Reader Comments

Joint N-11

by Jerome Princy (2019-12-17)

It is important to remember Joint N-11 Review that injury location in the hamstring group can help predict length of treatment and rehabilitation. Specifically, the closer the injury is to the ischial tuberosity, and the greater the size of the injured area, the longer the rehab. Due to a high incidence of hamstring strain injuries involving multiple sports and activities the authors of this commentary advocate developing improved injury prevention techniques. There is some evidence to suggest improving hamstring flexibility and strength may be useful, but unfortunately there have been no conclusive findings to suggest a reduction in injuries with these strategies. That being said, the incorporation of eccentric hamstring exercises with routine training has been found to substantially reduce the frequency of injuries to the hamstring. Previous literature suggests that when there is an imbalance (>20% side-to-side deficit) between eccentric hamstrings and concentric quadriceps strength during isokinetic testing there is a 4-fold increase in risk ratio of hamstring injury. An insufficient eccentric capacity of the hamstring muscles to offset the concentric action of the quadriceps during the terminal swing phase or gait/running is thought to result in this increased injury risk (3). There is also evidence that eccentric training can result in a shift in peak force development to longer muscle lengths. As always, clinicians should be cautious when implementing an eccentric training program due to delayed onset of muscle soreness which may influence patient compliance. Progressive loading and intensity is therefore recommended. Another important consideration for injury rehabilitation is neuromuscular control exercises (e.g. high knee marching, quick-support running drills, forward-falling running drills and explosive starts) which target the lower extremities and lumbopelvic region and are considered by the authors to be emphasized in hamstring injury prevention programs.