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Anders Hauge Engebretsen - Hamstring Injuries

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Anders Hauge Engebretsen
Former researcher at the Oslo Sports Trauma Research Center. Resident at the Oslo University Hospital, Rikshospitalet/ Ullevål, Department of pediatric surgery.
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The Oslo Sports Trauma Research Center and hamstring injuries
(6th MuscleTech Network Workshop)
13th and 14th October, Barcelona 2014

Publicado en: Salud y medicina

Anders Hauge Engebretsen - Hamstring Injuries

  1. 1. Hamstring injuries Prevention and risk factors Anders Hauge Engebretsen MD PhD Oslo Sports Trauma Research Center
  2. 2. Oslo Sports Trauma Research Center Background Hamstring injuries Prevention Risk factors Discussion Take Home message Hamstring injuries
  3. 3. Oslo Sports Trauma Research Center Background Hamstring injuries Prevention Risk factors Discussion Take Home message Hamstring injuries
  4. 4. ”Intellectuals solve problems; geniuses prevent them” Albert Einstein (1879 – 1955)
  5. 5. www.ostrc.no – www.klokeavskade.no … to prevent injuries and other health problems in sports through research on risk factors, injury mechanisms and injury prevention methods in sports, particularly football, team handball and alpine skiing.
  6. 6. Combining clinical work and research Oslo Sports Trauma Research Center Oslo University Hospital (Ullevål) Olympic Training Center
  7. 7. The partners Olympic Training Center Ullevål University Hospital Oslo Sports Trauma Research Center Norwegian Research Center for Active Rehabilitation (NAR)
  8. 8. Growing…
  9. 9. And growing…
  10. 10. Oslo Sports Trauma Research Center Background Hamstring injuries Prevention Risk factors Discussion Take Home message Hamstring injuries
  11. 11. Hamstrings muscles
  12. 12. Swanson & Caldwell Med Sci Sports Exerc 32: 1146-1155, 2000 When does the injury occur? Maximal EMG- activity during sprinting: Towards end of swing phase – eccentric phase Push-off during knee extension
  13. 13. Junge&Dvorak -00; Andersen -04; Ekstrand -10; Ekstrand -13 Injured body parts - head: 2-10% - trunk: 5-9% - arms: 2-6% - lower extremities: 70-90% - groin: 10-20% - thigh: 12-25% - knee: 15-23% - ankle: 17-36% - foot: 5-8%
  14. 14. Junge&Dvorak -00; Andersen -04; Ekstrand -10; Ekstrand -13 Injured body parts - head: 2-10% - trunk: 5-9% - arms: 2-6% - lower extremities: 70-90% - groin: 10-20% - thigh: 12-25% - knee: 15-23% - ankle: 17-36% - foot: 5-8%
  15. 15. Junge&Dvorak -00; Andersen -04; Ekstrand -10; Ekstrand -13 Injured body parts - head: 2-10% - trunk: 5-9% - arms: 2-6% - lower extremities: 70-90% - groin: 10-20% - thigh: 12-25% - knee: 15-23% - ankle: 17-36% - foot: 5-8%
  16. 16. Drawer and Fuller -01; Andersen et. al -04; Ekstrand et al.-10; Ekstrand et al-13 Type of injury - muscle injuries 20-45% - joint and ligament 18-48% - contusion 14-20% - fracture 2-7%
  17. 17. Risk of hamstring injury 6-29% of all injuries in football, Australian rules football, rugby, basketball, track sprint High recurrence rate Woods -04; Orchard -02; Meeuwisse -03; Croisier -04; Brooks -05; Brooks -05; Garrett -06; Engebretsen -13; Alonso -11; Petersen -10; De Vos -14
  18. 18. Risk of hamstring injury Continued high prevalence of injury rates from 2001 to 2008 Eccentric training seems promising for prevention Prevention of hamstring strains more effective than knee injuries Drawer and Fuller -01; Andersen et. al -04; Ekstrand et al.-11; Ekstrand et al-13; Petersen et al -10
  19. 19. Risk factors Previous injury Age Males vs Females Low hamstring strength Low H:Q strength ratio Low ROM? Inadequate warm-up before maximal activity? Muscular fatigue towards end of match or training? Peak performance? Junge & Dvorak 2000; Dupont 2010; Ekstrand 13;
  20. 20. Mechanisms of injury 40-60% player to player contact 20% «foul play» Muscle injuries Running Giza et al. -03, Andersen -04 et al., Fuller -04 et al., Ekstrand et al. -13
  21. 21. Oslo Sports Trauma Research Center Background Hamstring injuries Prevention Risk factors Discussion Take Home message Hamstring injuries
  22. 22. Football and injuries Screening, risk factors and prevention Anders Hauge Engebretsen Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences & Orthopaedic Center, Division of Neuroscience and Musculoskeletal Medicine Ullevaal University Hospital
  23. 23. Age Physical fitness (speed, spenst) Previous injury Weight/height Impared function Anatomy Multifactorial model of etiology Exposure to extrinsic risk factors Inciting event Predisposed athlete Athlete at risk INJURY Intrinsic risk factors Risk factors for injury Injury mechanisms Meeuwisse WH: Clin J Sports Med 4; 166-170, 1994
  24. 24. All players (n=508) Testing for potential risk factors Questionnaire Clinical examination Specific tests
  25. 25. All players (n=508) Players with increased risk of injury (n=388) Players with low risk of injury (n=120) Simple self assessment (questionnaire) Previous injury last year Impaired function
  26. 26. All players (n=508) Players with increased risk of injury (n=388) Players with low risk of injury (n=120) Simple self assessment (questionnaire) High risk intervention group (n=193)
  27. 27. All players (n=508) Players with increased risk of injury (n=388) Players with low risk of injury (n=120) Simple self assessment (questionnaire) High risk control group (n=195) High risk intervention group (n=193)
  28. 28. All players (n=508) Players with increased risk of injury (n=388) Players with low risk of injury (n=120) Simple self assessment (questionnaire) High risk control group (n=195) High risk intervention group (n=193) Low risk control group (LRc) (n=120)
  29. 29. Number of players with different programs 115 players - one program 72 players - two programs 21 players - three programs 2 players - four programs 105 ankle programs 81 hamstrings programs 65 knee programs 64 groin programs Total 315 programs
  30. 30. Nordic Hamstring exercise Week 1 2 3 4 Sessions/week 1 2 3 3 Sets and Repetitions 2 x 5 2 x 6 3 x 6-8 3 x 8-10 5-10 3 3 x 12+10+8 10+ 1 3 x 12+10+8
  31. 31. With gratitude to ”Muscle Animations” (Tron.Krosshaug@nih.no
  32. 32. Injury definition Acute injury ”Time-loss” injury Overuse injury Medical attention (independent of time-loss or not) Ankle, Knee Acute injury Hamstring, Groin injury Acute and overuse injuries
  33. 33. Statistical methods Screening and prevention Z-test Chi-square tests Risk factors Generalized estimating equations (STATA, Texas, USA) Univariate analyses (p<0,10) Multivariate analysis
  34. 34. Oslo Sports Trauma Research Center Background Hamstring injuries Prevention Risk factors Discussion Take Home message Hamstring injuries
  35. 35. Incidence of injuries (per 1000h) 0 1 2 Intention to treat analysis – Hamstring RR=1.55 95%CI 0.83-2.90 HRi Hamstring (n=76) HRc Hamstring (n=85)
  36. 36. Oslo Sports Trauma Research Center Background Hamstring injuries Prevention Risk factors Discussion Take Home message Hamstring injuries
  37. 37. Hamstring - questionnaire 0 1 HaOS Player information and injury history Hamstring Outcome Score P-value
  38. 38. Hamstring - questionnaire 0 1 HaOS Player information and injury history Hamstring Outcome Score P-value
  39. 39. Hamstring - Clinical examination and tests 0 1 P-value Clinical examination Specific tests
  40. 40. Risk factors for hamstring injury Previous injury Adjusted OR, 2.19; 95% CI, 1.19-4.03; P=0.01 Don’t panic - it’s just a pulled hamstring
  41. 41. Oslo Sports Trauma Research Center Background Hamstring injuries Prevention Risk factors Discussion Take Home message Hamstring injuries
  42. 42. Conclusions - Injury prevention The targeted intervention did not affect injury risk Low compliance
  43. 43. Compliance 0 10 20 30 40 50 60 70 80 90 Ankle Knee Hamstring Groin Non-compliant Compliant %
  44. 44. Per protocoll analysis - Hamstring HRi Compliant HRc Incidence of injuries (per 1000h) 0 1 2 RR=0.94 95%CI 0.28-3.22
  45. 45. Prevention of hamstring injuries Conclusion: Eccentric training, with good compliance, appears to be successful in prevention of hamstring injury.
  46. 46. Bahr R, BJSM 2009 Adapted from Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med 1992;11:533-78
  47. 47. Time-loss Symptoms
  48. 48. Oslo Sports Trauma Research Center Background Hamstring injuries Prevention Risk factors Discussion Take Home message Hamstring injuries
  49. 49. Hamstring injuries Prevention Eccentric training Risk factors Previous injury
  50. 50. Mjølsnes et al. Scand J Med Sci Sports, 14: 311-317, 2004 cons ext ecc flex isom flex 90 isom flex 60 isom flex 30 Knee torque (Nm) -10 -5 0 5 10 15 20 25 30 Nordic hamstring Hamstring curl Eccentric strength training
  51. 51. Pyramide of evidence Level VI Level V Level IV Level III Level II Level I Sackett et al, 2000
  52. 52. Prevention of hamstring injuries Askling Arnason fleks Arnason NH Petersen Relativ risiko 0 1 2 3 ♂ ♂ ♂ n= 30 n= n/a n= 942
  53. 53. Overuse injuries ”Time-loss” vs pain All injuries included? Impared function not necessarily included
  54. 54. Overuse injuries under-reported Limited knowledge Significant complaints Still players choose to play

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