{"id":1745,"date":"2015-11-12T13:16:32","date_gmt":"2015-11-12T13:16:32","guid":{"rendered":"https:\/\/andreasphysioblog.com\/?p=1745"},"modified":"2021-05-20T06:30:39","modified_gmt":"2021-05-20T06:30:39","slug":"hamstring-injuries-prevention-and-treatment-an-update","status":"publish","type":"post","link":"https:\/\/andreasphysioblog.com\/?p=1745","title":{"rendered":"Hamstring injuries: prevention and treatment\u2014 an update"},"content":{"rendered":"<header class=\"entry-header\">\n<h1 class=\"entry-title\">Hamstring injuries: prevention and treatment\u2014 an update<\/h1>\n<\/header>\n<div class=\"entry-body\">\n<div class=\"entry-content\">\n<p>Based on:<br \/>\n<a href=\"http:\/\/bjsm.bmj.com\/content\/49\/19\/1241.full.pdf+html?sid=aaff6a8c-09aa-49f4-a0bb-f8f1fa5f3a88\">Hamstring injuries: prevention and treatment -an update, Peter Brukner,Br J Sports Med 2015 49: 1241-1244 \u00a0doi: 10.1136\/bjsports-2014-094427<\/a><\/p>\n<p>While the concept of eccentric muscle training has been an\u00a0important component of the rehabilitation process for many years, it now appears that these exercises must be in the lengthened position.<\/p>\n<p>This makes sense when you think that the majority of hamstring muscle injuries are located in the long head of biceps femoris, a muscle that straddles both the hip and knee joints.<\/p>\n<p>The standard leg curl exercise, therefore, does not work the long head sufficiently. As a result, lengthening eccentric exercises such as the <a href=\"https:\/\/www.youtube.com\/watch?v=Sfxy9RBm0qI\">Nordic hamstring exercise (NHE)<\/a>, the <a href=\"https:\/\/www.youtube.com\/watch?v=CdWCLR9aXoI\">Romanian dead lift<\/a> and <a href=\"https:\/\/www.youtube.com\/watch?v=wPwtUt2gOJM\">Askling\u2019s \u2018extender\u2019, \u2018diver\u2019 and \u2018glider\u2019 exercises<\/a>\u00a0are now becoming the mainstay of post injury rehabilitatio<img decoding=\"async\" class=\"wp-image-6109 alignright\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2014\/04\/skc3a6rmbillede-2015-11-11-kl-14-36-11.png?w=202&amp;h=162\" sizes=\"(max-width: 202px) 100vw, 202px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2014\/04\/skc3a6rmbillede-2015-11-11-kl-14-36-11.png?w=202&amp;h=162 202w, https:\/\/andreasbjerregaard.files.wordpress.com\/2014\/04\/skc3a6rmbillede-2015-11-11-kl-14-36-11.png?w=404&amp;h=324 404w, https:\/\/andreasbjerregaard.files.wordpress.com\/2014\/04\/skc3a6rmbillede-2015-11-11-kl-14-36-11.png?w=150&amp;h=120 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2014\/04\/skc3a6rmbillede-2015-11-11-kl-14-36-11.png?w=300&amp;h=240 300w\" alt=\"Sk\u00e6rmbillede 2015-11-11 kl. 14.36.11\" width=\"202\" height=\"162\" data-attachment-id=\"6109\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2014\/04\/21\/ovelser-for-tennisalbue-golfalbue-klatreralbue-handboldalbue-og-musearm\/skaermbillede-2015-11-11-kl-14-36-11\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2014\/04\/skc3a6rmbillede-2015-11-11-kl-14-36-11.png\" data-orig-size=\"1012,808\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-11-11 kl. 14.36.11\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2014\/04\/skc3a6rmbillede-2015-11-11-kl-14-36-11.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2014\/04\/skc3a6rmbillede-2015-11-11-kl-14-36-11.png?w=825\" \/>n<a href=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png\"><img fetchpriority=\"high\" decoding=\"async\" class=\"alignleft wp-image-6122 \" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png?w=389&amp;h=149\" sizes=\"(max-width: 389px) 100vw, 389px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png?w=389&amp;h=149 389w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png?w=778&amp;h=298 778w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png?w=150&amp;h=57 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png?w=300&amp;h=115 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png?w=768&amp;h=293 768w\" alt=\"Sk\u00e6rmbillede 2015-11-12 kl. 23.02.23\" width=\"389\" height=\"149\" data-attachment-id=\"6122\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/11\/12\/hamstring-injuries-prevention-and-treatment-an-update\/skaermbillede-2015-11-12-kl-23-02-23\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png\" data-orig-size=\"1068,408\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-11-12 kl. 23.02.23\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png?w=825\" \/><\/a><\/p>\n<p><a href=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-23-02-23.png\"><br \/>\n<\/a><br \/>\n<a href=\"http:\/\/bjsm.bmj.com\/content\/49\/19\/1241.full.pdf+html?sid=aaff6a8c-09aa-49f4-a0bb-f8f1fa5f3a88\">http:\/\/bjsm.bmj.com\/content\/49\/19\/1241.full.pdf+html?sid=aaff6a8c-09aa-49f4-a0bb-f8f1fa5f3a88<\/a><\/p>\n<p><strong>Two papers have proposed parameters by which hamstring rehabilitation programmes can be created<\/strong><\/p>\n<p>1.<br \/>\nMalliaropoulos et al suggested the following parameters\u2014injury mechanism, hip or knee dominant, location, targeted muscle, length rather than strength, training parameters\u2014should be considered when devising a rehabilitation protocol.<\/p>\n<p><a href=\"http:\/\/bjsm.bmj.com\/content\/46\/12\/846.full.pdf+html?sid=2f01ff00-0fa4-40fe-aa71-3d5a14ec8888\">http:\/\/bjsm.bmj.com\/content\/46\/12\/846.full.pdf+html?sid=2f01ff00-0fa4-40fe-aa71-3d5a14ec8888<\/a><\/p>\n<div class=\"jetpack-video-wrapper\"><span class=\"embed-youtube\"><iframe class=\"youtube-player\" src=\"https:\/\/www.youtube.com\/embed\/C7EGpedzkr8?version=3&amp;rel=1&amp;showsearch=0&amp;showinfo=1&amp;iv_load_policy=1&amp;fs=1&amp;hl=en&amp;autohide=2&amp;wmode=transparent\" sandbox=\"allow-scripts allow-same-origin allow-popups allow-presentation\" allowfullscreen=\"allowfullscreen\" data-ratio=\"0.5636363636363636\" data-width=\"825\" data-height=\"465\" data-mce-fragment=\"1\"><\/iframe><\/span><\/div>\n<p>2. Guex and Millet suggested a conceptual framework for strengthening exercises for hamstring muscles specific to the terminal swing phase of sprinting based on six key parameters (contraction type, load, range of motion, angular velocity, unilateral\/bilateral exercises, kinetic chain) for strain prevention.<\/p>\n<p><a href=\"http:\/\/www.researchgate.net\/publication\/256985333_Conceptual_Framework_for_Strengthening_Exercises_to_Prevent_Hamstring_Strains\">http:\/\/www.researchgate.net\/publication\/256985333_Conceptual_Framework_for_Strengthening_Exercises_to_Prevent_Hamstring_Strains<\/a><\/p>\n<p><a href=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png\"><img decoding=\"async\" class=\"aligncenter wp-image-6115 size-large\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png?w=825&amp;h=262\" sizes=\"(max-width: 825px) 100vw, 825px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png?w=825&amp;h=262 825w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png?w=150&amp;h=48 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png?w=300&amp;h=95 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png?w=768&amp;h=244 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png?w=1024&amp;h=325 1024w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png 1290w\" alt=\"Sk\u00e6rmbillede 2015-11-12 kl. 22.31.44\" data-attachment-id=\"6115\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/11\/12\/hamstring-injuries-prevention-and-treatment-an-update\/skaermbillede-2015-11-12-kl-22-31-44\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png\" data-orig-size=\"1290,410\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-11-12 kl. 22.31.44\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-12-kl-22-31-44.png?w=825\" \/><\/a><\/p>\n<p>After analysing some of the frequently used hamstring strengthening exercises, they came to the conclusion that the \u2018optimal exercise had not been designed yet\u2019. Finally, they noted that strain prevention is not only a question of strength, but also depends on the timing of contraction, or a combination of both<\/p>\n<p>For a number of years the only RCT comparing different hamstring rehabilitation programmes was <strong>Sherry and Best study<\/strong>, which reported significantly lower reinjury rates in athletes who completed a progressive agility and trunk stabilisation (PATS) programme, compared to those whose rehabilitation programmes focused on isolated hamstring strengthening and stretching.<\/p>\n<p><a href=\"http:\/\/www.jospt.org\/doi\/pdf\/10.2519\/jospt.2004.34.3.116\">A Comparison of 2 Rehabilitation Programs in the Treatment of Acute Hamstring Strains Marc A. Sherry, Thomas M. Best, Journal of Orthopaedic &amp; Sports Physical Therapy 2004 http:\/\/www.jospt.org\/doi\/pdf\/10.2519\/jospt.2004.34.3.116<\/a><\/p>\n<p>Askling et al performed two identical studies, one in footballers and other in sprinters and jumpers, and demonstrated that a rehabilitation protocol consisting of mainly lengthening type of exercises (L-protocol) is more effective than a conventional protocol in promoting return to sport after acute hamstring injury.<\/p>\n<p>The most conspicuous characteristics of the more successful L-protocol were the systematic attempts to put load on the hamstrings during maximal dynamic lengthening, using exercises entitled <a href=\"https:\/\/www.youtube.com\/watch?v=wPwtUt2gOJM\">The Extender, The Diver and The Glider.<\/a> On this basis, they recommended that hamstring injury rehabilitation protocols should be preferentially based on strength and flexibility exercises that primarily involve exercises with high loads at long muscle\u2013tendon lengths.<\/p>\n<p><a href=\"http:\/\/bjsm.bmj.com\/content\/48\/7\/532.full.pdf+html?sid=aaff6a8c-09aa-49f4-a0bb-f8f1fa5f3a88\">http:\/\/bjsm.bmj.com\/content\/48\/7\/532.full.pdf+html?sid=aaff6a8c-09aa-49f4-a0bb-f8f1fa5f3a88<\/a><\/p>\n<div class=\"jetpack-video-wrapper\"><span class=\"embed-youtube\"><iframe class=\"youtube-player\" src=\"https:\/\/www.youtube.com\/embed\/7Yz4uhJrGtk?version=3&amp;rel=1&amp;showsearch=0&amp;showinfo=1&amp;iv_load_policy=1&amp;fs=1&amp;hl=en&amp;autohide=2&amp;wmode=transparent\" sandbox=\"allow-scripts allow-same-origin allow-popups allow-presentation\" allowfullscreen=\"allowfullscreen\" data-ratio=\"0.5636363636363636\" data-width=\"825\" data-height=\"465\" data-mce-fragment=\"1\"><\/iframe><\/span><\/div>\n<p><strong>Other exercises (Not\u00a0<em>Evidence<\/em>\u2013<em>Based<\/em>, but more Open Kinetic Chain exercise)<\/strong><\/p>\n<div class=\"jetpack-video-wrapper\"><span class=\"embed-youtube\"><iframe class=\"youtube-player\" src=\"https:\/\/www.youtube.com\/embed\/jPLMwqIOIB0?version=3&amp;rel=1&amp;showsearch=0&amp;showinfo=1&amp;iv_load_policy=1&amp;fs=1&amp;hl=en&amp;autohide=2&amp;wmode=transparent\" sandbox=\"allow-scripts allow-same-origin allow-popups allow-presentation\" allowfullscreen=\"allowfullscreen\" data-ratio=\"0.5636363636363636\" data-width=\"825\" data-height=\"465\" data-mce-fragment=\"1\"><\/iframe><\/span><\/div>\n<p><strong>CAN WE PREDICT HAMSTRING INJURY?<\/strong><\/p>\n<p>It was concluded that measuring postgame hamstring isometric maximal voluntary contraction asymmetry on a weekly basis may be helpful in identifying adverse reactions to load (ie, inhibition, presence of symptoms, or both) that could represent early warning signs for hamstring strain susceptibility<\/p>\n<p><a href=\"http:\/\/bjsm.bmj.com\/content\/46\/2\/81.full.pdf+html?sid=511c3304-6de5-4ccf-9716-b6a8e603f63c\">http:\/\/bjsm.bmj.com\/content\/46\/2\/81.full.pdf+html?sid=511c3304-6de5-4ccf-9716-b6a8e603f63c<\/a><\/p>\n<p><strong>CAN WE PREVENT HAMSTRING INJURIES?<\/strong><br \/>\nPrevention is better than cure and there is evidence that a programme of eccentric hamstring exercises, such as the (1) <a href=\"https:\/\/www.youtube.com\/watch?v=3IteKyRfKz0\">yo-yo curl<\/a> og <a href=\"https:\/\/www.youtube.com\/watch?v=Sfxy9RBm0qI\">nordic hamstring exercise (2)<\/a><\/p>\n<ul>\n<li><a href=\"http:\/\/www.udel.edu\/PT\/PT%20Clinical%20Services\/journalclub\/sojc\/04_05\/oct04\/askling.pdf\">Hamstring injury occurence in elite soccer players after preseason strenght training with eccentric\u00a0overload<\/a><\/li>\n<li><a href=\"http:\/\/www.dbu.dk\/~\/media\/Files\/DBU_Broendby\/111_AAA_traenermagasin\/Petersen%20Thorborg%20et%20al%20Am%20J%20Sports%20Med2011Nordic%20hamstring.pdf\">Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men\u2019s Soccer A Cluster-Randomized Controlled Trial<\/a><\/li>\n<li><a href=\"http:\/\/ojs.sagepub.com\/content\/2\/6\/2325967114535351.full\">Preventive Effects of Eccentric Training on Acute Hamstring Muscle Injury in Professional Baseball<\/a><strong>Read prevoiusly blog:<\/strong><\/li>\n<li><a href=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/07\/28\/hamstring\/\" rel=\"bookmark\">Hamstring \/ Haser \/ Muskelforstr\u00e6knin<\/a>g<\/li>\n<li><a href=\"https:\/\/physioblogandreasbjerregaard.com\/2014\/07\/17\/vm2014-usas%ef%bb%bf-jozyaltidore-grayinstitute-cafs-haseskader-movementtherapist\/\" rel=\"bookmark\">#VM2014 #USAs #JozyAltidore #GrayInstitute #CAFS #haseskader\u00a0<\/a><a href=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/07\/28\/hamstring\/\" rel=\"bookmark\">#PNF\/dynamic strecthing<\/a><\/li>\n<\/ul>\n<p><a href=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png\"><img decoding=\"async\" class=\"aligncenter wp-image-6129 size-full\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png?w=825\" sizes=\"(max-width: 825px) 100vw, 825px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png?w=825 825w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png?w=150 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png?w=300 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png?w=768 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png?w=1024 1024w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png 1216w\" alt=\"Sk\u00e6rmbillede 2015-11-14 kl. 10.09.17\" data-attachment-id=\"6129\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/11\/12\/hamstring-injuries-prevention-and-treatment-an-update\/skaermbillede-2015-11-14-kl-10-09-17\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png\" data-orig-size=\"1216,1168\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-11-14 kl. 10.09.17\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/11\/skc3a6rmbillede-2015-11-14-kl-10-09-17.png?w=825\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Hamstring injuries: prevention and treatment\u2014 an update Based on: Hamstring injuries: prevention and treatment -an update, Peter Brukner,Br J Sports Med 2015 49: 1241-1244 \u00a0doi: 10.1136\/bjsports-2014-094427 While the concept of eccentric muscle training has been an\u00a0important component of the rehabilitation process for many years, it now appears that these exercises must be in the lengthened 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