Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport – grading the evidence: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

Abstract

This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.

Hamstring injury prevention practices and compliance of the Nordic hamstring program in English professional football

“…The NH exercise is an evidence-based injury prevention strategy considered essential to reduce hamstring injury incidence but uptake of the NHP in elite football is low. 21,27 This study surveyed English professional football teams to report current hamstring practices, adoption of the NHP and understand reasons for compliance or noncompliance to it.…”

“…34 The low compliance to the NHP may offer one reason alongside increased high-intensity physical game demands as to why a continuous rise in hamstring strain injuries in football exists. 2,15,27,35…”

“…of the 53 clubs (81%, 69-89) had a formal hamstring injury prevention program. Three clubs from the EPL(30, 11- 60), four from EFL1(27,, and three from EFL2 (27, 10-57) do not currently adopt a formal prevention program.Table 1shows the variety of strategies implemented in prevention programs. 41 of the 43 clubs (95%, 8-99) who implemented a formal program included the NH exercise among its injury prevention strategies.…”

Development of a Novel Nordic Hamstring Exercise Device to Measure and Modify the Knee Flexors' Torque-Length Relationship

“…Rightward-shifts in the torque-angle relationship could be of critical importance for athletes that require high eccentric hamstring force application at specific knee angles, such as those seen in high-speed running (Figure 1). Where the torque is being produced in the muscle is of importance as current research suggests having "strong and long" hamstring muscles is effectual for injury prevention (Bourne et al, 2015;Timmins et al, 2015) with lengthening hamstring exercises showing the fastest return-to-play and a lower reinjury rate compared with conventional hamstring exercises (Ishøi et al, 2020).…”

The effect of including the Nordic Hamstring exercise on sprint and jump performance in athletes: protocol of a systematic review and meta-analyses

“…7–10 Football and its various codes are the most popular sports worldwide, 11 but do carry risk of injuries, 12 of which the most common and burdensome are hamstring strain injuries. 13–15 These injuries are preventable by implementation of the Nordic Hamstring exercise in various doses, 16 even in other sports besides football. 17–19 However, even at the elite football level the exercise is not implemented, 20 and hamstring strain injuries continue to top the injury-statistics.…”