Objectives The British Athletics Muscle Injury Classification (BAMIC) correlates with return to play in muscle injury. The aim of this study was to examine hamstring injury diagnoses and outcomes within elite track and field athletes following implementation of the British Athletics hamstring rehabilitation approach. Methods All hamstring injuries sustained by elite track and field athletes on the British Athletics World Class Programme between December 2015 and November 2019 that underwent an MRI and had British Athletics medical team prescribed rehabilitation were included. Athlete demographics and specific injury details, including mechanism of injury, self-reported gait phase, MRI characteristics and time to return to full training (TRFT) were contemporaneously recorded. Results 70 hamstring injuries in 46 athletes (24 women and 22 men, 24.6±3.7 years) were included. BAMIC grade and the intratendon c classification correlated with increased TRFT. Mean TRFT was 18.6 days for the entire cohort. Mean TRFT for intratendon classifications was 34±7 days (2c) and 48±17 days (3c). The overall reinjury rate was 2.9% and no reinjuries were sustained in the intratendon classifications. MRI variables of length and cross-sectional (CSA) area of muscle oedema, CSA of tendon injury and loss of tendon tension were associated with TRFT. Longitudinal length of tendon injury, in the intratendon classes, was not associated with TRFT. Conclusion The application of BAMIC to inform hamstring rehabilitation in British Athletics results in low reinjury rates and favourable TRFT following hamstring injury. The key MRI variables associated with longer recovery are length and CSA of muscle oedema, CSA of tendon injury and loss of tendon tension.

https://bjsm.bmj.com/content/bjsports/early/2021/04/14/bjsports-2020-103791.full.pdf

A 4-year study of hamstring injury outcomes in elite track and field using the British Athletics rehabilitation approach.

Hamstring injuries (HSI) are the source of significant impairment and disability for both professional and recreational athletes. The incidence and prevalence of HSIs has been well documented in the literature, as they are among the most common soft tissue injuries reported. The significant time loss due to injury and the inherent risk of reinjury pose a significant issue to the athlete, their career longevity and the success of their respective team. This review will deal predominantly with describing the prevalence and incidence of HSI in athletes, discuss risk factors and the mechanisms of injury for HSI, how to properly diagnose, image and prognosticate appropriate return to sport (RTS) for individuals who have sustained an HSI, prescribe treatment and prevention strategies and to discuss relevant options to decrease overall risk of primary and secondary recurrence of HSI. Current treatments of acute HSI necessitate a thorough understanding of the mechanism of injury, identifying muscle imbalances and/or weakness, inclusion of eccentric and concentric hamstring (HS) and hip extension (HE) exercises, evaluation of pathokinematic movement patterns and use non-surgical methods to promote healing and RTS. This methodology can be used prospectively to mitigate the overall risk of HSI. Injection therapies for HSI, including ultrasound-guided platelet-rich plasma and corticosteroids, may impart some short-term benefit, but the existing literature is largely inconclusive with respect to long-term functional outcomes. Future directions should prioritise injury prevention, early diagnosis and targeted interventions that combine both non-surgical and minimally invasive orthobiological approaches and identifying biomechanical risk factors prospectively to mitigate risk.

https://jisakos.bmj.com/content/jisakos/6/3/170.full.pdf

Hamstring muscle injury in the athlete: state of the art

The incidence and recurrence of hamstrings injuries are very high in sports, posing elevated performance and financial-related costs. Attempts to identify the risk factors involved in predicting vulnerability to hamstrings injury is important for designing exercise-based programs that aim to mitigate the rate and severity of hamstrings injuries and improve rehabilitation strategies. However, research has shown that non-modifiable risk factors may play a greater role than modifiable risk factors. Recognizing non-modifiable risk factors and understanding their implications will afford the prescription of better suited exercise programs, i.e., that are more respectful of the individual characteristics. In a nutshell, non-modifiable risk factors can still be acted upon, even if indirectly. In this context, an underexplored topic is how intra and inter- individual anatomic and physiologic variations in hamstrings (e.g., muscle bellies, fiber types, tendon length, aponeurosis width, attachment sites, sex- and age-related differences) concur to alter hamstrings injuries risk. Some anatomic and physiologic variations may be modifiable through exercise interventions (e.g., cross-sectional area), while others may not (e.g., supernumerary muscle bellies). This apparent dichotomy may hide a greater complexity, i.e., there may be risk factors that are partially modifiable. Therefore, we explored the available information on the anatomic variations of the hamstrings, providing a deeper insight into the individual risk factors for hamstrings injuries and contributing with better knowledge and potential applications toward a more individualized exercise prescription.

/pdf/the-hamstrings-anatomic-and-physiologic-variations-and-their-342fhr1qh7.pdf

The Hamstrings: Anatomic and Physiologic Variations and Their Potential Relationships With Injury Risk

Objective To investigate the relationship between baseball participation and health (musculoskeletal, general, and psychological health) and to identify research gaps in the existing literature. De...

The Relationship Between Baseball Participation and Health: A Systematic Scoping Review

Proximal Hamstring Injuries.

Background:Hamstring strains are the most common injury for professional baseball players and can result in significant time on the disabled list. To date, no study has reported the current trends ...

https://journals.sagepub.com/doi/pdf/10.1177/2325967119861064

Hamstring Injury Trends in Major and Minor League Baseball: Epidemiological Findings From the Major League Baseball Health and Injury Tracking System.

Background: Hip strength is an important factor for control of the lumbo-pelvic-hip complex. Deficits in hip strength may affect throwing performance and contribute to upper extremity injuries. Hypothesis: Deficits in hip abduction isometric strength would be greater in those who sustained an upper extremity injury and hip strength would predict injury incidence. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: Minor League baseball players (n = 188, age = 21.5 ± 2.2 years; n = 98 pitchers; n = 90 position players) volunteered. Hip abduction isometric strength was assessed bilaterally with a handheld dynamometer in side-lying position, expressed as torque using leg length (N·m). Hip abduction strength asymmetry was represented by [(trail leg/lead leg) × 100]. Overuse or nontraumatic throwing arm injuries were prospectively tracked. Poisson regression models were used to estimate relative risk ratios associated with hip asymmetry; confounders, including history of prior overuse injury in the past year, were included. Results: Hip abduction asymmetry ranged from 0.05% to 57.5%. During the first 2 months of the season, 18 players (n = 12 pitchers) sustained an upper extremity injury. In pitchers, for every 5% increase in hip abduction asymmetry, there was a 1.24 increased risk of sustaining a shoulder or elbow injury. No relationship between hip abduction strength and injury was observed for position players. Conclusion: Hip abduction asymmetry in pitchers was related to subsequent upper extremity injuries. The observed risk ratio indicates that hip abduction asymmetry may contribute a significant but small increased risk of injury. Clinical Relevance: Hip abduction muscle deficits may affect pitching mechanics and increase arm stress. Addressing hip asymmetry deficits that exceed 5% may be beneficial in reducing upper extremity injury rates in pitchers.

Hip Abductor Strength Asymmetry: Relationship to Upper Extremity Injury in Professional Baseball Players

Objectives:The purpose of this study is to test the efficacy of a hamstring injury prevention program designed to address the high incidence of acute and chronic hamstring injuries and re-injuries ...

https://journals.sagepub.com/doi/pdf/10.1177/2325967116S00182

Hamstring Injuries in Major and Minor League Baseball: Are They Preventable?

Background and Purpose Hamstring injuries (HSI) occur more commonly in baseball than are often appreciated and can impact the potential career of a player. Little is known about the historical incidence of these injuries in summer league players preparing for their upcoming collegiate season or being drafted by major league team(s). Summer league baseball players have a high historical incidence of HSI which are often unknown at the start of their summer league play. The purpose of this study was to administer a validated questionnaire to assess various factors regarding the prevalence of prior hamstring injuries, current symptoms of posterior thigh pain or hamstring injuries in amateur summer league baseball players, and to provide details on the injury history, time lost from injury, injury reocurrence, position, individual player physical characteristics and physical activities that might be associated with those injuries. Study Design Cross-sectional Observational Study. Method A self-reported, validated questionnaire regarding the history, prevalence, reoccurrence and functional impact of HSI and posterior thigh pain was administered to and completed by 201 out of 251 summer league baseball players associated with the Cape Cod League and the Northwoods League at the start of the 2013-2015 seasons. The questionnaire was administered by certified athletic trainers associated with each team. Participation was voluntary and informed consent was obtained from all players. Results Forty seven out of 201 players surveyed reported a HSI history. Sixty-six percent of these players (N = 31) reported unilateral injuries and 34% (N = 16) reported bilateral injuries. Reoccurrence rate was 27.7% across all players. Approximately 1/3rd of all position players (catchers 33.3%, infielders 32.6% and outfielders 31.6%) reported a HSI history compared to 12.9% of all pitchers. Significant differences (p<.05) existed between the HSI and Non-HSI groups for self-reported symptoms, soreness, and pain, as well as function and quality of life. Within the HSI history group, players who batted left and threw right reported the most injuries. Conclusion A large number of position players and pitchers who report for summer league baseball have a history of posterior thigh pain and HSI. Those with prior injuries have a high reoccurrence rate. Position players have a higher incidence of injury than do pitchers. Level of Evidence 3.

Prevalence of hamstring injuries in summer league baseball players.

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Hamstring Injury Trends in Major and Minor League Baseball: Epidemiological Findings From the Major League Baseball Health and Injury Tracking System.

Hip Abductor Strength Asymmetry: Relationship to Upper Extremity Injury in Professional Baseball Players

Hamstring Injuries in Major and Minor League Baseball: Are They Preventable?

Prevalence of hamstring injuries in summer league baseball players.