The Institute Sport Exercise and Health’s (ISEH) Dr Bruce Paton, Professor Fares Haddad, Professor Mat Wilson, Dr Noel Pollock, Dr Paul Read & UCLH’s Dr Ricci Plastow have developed and led a 3-part consensus following an extensive in-depth and detailed review of the current management of hamstring injuries in athletes, with their findings published in the British Journal of Sports Medicine.
The authors set out to develop consensus on what represents optimal Hamstring Management in athletes after identifying three key topics where evidence was lacking after reviewing current practices and guidelines following a rise in hamstring injuries over the last decade in competitive sports. This is despite the various injury prevention programmes and an uptake in dedicated research.
These areas were:
1) defining the problem: diagnosis and classification of HSI
2) the role of restoring anatomy: surgical decision-making
3) recovery and reducing the risk of recurrence
Following a vigorous process of debate and voting the consensus statements were developed by the authors and included the involvement and expert opinion of a larger global body of Hamstring injury experts.
The outcomes of the study – some of the key findings and recommendations:
Part 1: Classification
The experts agreed that muscle injury classification systems must evolve to include:
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individual muscles
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intramuscular injuries
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mechanism of injury
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sporting demand
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functional criteria
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patientrelated outcome measures.
It is important to note that improvements should be made to the validity and reliability of classification systems to prognosticate and guide treatment decision-making.
Part 2: Operative management
Although only a minority of hamstring injuries require surgical care, certain factors aid management, and the majority of experts were in agreement that the surgical criteria within Hamstring injury classification systems must improve.
Surgical consideration as well as the non-surgical rehabilitation should be the recommended treatment options for elite-level athletes with severe grade musculotendinous junction and distal hamstring injuries who are looking to return to previous sporting level and who are at low risk of reinjury.
Part 3: Rehabilitation and return to sport
After hamstring injury, the experts agreed that differences in hamstring musculotendinous tissue, anatomy and functional roles should inform rehabilitation prescription. In the early phase of injury, most of the specialists agreed the importance of protection of injured tissue from loading at length and elastic loads, but there was a difference of opinion in the order and types of load/contraction when initiating rehabilitation (e.g., concentric vs isometric loads). In later stage rehabilitation experts aim to achieve full outer length and eccentric strength as key criteria for return to running and sport.
The editorial discusses the outcomes of the study in further detail and highlights the importance and criterial need of doing the basics well, in order to reduce the burden of hamstring injuries - read the editorial.
Dr Bruce Paton, Consultant Physiotherapist and Associate Professor at ISEH who led Part 1 and 3 of the consensus statements shared: “We would like to thank all of the expert clinicians/researchers for their involvement and noteworthy contributions to this project; we are extremely grateful to the research panel and all of the experts who took the time to provide their opinions, their expertise was integral to the success of this project.”
To find out more, you can read the findings of the study ‘The London International Consensus and Delphi study on Hamstring Injuries’ in the British Journal of Sports Medicine.
Part 1 - Classification
Part 2 – Operative management
Part 3 - Rehabilitation and return to sport