Revisiting the hamstring injury prevention and rehabilitation literature: filling the gaps

• Published in: British journal of sports medicine Vol. 58; no. 5; pp. 243 - 244
• Main Authors: Afonso, José, Reurink, Guus, Clemente, Filipe Manuel, Ramirez-Campillo, Rodrigo, Pizzari, Tania, Andrade, Renato
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine 01.03.2024; BMJ Publishing Group LTD
• Subjects: Athletic Injuries - prevention & control; Clinical medicine; Drug dosages; Editorial; Exercise Therapy; Exercise training; Hamstring Muscles; Hamstring Muscles - injuries; Hamstring Tendons; Humans; Injury prevention; Leg Injuries - prevention & control; Meta-analysis; Preventive Medicine; Rehabilitation; Risk factors; Systematic review; Hamstring Tendons; Exercise training; Rehabilitation; Preventive Medicine; Hamstring Muscles
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2023-106878

On the topic of hamstring injury prevention and rehabilitation, ~30 reviews have been published since 2011, alongside clinical practice guidelines (comprehensive list in online supplemental material) and a recent consensus.1–3 The aim of this editorial is to offer a perspective on the existing hamstring injury prevention and rehabilitation literature, highlighting current limitations that could benefit from different research paths in the future. [...]a recent systematic review included 108 published randomised controlled trials (RCTs) on hamstring prevention and risk factor management.5 Only four RCTs (3.7% of all trials) were focused on prevention and assessed injury incidence, all other trials assessed risk factor management (through surrogate outcomes).5 This suggests a research imbalance that could benefit from more intervention studies providing direct evidence of the efficacy and effectiveness of injury prevention strategies in reducing injury occurrence. The rehabilitation studies implemented different exercise protocols (eg, L-protocol, progressive agility and trunk stabilisation), but no protocol was investigated in more than two studies (or was combined with other procedures), and only one specific comparison (the L-protocol emphasising lengthening exercises vs the C-protocol focused on conventional exercises with less emphasis on lengthening) was investigated twice.10 There was considerable heterogeneity in injury diagnosis and classification, return to play criteria and in how outcomes were registered and reported, which hampers more direct comparisons.10 11 Clinicians and authors often propose and implement interventions for rehabilitating hamstring injuries that reflect their clinical practice and distinct underlying rationales, or adaptations to different populations and contexts.