Wednesday, April 20, 2011

VHI Evidence Based Newsletter

VHI Evidence Based Newsletter

Can hamstring injuries be prevented with a targeted exercise program?
A: To answer this question, we performed a comprehensive search of the PubMed database (November 2010) for randomized, controlled trials and systematic reviews that addressed this specific research question. 1

Eight studies met the criteria for inclusion in this review, evaluating sport-specific exercise in soccer (1) and Australian Rules football (7); isokinetic hamstring strengthening in soccer players (3); and eccentric hamstring exercise in soccer (2,4,8), rugby (5) and Australian Rules football (6).

Kraemer et al conducted a prospective cohort study of soccer-specific balancing exercises among 24 elite level female soccer players, and found a significant decrease in hamstring injuries across two seasons (1). Verrall et al followed a team of 70 Australian Rules football players during two seasons and incorporated a sport-specific intervention during two subsequent seasons, finding a significant reduction in the incidence of match-play hamstring injuries (7). Among professional soccer players, Croiser et al found that players successfully correcting hamstring strength imbalances had a significantly reduced risk of injury compared to players that were untreated (3).

Five studies examined the effect of eccentric hamstring exercise (2-5,7). Engebretsen (4) and Gabbe (6) et al studied Nordic hamstring exercise in elite level athletes and showed no significant benefit related to poor compliance. Brooks et al compared three exercise protocols among 546 rugby players, and found that strengthening, stretching, and Nordic hamstrings resulted in a significantly lower rate of injury compared to strengthening only (5). Similarly, Arnason found the addition of Nordic hamstring exercise to reduce the incidence of hamstring injuries in elite level soccer players (2) Askling found a significant reduction in hamstring injuries among 15 elite level players completing concentric and eccentric overload exercises to the hamstring muscles during the preseason compared to 15 control players (8).

Based on this review, it can be concluded that hamstring strengthening exercises, specifically eccentric, can reduce the incidence of hamstring strain injury provided compliance is maintained. Sample exercises from VHI PC-Kits have been provided based on examples from these studies.

Dr. Brooks
Chiropractor Fairfax, VA 22031

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