstract
Static quantitative magnetic resonance imaging (MRI) provides readouts of structural changes in diseased muscle, but current approaches lack the ability to fully explain the loss of contractile function. Muscle contractile function can be assessed using various techniques including phase-contrast MRI (PC-MRI), where strain rates are quantified. However, current two-dimensional implementations are limited in capturing the complex motion of contracting muscle in the context of its three-dimensional (3D) fiber architecture. The MR acquisitions (chemical shift-encoded water-fat separation scan, spin echo-echoplanar imaging with diffusion weighting, and two time-resolved 3D PC-MRI) wereperformed at 3 T. PC-MRI acquisitions and performed with and without load at 7.5% of the maximum voluntary dorsiflexion contraction force. Acquisitions (3 T, chemical shift-encoded water-fat separation scan, spin echo-echo planar imaging with diffusion weighting, and two time-resolved 3D PC-MRI) were performed with and without load at 7.5% of the maximum voluntary dorsiflexion contraction force. Strain rates and diffusion tensors were calculated and combined to obtain strain rates along and perpendicular to the muscle fibers in seven lower leg muscles during the dynamic dorsi-/plantarflexion movement cycle. To evaluate strain rates along the proximodistal muscle axis, muscles were divided into five equal segments. t-tests were used to test if cyclic strain rate patterns (amplitude > 0) were present along and perpendicular to the muscle fibers. The effects of proximal-distal location and load were evaluated using repeated measures ANOVAs. Cyclic temporal strain rate patterns along and perpendicular to the fiber were found in all muscles involved in dorsi-/plantarflexion movement (p < 0.0017). Strain rates along and perpendicular to the fiber were heterogeneously distributed over the length of most muscles (p < 0.003). Additional loading reduced strain rates of the extensor digitorum longus and gastrocnemius lateralis muscle (p < 0.001). In conclusion, the lower leg muscles involved in cyclic dorsi-/plantarflexion exercise showed cyclic fiber strain rate patterns with amplitudes that varied between muscles and between the proximodistal segments within the majority of muscles.
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Affiliation(s)
- Melissa T Hooijmans
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Thom T J Veeger
- C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Valentina Mazzoli
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurriaan H de Groot
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Lukas M Gottwald
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Hermien E Kan
- C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Duchenne Center Netherlands, Leiden, The Netherlands
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Plastow R, Raj RD, Fontalis A, Haddad FS. Quadriceps injuries. Bone Joint J 2023; 105-B:1244-1251. [PMID: 38035603 DOI: 10.1302/0301-620x.105b12.bjj-2023-0399.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Injuries to the quadriceps muscle group are common in athletes performing high-speed running and kicking sports. The complex anatomy of the rectus femoris puts it at greatest risk of injury. There is variability in prognosis in the literature, with reinjury rates as high as 67% in the severe graded proximal tear. Studies have highlighted that athletes can reinjure after nonoperative management, and some benefit may be derived from surgical repair to restore function and return to sport (RTS). This injury is potentially career-threatening in the elite-level athlete, and we aim to highlight the key recent literature on interventions to restore strength and function to allow early RTS while reducing the risk of injury recurrence. This article reviews the optimal diagnostic strategies and classification of quadriceps injuries. We highlight the unique anatomy of each injury on MRI and the outcomes of both nonoperative and operative treatment, providing an evidence-based management framework for athletes.
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Affiliation(s)
- Ricci Plastow
- Department of Trauma and Orthopaedics, University College London NHS Hospitals, London, UK
| | - Rhody D Raj
- Department of Trauma and Orthopaedics, University College London NHS Hospitals, London, UK
- Princess Grace Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedics, University College London NHS Hospitals, London, UK
- Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College London NHS Hospitals, London, UK
- Princess Grace Hospital, London, UK
- The Bone & Joint Journal , London, UK
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5
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Abalymov A, Pinchasik BE, Akasov RA, Lomova M, Parakhonskiy BV. Strategies for Anisotropic Fibrillar Hydrogels: Design, Cell Alignment, and Applications in Tissue Engineering. Biomacromolecules 2023; 24:4532-4552. [PMID: 37812143 DOI: 10.1021/acs.biomac.3c00503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Efficient cellular alignment in biomaterials presents a considerable challenge, demanding the refinement of appropriate material morphologies, while ensuring effective cell-surface interactions. To address this, biomaterials are continuously researched with diverse coatings, hydrogels, and polymeric surfaces. In this context, we investigate the influence of physicochemical parameters on the architecture of fibrillar hydrogels that significantly orient the topography of flexible hydrogel substrates, thereby fostering cellular adhesion and spatial organization. Our Review comprehensively assesses various techniques for aligning polymer fibrils within hydrogels, specifically interventions applied during and after the cross-linking process. These methodologies include mechanical strains, precise temperature modulation, controlled fluidic dynamics, and chemical modulators, as well as the use of magnetic and electric fields. We highlight the intrinsic appeal of these methodologies in fabricating cell-aligning interfaces and discuss their potential implications within the fields of biomaterials and tissue engineering, particularly concerning the pursuit of optimal cellular alignment.
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Affiliation(s)
- Anatolii Abalymov
- Science Medical Center, Saratov State University, 410012 Saratov, Russia
| | - Bat-El Pinchasik
- School of Mechanical Engineering, Faculty of Engineering, Tel-Aviv University, 69978 Tel-Aviv, Israel
| | - Roman A Akasov
- Sechenov University and Federal Scientific Research Centre "Crystallography and Photonics" of Russian Academy of Sciences, 101000 Moscow, Russia
| | - Maria Lomova
- Science Medical Center, Saratov State University, 410012 Saratov, Russia
| | - Bogdan V Parakhonskiy
- Department of Biotechnology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium
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Plastow R, Kerkhoffs GMMJ, Wood D, Paton BM, Kayani B, Pollock N, Court N, Giakoumis M, Head P, Kelly S, Moore J, Moriarty P, Murphy S, Read P, Stirling B, Tulloch L, van Dyk N, Wilson M, Haddad F. London International Consensus and Delphi study on hamstring injuries part 2: operative management. Br J Sports Med 2023; 57:266-277. [PMID: 36650033 DOI: 10.1136/bjsports-2021-105383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
The key indications for surgical repair of hamstring injuries (HSIs) remain unclear in the literature due to a lack of high-level evidence and expert knowledge. The 2020 London International Hamstring Consensus meeting aimed to highlight clear surgical indications and to create a foundation for future research. A literature review was conducted followed by a modified Delphi process, with an international expert panel. Purposive sampling was used with two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering (round 1) questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15) comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion of each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. The consensus threshold was set a priori at 70% agreement. Rounds 1 and 2 survey respondents were 35/46 (76%) and 99/112 (88.4%), respectively. The consensus group agreed that the indications for operative intervention included: gapping at the zone of tendinous injury (87.2% agreement) and loss of tension (70.7%); symptomatic displaced bony avulsions (72.8%); and proximal free tendon injuries with functional compromise refractory to non-operative treatment (72.2%). Other important considerations for operative intervention included: the demands of the athlete/patient and the expected functional outcome (87.1%) based on the anatomy of the injury; the risk of functional loss/performance deficit with non-operative management (72.2%); and the capacity to restore anatomy and function (87.1%). Further research is needed to determine whether surgery can reduce the risk of reinjury as consensus was not reached within the whole group (48.2%) but was agreed by surgeons (70%) in the cohort. The consensus group did not support the use of corticosteroids or endoscopic surgery without further evidence. These guidelines will help standardise treatment of HSIs, specifically the indications and decision-making for surgical intervention.
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Affiliation(s)
- Ricci Plastow
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicin, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Bruce M Paton
- Division of Medicine, Institute of Sport Exercise Health, University College London, London, UK.,Physiotherapy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Babar Kayani
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Noel Pollock
- British Athletics Medical Team, London, UK.,Sports Medicine, Institute of Sport Exercise and Health, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Sam Kelly
- Salford City Football Club, Salford, UK.,Blackburn Rovers FC, Blackburn, Lancashire, UK
| | - James Moore
- Sports & Exercise Medicine, Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Simon Murphy
- Sports Medicine, Arsenal Football Club, London, UK
| | - Paul Read
- Institute of Sport Exercise & Health, London, UK.,Princess Grace Hospital, London, London, UK
| | | | | | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew Wilson
- Princess Grace Hospital, London, London, UK.,Targeted Intervention, University College London, London, UK
| | - Fares Haddad
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Sport Exercise & Health, London, UK
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7
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Suskens JJM, Tol JL, Kerkhoffs GMMJ, Maas H, van Dieën JH, Reurink G. Activity distribution among the hamstring muscles during high-speed running: A descriptive multichannel surface EMG study. Scand J Med Sci Sports 2023; 33:954-965. [PMID: 36752650 DOI: 10.1111/sms.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE This study assessed activity distribution among the hamstring muscles during high-speed running. The objective was to compare within and between muscle activity, relative contribution and hip and knee joint angles at peak muscle activity during high-speed running. METHODS Through multichannel electromyography, we measured muscle activity in male basketball players during high-speed running on a treadmill at 15 locations: five for biceps femoris long head, four for semitendinosus, and six for semimembranosus. Muscle activity was calculated for each location within each hamstring muscle individually for each percent of a stride cycle. RESULTS Twenty-nine non-injured basketball players were included (mean age: 17 ± 1 years; mass, 85 ± 9 kg; height, 193 ± 9 cm). Heterogeneous activity was found for all individual hamstring muscles across multiple events of the stride cycle. In the late-swing phase, muscle activity and relative contribution of the semimembranosus was significantly higher than of the semitendinosus. There was no significant difference in hip and knee joint angles at instant of peak muscle activity, assessed locally within individual hamstring muscles, as well as in general over the whole hamstring muscle. CONCLUSION Hamstring muscles were most active in the late-swing phase during high-speed running. In this phase, the semimembranosus was most active and the semitendinosus was least active. Within the biceps femoris long head, the most proximal region was significantly more active in the late-swing phase, compared to other muscle regions. For each muscle and location, peak muscle activity occurred at similar hip and knee joint angles.
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Affiliation(s)
- Jozef J M Suskens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Johannes L Tol
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Huub Maas
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Gustaaf Reurink
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
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8
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Differences in the Contractile Properties of the Biceps Femoris and Semitendinosus Muscles Throughout a Season in Professional Soccer Players. J Hum Kinet 2022; 84:74-81. [DOI: 10.2478/hukin-2022-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
The aim of this study was to monitor seasonal changes in the mechanical and neuromuscular characteristics of the knee flexor muscles with tensiomyography, the biceps femoris (BF) and semitendinosus (ST) muscles, of 27 soccer players. All male professional soccer players (age 25 ± 4 years) were measured at the beginning of the preseason (second week) and in the competitive season (10 weeks later). The variables contraction time (Tc) and muscle displacement (Dm) showed significant differences in some muscles, and in others they indicated a tendency to change. In general, the BF improved (more explosive and better muscle tone) and the ST worsened (slower and worse muscle tone) its values during the season. The findings of this study suggest that usual daily soccer training and weekly competition might produce antagonistic changes between the knee flexor muscles.
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9
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Heiderscheit BC, Blemker SS, Opar D, Stiffler-Joachim MR, Bedi A, Hart J, Mortensen B, Kliethermes SA. The development of a HAMstring InjuRy (HAMIR) index to mitigate injury risk through innovative imaging, biomechanics, and data analytics: protocol for an observational cohort study. BMC Sports Sci Med Rehabil 2022; 14:128. [PMID: 35841053 PMCID: PMC9288010 DOI: 10.1186/s13102-022-00520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
Background The etiology of hamstring strain injury (HSI) in American football is multi-factorial and understanding these risk factors is paramount to developing predictive models and guiding prevention and rehabilitation strategies. Many player-games are lost due to the lack of a clear understanding of risk factors and the absence of effective methods to minimize re-injury. This paper describes the protocol that will be followed to develop the HAMstring InjuRy (HAMIR) index risk prediction models for HSI and re-injury based on morphological, architectural, biomechanical and clinical factors in National Collegiate Athletic Association Division I collegiate football players. Methods A 3-year, prospective study will be conducted involving collegiate football student-athletes at four institutions. Enrolled participants will complete preseason assessments of eccentric hamstring strength, on-field sprinting biomechanics and muscle–tendon volumes using magnetic-resonance imaging (MRI). Athletic trainers will monitor injuries and exposure for the duration of the study. Participants who sustain an HSI will undergo a clinical assessment at the time of injury along with MRI examinations. Following completion of structured rehabilitation and return to unrestricted sport participation, clinical assessments, MRI examinations and sprinting biomechanics will be repeated. Injury recurrence will be monitored through a 6-month follow-up period. HAMIR index prediction models for index HSI injury and re-injury will be constructed. Discussion The most appropriate strategies for reducing risk of HSI are likely multi-factorial and depend on risk factors unique to each athlete. This study will be the largest-of-its-kind (1200 player-years) to gather detailed information on index and recurrent HSI, and will be the first study to simultaneously investigate the effect of morphological, biomechanical and clinical variables on risk of HSI in collegiate football athletes. The quantitative HAMIR index will be formulated to identify an athlete’s propensity for HSI, and more importantly, identify targets for injury mitigation, thereby reducing the global burden of HSI in high-level American football players. Trial Registration The trial is prospectively registered on ClinicalTrials.gov (NCT05343052; April 22, 2022).
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Affiliation(s)
- Bryan C Heiderscheit
- Badger Athletic Performance Program, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 1685 Highland Avenue, 6136 Medical Foundation Centennial Building, Madison, WI, 53705, USA.
| | | | - David Opar
- Sports Performance, Recovery, Injury and New Technologies Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - Mikel R Stiffler-Joachim
- Badger Athletic Performance Program, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 1685 Highland Avenue, 6136 Medical Foundation Centennial Building, Madison, WI, 53705, USA
| | - Asheesh Bedi
- NorthShore Orthopedic and Spine Institute, Skokie, IL, USA
| | - Joseph Hart
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | - Stephanie A Kliethermes
- Badger Athletic Performance Program, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 1685 Highland Avenue, 6136 Medical Foundation Centennial Building, Madison, WI, 53705, USA.,American Medical Society for Sports Medicine Collaborative Research Network, Leawood, KS, USA
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10
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Is Muscle Architecture Different in Athletes with a Previous Hamstring Strain? A Systematic Review and Meta-Analysis. J Funct Morphol Kinesiol 2022; 7:jfmk7010016. [PMID: 35225902 PMCID: PMC8884017 DOI: 10.3390/jfmk7010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Hamstring strains are a frequent injury in sports and are characterized by a high recurrence rate. The aim of this review was to examine the muscle and tendon architecture in individuals with hamstring injury. A systematic literature search in four databases yielded eleven studies on architecture following injury. Differences in the fascicle length (FL), pennation angle (PA) and muscle size measures (volume, thickness and physiological cross-sectional area) at rest were not significantly different between the previously injured limb and the contralateral limb (p > 0.05). There was moderate evidence that biceps femoris long head (BFlh) FL shortening was greater during contraction in the injured compared to the contralateral limb. The BFlh FL was smaller in athletes with a previous injury compared to uninjured individuals (p = 0.0015) but no differences in the FL and PA of other muscles as well as in the aponeurosis/tendon size were observed (p > 0.05). An examination of the FL of both leg muscles in individuals with a previous hamstring strain may be necessary before and after return to sport. Exercises that promote fascicle lengthening of both injured and uninjured leg muscles may be beneficial for athletes who recover from a hamstring injury.
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11
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Alizadeh S, Sarvestan J, Svoboda Z, Alaei F, Linduška P, Ataabadi PA. Hamstring and ACL injuries impacts on hamstring-to-quadriceps ratio of the elite soccer players: A retrospective study. Phys Ther Sport 2021; 53:97-104. [PMID: 34894617 DOI: 10.1016/j.ptsp.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to compare the angle-specific (AS) and non-angle-specific (NAS) hamstring to quadriceps conventional and functional ratios between healthy, hamstring- and ACL-injured elite soccer players. One hundred and eleven players (27.42 ± 8.01 years, 182.11 ± 6.79 cm, 75.93 ± 7.25 kg) completed a series of concentric knee flexor and extensor strength in addition to eccentric knee flexor strength was measured at an angular velocity of 60°.s-1. Normalized and raw peak torque values, and the torque-angle profiles were extracted for analysis. Conventional and functional NAS (peak values) and AS (waveform ratios) hamstring to quadriceps ratios were calculated and compared between the groups. Healthy players produced greater functional and conventional ratios compared to players with either ACL or hamstring injury. Players with hamstring injury produced a lower AS functional ratios between 46° and 54° of knee flexion. Players suffering from ACL injury depicted a lower value for the AS functional ratio between 33° and 56° of knee flexion. Although NAS can identify soccer players with previous hamstring or ACL injury, the range where there is a strength deficiency is eluded. With the use of AS the range where the deficiency is present can be identified, and clinicians can benefit from this analysis to design robust rehabilitation protocols.
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Affiliation(s)
- Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Javad Sarvestan
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic.
| | - Zdeněk Svoboda
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Fatemeh Alaei
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Petr Linduška
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Peyman Aghaie Ataabadi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
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12
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Martínez-Rodríguez R, Galán-Del-Río F, Cantalapiedra JA, Flórez-García MT, Martínez-Martín J, Álvaro-Meca A, Koppenhaver SL, Fernández-de-Las-Peñas C. Reliability and discriminative validity of real-time ultrasound elastography in the assessment of tissue stiffness after calf muscle injury. J Bodyw Mov Ther 2021; 28:463-469. [PMID: 34776179 DOI: 10.1016/j.jbmt.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/18/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the reliability and discriminative validity of real-time ultrasound elastography (RTE) measures of soft-tissue elasticity after calf muscle tear. DESIGN Cross-sectional, intra/inter-examiner reliability and comparative validity study. SETTING Department of Physical Therapy. PARTICIPANTS Twenty-one recreational athletes were included and examined 6 weeks after sustaining a grade I-II calf musculature tear. MAIN OUTCOME MEASURES Soft-tissue elasticity was measured by two experienced assessors using RTE assessments in both the longitudinal and transverse planes of the athletes' injured and uninjured calf muscles. Elasticity was estimated by using the strain ratio (SR), which was calculated by dividing the strain (displacement) value taken at the medial gastrocnemius-soleus myotendinous junction (reference) by the strain value taken at the centre of the injury (index) as visualized on B-mode sonogram. Intra- and inter-observer reliability was estimated calculating intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). Differences in elasticity between injured and healthy legs were assessed using t-tests or Wilcoxon tests for repeated measures. RESULTS All RTE assessments in both planes showed ICC values ranging from 0.77 to 0.95 and SEM values ranging from 0.72 to 0.99. Additionally, RTE enabled both assessors to determine differences in elastic properties between injured and control legs (p < 0.001). CONCLUSION RTE measures of calf muscles demonstrated good reliability and were able to differentiate injured from non-injured muscle tissue. RTE may provide a fast and objective measure in sports medicine to improve the detection of risk factors for muscle injury related to alterations of the mechanical behaviour of soft tissues during healing process.
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Affiliation(s)
| | - Fernando Galán-Del-Río
- Spanish Football Federation, Physiotherapy Team, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain.
| | - Juan Aboítiz Cantalapiedra
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; Orthopaedic Surgery, Traumatology and Rehabilitation Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Mariano T Flórez-García
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; Orthopaedic Surgery, Traumatology and Rehabilitation Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Javier Martínez-Martín
- Orthopaedic Surgery, Traumatology and Rehabilitation Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Alejandro Álvaro-Meca
- Department of Preventive Medicine & Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
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13
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The Relationship between Preseason Common Screening Tests to Identify Inter-Limb Asymmetries in High-Level Senior and Professional Soccer Players. Symmetry (Basel) 2021. [DOI: 10.3390/sym13101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study sought to examine inter-limb asymmetries in common screening tests performed during preseason and to analyze the relationship between the performance in the different tests. Nineteen high-level senior and professional soccer players (age: 23.2 ± 3.1 years; height: 181 ± 0.06 cm; body mass: 75.2 ± 4.8 kg) performed several common screening tests during preseason: Dorsiflexion lunge test (DLT); bent knee fall out test (BKFO); y-balance anterior test (YBT A); y-balance posterolateral test (YBT PL); Y-balance posteromedial test (YBT PM); Heel-rise test (HRT) and single leg hamstring bridge test (SLHBT). High levels of reliability (ICC > 0.88 and <0.94) were observed in all the studied variables. Inter-limb significant differences were observed in DLT and YBT PM test (p < 0.01) but YBT A, HRT and SLHBT presented trivial effect size (ES) (0.03; 0.07 and 0.13, respectively), contrary to DLT, BKFO and YBT PL, all with small ES (0.20; −0.23 and −0.22) and YBT PM, which revealed very large ES (2.91). Considering all data, high-level senior and professional soccer players present fairly good mean values of lower limb symmetry. Performance considering all tests was different, a fact associated with different biomechanical dynamics (e.g., YBT), nonetheless, the correlations between tests underline the relationship between these, which could represent important evidence to consider for injury prevention and performance enhancement programs.
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14
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Bayer ML, Hoegberget-Kalisz M, Svensson RB, Hjortshoej MH, Olesen JL, Nybing JD, Boesen M, Magnusson SP, Kjaer M. Chronic Sequelae After Muscle Strain Injuries: Influence of Heavy Resistance Training on Functional and Structural Characteristics in a Randomized Controlled Trial. Am J Sports Med 2021; 49:2783-2794. [PMID: 34264782 DOI: 10.1177/03635465211026623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Muscle strain injury leads to a high risk of recurrent injury in sports and can cause long-term symptoms such as weakness and pain. Scar tissue formation after strain injuries has been described, yet what ultrastructural changes might occur in the chronic phase of this injury have not. It is also unknown if persistent symptoms and morphological abnormalities of the tissue can be mitigated by strength training. PURPOSE To investigate if heavy resistance training improves symptoms and structural abnormalities after strain injuries. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 30 participants with long-term weakness and/or pain after a strain injury of the thigh or calf muscles were randomized to eccentric heavy resistance training of the injured region or control exercises of the back and abdominal muscle. Isokinetic (hamstring) or isometric (calf) muscle strength was determined, muscle cross-sectional area measured, and pain and function evaluated. Scar tissue ultrastructure was determined from biopsy specimens taken from the injured area before and after the training intervention. RESULTS Heavy resistance training over 3 months improved pain and function, normalized muscle strength deficits, and increased muscle cross-sectional area in the previously injured region. No systematic effect of training was found upon pathologic infiltration of fat and blood vessels into the previously injured area. Control exercises had no effect on strength, cross-sectional area, or scar tissue but a positive effect on patient-related outcome measures, such as pain and functional scores. CONCLUSION Short-term strength training can improve sequelae symptoms and optimize muscle function even many years after a strain injury, but it does not seem to influence the overall structural abnormalities of the area with scar tissue. REGISTRATION NCT02152098 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Monika L Bayer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maren Hoegberget-Kalisz
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel H Hjortshoej
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jens L Olesen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Janus D Nybing
- Department of Radiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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15
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Crawford SK, Lee KS, Bashford GR, Heiderscheit BC. Spatial-frequency Analysis of the Anatomical Differences in Hamstring Muscles. ULTRASONIC IMAGING 2021; 43:100-108. [PMID: 33563139 PMCID: PMC7952215 DOI: 10.1177/0161734621990707] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Spatial frequency analysis (SFA) is a quantitative ultrasound method that characterizes tissue organization. SFA has been used for research involving tendon injury, but may prove useful in similar research involving skeletal muscle. As a first step, we investigated if SFA could detect known architectural differences within hamstring muscles. Ultrasound B-mode images were collected bilaterally at locations corresponding to proximal, mid-belly, and distal thirds along the hamstrings from 10 healthy participants. Images were analyzed in the spatial frequency domain by applying a two-dimensional Fourier Transform in all 6.5 × 6.5 mm kernels in a region of interest corresponding to the central portion of the muscle. SFA parameters (peak spatial frequency radius [PSFR], maximum frequency amplitude [Mmax], sum of frequencies [Sum], and ratio of Mmax to Sum [Mmax%]) were extracted from each muscle location and analyzed by separate linear mixed effects models. Significant differences were observed proximo-distally in PSFR (p = .039), Mmax (p < .0001), and Sum (p < .0001), consistent with architectural descriptions of the hamstring muscles. These results suggest that SFA can detect regional differences of healthy tissue structure within the hamstrings-an important finding for future research in regional muscle structure and mechanics.
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Affiliation(s)
- Scott K. Crawford
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth S. Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Greg R. Bashford
- Department of Biological Systems Engineering, University of Nebraska, Lincoln, NE, USA
| | - Bryan C. Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
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16
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van de Hoef PA, Brink MS, van der Horst N, van Smeden M, Backx FJG. The prognostic value of the hamstring outcome score to predict the risk of hamstring injuries. J Sci Med Sport 2021; 24:641-646. [PMID: 33478885 DOI: 10.1016/j.jsams.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 08/25/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Hamstring injuries are common among soccer players. The hamstring outcome score (HaOS) might be useful to identify amateur players at risk of hamstring injury. Therefore the aims of this study were: To determine the association between the HaOS and prior and new hamstring injuries in amateur soccer players, and to determine the prognostic value of the HaOS for identifying players with or without previous hamstring injuries at risk of future injury. DESIGN Cohort study. METHODS HaOS scores and information about previous injuries were collected at baseline and new injuries were prospectively registered during a cluster-randomized controlled trial involving 400 amateur soccer players. Analysis of variance and t-tests were used to determine the association between the HaOS and previous and new hamstring injury, respectively. Logistic regression analysis indicated the prognostic value of the HaOS for predicting new hamstring injuries. RESULTS Analysis of data of 356 players indicated that lower HaOS scores were associated with more previous hamstring injuries (F=17.4; p=0.000) and that players with lower HaOS scores sustained more new hamstring injuries (T=3.59, df=67.23, p=0.001). With a conventional HaOS score cut-off of 80%, logistic regression models yielded a probability of hamstring injuries of 11%, 18%, and 28% for players with 0,1, or 2 hamstring injuries in the previous season, respectively. CONCLUSIONS The HaOS is associated with previous and future hamstring injury and might be a useful tool to provide players with insight into their risk of sustaining a new hamstring injury risk when used in combination with previous injuries.
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Affiliation(s)
- P A van de Hoef
- Utrecht University, University Medical Center, Division Brain, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, The Netherlands.
| | - M S Brink
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - N van der Horst
- FIFA Medical Center, Royal Netherlands Football Association, Zeist, The Netherlands
| | - M van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - F J G Backx
- Utrecht University, University Medical Center, Division Brain, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, The Netherlands
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17
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Porrati-Paladino G, Cuesta-Barriuso R. Effectiveness of Plyometric and Eccentric Exercise for Jumping and Stability in Female Soccer Players-A Single-Blind, Randomized Controlled Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010294. [PMID: 33401532 PMCID: PMC7796027 DOI: 10.3390/ijerph18010294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022]
Abstract
Hamstring muscle injury is common in female soccer players. Changes affecting eccentric strength, flexibility, and the quadriceps–hamstring contraction cycle are risk factors associated with this type of injury. Methods: Seventeen soccer players were randomized to two groups: experimental (plyometric and eccentric exercises without external loads) and control (eccentric exercises without external loads). Eighteen sessions were scheduled over 6 weeks. The exercise program included three plyometric exercises (single-leg squat and lunge, 180 jump, and broad jump stick landing) and three eccentric exercises (Nordic hamstring exercise, diver, and glider). Dependent variables were jumping height (My Jump 2.0 App) and anterior, posteromedial, and posterolateral lower limb stability (Y-Balance test). Results: Following intervention, improvements were found in anterior and posteromedial stability (p = 0.04) in the experimental group. Posterolateral stability improved in athletes included in the control group (p = 0.02). There were differences in the repeated measures analysis for all variables, with no changes in group interaction (p > 0.05). Conclusions: Eccentric exercises, either combined with plyometric exercises or alone, can improve lower limb stability. No changes in jump height were noted in either group. There were no differences between the two groups in the variables studied. Future studies should analyze the effect of external loads on jumping stability and height in the performance of plyometric exercises.
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18
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Rojas-Valverde D, Gutiérrez-Vargas JC, Sánchez-Ureña B. Sport Readaptation: Where Do We Draw the Lines Between Professionals? Front Sports Act Living 2020; 1:62. [PMID: 33344985 PMCID: PMC7739741 DOI: 10.3389/fspor.2019.00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/04/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica.,Grupo de Avances en Entrenamiento Deportivo y Acondicionamiento Físico, Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
| | - Juan Carlos Gutiérrez-Vargas
- Centro de Estudios para el Desarrollo y Rehabilitación en Salud, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica
| | - Braulio Sánchez-Ureña
- Programa de Ciencias del Ejercicio y la Salud, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica
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19
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Chesterton P, Evans W, Wright M, Lolli L, Richardson M, Atkinson G. Influence of Lumbar Mobilizations During the Nordic Hamstring Exercise on Hamstring Measures of Knee Flexor Strength, Failure Point, and Muscle Activity: A Randomized Crossover Trial. J Manipulative Physiol Ther 2020; 44:1-13. [PMID: 33248746 DOI: 10.1016/j.jmpt.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aims of this study were to quantify the effects of spinal mobilization on force production, failure point, and muscle activity of the hamstrings during the Nordic hamstring exercise (NHE), and to explore individual differences in responses. METHODS In a replicated randomized crossover trial, 24 asymptomatic, recreationally active men (age [mean ± standard deviation]: 27 ± 6 years; body mass: 82 ± 17 kg; height: 181 ± 8 cm) completed 2 standardized intervention trials (L4/5 zygapophyseal mobilizations) and 2 control trials. The failure point of the NHE was determined with 3D motion capture. Peak force, knee flexor torque, and electromyography (EMG) of the biceps femoris were measured. Data analyses were undertaken to quantify mean intervention response and explore any individual response heterogeneity. RESULTS Mean (95% confidence interval) left-limb force was higher in intervention than in control trials by 18.7 (4.6-32) N. Similarly, right-limb force was higher by 22.0 (3.4-40.6) N, left peak torque by 0.14 (0.06-0.22) N • m, and right peak torque by 0.14 (0.05-0.23) N • m/kg. Downward force angle was decreased in intervention vs control trials by 4.1° (0.5°-7.6°) on the side of application. Both peak EMG activity (P = .002), and EMG at the downward force (right; P = .020) increased in the intervention condition by 16.8 (7.1-26.4) and 8.8 (1.5-16.1) mV, respectively. Mean downward acceleration angle changed by only 0.3° (-8.9° to 9.4°) in intervention vs control trials. A clear response heterogeneity was indicated only for right force (Participant × Intervention interaction: P = .044; response heterogeneity standard deviation = 34.5 [5.7-48.4] N). Individual response heterogeneity was small for all other outcomes. CONCLUSION After spinal mobilization, immediate changes in bilateral hamstring force production and peak torque occurred during the NHE. The effect on the NHE failure point was unclear. Electromyographic activity increased on the ipsilateral side. Response heterogeneity was generally similar to the random trial-to-trial variability inherent in the measurement of the outcomes.
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Affiliation(s)
- Paul Chesterton
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom.
| | - Will Evans
- Faculty of Health Sciences and Wellbeing, Sunderland University, Sunderland, United Kingdom
| | - Matthew Wright
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Lorenzo Lolli
- Football Exchange, Research Institute of Sport Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Mark Richardson
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Greg Atkinson
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
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20
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Higashihara A, Nakagawa K, Inami T, Fukano M, Iizuka S, Maemichi T, Hashizume S, Narita T, Hirose N. Regional differences in hamstring muscle damage after a marathon. PLoS One 2020; 15:e0234401. [PMID: 32584826 PMCID: PMC7316338 DOI: 10.1371/journal.pone.0234401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/24/2020] [Indexed: 02/04/2023] Open
Abstract
Previous studies suggest that marathon running induces lower extremity muscle damage. This study aimed to examine inter- and intramuscular differences in hamstring muscle damage after a marathon using transverse relaxation time (T2)–weighted magnetic resonance images (MRI). 20 healthy collegiate marathon runners (15 males) were recruited for this study. T2-MRI was performed before (PRE) and at 1 (D1), 3 (D3), and 8 days (D8) after marathon, and the T2 values of each hamstring muscle at the distal, middle, and proximal sites were calculated. Results indicated that no significant intermuscular differences in T2 changes were observed and that, regardless of muscle, the T2 values of the distal and middle sites increased significantly at D1 and D3 and recovered at D8, although those values of the proximal site remained constant. T2 significantly increased at distal and middle sites of the biceps femoris long head on D1 (p = 0.030 and p = 0.004, respectively) and D3 (p = 0.007 and p = 0.041, respectively), distal biceps femoris short head on D1 (p = 0.036), distal semitendinosus on D1 (p = 0.047) and D3 (p = 0.010), middle semitendinosus on D1 (p = 0.005), and distal and middle sites of the semimembranosus on D1 (p = 0.008 and p = 0.040, respectively) and D3 (p = 0.002 and p = 0.018, respectively). These results suggest that the distal and middle sites of the hamstring muscles are more susceptible to damage induced by running a full marathon. Conditioning that focuses on the distal and middle sites of the hamstring muscles may be more useful in improving recovery strategies after prolonged running.
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Affiliation(s)
- Ayako Higashihara
- Institute of Physical Education, Keio University, Kanagawa, Japan
- * E-mail:
| | - Kento Nakagawa
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Takayuki Inami
- Institute of Physical Education, Keio University, Kanagawa, Japan
| | - Mako Fukano
- Shibaura Institute of Technology, Tokyo, Japan
| | - Satoshi Iizuka
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | | | - Satoru Hashizume
- National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Takaya Narita
- Department of Sport Technology, Toin University of Yokohama, Kanagawa, Japan
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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21
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Wing C, Bishop C. Hamstring Strain Injuries: Incidence, Mechanisms, Risk Factors, and Training Recommendations. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Davis JD, Orr R, Knapik JJ, Harris D. Functional Movement Screen (FMS™) Scores and Demographics of US Army Pre-Ranger Candidates. Mil Med 2019; 185:e788-e794. [DOI: 10.1093/milmed/usz373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Abstract
Introduction
The United States Army Rangers are a unique population whose training requirements are intensive, and physically and mentally demanding. The Functional Movement Screen (FMS) is a movement screening tool designed to assess movement quality and asymmetries in movement with the potential to identify injury risk. This study was a descriptive, cross-sectional investigation examining associations between FMS scores and the various measures of health and performance of active duty soldiers in light infantry units who were involved in the U.S. Army Pre-Ranger Course (PRC).
Materials and Methods
Before the PRC, 491 male soldiers (mean age = 24.0 ± 3.8 years; mean height = 176.6 ± 7.2 cm; mean body mass = 80.2 ± 9.8 kg) completed a questionnaire which included items on self-assessed physical fitness, last Army physical fitness test (APFT) score, tobacco use, and injury history. The soldiers then completed the FMS, which consisted of seven movements and three clearing tests. From the FMS results, a determination of asymmetries (i.e., differences in FMS scores between the right and left side of the body) was made. Differences between groups were analyzed via an independent sample t-test, a one-way analysis of variance, or a chi-square as appropriate. Significance was set at 0.05 a priori.
Results
The average composite FMS score was 16.4 (±1.9) points. Soldiers reporting ≥290 APFT points achieved a higher FMS score than those reporting lower APFT scores (16.5 ± 2.0 vs 16.1 ± 2.0 points, P = 0.03). Soldiers reporting either tobacco use or a previous musculoskeletal injury had lower FMS scores than those not reporting these (tobacco: 16.1 ± 2.1 vs 16.5 ± 1.8 points, P = 0.02; injury: 16.0 ± 2.2 vs 16.6 ± 1.8 points, P < 0.01). FMS asymmetries were not related to APFT scores, tobacco use, or self-rated fitness. As self-rated fitness increased so did APFT scores.
Conclusions
Active duty soldiers of a light infantry division achieved FMS scores similar to other military populations tested, and the composite FMS score was related to higher APFT scores, absence of tobacco use, and absence of previous musculoskeletal injuries. Improving PRC candidate healthy habits through highlighting the negative associations between poorer fitness, cigarette tobacco use and movement quality, may reduce injury risk and increase PRC completion potential.
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Affiliation(s)
- Joel D Davis
- Guthrie Ambulatory Health Clinic; Musculoskeletal/Physical Therapy Department; 11050 Mount; Belvedere Blvd.; Fort Drum, NY 13602
| | - Robin Orr
- Tactical Research Unit; Bond University; 2 Promethean Way; Robina, Gold Coast; Australia
| | - Joseph J Knapik
- Tactical Research Unit; Bond University; 2 Promethean Way; Robina, Gold Coast; Australia
| | - Danny Harris
- Guthrie Ambulatory Health Clinic; Musculoskeletal/Physical Therapy Department; 11050 Mount; Belvedere Blvd.; Fort Drum, NY 13602
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23
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Kellis E. Intra- and Inter-Muscular Variations in Hamstring Architecture and Mechanics and Their Implications for Injury: A Narrative Review. Sports Med 2019; 48:2271-2283. [PMID: 30117053 DOI: 10.1007/s40279-018-0975-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Understanding the architecture, anatomy, and biomechanics of the hamstrings may assist in explaining the mechanisms that affect and improve their function. The aim of this review is to specifically examine intra- and inter-muscular variations in architecture and mechanical properties of the hamstrings. Of the hamstrings, the long head of the biceps femoris shows the shortest and more pennated fibers. The semimembranosus has a similar muscle architecture with a long head of the biceps femoris but it has a different proximal attachment as well as a different moment arm compared with the long head of the biceps femoris. For the same joint motion, the semitendinosus displays less relative strain than the other hamstrings probably owing to a greater length, longer fascicles and, possibly, a longer tendon. Intra-muscular variations in architecture are documented but their implications are currently unclear. Proximally, the long head of the biceps femoris has shorter and more pennated fibers coupled with a narrower aponeurosis than distally, while the semitendinosus is the only muscle that entails a tendinous inscription. In conclusion, some of the identified intra- and inter-muscular variations in architecture may help explain why some muscles sustain injuries more than others. In the same line, exercises designed for the hamstrings may not provide the same stimulus for all components of this muscle group. Future research could examine whether intervention strategies that target specific muscles or specific areas of the hamstrings may offer additional benefits for injury prevention or rehabilitation of their function.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, 62110, Greece.
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24
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Tijs C, Bernabei M, van Dieën JH, Maas H. Myofascial Loads Can Occur without Fascicle Length Changes. Integr Comp Biol 2019; 58:251-260. [PMID: 29873725 DOI: 10.1093/icb/icy049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many studies have shown that connective tissue linkages can transmit force between synergistic muscles and that such force transmission depends on the position of these muscles relative to each other and on properties of their intermuscular connective tissues. Moving neighboring muscles has been reported to cause longitudinal deformations within passive muscles held at a constant muscle-tendon unit (MTU) length (e.g., soleus [SO]), but muscle forces were not directly measured. Deformations do not provide a direct measure of the force transmitted between muscles. We combined two different muscle preparations to assess whether myofascial loads exerted by neighboring muscles result in length changes of SO fascicles. We investigated the effects of proximal MTU length changes of two-joint gastrocnemius (GA) and plantaris (PL) muscles on the fascicle length of the one-joint SO muscle within (1) an intact muscle compartment and (2) a disrupted compartment that allowed measurements of fascicle length and distal tendon force of SO simultaneously. SO muscle bellies of Wistar rats (n = 5) were implanted with sonomicrometry crystals. In three animals, connectivity between SO and GA+PL was enhanced. Measurements were performed before and during maximal excitation of all plantar flexor muscles. In both setups, MTU length of GA+PL did not affect the length of SO fascicles, neither during passive nor active conditions. However, lengthening the MTU of GA+PL increased distal tendon force of SO by 43.3-97.8% (P < 0.001) and 27.5-182.6% (P < 0.001), respectively. This indicates that substantial myofascial force transmission between SO and synergistic muscle can occur via a connective tissue network running parallel to the series of SO sarcomeres without substantial length changes of SO fascicles.
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Affiliation(s)
- Chris Tijs
- Department of Organismic and Evolutionary Biology, Concord Field Station-Harvard University, Bedford, MA 01730, USA
| | - Michel Bernabei
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, 1081 BT, Amsterdam, The Netherlands
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, 1081 BT, Amsterdam, The Netherlands
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25
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Hegyi A, Péter A, Finni T, Cronin NJ. Region-dependent hamstrings activity in Nordic hamstring exercise and stiff-leg deadlift defined with high-density electromyography. Scand J Med Sci Sports 2017; 28:992-1000. [PMID: 29143379 DOI: 10.1111/sms.13016] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 01/03/2023]
Abstract
Recent studies suggest region-specific metabolic activity in hamstring muscles during injury prevention exercises, but the neural representation of this phenomenon is unknown. The aim of this study was to examine whether regional differences are evident in the activity of biceps femoris long head (BFlh) and semitendinosus (ST) muscles during two common injury prevention exercises. Twelve male participants without a history of hamstring injury performed the Nordic hamstring exercise (NHE) and stiff-leg deadlift (SDL) while BFlh and ST activities were recorded with high-density electromyography (HD-EMG). Normalized activity was calculated from the distal, middle, and proximal regions in the eccentric phase of each exercise. In NHE, ST overall activity was substantially higher than in BFlh (d = 1.06 ± 0.45), compared to trivial differences between muscles in SDL (d = 0.19 ± 0.34). Regional differences were found in NHE for both muscles, with different proximal-distal patterns: The distal region showed the lowest activity level in ST (regional differences, d range = 0.55-1.41) but the highest activity level in BFlh (regional differences, d range = 0.38-1.25). In SDL, regional differences were smaller in both muscles (d range = 0.29-0.67 and 0.16-0.63 in ST and BFlh, respectively) than in NHE. The use of HD-EMG in hamstrings revealed heterogeneous hamstrings activity during typical injury prevention exercises. High-density EMG might be useful in future studies to provide a comprehensive overview of hamstring muscle activity in other exercises and high-injury risk tasks.
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Affiliation(s)
- A Hegyi
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - A Péter
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - T Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - N J Cronin
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
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26
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Erickson LN, Sherry MA. Rehabilitation and return to sport after hamstring strain injury. JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:262-270. [PMID: 30356646 PMCID: PMC6189266 DOI: 10.1016/j.jshs.2017.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/25/2017] [Accepted: 02/24/2017] [Indexed: 06/01/2023]
Abstract
Hamstring strain injuries are common among sports that involve sprinting, kicking, and high-speed skilled movements or extensive muscle lengthening-type maneuvers with hip flexion and knee extension. These injuries present the challenge of significant recovery time and a lengthy period of increased susceptibility for recurrent injury. Nearly one third of hamstring strains recur within the first year following return to sport with subsequent injuries often being more severe than the original. This high re-injury rate suggests that athletes may be returning to sport prematurely due to inadequate return to sport criteria. In this review article, we describe the epidemiology, risk factors, differential diagnosis, and prognosis of an acute hamstring strain. Based on the current available evidence, we then propose a clinical guide for the rehabilitation of acute hamstring strains and an algorithm to assist clinicians in the decision-making process when assessing readiness of an athlete to return to sport.
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27
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Bernabei M, van Dieën JH, Maas H. Evidence of adaptations of locomotor neural drive in response to enhanced intermuscular connectivity between the triceps surae muscles of the rat. J Neurophysiol 2017; 118:1677-1689. [PMID: 28490645 DOI: 10.1152/jn.00625.2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 01/13/2023] Open
Abstract
The aims of this study were to investigate changes 1) in the coordination of activation of the triceps surae muscle group, and 2) in muscle belly length of soleus (SO) and lateral gastrocnemius (LG) during locomotion (trotting) in response to increased stiffness of intermuscular connective tissues in the rat. We measured muscle activation and muscle belly lengths, as well as hindlimb kinematics, before and after an artificial enhancement of the connectivity between SO and LG muscles obtained by implanting a tissue-integrating surgical mesh at the muscles' interface. We found that SO muscle activation decreased to 62%, while activation of LG and medial gastrocnemius muscles increased to 134 and 125%, respectively, compared with the levels measured preintervention. Although secondary additional or amplified activation bursts were observed with enhanced connectivity, the primary pattern of activation over the stride and the burst duration were not affected by the intervention. Similar muscle length changes after manipulation were observed, suggesting that length feedback from spindle receptors within SO and LG was not affected by the connectivity enhancement. We conclude that peripheral mechanical constraints given by morphological (re)organization of connective tissues linking synergists are taken into account by the central nervous system. The observed shift in activity toward the gastrocnemius muscles after the intervention suggests that these larger muscles are preferentially recruited when the soleus has a similar mechanical disadvantage in that it produces an unwanted flexion moment around the knee.NEW & NOTEWORTHY Connective tissue linkages between muscle-tendon units may act as an additional mechanical constraint on the musculoskeletal system, thereby reducing the spectrum of solutions for performing a motor task. We found that intermuscular coordination changes following intermuscular connectivity enhancement. Besides showing that the extent of such connectivity is taken into account by the central nervous system, our results suggest that recruitment of triceps surae muscles is governed by the moments produced at the ankle-knee joints.
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Affiliation(s)
- Michel Bernabei
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
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28
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Noehren B, Andersen A, Hardy P, Johnson DL, Ireland ML, Thompson KL, Damon B. Cellular and Morphological Alterations in the Vastus Lateralis Muscle as the Result of ACL Injury and Reconstruction. J Bone Joint Surg Am 2016; 98:1541-7. [PMID: 27655981 PMCID: PMC5026157 DOI: 10.2106/jbjs.16.00035] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Individuals who have had an anterior cruciate ligament (ACL) tear and reconstruction continue to experience substantial knee extensor strength loss despite months of physical therapy. Identification of the alterations in muscle morphology and cellular composition are needed to understand potential mechanisms of muscle strength loss, initially as the result of the injury and subsequently from surgery and rehabilitation. METHODS We performed diffusion tensor imaging-magnetic resonance imaging and analyzed muscle biopsies from the vastus lateralis of both the affected and unaffected limbs before surgery and again from the reconstructed limb following the completion of rehabilitation. Immunohistochemistry was done to determine fiber type and size, Pax-7-positive (satellite) cells, and extracellular matrix (via wheat germ agglutinin straining). Using the diffusion tensor imaging data, the fiber tract length, pennation angle, and muscle volume were determined, yielding the physiological cross-sectional area (PCSA). Paired t tests were used to compare the effects of the injury between injured and uninjured limbs and the effects of surgery and rehabilitation within the injured limb. RESULTS We found significant reductions before surgery in type-IIA muscle cross-sectional area (CSA; p = 0.03), extracellular matrix (p < 0.01), satellite cells per fiber (p < 0.01), pennation angle (p = 0.03), muscle volume (p = 0.02), and PCSA (p = 0.03) in the injured limb compared with the uninjured limb. Following surgery, these alterations in the injured limb persisted and the frequency of the IIA fiber type decreased significantly (p < 0.01) and that of the IIA/X hybrid fiber type increased significantly (p < 0.01). CONCLUSIONS Significant and prolonged differences in muscle quality and morphology occurred after ACL injury and persisted despite reconstruction and extensive physical therapy. CLINICAL RELEVANCE These results suggest the need to develop more effective early interventions following an ACL tear to prevent deleterious alterations within the quadriceps.
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Affiliation(s)
- Brian Noehren
- Departments of Rehabilitation Sciences (B.N.), Anatomy and Neurobiology (A.A. and P.H.), Radiology (P.H.), Orthopaedic Surgery (A.A. and P.H.), Sports Medicine (D.L.J. and M.L.I.), and Statistics (K.L.T.), University of Kentucky, Lexington, Kentucky,E-mail address for B. Noehren:
| | - Anders Andersen
- Departments of Rehabilitation Sciences (B.N.), Anatomy and Neurobiology (A.A. and P.H.), Radiology (P.H.), Orthopaedic Surgery (A.A. and P.H.), Sports Medicine (D.L.J. and M.L.I.), and Statistics (K.L.T.), University of Kentucky, Lexington, Kentucky
| | - Peter Hardy
- Departments of Rehabilitation Sciences (B.N.), Anatomy and Neurobiology (A.A. and P.H.), Radiology (P.H.), Orthopaedic Surgery (A.A. and P.H.), Sports Medicine (D.L.J. and M.L.I.), and Statistics (K.L.T.), University of Kentucky, Lexington, Kentucky
| | - Darren L. Johnson
- Departments of Rehabilitation Sciences (B.N.), Anatomy and Neurobiology (A.A. and P.H.), Radiology (P.H.), Orthopaedic Surgery (A.A. and P.H.), Sports Medicine (D.L.J. and M.L.I.), and Statistics (K.L.T.), University of Kentucky, Lexington, Kentucky
| | - Mary Lloyd Ireland
- Departments of Rehabilitation Sciences (B.N.), Anatomy and Neurobiology (A.A. and P.H.), Radiology (P.H.), Orthopaedic Surgery (A.A. and P.H.), Sports Medicine (D.L.J. and M.L.I.), and Statistics (K.L.T.), University of Kentucky, Lexington, Kentucky
| | - Katherine L. Thompson
- Departments of Rehabilitation Sciences (B.N.), Anatomy and Neurobiology (A.A. and P.H.), Radiology (P.H.), Orthopaedic Surgery (A.A. and P.H.), Sports Medicine (D.L.J. and M.L.I.), and Statistics (K.L.T.), University of Kentucky, Lexington, Kentucky
| | - Bruce Damon
- Institute of Imaging Science and Departments of Biomedical Engineering and Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee
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29
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Characterization of three dimensional volumetric strain distribution during passive tension of the human tibialis anterior using Cine Phase Contrast MRI. J Biomech 2016; 49:3430-3436. [PMID: 27665350 DOI: 10.1016/j.jbiomech.2016.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/25/2016] [Accepted: 09/07/2016] [Indexed: 11/23/2022]
Abstract
Intramuscular pressure correlates strongly with muscle tension and is a promising tool for quantifying individual muscle force. However, clinical application is impeded by measurement variability that is not fully understood. Previous studies point to regional differences in IMP, specifically increasing pressure with muscle depth. Based on conservation of mass, intramuscular pressure and volumetric strain distributions may be inversely related. Therefore, we hypothesized volumetric strain would decrease with muscle depth. To test this we quantified 3D volumetric strain in the tibialis anterior of 12 healthy subjects using Cine Phase Contrast Magnetic Resonance Imaging. Cine Phase Contrast data were collected while a custom apparatus rotated the subjects' ankle continuously between neutral and plantarflexion. A T2-weighted image stack was used to define the resting tibials anterior position. Custom and commercial post-processing software were used to quantify the volumetric strain distribution. To characterize regional strain changes, the muscle was divided into superior-inferior sections and either medial-lateral or anterior-posterior slices. Mean volumetric strain was compared across the sections and slices. As hypothesized, volumetric strain demonstrated regional differences with a decreasing trend from the anterior (superficial) to the posterior (deep) muscle regions. Statistical tests showed significant main effects and interactions of superior-inferior and anterior-posterior position as well as superior-inferior and medial-lateral position on regional strain. These data support our hypothesis and imply a potential relationship between regional volumetric strain and intramuscular pressure. This finding may advance our understanding of intramuscular pressure variability sources and lead to more reliable measurement solutions in the future.
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30
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Tosovic D, Muirhead J, Brown J, Woodley S. Anatomy of the long head of biceps femoris: An ultrasound study. Clin Anat 2016; 29:738-45. [DOI: 10.1002/ca.22718] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 12/17/2022]
Affiliation(s)
- D. Tosovic
- Department of Anatomy and Developmental Biology; School of Biomedical Sciences, University of Queensland; Brisbane 4072 Australia
| | - J.C. Muirhead
- Department of Anatomy; Otago School of Medical Sciences, University of Otago; Dunedin 9016 New Zealand
| | - J.M.M. Brown
- Department of Anatomy and Developmental Biology; School of Biomedical Sciences, University of Queensland; Brisbane 4072 Australia
| | - S.J. Woodley
- Department of Anatomy; Otago School of Medical Sciences, University of Otago; Dunedin 9016 New Zealand
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31
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Bernabei M, Maas H, van Dieën JH. A lumped stiffness model of intermuscular and extramuscular myofascial pathways of force transmission. Biomech Model Mechanobiol 2016; 15:1747-1763. [PMID: 27193153 PMCID: PMC5106516 DOI: 10.1007/s10237-016-0795-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/03/2016] [Indexed: 12/02/2022]
Abstract
Mechanical behavior of skeletal muscles is commonly modeled under the assumption of mechanical independence between individual muscles within a muscle group. Epimuscular myofascial force transmission via the connective tissue network surrounding a muscle challenges this assumption as it alters the force distributed to the tendons of individual muscles. This study aimed to derive a lumped estimate of stiffness of the intermuscular and extramuscular connective tissues and to assess changes in such stiffness in response to a manipulation of the interface between adjacent muscles. Based on in situ measurements of force transmission in the rat plantar flexors, before and after resection of their connective tissue network, a nonlinear estimate of epimuscular myofascial stiffness was quantified and included in a multi-muscle model with lumped parameters which allows for force transmission depending on the relative position between the muscles in the group. Such stiffness estimate was assessed for a group with normal intermuscular connective tissues and for a group with increased connectivity, mimicking scar tissue development. The model was able to successfully predict the amount of epimuscular force transmission for different experimental conditions than those used to obtain the model parameters. The proposed nonlinear stiffness estimates of epimuscular pathways could be integrated in larger musculoskeletal models, to provide more accurate predictions of force when effects of mechanical interaction or altered epimuscular connections, e.g. after surgery or injury, are substantial.
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Affiliation(s)
- Michel Bernabei
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Van der Boechorststraat 9, 1081, Amsterdam, The Netherlands
| | - Huub Maas
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Van der Boechorststraat 9, 1081, Amsterdam, The Netherlands.
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Van der Boechorststraat 9, 1081, Amsterdam, The Netherlands
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32
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Whitehouse T, Orr R, Fitzgerald E, Harries S, McLellan CP. The Epidemiology of Injuries in Australian Professional Rugby Union 2014 Super Rugby Competition. Orthop J Sports Med 2016; 4:2325967116634075. [PMID: 27069947 PMCID: PMC4811007 DOI: 10.1177/2325967116634075] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Rugby union is a collision-based ball sport played at the professional level internationally. Rugby union has one of the highest reported incidences of injury of all team sports. Purpose: To identify the characteristics, incidence, and severity of injuries occurring in Australian professional Super Rugby Union. Design: Descriptive epidemiology study. Methods: The present study was a prospective epidemiology study on a cohort of 180 professional players from 5 Australian Super Rugby teams during the 2014 Super Rugby Union Tournament. Team medical staff collected and submitted daily training and match-play injury data through a secure, web-based electronic platform. The injury data included the main anatomic location of the injury, specific anatomic structure of the injury, injury diagnosis, training or match injury occurrence, main player position, mechanism of injury, and the severity of the injury quantified based on the number of days lost from training and/or competition due to injury. Results: The total combined incidence rate for injury during training and match-play across all Australian Super Rugby Union teams was 6.96 per 1000 hours, with a mean injury severity of 37.45 days lost from training and competition. The match-play injury incidence rate was 66.07 per 1000 hours, with a mean severity of 39.80 days lost from training and competition. No significant differences were observed between forward- and back-playing positions for match or training injury incidence rate or severity. Conclusion: The incidence of injury for the present study was lower during match-play than has previously been reported in professional rugby union; however, the overall time loss was higher compared with previous studies in professional rugby union. The high overall time loss was due fundamentally to a high incidence of injuries with greater than 28 days’ severity.
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Affiliation(s)
- Timothy Whitehouse
- Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
- Timothy Whitehouse, BSpSc(Hons), Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia, 4229 ()
| | - Robin Orr
- Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Edward Fitzgerald
- Sports Science and Sports Medicine Group, Australian Rugby Union Limited, St Leonards, New South Wales, Australia
| | - Simon Harries
- Sports Science and Sports Medicine Group, Australian Rugby Union Limited, St Leonards, New South Wales, Australia
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33
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Kellis E, Galanis N, Chrysanthou C, Kofotolis N. Use of Ultrasound to Monitor Biceps Femoris Mechanical Adaptations after Injury in a Professional Soccer Player. J Sports Sci Med 2016; 15:75-79. [PMID: 26957929 PMCID: PMC4763849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
This study examined the use of ultrasound to monitor changes in the long head of the biceps femoris (BF) architecture of aprofessional soccer player with acute first-time hamstring strain. The player followed a 14 session physiotherapy treatment until return to sport. The pennation angle and aponeurosis strain of the long head of the biceps femoris (BF) were monitored at 6 occasions (up until 1 year) after injury. The size of the scar / hematoma was reduced by 63.56% (length) and 67.9% (width) after the intervention and it was almost non-traceable one year after injury. The pennation angle of the fascicles underneath the scar showed a decline of 51.4% at the end of the intervention while an increase of 109.2% of the fascicles which were closer to deep aponeurosis was observed. In contrast, pennation angle of fascicles located away from the injury site were relatively unaffected. The treatment intervention resulted in a 57.9% to 77.3% decline of maximum strain per unit of MVC moment and remained similar one year after the intervention. This study provided an example of the potential use of ultrasound-based parameters to link the mechanical adaptations of the injured muscle to specific therapeutic intervention. Key pointsChanges in fascicle orientation after biceps femoris mild tear were reduced after a 28 day intervention and remained similar one year after injury.Tendon/aponeurosis strain per unit of moment of force decreased during the course of the therapeutic intervention.Future studies could utilize ultrasonography to monitor mechanical responses after various types of hamstring injury and interventions in order to improve criteria for a safe return to sport.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics , Department of Physical Education and Sport Sciences at Serres
| | - Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | | | - Nikolaos Kofotolis
- Laboratory of Neuromechanics , Department of Physical Education and Sport Sciences at Serres
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34
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Bernabei M, van Dieën JH, Maas H. Altered mechanical interaction between rat plantar flexors due to changes in intermuscular connectivity. Scand J Med Sci Sports 2016; 27:177-187. [PMID: 26773332 DOI: 10.1111/sms.12644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 01/20/2023]
Abstract
Connective tissue formation following muscle injury and remedial surgery may involve changes in the stiffness and configuration of the connective tissues linking adjacent muscles. We investigated changes in mechanical interaction of muscles by implanting either a tissue-integrating mesh (n = 8) or an adhesion barrier (n = 8) to respectively increase or decrease the intermuscular connectivity between soleus muscle (SO) and the lateral gastrocnemius and plantaris complex (LG+PL) of the rat. As a measure of mechanical interaction, changes in SO tendon forces and proximal-distal LG+PL force differences in response to lengthening LG+PL proximally were assessed 1 and 2 weeks post-surgery. The extent of mechanical interaction was doubled 1 week post-implantation of the tissue-integrating mesh compared to an unaffected compartment (n = 8), and was more than four times higher 2 weeks post-surgery. This was found only for maximally activated muscles, but not when passive. Implanting the adhesion barrier did not result in a reduction of the mechanical interaction between these muscles. Our findings indicate that the ratio of force transmitted via myofascial, rather than myotendinous pathways, can increase substantially when the connectivity between muscles is enhanced. This improves our understanding of the consequences of connective tissue formation at the muscle boundary on skeletal muscle function.
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Affiliation(s)
- M Bernabei
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - J H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - H Maas
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
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35
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Storey RN, Meikle GR, Stringer MD, Woodley SJ. Proximal hamstring morphology and morphometry in men: an anatomic and MRI investigation. Scand J Med Sci Sports 2015; 26:1480-1489. [DOI: 10.1111/sms.12625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- R. N. Storey
- Department of Anatomy; University of Otago; Dunedin New Zealand
| | - G. R. Meikle
- Radiology Department; Dunedin Public Hospital; Dunedin New Zealand
| | - M. D. Stringer
- Department of Anatomy; University of Otago; Dunedin New Zealand
| | - S. J. Woodley
- Department of Anatomy; University of Otago; Dunedin New Zealand
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Jensen ER, Morrow DA, Felmlee JP, Murthy NS, Kaufman KR. Method of quantifying 3D strain distribution in skeletal muscle using cine phase contrast MRI. Physiol Meas 2015; 36:N135-46. [PMID: 26595686 PMCID: PMC4838532 DOI: 10.1088/0967-3334/36/12/n135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Intramuscular pressure (IMP), a correlate of muscle tension, may fill an important clinical testing void. A barrier to implementing this measure clinically is its non-uniform distribution, which is not fully understood. Pressure is generated by changes in fluid mass and volume, therefore 3D volumetric strain distribution may affect IMP distribution. The purpose of this study was to develop a method for quantifying 3D volumetric strain distribution in the human tibialis anterior (TA) during passive tension using cine phase contrast (CPC) MRI and to assess its accuracy and precision.Five healthy subjects each participated in three data collections. A custom MRI-compatible apparatus repeatedly rotated a subject's ankle between 0° and 26° plantarflexion while CPC MRI data were collected. Additionally, T2-weighted images of the lower leg were collected both before and after the CPC data collection with the ankle stationary at both 0° and 26° plantarflexion for TA muscle segmentation. A 3D hexahedral mesh was generated based on the TA surface before CPC data collection with the ankle at 0° plantarflexion and the node trajectories were tracked using the CPC data. The volumetric strain of each element was quantified.Three tests were employed to assess the measure accuracy and precision. First, to quantify leg position drift, the TA segmentations were compared before and after CPC data collection. The Hawsdorff distance measure (error) was 1.5 ± 0.7 mm. Second, to assess the surface node trajectory accuracy, the deformed mesh surface was compared to the TA segmented at 26° of ankle plantarflexion. This error was 0.6 ± 0.2 mm. Third, the standard deviation of volumetric strain across the three data collections was calculated for each element and subject. The median between-day variability across subjects and mesh elements was 0.06 mm3 mm(-3) (95% confidence interval 0.01 to 0.18 mm3 mm(-3)). Overall the results demonstrated excellent accuracy and precision.
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Affiliation(s)
- Elisabeth R. Jensen
- Mayo Graduate School, Biomedical Engineering and Physiology Track,
Mayo Clinic, Rochester, MN 55905 USA
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo
Clinic, Rochester, MN 55905 USA
| | - Duane A. Morrow
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo
Clinic, Rochester, MN 55905 USA
| | - Joel P. Felmlee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905 USA
| | | | - Kenton R. Kaufman
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo
Clinic, Rochester, MN 55905 USA
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Effects of external pelvic compression on electromyographic activity of the hamstring muscles during unipedal stance in sportsmen with and without hamstring injuries. ACTA ACUST UNITED AC 2015; 20:412-9. [DOI: 10.1016/j.math.2014.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/09/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022]
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38
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Reurink G, Almusa E, Goudswaard GJ, Tol JL, Hamilton B, Moen MH, Weir A, Verhaar JAN, Maas M. No association between fibrosis on magnetic resonance imaging at return to play and hamstring reinjury risk. Am J Sports Med 2015; 43:1228-34. [PMID: 25748473 DOI: 10.1177/0363546515572603] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Connective tissue scar (fibrosis) is a common finding on magnetic resonance imaging (MRI) after recovery from acute hamstring injuries. Fibrosis has been suggested as a predisposing factor for reinjury, but evidence from clinical studies is lacking. PURPOSE/HYPOTHESIS The aim of this study was to examine the association between the presence of fibrosis on MRI at return to play after an acute hamstring injury and the risk of reinjury. The hypothesis was that fibrous tissue on MRI was associated with an increased reinjury risk. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Magnetic resonance images were obtained from 108 consecutive athletes with modified Peetrons classification grade 1 or 2 hamstring injuries within 5 days of injury and within 7 days of return to play. The presence and extent of abnormally low signal intensity in the intramuscular tissue on MRI, suggestive of fibrosis, were assessed on both T1- and T2-weighted images. Reinjuries were recorded over a 1-year follow-up period. The association between fibrosis and reinjury risk was analyzed with a Cox proportional hazards model. RESULTS The MRIs of the initial injury showed 45 (43%) grade 1 and 63 (57%) grade 2 injuries. Median time of return to play was 30 days (interquartile range [IQR], 22-42 days). At return to play, 41 athletes (38%) had fibrosis on MRI with a median longitudinal length of 5.8 cm (IQR, 3.3-12.5 cm) and a median volume of 1.5 cm3 (IQR, 1.5-3.9 cm3). In athletes with fibrosis, 24% (10/41) sustained a reinjury, and in the subjects without fibrosis, 24% (16/67) had a reinjury, resulting in a hazard ratio of 0.95 (95% CI, 0.43-2.1; P=.898). CONCLUSION Fibrosis is commonly seen on MRI at return to play after grade 1 or 2 hamstring injuries but is not associated with reinjury risk.
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Affiliation(s)
- Gustaaf Reurink
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, the Netherlands Department of Sports Medicine, The Sports Physicians Group, St Lucas Andreas Hospital, Amsterdam, the Netherlands
| | - Emad Almusa
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gert Jan Goudswaard
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Johannes L Tol
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Bruce Hamilton
- High Performance Sport New Zealand, Millennium Institute of Sport and Health, Mairangi Bay, Auckland, New Zealand
| | - Maarten H Moen
- Department of Sports Medicine, The Sports Physicians Group, St Lucas Andreas Hospital, Amsterdam, the Netherlands Department of Sports Medicine, Bergman Clinics, Naarden, the Netherlands
| | - Adam Weir
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Centre University of Amsterdam, Amsterdam, the Netherlands
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Sherry MA, Johnston TS, Heiderscheit BC. Rehabilitation of Acute Hamstring Strain Injuries. Clin Sports Med 2015; 34:263-84. [DOI: 10.1016/j.csm.2014.12.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Change in muscle thickness under contracting conditions following return to sports after a hamstring muscle strain injury-A pilot study. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:63-67. [PMID: 29264242 PMCID: PMC5730642 DOI: 10.1016/j.asmart.2015.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/26/2014] [Accepted: 01/06/2015] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to measure the change in hamstring muscle thickness between contracting and relaxing conditions following a return to sports after a hamstring muscle strain and thereby evaluate muscle function. Six male track and field sprinters participated in this study. All had experienced a prior hamstring strain injury that required a minimum of 2 weeks away from sport participation. Transverse plane scans were performed at the following four points on the affected and unaffected sides under contracting and relaxing conditions: proximal biceps femoris long head, proximal semitendinosus, middle biceps femoris long head, and middle semitendinosus. The results demonstrated an increase in the thickness of the middle biceps femoris long head and middle semitendinosus regions on the unaffected side with contraction, whereas the affected side did not show a significant increase. The proximal semitendinosus muscle thickness was increased with contraction on both the unaffected and the affected sides. By contrast, the proximal biceps femoris muscle thickness did not show a significant increase on both sides. The results of this study show that evaluation of muscle thickness during contraction may be useful for assessing the change in muscle function after a hamstring muscle strain injury.
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On Using Model Populations to Determine Mechanical Properties of Skeletal Muscle. Application to Concentric Contraction Simulation. Ann Biomed Eng 2015; 43:2444-55. [PMID: 25691399 DOI: 10.1007/s10439-015-1279-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/10/2015] [Indexed: 02/01/2023]
Abstract
In the field of computational biomechanics, the experimental evaluation of the material properties is crucial for the development of computational models that closely reproduce real organ systems. When simulations of muscle tissue are concerned, stress/strain relations for both passive and active behavior are required. These experimental relations usually exhibit certain variability. In this study, a set of material parameters involved in a 3D skeletal muscle model are determined by using a system biology approach in which the parameters are randomly varied leading to a population of models. Using a set of experimental results from an animal model, a subset of the entire population of models was selected. This reduced population predicted the mechanical response within the window of experimental observations. Hence, a range of model parameters, instead of a single set of them, was determined. Rat Tibialis Anterior muscle was selected for this study. Muscles ([Formula: see text]) were activated through the sciatic nerve and during contraction the tissue pulled a weight fixed to the distal tendon (concentric contraction). Three different weights 1, 2 and 3 N were used and the time course of muscle stretch was analyzed obtaining values of (mean [Formula: see text] standard deviation): [Formula: see text], [Formula: see text] and [Formula: see text] respectively. A paired two-sided sign rank test showed significant differences between the muscle response for the three weights ([Formula: see text]). This study shows that the Monte Carlo method could be used for determine muscle characteristic parameters considering the variability of the experimental population.
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Bernabei M, van Dieën JH, Baan GC, Maas H. Significant mechanical interactions at physiological lengths and relative positions of rat plantar flexors. J Appl Physiol (1985) 2015; 118:427-36. [DOI: 10.1152/japplphysiol.00703.2014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In situ studies involving supraphysiological muscle lengths and relative positions have shown that connective tissue linkages connecting adjacent muscles can transmit substantial forces, but the physiological significance is still subject to debate. The present study investigates effects of such epimuscular myofascial force transmission in the rat calf muscles. Unlike previous approaches, we quantified the mechanical interaction between the soleus (SO) and the lateral gastrocnemius and plantaris complex (LG+PL) applying a set of muscle lengths and relative positions corresponding to the range of knee and ankle angles occurring during normal movements. In nine deeply anesthetized Wistar rats, the superficial posterior crural compartment was exposed, and distal and proximal tendons of LG+PL and the distal SO tendon were severed and connected to force transducers. The target muscles were excited simultaneously. We found that SO active and passive tendon force was substantially affected by proximally lengthening of LG+PL mimicking knee extension (10% and 0.8% of maximal active SO force, respectively; P < 0.05). Moreover, SO relative position significantly changed the LG+PL length-force relationship, resulting in nonunique values for passive slack-length and optimum-length estimates. We conclude that also, for physiological muscle conditions, isometric force of rat triceps surae muscles is determined by its muscle-tendon unit length as well as by the length and relative position of its synergists. This has implications for understanding the neuromechanics of skeletal muscle in normal and pathological conditions, as well as for studies relying on the assumption that muscles act as independent force actuators.
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Affiliation(s)
- Michel Bernabei
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands
| | - Jaap H. van Dieën
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands
| | - Guus C. Baan
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands
| | - Huub Maas
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands
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43
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Fiorentino NM, Rehorn MR, Chumanov ES, Thelen DG, Blemker SS. Computational models predict larger muscle tissue strains at faster sprinting speeds. Med Sci Sports Exerc 2015; 46:776-86. [PMID: 24145724 DOI: 10.1249/mss.0000000000000172] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Proximal biceps femoris musculotendon strain injury has been well established as a common injury among athletes participating in sports that require sprinting near or at maximum speed; however, little is known about the mechanisms that make this muscle tissue more susceptible to injury at faster speeds. PURPOSE This study aimed to quantify localized tissue strain during sprinting at a range of speeds. METHODS Biceps femoris long head (BFlh) musculotendon dimensions of 14 athletes were measured on magnetic resonance (MR) images and used to generate a finite-element computational model. The model was first validated through comparison with previous dynamic MR experiments. After validation, muscle activation and muscle-tendon unit length change were derived from forward dynamic simulations of sprinting at 70%, 85%, and 100% maximum speed and used as input to the computational model simulations. Simulations ran from midswing to foot contact. RESULTS The model predictions of local muscle tissue strain magnitude compared favorably with in vivo tissue strain measurements determined from dynamic MR experiments of the BFlh. For simulations of sprinting, local fiber strain was nonuniform at all speeds, with the highest muscle tissue strain where injury is often observed (proximal myotendinous junction). At faster sprinting speeds, increases were observed in fiber strain nonuniformity and peak local fiber strain (0.56, 0.67, and 0.72 for sprinting at 70%, 85%, and 100% maximum speed). A histogram of local fiber strains showed that more of the BFlh reached larger local fiber strains at faster speeds. CONCLUSIONS At faster sprinting speeds, peak local fiber strain, fiber strain nonuniformity, and the amount of muscle undergoing larger strains are predicted to increase, likely contributing to the BFlh muscle's higher injury susceptibility at faster speeds.
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Affiliation(s)
- Niccolo M Fiorentino
- 1Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA; 2Department of Biomedical Engineering, University of Virginia, Charlottesville, VA; 3Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI; 4Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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Jensen ER, Morrow DA, Felmlee JP, Odegard GM, Kaufman KR. Error analysis of cine phase contrast MRI velocity measurements used for strain calculation. J Biomech 2015; 48:95-103. [PMID: 25433567 DOI: 10.1016/j.jbiomech.2014.10.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 11/19/2022]
Abstract
Cine Phase Contrast (CPC) MRI offers unique insight into localized skeletal muscle behavior by providing the ability to quantify muscle strain distribution during cyclic motion. Muscle strain is obtained by temporally integrating and spatially differentiating CPC-encoded velocity. The aim of this study was to quantify CPC measurement accuracy and precision and to describe error propagation into displacement and strain. Using an MRI-compatible jig to move a B-gel phantom within a 1.5 T MRI bore, CPC-encoded velocities were collected. The three orthogonal encoding gradients (through plane, frequency, and phase) were evaluated independently in post-processing. Two systematic error types were corrected: eddy current-induced bias and calibration-type error. Measurement accuracy and precision were quantified before and after removal of systematic error. Through plane- and frequency-encoded data accuracy were within 0.4 mm/s after removal of systematic error - a 70% improvement over the raw data. Corrected phase-encoded data accuracy was within 1.3 mm/s. Measured random error was between 1 to 1.4 mm/s, which followed the theoretical prediction. Propagation of random measurement error into displacement and strain was found to depend on the number of tracked time segments, time segment duration, mesh size, and dimensional order. To verify this, theoretical predictions were compared to experimentally calculated displacement and strain error. For the parameters tested, experimental and theoretical results aligned well. Random strain error approximately halved with a two-fold mesh size increase, as predicted. Displacement and strain accuracy were within 2.6 mm and 3.3%, respectively. These results can be used to predict the accuracy and precision of displacement and strain in user-specific applications.
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Affiliation(s)
- Elisabeth R Jensen
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905 USA
| | - Duane A Morrow
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905 USA
| | - Joel P Felmlee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905 USA
| | - Gregory M Odegard
- Computational Mechanics and Materials Research Laboratory, Department of Mechanical Engineering-Engineering Mechanics, Michigan Technological University, Houghton, MI 49931 USA
| | - Kenton R Kaufman
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905 USA.
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Heterogeneous fascicle behavior within the biceps femoris long head at different muscle activation levels. J Biomech 2014; 47:3050-5. [DOI: 10.1016/j.jbiomech.2014.06.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 05/18/2014] [Accepted: 06/27/2014] [Indexed: 11/21/2022]
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46
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Musculotendon variability influences tissue strains experienced by the biceps femoris long head muscle during high-speed running. J Biomech 2014; 47:3325-33. [PMID: 25189094 DOI: 10.1016/j.jbiomech.2014.08.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 08/03/2014] [Accepted: 08/08/2014] [Indexed: 11/22/2022]
Abstract
The hamstring muscles frequently suffer injury during high-speed running, though the factors that make an individual more susceptible to injury remain poorly understood. The goals of this study were to measure the musculotendon dimensions of the biceps femoris long head (BFlh) muscle, the hamstring muscle injured most often, and to use computational models to assess the influence of variability in the BFlh's dimensions on internal tissue strains during high-speed running. High-resolution magnetic resonance (MR) images were acquired over the thigh in 12 collegiate athletes, and musculotendon dimensions were measured in the proximal free tendon/aponeurosis, muscle and distal free tendon/aponeurosis. Finite element meshes were generated based on the average, standard deviation and range of BFlh dimensions. Simulation boundary conditions were defined to match muscle activation and musculotendon length change in the BFlh during high-speed running. Muscle and connective tissue dimensions were found to vary between subjects, with a coefficient of variation (CV) of 17±6% across all dimensions. For all simulations peak local strain was highest along the proximal myotendinous junction, which is where injury typically occurs. Model variations showed that peak local tissue strain increased as the proximal aponeurosis width narrowed and the muscle width widened. The aponeurosis width and muscle width variation models showed that the relative dimensions of these structures influence internal muscle tissue strains. The results of this study indicate that a musculotendon unit's architecture influences its strain injury susceptibility during high-speed running.
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47
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De Vos RJ, Reurink G, Goudswaard GJ, Moen MH, Weir A, Tol JL. Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not. Br J Sports Med 2014; 48:1377-84. [DOI: 10.1136/bjsports-2014-093737] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Opar DA, Serpell BG. Is There a Potential Relationship Between Prior Hamstring Strain Injury and Increased Risk for Future Anterior Cruciate Ligament Injury? Arch Phys Med Rehabil 2014; 95:401-5. [DOI: 10.1016/j.apmr.2013.07.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
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49
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Reurink G, Goudswaard GJ, Tol JL, Almusa E, Moen MH, Weir A, Verhaar JAN, Hamilton B, Maas M. MRI observations at return to play of clinically recovered hamstring injuries. Br J Sports Med 2013; 48:1370-6. [PMID: 24255767 PMCID: PMC4174122 DOI: 10.1136/bjsports-2013-092450] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Previous studies have shown that MRI of fresh hamstring injuries have diagnostic and prognostic value. The clinical relevance of MRI at return to play (RTP) has not been clarified yet. The aim of this study is to describe MRI findings of clinically recovered hamstring injuries in amateur, elite and professional athletes that were cleared for RTP. Methods We obtained MRI of 53 consecutive athletes with hamstring injuries within 5 days of injury and within 3 days of RTP. We assessed the following parameters: injured muscle, grading of injury, presence and extent of intramuscular signal abnormality. We recorded reinjuries within 2 months of RTP. Results MRIs of the initial injury showed 27 (51%) grade 1 and 26 (49%) grade 2 injuries. Median time to RTP was 28 days (range 12–76). On MRI at RTP 47 athletes (89%) had intramuscular increased signal intensity on fluid-sensitive sequences with a mean longitudinal length of 77 mm (±53) and a median cross-sectional area of 8% (range 0–90%) of the total muscle area. In 22 athletes (42%) there was abnormal intramuscular low-signal intensity. We recorded five reinjuries. Conclusions 89% of the clinically recovered hamstring injuries showed intramuscular increased signal intensity on fluid-sensitive sequences on MRI. Normalisation of this increased signal intensity seems not required for a successful RTP. Low-signal intensity suggestive of newly developed fibrous tissues is observed in one-third of the clinically recovered hamstring injuries on MRI at RTP, but its clinical relevance and possible association with increased reinjury risk has to be determined.
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Affiliation(s)
- Gustaaf Reurink
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gert Jan Goudswaard
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Johannes L Tol
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Emad Almusa
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Maarten H Moen
- Department of Sports Medicine, Bergman Clinics, Naarden, The Netherlands
| | - Adam Weir
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bruce Hamilton
- Department of Sports Medicine, High Performance Sport New Zealand, Millennium Institute of Sport and Health, Mairangi Bay, Auckland, New Zealand
| | - Mario Maas
- Department of Radiology, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
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50
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Schache AG, Dorn TW, Wrigley TV, Brown NAT, Pandy MG. Stretch and activation of the human biarticular hamstrings across a range of running speeds. Eur J Appl Physiol 2013; 113:2813-28. [DOI: 10.1007/s00421-013-2713-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/21/2013] [Indexed: 11/30/2022]
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