Abstract
Hamstring strain injuries (HSIs) are the most prevalent injury in a number of sports,
and while anterior cruciate ligament (ACL) injuries are less common, they are far
more severe and have long-term implications, such as an increased risk of developing
osteoarthritis later in life. Given the high incidence and severity of these injuries,
they are key targets of injury preventive programs in elite sport. Evidence has shown
that a previous severe knee injury (including ACL injury) increases the risk of HSI;
however, whether the functional deficits that occur after HSI result in an increased
risk of ACL injury has yet to be considered. In this clinical commentary, we present
evidence that suggests that the link between previous HSI and increased risk of ACL
injury requires further investigation by drawing parallels between deficits in hamstring
function after HSI and in women athletes, who are more prone to ACL injury than men
athletes. Comparisons between the neuromuscular function of the male and female hamstring
has shown that women display lower hamstring-to-quadriceps strength ratios during
isokinetic knee flexion and extension, increased activation of the quadriceps compared
with the hamstrings during a stop-jump landing task, a greater time required to reach
maximal isokinetic hamstring torque, and lower integrated myoelectrical hamstring
activity during a sidestep cutting maneuver. Somewhat similarly, in athletes with
a history of HSI, the previously injured limb, compared with the uninjured limb, displays
lower eccentric knee flexor strength, a lower hamstrings-to-quadriceps strength ratio,
lower voluntary myoelectrical activity during maximal knee flexor eccentric contraction,
a lower knee flexor eccentric rate of torque development, and lower voluntary myoelectrical
activity during the initial portion of eccentric contraction. Given that the medial
and lateral hamstrings have different actions at the knee joint in the coronal plane,
which hamstring head is previously injured might also be expected to influence the
likelihood of future ACL. Whether the deficits in function after HSI, as seen in laboratory-based
studies, translate to deficits in hamstring function during typical injurious tasks
for ACL injury has yet to be determined but should be a consideration for future work.
Keywords
List of abbreviations:
ACL (anterior cruciate ligament), BF (biceps femoris), HSI (hamstring strain injury), SM (semimembranosus), ST (semitendinosus)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Injury report 2010: Australian football league.Sport Health. 2011; 29: 15
England Rugby Premiership Injury and Training Audit Steering Group. England rugby: premiership injury and training audit 2009-2010 season report. Available at: http://www.rfu.com/News/2011/February/News%20Articles/∼/media/Files/2011/News/RFU_Injury_and_Training_Audit.ashx. Accessed February 10, 2012.
O'Connor D. NRL injury surveillance report 2009 season. Available at: http://resources.news.com.au/files/2010/04/14/1225853/788387-nrl-injury-report-2009.pdf. Accessed February 8, 2012.
- Association between abnormal kinematics and degenerative change in knees of people with chronic anterior cruciate ligament deficiency: a magnetic resonance imaging study.Aust J Physiother. 2005; 51: 233-240
- Does anterior cruciate ligament reconstruction restore normal knee kinematics? A prospective MRI analysis over two years.J Bone Joint Surg Br. 2006; 88: 324-330
- Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes.Am J Sports Med. 2007; 35: 1500-1506
- Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging.Br J Sports Med. 2001; 35: 435-439
- Predicting hamstring strain injury in elite athletes.Med Sci Sports Exerc. 2004; 36: 379-387
- Hamstring muscle strain recurrence and strength performance disorders.Am J Sports Med. 2002; 30: 199-203
- Running biomechanics and lower limb strength associated with prior hamstring injury.Med Sci Sports Exerc. 2009; 41: 1942-1951
- Knee flexor strength and bicep femoris electromyographical activity is lower in previously strained hamstrings.J Electromyogr Kinesiol. 2012; 23: 696-703
- Rate of torque and electromyographic development during anticipated eccentric contraction is lower in previously strained hamstrings.Am J Sports Med. 2013; 41: 116-125
- MR observations of long-term musculotendon remodeling following a hamstring strain injury.Skeletal Radiol. 2008; 37: 1101-1109
- The influence of prior hamstring injury on lengthening muscle tissue mechanics.J Biomech. 2010; 43: 2254-2260
- Selective strength loss and decreased muscle activity in hamstring injury.J Orthop Sports Phys Ther. 2011; 41: 354-363
- Hamstring strain injuries: factors that lead to injury and re-injury.Sports Med. 2012; 42: 209-226
- Mechanisms and risk factors for non-contact ACL injury in age mature athletes who engage in field or court sports: a summary of literature since 1980.J Strength Cond Res. 2011; 26: 3160-3176
- Muscle activation strategies at the knee during running and cutting maneuvers.Med Sci Sports Exerc. 2003; 35: 119-127
- Characteristics of anterior cruciate ligament injuries in Australian football.J Sci Med Sport. 2007; 10: 96-104
- Anticipatory effects on knee joint loading during running and cutting maneuvers.Med Sci Sports Exerc. 2001; 33: 1176-1181
- Identification of athletes at future risk of anterior cruciate ligament ruptures by neuromuscular screening.Am J Sports Med. 2009; 37: 1967-1973
- Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data.J Pediatr Orthop. 2004; 24: 623-628
- Effect of gender and maturity on quadriceps-to-hamstring strength ratio and anterior cruciate ligament laxity.Am J Sports Med. 2006; 34: 370-374
- Plyometric training in female athletes. Decreased impact forces and increased hamstring torques.Am J Sports Med. 1996; 24: 765-773
- Comparison of hamstring neuromechanical properties between healthy males and females and the influence of musculotendinous stiffness.J Electromyogr Kinesiol. 2009; 19: 362-369
- A comparison of knee joint motion patterns between men and women in selected athletic tasks.Clin Biomech (Bristol, Avon). 2001; 16: 438-445
- Risk factors for injuries in football.Am J Sports Med. 2004; 32: 5S-16S
- Intrinsic and extrinsic risk factors for muscle strains in Australian football.Am J Sports Med. 2001; 29: 300-303
- Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study.Am J Sports Med. 2008; 36: 1469-1475
- Strength deficits identified with concentric action of the hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters.J Orthop Sports Phys Ther. 2008; 38: 457-464
- Evaluation of the hamstring muscle complex following acute injury.Skeletal Radiol. 2003; 32: 582-589
- Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players.Am J Sports Med. 1999; 27: 312-319
- Anterior cruciate ligament injuries in female athletes: part 1, mechanisms and risk factors.Am J Sports Med. 2006; 34: 299-311
- Anterior tibial translation during eccentric, isokinetic quadriceps work in healthy subjects.Scand J Med Sci Sports. 1999; 9: 189-194
- The effect of technique change on knee loads during sidestep cutting.Med Sci Sports Exerc. 2007; 39: 1765-1773
Article info
Publication history
Published online: October 11, 2013
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
