Abstract
Purpose
The aim was to introduce and evaluate the reliability and validity of an active hamstring flexibility test as a complement to common clinical examination when determining safe return to sport after hamstring injury.
Methods
Eleven healthy subjects (28 years) were tested on repeated occasions, and 11 athletes (21 years) with MRI-verified acute hamstring strain were tested when common clinical examination revealed no signs of remaining injury, i.e. there was no differences between the legs in palpation pain, manual strength tests, and passive straight leg raise. Flexibility, i.e. highest range of motion of three consecutive trials, was calculated from electrogoniometer data during active ballistic hip flexions and conventional passive slow hip-flexions in a supine position. A VAS-scale (0–100) was used to estimate experience of insecurity during active tests.
Results
No significant test–retest differences were observed. Intra-class correlation coefficients ranged 0.94–0.99 and coefficients of variation 1.52–4.53%. Active flexibility was greater (23%) than passive flexibility. In the athletes, the injured leg showed smaller (8%) active, but not passive, flexibility than the uninjured leg. Average insecurity estimation was 52 (range 28–98) for the injured and 0 for the uninjured leg, respectively.
Conclusion
The new test showed high reliability and construct validity; furthermore, it seems to be sensitive enough to detect differences both in active flexibility and in insecurity after acute hamstring strains at a point in time when the commonly used clinical examination fails to reveal injury signs. Thus, the test could be a complement to the common clinical examination before the final decision to return to sport is made.
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References
Askling C, Saartok T, Thorstensson A (2006) Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Br J Sports Med 40:40–44
Atkinson G, Nevill AM (1998) Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 26:217–238
Bradley PS, Portas MD (2007) The relationship between preseason range of motion and muscle strain injury in elite soccer players. J Strength Cond Res 21:1155–1159
Brooks JHM, Fuller CW, Kemp SPT, Reddin DB (2006) Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med 34:1297–1306
Copland ST, Tipton JS, Fields KB (2009) Evidence-based treatment of hamstring tears. Curr Sports Med Rep 8:308–314
Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM (2008) Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med 36:1469–1475
Davis DS, Quinn RO, Whiteman CT, Williams JD, Young CR (2008) Concurrent validity of four clinical tests used to measure hamstring flexibility. J Strength Cond Res 22:583–588
Denegar CR, Ball DW (1993) Assessing reliability and precision of measurement: an introduction to intraclass correlation and standard error measurement. J Sport Rehabil 2:35–42
Ekstrand J, Wiktorsson M, Öberg B, Gillquist J (1982) Lower extremity goniometric measurements: a study to determine their reliability. Arch Phys Med Rehabil 63:171–175
Fasen JM, O’connor AM, Schwartz SL, Watson JO, Plastaras CT, Garvan CW, Bulcao C, Johnson SC, Akuthota V (2009) A randomized controlled trial of hamstring stretching: comparison of four techniques. J Strength Cond Res 23:660–667
Gajdosik R, Lusin G (1983) Hamstring muscle tightness. Reliability of an active knee extension test. Phys Ther 63:1085–1088
Gajdosik RL, Rieck MA, Sullivan DK, Wightman SE (1993) Comparison of four clinical tests for assessing hamstring muscle length. J Orthop Sports Phys Ther 18:614–618
Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG (2010) Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther 40:67–81
Henderson G, Barnes CA, Portas MD (2010) Factors associated with increased propensity for hamstring injury in english premier league soccer players. J Sci Med Sport. 13:397–402
Orchard J, Best TM, Verrall GM (2005) Return to play following muscle strains. Clin J Sport Med 15:436–441
Orchard J, Seward H (2002) Epidemiology of injuries in the Australian football league, season 1997–2000. Br J Sports Med 36:39–44
Prior M, Guerin M, Grimmer K (2009) An evidence-based approach to hamstring strain injury: a systematic review of the literature. Am Ortho Soc Sports Med 1:154–164
Sherry MA, Tm Best (2004) A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther 34:116–125
Thomée P, Währborg P, Börjesson M, Thomée R, Eriksson BI, Karlsson J (2006) A new instrument for measuring self-efficacy in patients with an anterior cruciate ligament injury. Scand J Med Sci Sports 16:181–187
Waldén M, Hägglund M, Ekstrand J (2005) UEFA Champions Leauge study: a prospective study of injuries in professional football during the 2001–2002 season. Br J Sports Med 39:542–546
Witvrouw E, Danneels L, Asselman P, D′Have T, Cambier D (2003) Muscle flexibility as a risk factor for developing muscle injuries in male professional players. Am J Sports Med 31:41–46
Worrell TW (1994) Factors associated with hamstring injuries. An approach to treatment and preventative measures. Sports Med 17:338–345
Acknowledgments
The authors thank Dr Klas Östberg, Solnakliniken, Dr Magnus Tengvar, and the radiography staff at Sophiahemmet for their skilful contributions to this research. We also like to thank Ulf Gustafsson, Peter Sandström, Fredrik Tinmark and Louise Welin for assistance when testing the subjects. Lastly, The Swedish Centre for Sport Research is gratefully acknowledged for financial support.
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The authors declare that they have no conflict of interest.
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Askling, C.M., Nilsson, J. & Thorstensson, A. A new hamstring test to complement the common clinical examination before return to sport after injury. Knee Surg Sports Traumatol Arthrosc 18, 1798–1803 (2010). https://doi.org/10.1007/s00167-010-1265-3
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DOI: https://doi.org/10.1007/s00167-010-1265-3