Predisposing factors to hamstring neuromuscular deficits—implications for prevention and rehabilitation of hamstring strain injuries: a narrative review

Background: Scientific knowledge on hamstring strain injuries (HSI) constantly accumulates for the last 100 years. However HSI still exhibit high injury/re-injury rates and new areas of research must be thoroughly explored. Deficiencies that impact the close relationship between the nervous system and muscle functioning constitute a promising research direction, according to existing literature.

Objectives: To outline the often-overlooked factors that pre-dispose to hamstring neuromuscular deficits, with a special emphasis on hamstring strain injury and re-injury.

Major Findings: Sensory input impairment, neural tension, fatigue, competitive anxiety and lumbar-pelvic motor control deficit can all induce dysregulations of the hamstring neuromuscular functioning that may be detrimental during high-speed running. They constitute therefore serious risk factors for hamstring strain injury and re-injury.

Conclusions: We devised an intervention algorithm including both evaluation procedures and hamstring management plan, by compiling and adjusting the most promising doctrines of the literature reviewed. Further research, such as randomized controlled trials, is required to provide evidence of the effectiveness and feasibility of this algorithm for patients in post-HSI recovery or as a preventive approach in the event of high suspicion of re-injury.     

Spinal manual therapy and exercises for chronic hamstring injuries in a sprinter: A case report

IntroductionHamstring injuries tend to be chronic in nature and thus require considerable recovery time in athletes. Although some rehabilitation protocols have been previously advocated, there is no consensus in terms of the treatment protocol for chronic hamstring injuries.MethodsWe present the case of a 15-year-old male sprinter who was successfully treated with a combination of manual therapy targeting the lumbosacral region and hamstring-specific exercises. The patient presented with hamstring pain which persisted for 7 weeks.ResultsManual therapy immediately reduced pain and increased muscle strength. The patient was able to run satisfactorily without pain 30 days after the initial intervention.ConclusionsThis case report suggests that the use of manual therapy targeting the lumbosacral region, along with hamstring exercises, may be beneficial in chronic hamstring pain management.     

A comparison of two muscle energy techniques for increasing flexibility of the hamstring muscle group

Variations in the application of muscle energy technique (MET) for increasing the extensibility of muscles have been advocated, but little evidence exists to support the relative merit of a particular approach. This study investigated two types of muscle energy techniques that have been advocated in the osteopathic literature that differ primarily in the duration of the post-contraction stretch phase. Forty asymptomatic participants (mean age=22.1±3.5, male female=1:4) were randomly allocated to one of two groups (Group 1: MET with 30-s post-isometric stretch phase; Group 2: MET with 3-s post-isometric stretch phase). Hamstring length was measured using active knee extension (AKE). Participants received an initial application of the allocated intervention, and then a second application 1 week later. Analysis with a split-plot ANOVA revealed a significant effect of time (F_3,36=42.30;p<0.01), but no significant time*group interaction (F_3,36=0.12; p=0.95). Post-hoc analysis revealed that the significant differences over time occurred between pre- and post-measurements at both weeks, and between post-Week 1 and pre-Week 2 measurements.Both techniques appeared to be equally effective in increasing hamstring extensibility, and there appeared to be sustained improvement 1 week following the initial treatment. The findings suggest that altering the duration of the passive stretch component does not have a significant impact on the efficacy of MET for short-term increases in muscle extensibility.     

Interventions on mealtime difficulties in older adults with dementia: A systematic review

Objectives

To evaluate the effects of interventions on mealtime difficulties in older adults with dementia.

Design

A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement.

Data sources

Pubmed, Medline (OVID), CINAHL (EBSCOHost), EBM Reviews (OVID) and PsychINFO (OVID) were searched between January 2004 and September 2012 by using keywords as dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, nutrition, intervention, experimental, quasi-experimental and any matched terms. Other sources included Google Scholar and relevant bibliographies.

Review methods

Eligibility criteria were established by defining the population, intervention, comparator, outcomes, timing and setting of interest. Studies were reviewed by title and abstract screening, and full-text assessing for eligibility. Data were abstracted from eligible studies using a self-made structured tool. Eligible studies were classified by intervention, accessed for quality using the Quality Assessment Tool for Quantitative Studies, and graded for evidence using the Grading of Recommendations, Assessment, Development and Evaluation Working Group criteria.

Results

Twenty-two intervention studies (9 RCTs), including a total of 2082 older adults with dementia and 95 professionals from more than 85 long-term care facilities, were selected, and classified into five types: nutritional supplements, training/education programs, environment/routine modification, feeding assistance and mixed interventions. Eight studies were strong, eleven moderate and three weak in quality. Limitations of body of research included lack of randomization and/or control group, small sample size without power analysis, lack of theory-based interventions and blinding, inadequate statistical analysis and plausible confounding bias. “Nutritional supplements” showed moderate evidence to increase food intake, body weight and BMI. “Training/education programs” demonstrated moderate evidence to increase eating time and decrease feeding difficulty. Both “training/education programs” and “feeding assistance” were insufficient to increase food intake. “Environment/routine modification” indicated low evidence to increase food intake, and insufficient to decrease agitation. Evidence was sparse on nutritional status, eating ability, behavior disturbance, behavioral and cognitive function, or level of dependence.

Conclusions

This review provides updated evidence for clinical practice and points out priorities for nursing research. Current evidence is based on a body of research with moderate quality and existing limitations, and needs to be further explored with more rigorous studies.     

Influence of static stretching on hamstring flexibility in healthy young adults: Systematic review and meta-analysis

The aim of the current study was to investigate the influence of static stretching on hamstring flexibility in healthy young adults by means of systematic review and meta-analysis. The search strategy included MEDLINE, PEDro, Cochrane CENTRAL, EMBASE, LILACS, and manual search from inception to June 2015. Randomized and controlled clinical trials studies that have compared static stretching to control group, and evaluated range of motion (ROM), were included. On the other hand, studies that have worked with special population such as children, elderly people, athletes, and people with any dysfunction/disease were excluded, as well as articles that have used contralateral leg as control group or have not performed static stretching. The meta-analysis was divided according to three types of tests. Nineteen studies were included out of the 813 articles identified. In all tests, the results favored static stretching compared to control group: passive straight leg raise (12.04; 95% CI: 9.61 to 14.47), passive knee extension test (8.58; 95% CI: 6.31 to 10.84), and active knee extension test (8.35; 95% CI: 5.15 to 11.55). In conclusion, static stretching was effective in increasing hamstring flexibility in healthy young adults.     

The natural history and management of hamstring injuries

Hamstring injuries in sport can be debilitating. The anatomical complexity of this muscle makes uniform assessment of injury epidemiology difficult and insures that post-injury management strategies must be individually focused. This article reviews the anatomy of the hamstring, its role in athletic movement, common mechanisms of injury, and management guidelines with the goal of return into sporting activity in mind.     

A systematic review of surgical intervention in the treatment of hamstring tendon ruptures: current evidence on the impact on patient outcomes

Hamstring injuries are among the most common muscle injuries. They have been reported in many different sports, such as running, soccer, track and field, rugby, and waterskiing. However, they are also present among the general population. Most hamstring injuries are mild strains, but also moderate and severe injuries occur. Hamstring injuries usually occur in rapid movements involving eccentric demands of the posterior thigh. Sprinting has been found to mainly affect the isolated proximal biceps femoris, whereas stretching-type injuries most often involve an isolated proximal injury of the semimembranosus muscle. The main cause of severe 2- or 3-tendon avulsion is a rapid forceful hip flexion with the ipsilateral knee extended. Most hamstring injuries are treated non-surgically with good results. However, there are also clear indications for surgical treatment, such as severe 2- or 3-tendon avulsions. In athletes, more aggressive recommendations concerning surgical treatment can be found. For a professional athlete, a proximal isolated tendon avulsion with clear retraction should be treated operatively regardless of the injured tendon. Surgical treatment has been found to have good results in severe injuries, especially if the avulsion injury is repaired in acute phase. In chronic hamstring injuries and recurring ruptures, the anatomical apposition of the retracted muscles is more difficult to be achieved. This review article analyses the outcomes of surgical treatment of hamstring ruptures. The present study confirms the previous knowledge that surgical treatment of hamstring tendon injuries causes good results with high satisfaction rates, both in complete and partial avulsions. Early surgical repair leads to better functional results with lower complication rates, especially in complete avulsions.

KEY MESSAGEs

• Surgical treatment of hamstring tendon ruptures leads to high satisfaction and return to sport rates.
• Both complete and partial hamstring tendon ruptures have better results after acute surgical repair, when compared to cases treated surgically later.
• Athletes with hamstring tendon ruptures should be treated more aggressively with operative methods.

     

Interventions for preparing patients for chemotherapy and radiotherapy: a systematic review

Purpose

Undergoing chemotherapy and radiotherapy can be physically and psychologically stressful for people with cancer. Providing preparatory information to cancer patients as they face treatment and its aftermath has the potential to improve patient outcomes. This study assessed the methodological quality and effectiveness of interventions providing preparatory information about chemotherapy and/or radiotherapy to cancer patients in improving patient outcomes and health care use.

Methods

MEDLINE, EMBASE, and Cochrane databases were systematically searched from January 1995 until October 2012. Inclusion criteria: (1) met Effective Practice and Organisation of Care (EPOC) criteria for study design; (2) included adults with a current cancer diagnosis; (3) delivered preparatory information via a health care provider or was self-directed; (4) examined psychological well-being, quality of life, physical symptoms, satisfaction, knowledge, or health service utilisation. Studies were assessed for methodological quality using the EPOC criteria.

Results

Eighteen studies involving 3,443 cancer patients met inclusion criteria. Interventions included written information, audiotapes, videotapes, and computer programs. Interventions improved patient satisfaction (6/7 studies), information needs and patient knowledge (5/6 studies), physical symptoms (3/4 studies) and cost (1/1 study). More than half of the interventions improved psychological outcomes and quality of life (10/17 studies).

Conclusion

Providing preparatory information can improve patient-reported outcomes in cancer patients undergoing chemotherapy and radiotherapy, especially with respect to satisfaction and knowledge. Some, but not all, studies improved psychological outcomes and physical symptoms. There is a need for methodologically rigorous research to determine the most effective timing and method of delivery of preparatory information to improve patient outcomes.     

Reliability of Sonographic Assessment of Biceps Femoris Distal Tendon Strain during Passive Stretching

The purpose of this study was to determine the intra-rater, inter-examiner and inter-observer reliability of biceps femoris long head (BFlh) tendon strain using ultrasound imaging. Nineteen patients (age: 20.4 ± 0.35 y) were tested twice with a 1-wk interval. Each session included passive stretching from three different hip positions. Tests were performed independently by two examiners while BFlh tendon displacement (mm) and strain (%) were manually extracted from ultrasound video footages by two observers. Intra-rater comparisons revealed an intra-class correlation coefficient (ICC_2,1) range of 0.87 to 0.98 and a variability less than 4.74%. Inter-examiner comparisons revealed an ICC_2,1 range of 0.83 to 0.99 and less than 4.69% variability. Inter-observer ICCs ranged from 0.93 to 0.97 with variability less than 4.89%. Using a well-defined scanning protocol, two experienced examiners attained high levels of intra-rater agreement, with similarly excellent results for inter-rater and inter-observer reliability for BFlh tendon displacement and strain.     

Interventions for caregivers of persons with dementia: a systematic review.

The prevalence of dementia in older adults in increasing. Due to cuts in funding for formal support, many families are having to provide care for a loved one with dementia at home. This systematic review gathered and synthesized information on interventions designed to enhance the well-being of caregivers of people with dementia. A search of the literature resulted in 36 relevant studies. Of these, 11 were rated as strong, 11 as moderate, 13 as weak, and 1 as poor. This paper focuses on the strong studies. No one intervention had an overall significant impact on the well-being of caregivers. Although several interventions have been shown to be of benefit to caregivers, non-significant findings were more common. Further investigation is greatly needed. Systematic reviews are an important means of guiding consumers and practitioners in making evidence-based decisions.     

Interventions to prevent and reduce the impact of musculoskeletal injuries among nurses: A systematic review

BackgroundMusculoskeletal injuries and musculoskeletal pain are prevalent among nurses compared to many other occupational groups.ObjectiveTo identify interventions that may be effective at reducing the prevalence and impact of musculoskeletal injuries and pain in registered nurses.DesignSystematic review.Data sourcesSeven databases were systematically searched, including MEDLINE, CINAHL, EMBASE, PsycInfo, Academic Search Complete, Health Source Nursing, and the Cochrane Database of Systematic Reviews.Review methodsPeer-reviewed journal articles reporting interventions designed to reduce the occurrence of musculoskeletal injuries and pain among registered nurses, published between January 2004 and June 2016, were eligible for inclusion. Randomised and non-randomised controlled trials, as well as studies implementing before-after designs were included. Studies investigating interventions in samples predominately comprised of nursing aides or non-nursing personnel were excluded. Relevant articles were collected and critically analysed using the Effective Public Health Practice Project methodology. Two reviewers independently extracted data and performed quality appraisals for each study. A narrative synthesis of study findings was performed.ResultsTwenty studies met criteria for inclusion in the review. Types of interventions reported included: patient lift systems (N = 8), patient handling training (N = 3), multi-component interventions (N = 7), cognitive behavioural therapy (N = 1), and unstable shoes (N = 1). Only two studies received a ‘strong’ quality rating according to quality assessment criteria. One of these found no evidence for the effectiveness of patient handling training; the other found preliminary support for unstable shoes reducing self-reported pain and disability among nurses. Overall, evidence for each intervention type was limited.ConclusionsThere is an absence of high quality published studies investigating interventions to protect nurses from musculoskeletal injuries and pain. Further research (including randomised controlled trials) is needed to identify interventions that may reduce the high rates of injury and pain among nurses.     

Instrument assisted soft tissue mobilization (IASTM) versus stretching: A comparison in effectiveness on hip active range of motion,muscle torque and power in people with hamstring tightness

BackgroundInstrument-assisted soft tissue mobilization (IASTM) is a new technique that has been known to be effective in reducing muscle tightness in athletics. However, little is known about its effect on the range of motion, muscle power, and torque compared to manual stretching among non-athletics. Thus, the study was aimed to compare the effectiveness between IASTM and manual stretching in improving hip flexion active range of motion (ROM), muscle torque and power on hamstring muscle complex (HMC) tightness in one session.MethodTwenty-three young male college students with unilateral hamstring tightness measured via straight leg raising (SLR) test (<65°) were randomly assigned to one of two groups. Twelve participants received the application of IASTM (group 1), and eleven received manual stretching (group 2). Hip flexion active ROM was measured via goniometer, the torque & power of the hamstring muscle were measured using Humac isokinetic dynamometer, before and after both interventions. (ISRCTN17693345).ResultsThere was no significant difference in the improvement of hip flexion active ROM (69.6 ± 6.6 vs 72.5 ± 7.9, p = .34), HMC torque (63.7 ± 14.5 vs 53.2 ± 16.3, p = .14), and HMC power (47.8 ± 11.8 vs 40.9 ± 16.3, p = .34) between group 1 and group 2 respectively. When a comparison was made within each group, significant improvements in hip active flexion ROM was found in both groups (p's < .001), and HMC power was significantly improved in group 1 (p = .04) but not in group 2.ConclusionThe current study findings demonstrate that IASTM was as effective as manual stretching in improving hip flexion active ROM, muscle torque and power among non-athletic people with HMC tightness.     

Interventions for enhancing adherence with physiotherapy: A systematic review

Poor adherence to treatment is commonplace and may adversely affect outcomes, efficiency and healthcare cost. The aim of this systematic review was to identify strategies to improve adherence with musculoskeletal outpatient treatment. Five suitable studies were identified which provided moderate evidence that a motivational cognitive–behavioural (CB) programme can improve attendance at exercise-based clinic sessions. There was conflicting evidence that adherence interventions increase short-term adherence with exercise. There was strong evidence that adherence strategies are not effective at improving long-term adherence with home exercise. Due to the multi-dimensional nature of non-adherence, the strategies to improve adherence with physiotherapy treatment are likely to be broad in spectrum. Combined interventions may be effective at promoting adherence with clinic appointments and exercise, though further research would be required to confirm this. Further research to increase basic understanding of the factors, which act as a barrier to adherence, could facilitate development of strategies to overcome non-adherence.     

The effectiveness of memory remediation strategies after traumatic brain injury: Systematic review and meta-analysis

BackgroundTraumatic brain injury (TBI) is a steadily rising health concern associated with significant risk of emotional, behavioral and cognitive impairments. Cognitive memory impairment is one of the most concerning outcomes after TBI, affecting a wide range of everyday activities, social interactions and employment. Several comparative and comprehensive reviews on the effects of cognitive interventions in individuals with TBI have been conducted but usually with a qualitative rather than quantitative approach. Thus, evidence synthesis of the effects of TBI interventions on memory difficulties is limited.ObjectiveIn this meta-analysis, we examined the memory-remediating effects of internal and external interventions, injury severity and the interaction of both factors for patients with TBI.MethodsData were extracted from studies published between 1980 and 2020 that used objective memory measures (computerized or pencil-and-paper), and multiple meta-analyses were conducted to compare effectiveness across these interventions. Publication bias was assessed, as was quality of evidence using the Cochrane Risk of Bias tool for randomized controlled studies. Our final meta-analysis included 16 studies of 17 interventions classified into 3 categories: internal, external and mixed.ResultsMixed interventions demonstrated the highest average effect size for memory difficulties (Morris d = 0.79). An evaluation of injury severity yielded 2 categories: mild-moderate and moderate-severe. Analyses demonstrated a homogenous medium effect size of improvement across injury severity, with moderate-severe injury with the largest average effect size (Morris d = 0.65). Further evaluation of injury severity interaction with intervention type revealed a mediating effect for both factors, demonstrating the largest effect size for mixed interventions with moderate-severe injury (Morris d = 0.81).ConclusionThis study highlights the effectiveness of memory remediation interventions on memory impairment after TBI. A wide range of interventions are more effective because they address individual variability for severity and memory deficits. The study further supports and expands existing intervention standards and guidelines.