Quantifying demands on the hamstrings during high-speed running: A systematic review and meta-analysis

Hamstring T-Junction Surgical Repair: An Elite Footballer's Return to Play Journey Through a New Football-Centered Complex Approach

Background

Hamstring strain injuries have a significant impact in football, with a high re-injury rate, particularly when the distal musculotendinous T-junction (DMTJ) is involved. In some cases, surgical repair is necessary to reduce the risk of re-injury and ensure return to play (RTP) at the pre-injury level.

Study design

Case Report.

Case description

A 24-year-old male football (soccer) player, playing in the Swiss first division, with recidivate hamstring injury, who undercame to surgical repair of DMTJ and returned to play through after 19 weeks. This case report introduces a new football-centered model divided into four main phases, showing how it guided the clinical reasoning used through the RTP process, along with MRI evaluations, clinical outcomes, global positioning system (GPS) data, and strength and power (S&P) neuromuscular testing.

Outcomes

The subject gradually returned to team training after 12 weeks and successfully returned to play after 19 weeks. The player participated in 26 official matches throughout the season, accumulating 1.323 minutes of play without reporting any symptoms at the injury site.

Conclusions

The subject had a successful return to play following the rehab model proposed in this case report, as he was involved in all the matches, and he played without any symptoms or new injuries.

Level of evidence

5.

Injury-inciting circumstances of sudden-onset hamstring injuries: video analyses of 63 match injuries in male professional football players in the Qatar Stars League (2013-2020)

OBJECTIVE

To describe and categorise the injury-inciting circumstances of sudden-onset hamstring match injuries in professional football players using systematic video analysis.

METHODS

Using a prospective injury surveillance database, all sudden-onset hamstring match injuries in male football players (18 years and older) from the Qatar Stars League between September 2013 and August 2020 were reviewed and cross-referenced with broadcasted match footage. Videos with a clear observable painful event (ie, a player grabbing their posterior thigh) were included. Nine investigators independently analysed all videos to describe and categorise injury-inciting circumstances. We used three main categories: playing situation (eg, time of injury), player action(s) (eg, running) and other considerations (eg, contact). Player action(s) and other considerations were not mutually exclusive.

RESULTS

We included 63 sudden-onset hamstring match injuries out of 295 registered injuries between 2013 and 2020. Running was involved in 86% of injuries. Hamstring injuries occurred primarily during acceleration of 0-10 m (24% of all injuries) and in general at different running distances (0-50 m) and speeds (slow to fast). At 0-10 m distance, indirect player-to-player contact and inadequate balance were involved in 53% and 67% of the cases, respectively. Pressing occurred in 46% of all injuries (injured player pressing opponent: 25%; being pressed by opponent: 21%) and frequently involved player-to-player contact (69% of the cases when the injured player was pressing vs 15% of the cases when the opponent was pressing) and inadequate balance (82% vs 50%, respectively). Other player actions that did not involve running (n=9, 14% of all injuries) were kicking (n=6) and jumping (n=3).

CONCLUSION

The injury-inciting circumstances of sudden-onset hamstring match injuries in football varied. The most common single-player action (24%) was acceleration over a distance of <10 m. Pressing, inadequate balance and indirect contact were frequently seen player actions. Injury prevention research in football should look beyond high-speed running as the leading risk factor for sudden-onset hamstring injuries.

Athletic Injury Research: Frameworks, Models and the Need for Causal Knowledge

Within applied sports science and medicine research, many challenges hinder the establishment and detailed understanding of athletic injury causality as well as the development and implementation of appropriate athletic injury prevention strategies. Applied research efforts are faced with a lack of variable control, while the capacity to compensate for this lack of control through the application of randomised controlled trials is often confronted by a number of obstacles relating to ethical or practical constraints. Such difficulties have led to a large reliance upon observational research to guide applied practice in this area. However, the reliance upon observational research, in conjunction with the general absence of supporting causal inference tools and structures, has hindered both the acquisition of causal knowledge in relation to athletic injury and the development of appropriate injury prevention strategies. Indeed, much of athletic injury research functions on a (causal) model-blind observational approach primarily driven by the existence and availability of various technologies and data, with little regard for how these technologies and their associated metrics can conceptually relate to athletic injury causality and mechanisms. In this article, a potential solution to these issues is proposed and a new model for investigating athletic injury aetiology and mechanisms, and for developing and evaluating injury prevention strategies, is presented. This solution is centred on the construction and utilisation of various causal diagrams, such as frameworks, models and causal directed acyclic graphs (DAGs), to help guide athletic injury research and prevention efforts. This approach will alleviate many of the challenges facing athletic injury research by facilitating the investigation of specific causal links, mechanisms and assumptions with appropriate scientific methods, aiding the translation of lab-based research into the applied sporting world, and guiding causal inferences from applied research efforts by establishing appropriate supporting causal structures. Further, this approach will also help guide the development and adoption of both relevant metrics (and technologies) and injury prevention strategies, as well as encourage the construction of appropriate theoretical and conceptual foundations prior to the commencement of applied injury research studies. This will help minimise the risk of resource wastage, data fishing, p-hacking and hypothesising after the results are known (HARK-ing) in athletic injury research.

Is the risk of muscle injuries higher in the finals than in previous rounds of the 100 m, 200 m and 400 m sprints of international athletics championships?

OBJECTIVES

To compare incidence rates of lower limb muscle injuries (LLMIs) and hamstring muscle injuries (HMIs) in 100 m, 200 m and 400 m sprints disciplines between finals, semi-finals and heats of international athletics championships.

DESIGN

Prospective total population study.

METHODS

We analysed in-competition LLMIs and HMIs of female and male athletes during eight championships between 2009 and 2022.

RESULTS

LLMI and HMI incidence rates in 100 m finals were significantly higher than in heats and semi-finals for female and male athletes. HMI incidence rates were significantly higher in 200 m finals than heats and semi-finals for male athletes.

CONCLUSIONS

LLMI and HMI risk was higher in finals compared to previous rounds during international athletics championships.