A Critical Analysis of: Predicting Return to Play After Hamstring Injuries
Manan Vora*
Bhartiya Arogya Nidhi Hospital, Juhu
Submission: September 12, 2021; Published: November 01, 2021
*Corresponding author: Manan Vora, Bhartiya Arogya Nidhi Hospital, Juhu
How to cite this article: Manan V. A Critical Analysis of: Predicting Return to Play After Hamstring Injuries. J Phy Fit Treatment & Sports. 2021; 9(3): 555762. DOI: 10.19080/JPFMTS.2021.09.555762
Keywords: Athlete; Football players; Magnetic resonance; Hamstring injury; Baseline assessment
Case Report
This paper has attempted to answer a very important question which is on the minds of every athlete, his/her coaching staff, as well as the sports doctor- when to return to play after an acute hamstring injury. The study has assessed the prognostic value of clinical and MRI parameters for the TTRTP (time to return to play) after acute hamstring injury. For this objective, they ensured a prospective design, multivariate analysis and blinding of athletes and decision makers for return to play. This study has been conducted and presented systematically, however the reader may wonder how significant the conclusion of this study is after going through previously published literature.
In the introduction, the authors have said that previous studies had certain limitations like relatively low number of participants, however, a similar study conducted by Warren et al investigated 59 football players [1] whereas this study eventually assessed 74, which is not a very large difference. The authors have also mentioned that the study aims to assess the prognostic value of clinical and MRI parameters for TTRTP, however a previous study comparing clinical assessment and magnetic resonance for acute hamstring injuries has already shown that magnetic resonance imaging is not required for estimating the duration of rehabilitation of an acute minor or moderate hamstring injury [2]. This does make the reader wonder about the aim of the study in the first place.
The eligibility criteria included athletes between the age of 18 and 50, which is a very large range as age is a risk factor for hamstring injuries and older athletes would be more susceptible to injury recurrence and hence delayed time to return to play [3]. For the baseline assessment, it would have helped the reader to understand the assessment better if some images had been included. For example, an image of the exact site of manual muscle palpation could have been present. Additionally, images for the testing of hamstring flexibility and isometric knee flexion force would have helped the reader understand exactly how the examination was carried out.
161 athletes were approached for the study, however only 74 were eventually included in the analysis. The vast difference in the ages of the 74 athletes and the fact that none of them were professionals makes you question whether the information obtained from the results can even be considered as evidence while managing professional athletes. Additionally, not all athletes played the same sport. Each sport has its own demands on various muscle groups and hence a study with the athletes of the same sport forming the sample population may have yielded more accurate results. There are at least two distinctly different types of acute hamstring strains, which are best distinguished by different injury situations [4]. The most common injury type occurs during high-speed running and the other occurs during movements leading to extensive lengthening of the hamstrings, such as; high kicking, sliding tackle and sagittal split [4]. The two types of hamstring strains require different approaches when rehabilitation is planned [5]. In the case of high-speed running type of injuries, it is common for the athlete to experience a considerable improvement 4-6 days after the injury has happened, especially with respect to pain, strength and flexibility, whereas for the stretching-type of injuries it is important to inform the athlete that the rehabilitation period is likely to be prolonged, even though the initial symptoms are relatively mild in terms of pain and functional impairment [5]. However, this current study did not consider different types of hamstring strains and the investigators have rehabilitated them all with the same protocol. Apart from different types of hamstring injuries, there are different grades to hamstring injuries. In this study, only athletes with grade 1 and 2 hamstring injuries were considered. The authors admit that no grade 0 and grade 3 injuries were included in this study, and no comparison with other studies that looked at the association of the different grades of injury of the hamstring, and their study, was possible.
The strongest risk factor for hamstring injuries is a recent history of that same injury and the next strongest risk factor is a past history of the same injury [3]. 60% of the athletes in the current study had a previous hamstring injury. Predicting time to return to play in a sample population which entirely had no history of hamstring injury, or one which entirely had a previous hamstring injury would have had more significance. In summary, while the strengths of this study lie in the extensive assessment, systematically presented data and the concise manner in which all the text has been written, the aforementioned weaknesses do show scope for improved studies in the future.
Take home message- As seen in previously published literature as well, performing an MRI to estimate the TTRTP is not routinely advised, especially in non-professional athletes. However, a passive straight leg raise test and self-predicted TTRTP may help to guide the prognosis in a case of hamstring injury.
References
- Warren P, Gabbe BJ, Schneider-Kolsky M, Bennell KL (2010) Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers Br J Sports Med 44(6): 415-419.
- Schneider-Kolsky ME, Hoving JL, Warren P, Connell DA (2001) A Comparison between Clinical Assessment and Magnetic Resonance Imaging of Acute Hamstring Injuries. Am J Sports Med 34(6): 1008-1015.
- Orchard JW (2001) Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med 29(3): 300-303.
- Askling CM, Malliaropoulos N, Karlsson J (2012) High-speed running type or stretching type of hamstring injuries makes a difference to treatment and prognosis. Br J Sports Med 46(2): 86-87.
- Malliaropoulos NG (2013) Non-contact Hamstring injuries in sports. Muscles Ligaments Tendons 2(4): 309-311.