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Green B, McClelland JA, Semciw AI, Schache AG, McCall A, Pizzari T. The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians. SPORTS MEDICINE - OPEN 2022; 8:10. [PMID: 35032233 PMCID: PMC8761182 DOI: 10.1186/s40798-021-00364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
Background Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews. Results Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands. Conclusions Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00364-0.
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Kalema RN, Schache AG, Williams MD, Heiderscheit B, Siqueira Trajano G, Shield AJ. Sprinting Biomechanics and Hamstring Injuries: Is There a Link? A Literature Review. Sports (Basel) 2021; 9:sports9100141. [PMID: 34678922 PMCID: PMC8540816 DOI: 10.3390/sports9100141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/25/2022] Open
Abstract
Hamstring strain injury (HSI) is a common and costly injury in many sports such as the various professional football codes. Most HSIs have been reported to occur during high intensity sprinting actions. This observation has led to the suggestion that a link between sprinting biomechanics and HSIs may exist. The aim of this literature review was to evaluate the available scientific evidence underpinning the potential link between sprinting biomechanics and HSIs. A structured search of the literature was completed followed by a risk of bias assessment. A total of eighteen studies were retrieved. Sixteen studies involved retrospective and/or prospective analyses, of which only three were judged to have a low risk of bias. Two other case studies captured data before and after an acute HSI. A range of biomechanical variables have been measured, including ground reaction forces, trunk and lower-limb joint angles, hip and knee joint moments and powers, hamstring muscle–tendon unit stretch, and surface electromyographic activity from various trunk and thigh muscles. Overall, current evidence was unable to provide a clear and nonconflicting perspective on the potential link between sprinting biomechanics and HSIs. Nevertheless, some interesting findings were revealed, which hopefully will stimulate future research on this topic.
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Affiliation(s)
- Rudy N. Kalema
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, O Block Victoria Park Road, Kelvin Grove, QLD 4059, Australia; (G.S.T.); (A.J.S.)
- Correspondence:
| | - Anthony G. Schache
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC 3086, Australia;
| | - Morgan D. Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 IDL, UK;
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Gabriel Siqueira Trajano
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, O Block Victoria Park Road, Kelvin Grove, QLD 4059, Australia; (G.S.T.); (A.J.S.)
| | - Anthony J. Shield
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, O Block Victoria Park Road, Kelvin Grove, QLD 4059, Australia; (G.S.T.); (A.J.S.)
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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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SPRINT PERFORMANCE IN FOOTBALL (SOCCER) PLAYERS WITH AND WITHOUT A PREVIOUS HAMSTRING STRAIN INJURY: AN EXPLORATIVE CROSS-SECTIONAL STUDY. Int J Sports Phys Ther 2020; 15:947-957. [PMID: 33344011 DOI: 10.26603/ijspt20200947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Hamstring strain injuries are common in many sports. Following a hamstring injury, deficits in peak and explosive strength may persist after return to sport potentially affecting sprint performance. Assessment of repeated-sprint ability is recognized as an important part of the return to sport evaluation after a hamstring injury.Purpose: This purpose of this exploratory cross-sectional study was to compare sprinting performance obtained during a repeated-sprint test between football players with and without a previous hamstring strain injury. Methods Forty-four fully active sub-elite football players, 11 with a previous hamstring strain injury during the preceding 12 months (cases; mean age, SD: 25.6 ± 4.4) and 33 demographically similar controls (mean age, SD: 23.2 ± 3.7), were included from six clubs. All players underwent a repeated-sprint test, consisting of six 30-meter maximal sprints with 90 seconds of recovery between sprints. Sprint performance was captured using high-speed video-recording and subsequently assessed by a blinded tester to calculate maximal sprint velocity, maximal horizontal force, maximal horizontal power, and mechanical effectiveness. Results A significant between-group difference was seen in favor of players having a previous hamstring injury over 6 sprints for maximal velocity (mean difference: 0.457 m/s, 95% CI: 0.059-0.849, p = 0.025) and mechanical effectiveness (mean difference: 0.009, 95% CI: 0.001-0.016, p = 0.020). Conclusion Repeated-sprint performance was not impaired in football players with a previous hamstring strain injury; in fact, higher mean maximal sprinting velocity and better mechanical effectiveness were found in players with compared to without a previous hamstring injury. The higher sprinting velocity, which likely increases biomechanical load on the hamstring muscles, in previously injured players may increase the risk of recurrent injuries. Level of evidence 3b.
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Maestroni L, Read P, Bishop C, Turner A. Strength and Power Training in Rehabilitation: Underpinning Principles and Practical Strategies to Return Athletes to High Performance. Sports Med 2020; 50:239-252. [PMID: 31559567 DOI: 10.1007/s40279-019-01195-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Injuries have a detrimental impact on team and individual athletic performance. Deficits in maximal strength, rate of force development (RFD), and reactive strength are commonly reported following several musculoskeletal injuries. This article first examines the available literature to identify common deficits in fundamental physical qualities following injury, specifically strength, rate of force development and reactive strength. Secondly, evidence-based strategies to target a resolution of these residual deficits will be discussed to reduce the risk of future injury. Examples to enhance practical application and training programmes have also been provided to show how these can be addressed.
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Affiliation(s)
- Luca Maestroni
- Smuoviti, Viale Giulio Cesare, 29, 24121, Bergamo, BG, Italy.
- StudioErre, Via della Badia, 18, 25127, Brescia, BS, Italy.
| | - Paul Read
- Athlete Health and Performance Research Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chris Bishop
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
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