Intramuscular Tendon Injuries of the Hamstring Muscles: A More Severe Variant? A Narrative Review.

Hamstring strain injuries (HSI) are one of the most common sport-related injuries. They have a high injury burden and a high recurrence rate. The development of novel muscle injury grading systems has provided new insights into the possible impact of injury location on the time to return to play (TTRTP) and re-injury following HSI. In particular, injuries to the intramuscular tendon (IMT) may be present in up to 41% of all HSI and have been described as a 'serious thigh muscle strain'. Re-injury rates as high as 60% have been described in elite track and field athletes, as well as prolonged TTRTP. A systematic search was carried out using appropriate keywords to identify articles reporting on HSI involving the IMT in athletes. The primary aim was to determine whether IMT injuries warrant being classified as a distinct clinical entity with different expected outcomes to other hamstring muscle injuries. This narrative review summarises the existing evidence on: (1) the anatomy of the IMT and its response to injury; (2) the role of MRI and novel grading scales in IMT injury management (3) clinical assessment of IMT injuries, (4) TTRTP and re-injury rates across sports following IMT, (5) conservative rehabilitation and the role of specific 'IMT-oriented' strategies, and (6) indications for and approaches to surgery. The review found that important clinical outcomes such as re-injury rates and TTRTP vary across populations, cohorts and sports which suggest that outcomes are specific to the sporting context. Bespoke rehabilitation, tailored to IMT injury, has been shown to significantly reduce re-injuries in elite track and field athletes, without compromising TTRTP. Continued prospective studies across other sports and cohorts, are warranted to further establish relevant clinical findings, indications for surgical intervention and outcomes across other sporting cohorts.

Contact injuries in field hockey and the potential role for personal protective equipment.

Field hockey is played with sticks and a hard ball. It is fast-paced, with athletes playing together in close proximity. Athletes may be at increased risk of sustaining injuries through contact. The aim of this study was to investigate the epidemiological characteristics of contact injuries in field hockey. Data were collected during the 2017/2018 and 2018/2019 Irish Hockey League seasons. This study included two methods of data collection among male athletes: self-reported injuries and via those reported by the teams' physiotherapists. Injuries were defined as any physical complaint sustained during field hockey, supplemented by medical attention and time-loss injuries. Only contact injuries were included for analysis. Overall, 107 contact injuries were incurred, giving rise to an injury incidence rate of 3.1/1000 h, and accounting for 33.1% of all injuries. Athletes had an absolute risk of 0.372 of sustaining a contact injury. Contusions (48.6%) were the most common type of contact injury, while injuries to the head/face (20.6%) were the most frequently reported location. Contact injuries represent an important proportion of all injuries. Rule changes to mandate the use of personal protective equipment in field hockey may assist in reducing the absolute risk and severity of contact injuries in field hockey.

Winter breaks: How do they affect injuries in field hockey?

OBJECTIVES: The Irish Hockey League (IHL) introduced an eight-week winter break for the first time in the 2018/2019 season. We evaluated the effects of this eight-week break by comparing injury outcome metrics in the 2018/2019 (winter break) season and the 2017/2018 (no winter break) season. DESIGN: Prospective cohort study. METHODS: Each season was split into three distinct periods: period one consisted of the first nine weeks of each season; period two, weeks ten to 18; and period three, the final weeks. For the 2018/2019 season, the winter break was implemented in period two (weeks 10 to18). Relative risk with 95 % CI and injury incidence (1000h) were compared across the two seasons. RESULTS: Overall, 173 and 150 injuries we incurred during the 2017/2018 (no winter break) and 2018/2019 (winter break season) seasons respectively. Compared to 2017/2018 season, total injury incidence rate, injury severity, and injury burden were all significantly higher in period three during the 2018/2019 season (i.e., following the winter break). Furthermore, injured athletes had a 2.5-times higher relative risk of sustaining an injury after the winter break. Relative risks of 15.3 and 21.4 were observed for lower back injuries and fractures after the winter break, when compared with no break. CONCLUSIONS: Although fewer injuries were incurred during the 2018/2019 season, significantly more injuries were sustained in the period after the implementation of the winter break when compared to the corresponding period during the 2017/2018 season.

The knowledge and attitudes of field hockey athletes to injury, injury reporting and injury prevention: A qualitative study.

OBJECTIVES: Researchers have often struggled to successfully implement injury prevention strategies in real-world practice. This is despite such strategies proving successful in reducing overall injury incidence and burden. It has been hypothesised that this may be because the behavioural and contextual factors related to sports injury are not fully understood. Such factors stem from multiple key stakeholders, including the athlete. The primary aim of this study was to investigate athletes' knowledge and attitudes towards injury, injury reporting and prevention, as well as some of the barriers that may impact the future implementation of prevention strategies. DESIGN: Qualitative; with semi-structured interviews following an interpretivist approach. METHODS: Twenty-two field hockey athletes, playing in the top-tier Irish Hockey League were interviewed. Data were analysed using reflexive thematic analysis, with three general dimensions containing six higher-order themes. RESULTS: The findings highlighted that athletes have a varied understanding of injury, which tends to improve with experience. The reporting of injuries by athletes to members of the coaching staff was relatively poor. This may be due to limited resources and supports available to athletes which also cause challenges to injury prevention. CONCLUSIONS: Future injury prevention strategies in field hockey need to account for athletes' varied understanding of what constitutes an injury. Furthermore, policy changes to influence potential barriers to injury may assist in preventing or reducing the number of injuries being sustained by athletes.

Its not all about sprinting: mechanisms of acute hamstring strain injuries in professional male rugby union-a systematic visual video analysis.

OBJECTIVES: The mechanisms of hamstring strain injuries (HSIs) in professional Rugby Union are not well understood. The aim of this study was to describe the mechanisms of HSIs in male professional Rugby Union players using video analysis. METHODS: All time-loss acute HSIs identified via retrospective analysis of the Leinster Rugby injury surveillance database across the 2015/2016 to 2017/2018 seasons were considered as potentially eligible for inclusion. Three chartered physiotherapists (analysts) independently assessed all videos with a consensus meeting convened to describe the injury mechanisms. The determination of the injury mechanisms was based on an inductive process informed by a critical review of HSI mechanism literature (including kinematics, kinetics and muscle activity). One of the analysts also developed a qualitative description of each injury mechanism. RESULTS: Seventeen acute HSIs were included in this study. Twelve per cent of the injuries were sustained during training with the remainder sustained during match-play. One HSI occurred due to direct contact to the injured muscle. The remainder were classified as indirect contact (ie, contact to another body region) or non-contact. These HSIs were sustained during five distinct actions-'running' (47%), 'decelerating' (18%), 'kicking' (6%), during a 'tackle' (6%) and 'rucking' (18%). The most common biomechanical presentation of the injured limb was characterised by trunk flexion with concomitant active knee extension (76%). Fifty per cent of cases also involved ipsilateral trunk rotation. CONCLUSION: HSIs in this study of Rugby Union were sustained during a number of playing situations and not just during sprinting. We identified a number of injury mechanisms including: 'running', 'decelerating', 'kicking', 'tackle', 'rucking' and 'direct trauma'. Hamstring muscle lengthening, characterised by trunk flexion and relative knee extension, appears to be a fundamental characteristic of the mechanisms of acute HSIs in Rugby Union.

Coaches' attitudes to injury and injury prevention: a qualitative study of Irish field hockey coaches.

Translating injury prevention research into practice has been challenging, which may be due to a poor understanding of the contextual factors influencing the occurrence of injury. Coaches are key figure in sporting environments and hold pivotal roles in preventing injury. Therefore, the aim of this study was to investigate the attitudes of field hockey coaches to injury and injury prevention. Thirteen field hockey coaches from the amateur Irish Hockey League were interviewed. Reflexive thematic analysis led to three general dimensions comprised five higher-order themes, categorised from 16 lower-order themes. Coaches had positive beliefs regarding the benefits of injury prevention over injury management. However, they lacked the necessary knowledge and skills to successfully implement injury prevention strategies with players. Coaches recognised the importance of empowering players to self-manage training loads to promote injury prevention but acknowledged the need to protect younger players from increased loads. Many barriers to injury prevention were not controllable by coaches including fixture congestion and poor structuring of the sport's domestic calendar. While coaches can play a key role in the implementation of injury prevention strategies, there is also a requirement to examine how system level barriers to injury prevention can be reduced.

The incidence of injury in male field hockey players: A systematic review and meta-analysis.

OBJECTIVE: Few studies have investigated injury incidence in field hockey. The aim of this systematic review was to determine the incidence and characteristics of injury in male field hockey athletes. DESIGN: Prognosis systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE via PubMed; EMBASE via Ovid; CINAHL via EBSCO; SPORTDiscus; and Web of Science were searched. STUDY SELECTION CRITERIA: Prospective studies and retrospective studies employing video analysis, written in English and published in peer-reviewed journals, expressing the incidence of injury in male field hockey athletes were included. Studies must have been of a duration of a minimum one season or one tournament. Studies were screened by two authors, assessing the eligibility of each record. Following selection of the studies, data were extracted by the two authors. DATA SYNTHESIS: Levels of heterogeneity were assessed in aggregate data using the I2 statistic. RESULTS: In total, 1722 records were identified. Twelve studies were included in the review. Injury incidence ranged from 4.5 to 57.9/1000h (I2 = 98.5%). Nine studies were undertaken in tournament settings, with the remaining three conducted in club-based athletes in season-long settings. When a medical attention definition was used, there was a pooled incidence rate of 48.1/1000h, all in tournament studies. Contusions and muscle strains were the most frequently reported injury types, while the lower limb was the most common site of injury. Contact injuries were most common in tournament-based studies, while non-contact was more common in season-long studies. CONCLUSION: Prospective, season-long epidemiological studies investigating injury incidence in field hockey are lacking.

The burden of injury in field hockey: A secondary analysis of prospective cohort data.

Most studies report injuries based upon their incidence rate, or the number of injuries which occur in a sport per unit of time. While this is recommended across numerous consensus statements on reporting injury data in sport, it may be of benefit to consider injury burden also. Reporting injuries as the duration of injury per 1000 exposure hours highlights those injuries which will likely cause greater disruption within a team. Therefore, the primary aim of this study was to report the burden of injury in field hockey. This secondary analysis of epidemiological data employed two methods of data collection: self-reported through an online reporting software, and through contact with the team physiotherapist. Athletes reported injury-related symptoms for 4170 days in total, giving rise to an injury burden of 121.0/1000 h, of which 61.4/1000 h were days lost through injury. Injuries to the hamstring, as well as muscle strain injuries, caused the most significant injury burden in athletes (22.6 and 35.8/1000 h respectively). Reporting injuries as the duration of injuries per 1000 hours highlights those injuries which cause the most significant disruption within a squad. Future injury prevention strategies in field hockey should prioritize the injuries which are most burdensome.

Detecting subtle mobility changes among older adults: the Quantitative Timed Up and Go test.

BACKGROUND: The Quantitative Timed Up and Go (QTUG) test uses wearable sensors, containing a triaxial accelerometer and an add-on triaxial gyroscope, to quantify performance during the TUG test with potential to capture more minor changes in mobility. AIMS: To examine the responsiveness, minimum detectable change (MDC) and observed effect size of QTUG in a cohort of socially active adults aged 50 years and over participating in a structured community exercise program. METHODS: 54 participants (91% females, mean age 63.6 ± 6.5 years) completed repeated QTUG testing under single- and dual-task conditions. Responsiveness of the QTUG was assessed by correlation of change in standard TUG with QTUG change (Pearson's correlation coefficient). MDC and effect sizes (standardized mean difference and Cohen's d) were also calculated for QTUG. RESULTS: There was a strong positive correlation between change in the standard TUG and change in QTUG (single task r = 0.91, p < 0.001). MDC in QTUG was calculated as 0.77 (Sd, 1.39; ICC 0.96) seconds (single task) and 2.33 (Sd 2.18; ICC 0.85) seconds (dual task). Several QTUG parameters showed improvements in mean values with small effect sizes (sit -to-stand transition time d = 0.418; walk time d = 0.398; cadence d = 0.306, swing time d = 0.314; step time d = 0.479; gait velocity d = 0.365; time to reach turn d = 0.322) under single-task conditions and with a moderate effect size (d = 0.549) in time taken to turn under the dual-task condition. CONCLUSION: Initial evidence of QTUG's responsiveness to change in mobility in active middle to older age adults has been demonstrated with small to moderate effect sizes observed in specific QTUG parameters.

Epidemiology of injuries in senior men's field hockey: A two-season prospective observational injury surveillance study.

Determining the rate and severity of injuries incurred through sport is accepted as the primary step towards designing, implementing and evaluating injury prevention programmes. The aim of this study was to determine the injury incidence rate and characteristics of male field hockey athletes participating in the Irish Hockey League. Athletes from eight field hockey teams were assigned to an online reporting system, where they logged injuries as they were incurred. Injuries were defined as any physical complaint. Coaches and physiotherapists were contacted weekly to corroborateinjuries. Overall 323 injuries were reported across 34,449 exposure hours, giving rise to an incidence rate of 9.4/1000 h. On average, athletes sustained one injury over the course of two seasons. Muscle strains, pain and contusions were the most common types of injury, while the hamstring, knee and hip/groin were the most frequently reported locations. While 66.9% of injuries occurred through non-contact mechanisms, contact injuries were also common. Injury recurrences accounted for 16.1% of injuries. In conclusion, the incidence of injury in field hockey is high, occurring from a variety of mechanisms. Future injury prevention strategies should prioritise injuries to the hamstring, knee and ankle, and be specific to particular playing positions.

Effect of the Triceps Brachii Facilitation Technique on Scapulohumeral Muscle Activation during Reach and Point in a Healthy Population.

Purpose: Neurodevelopmental techniques are commonly used in upper limb rehabilitation, but little evidence supports the facilitation techniques associated with this concept. This exploratory study determined whether a facilitation technique at the triceps muscle affected scapulothoracic muscle activity during reach in healthy participants compared with self-selected posture and reach. The secondary aim was to determine whether muscle activation levels differed between the facilitation technique and the optimized posture or guided movement. We also hypothesized that activity in the scapular stabilizers (lower trapezius [LT] and serratus anterior [SA]) would be increased during the facilitated movement than in the other conditions. Methods: The study included 17 healthy participants (aged 20-70 y). Surface electromyography recorded muscle activity in the upper trapezius (UT), middle trapezius (MT), and LT muscles and in the SA, middle deltoid (MD), and triceps during five performance conditions. We used Friedman's test to explore differences in muscle activity across conditions and Bonferroni's post hoc test to explore the differences between conditions. Results: The facilitation technique produced decreased activity in the SA, MD, and triceps muscles (p < 0.01) compared with the self-executed control condition. Compared with optimized posture with independent reach, facilitated movement again produced similar reductions in MD and triceps activity, with decreased LT activity also noted (p < 0.01). Lower activity levels were noted during facilitation than during manual guidance, with or without optimized posture, in the UT, MT, (p < 0.01), SA, and MD muscles (p < 0.05). Conclusions: Triceps facilitation did not increase scapular stability activity, but the activity levels in several other muscle groups (SA, MD, and triceps) were reduced during triceps facilitation compared with optimized posture or guided movement. Detailed analysis of this technique, including co-registered kinematic data and timing of muscle onset, is needed.

Objectif : les techniques neurodéveloppementales sont souvent utilisées pour la réadaptation des membres supérieurs, mais peu de données probantes appuient les techniques de facilitation associées à ce concept. La présente étude exploratoire visait à déterminer si une technique de facilitation au triceps touchait l'activité du muscle scapulothoracique pendant la portée chez des participants en santé par rapport à une posture et une portée autosélectionnée. L'objectif secondaire consistait à établir si les niveaux d'activation musculaire différaient entre la technique de facilitation et la posture optimisée ou le mouvement orienté. Les chercheurs postulaient également que l'activité des stabilisateurs scapulaires (trapèze inférieur [TI] et dentelé antérieur [DA]) serait plus élevée pendant le mouvement facilité plutôt que pendant les autres situations. Méthodologie : l'étude portait sur 17 participants en santé (de 20 à 70 ans). Par électromyographie de surface, ils ont enregistré l'activité du trapèze supérieur (TS), du trapèze moyen (TM), du TI et du DA, du deltoïde moyen (DM) et du triceps pendant cinq situations de performance. À l'aide du test de Friedman, ils ont établi les différences d'activité musculaire selon les situations, et à l'aide du test de Bonferroni post-hoc, les différences entre les situations. Résultats : la technique de facilitation a réduit l'activité du DA, du DM et du triceps (p < 0,01) par rapport à la situation de contrôle autoexécutée. Comparativement à une posture optimisée et une portée indépendante, les chercheurs ont remarqué une réduction semblable de l'activité du DM et du triceps, de même qu'une activité réduite du TI (p < 0,01). Ils ont constaté un niveau d'activité plus faible dans le TS, le TM, (p < 0,01), le DA et le DM (p < 0,05) pendant la facilitation que pendant l'orientation guidée, avec ou sans posture optimisée. Conclusion : la facilitation du triceps n'accroissait pas l'activité de la stabilité scapulaire, mais les niveaux d'activité de plusieurs autres groupes musculaires (DA, DM et triceps) étaient moins élevés pendant la facilitation du triceps que pendant la posture optimisée ou le mouvement orienté. Il faudra maintenant procéder à l'analyse détaillée de cette technique, y compris les données cinématiques coenregistrées et le moment d'apparition du mouvement musculaire.

The Effects of the Gaelic Athletic Association 15 Training Program on Neuromuscular Outcomes in Gaelic Football and Hurling Players: A Randomized Cluster Trial.

O'Malley, E, Murphy, JC, McCarthy Persson, U, Gissane, C, and Blake, C. The effects of the Gaelic Athletic Association 15 training program on neuromuscular outcomes in Gaelic football and hurling players: A randomized cluster trial. J Strength Cond Res 31(8): 2119-2130, 2017-Team-based neuromuscular training programs for injury prevention have been tested primarily in female and adolescent athletes in soccer, handball, and basketball with limited research in adult male field sports. This study explored whether the GAA 15, a multifaceted 8-week neuromuscular training program developed by the Gaelic Athletic Association (GAA), could improve risk factors for lower limb injury in male Gaelic footballers and hurlers. Four Gaelic sports collegiate teams were randomized into intervention or control groups. Two teams (n = 41), one football and one hurling, were allocated to the intervention, undertaking a 15 minutes program of neuromuscular training exercises at the start of team training sessions, twice weekly for 8 weeks. Two matched teams (n = 37) acted as controls, participating in usual team training. Lower extremity stability (Y-Balance test [YBT]) and jump-landing technique using the Landing Error Scoring System (LESS) were assessed preintervention and postintervention. There were moderate effect sizes in favor of the intervention for right (d = 0.59) and left (d = 0.69) composite YBT scores, with adjusted mean differences between intervention and control of 3.85 ± 0.91% and 4.34 ± 0.92% for right and left legs, respectively (p < 0.001). There was a greater reduction in the mean LESS score in favor of the intervention group after exercise training (Cohen's d = 0.72, adjusted mean difference 2.49 ± 0.54, p < 0.001). Clinically and statistically significant improvements in dynamic balance and jump-landing technique occurred in collegiate level Gaelic football and hurling players who adopted the GAA 15, when compared with usual training. These findings support application and evaluation of the GAA 15 in other player groups within the Gaelic games playing population.

The ability of athletes with long-standing groin pain to maintain a stable lumbopelvic position: A laboratory study.

OBJECTIVES: The ability to maintain a lumbopelvic position (LPP) was assessed in athletes with a history of long-standing groin pain (LSGP) and athletes without LSGP. DESIGN: Case-control study. SETTING: University motion analysis laboratory. PARTICIPANTS: Thirty male athletes-15 with a history of LSGP (>12 weeks) and 15 without. MAIN OUTCOME MEASURES: Maintenance of LPP was assessed using a pressure biofeedback unit (PBU) during supine single leg lift (SLL), single leg extension (SLE) and bent knee fallout (BKFO). Repeatability was assessed using intra-class correlation coefficients (ICC) and group differences analysed using MANOVA. RESULTS: Differences were detected between involved and uninvolved sides in the LSGP group during SLL (mean difference [md] = 9.82 mmHg, p < 0.01) and BKFO (md = 8.56 mmHg, p < 0.01) but not during SLE (md = 0.38 mmHg, p = 0.96). Between group differences were found during the SLL of the involved leg (md = 5.22 mmHg p = 0.034) and the BKFO of the uninvolved leg (md = 6.22 mmHg p = 0.017). Inter-session reliability varied for the different movement tasks in both groups (ICC = 0.35-0.94). CONCLUSIONS: Ability to maintain LPP differed between the involved and uninvolved legs within the LSGP group and between the athletes with and without LSGP. Despite resolution of groin pain, altered control of lumbopelvic position existed with possible implications for later injury recurrence.

Rehabilitative ultrasound measurement of trapezius muscle contractile states in people with mild shoulder pain.

INTRODUCTION: The utility of rehabilitative ultrasound imaging (RUSI) for assessing trapezius muscle contractile characteristics was investigated by examining whether muscle thickness changes during contraction (CT) differed between people with and without mild shoulder pain. METHODS: In 18 subjects with mild shoulder pain (aged 28±8 years) and 18 matched controls, trapezius muscle thickness change was measured in prone at rest at 0° and during isometric CTs at 90° and 120° of shoulder abduction. Images were taken at four sites using a real-time ultrasound scanner (7-MHz linear transducer, 40 mm footprint). Percentage change in muscle thickness from rest was calculated. Differences between painful and non-painful shoulders and participant groups were examined by analysis of variance (ANOVA) and t-tests. RESULTS: There were no significant differences between groups or sides in trapezius muscle thickness change during CT. There was no significant difference in trapezius muscle resting thickness (RT) between painful and non-painful shoulders in the same subjects. CONCLUSION: Contractile ability of the trapezius muscle, assessed using RUSI was not impaired in subjects with mild shoulder pain during the test manoeuvres used. Further research is warranted involving patients with different severity of symptoms, using other test manoeuvres before RUSI can be advocated for assessing scapular muscle dysfunction.

Effects of taping on thumb alignment and force application during PA mobilisations.

Work related thumb pain (WRTP) is a major problem among manipulative physiotherapists. Therapists who maintain the thumb joints in an extended alignment during PA mobilisation experience less WRTP. The purposes of this study were to investigate what effect taping of the thumbs has on thumb alignment during mobilisation and to gain normative data on the mobilisation forces applied by student physiotherapists. Forty final year student physiotherapists participated and were asked to apply a grade III PA mobilisation onto the C7 vertebra of one of 32 asymptomatic models. Participants were then instructed to apply the same mobilisation onto a force measurement instrument, in both the tape and no tape conditions, while the alignment of their metacarpophalangeal (MCP) and interphalangeal (IP) joints was noted via video recorder. Thumb alignment improved in 72.5% of participants post taping, with significant increases in the number of MCP joints maintained in a neutral alignment (p < 0.05). The mean peak mobilisation force applied by the students was 70.9 N. Taping of the thumbs prior to PA mobilisation improved thumb alignment during mobilisation in this cohort of undergraduate students, thus potentially influencing one of the contributory factors to WRTP.

An investigation into the effects of a simulated effusion in healthy subjects on knee kinematics during jogging and running.

BACKGROUND: Knee joint effusion can lead to changes in the activation of surrounding musculature and result in delayed return to baseline daily and sporting activity following injury. However, the effects of an isolated knee joint effusion on control of movement during cyclical activities such as gait are poorly understood. METHODS: Knee angular displacement and velocity was measured during treadmill jogging (8 km h(-1)) and running (12 km h(-1)) in 12 healthy subjects before and after a simulated knee joint effusion. Two separate pre-effusion recordings were taken to account for test-retest variability in gait measurement techniques. FINDINGS: Subjects demonstrated a small yet significant decrease in peak knee flexion following heel strike at 8 km h(-1) as a result of the effusion (P<0.05). However, there were no significant effects seen at 12 km h(-1). INTERPRETATION: Previous work has suggested that knee joint movement during walking and jump landing is affected by an effusion. However, this work demonstrates that these effects are minimal during jogging and running. Our results suggest that it may be prudent to consider measurement variability in future studies of this nature.