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Magnetic resonance imaging (MRI) is the gold standard for measuring muscle size. However, postural conditions for thigh musculature have not been standardized across studies, with some employing supine or prone positions and the thigh either placed on the examination table or suspended to avoid contact. In either case, the thigh is compressed or sagged by gravity, potentially affecting muscle size. This study aimed to examine the effects of postural conditions on thigh muscle size. Twenty Olympic-style weightlifters and 20 untrained controls (10 men and 10 women in each group) underwent 3-Tesla MRI in the supine and prone positions, with the thigh in compressed and suspended conditions to determine the maximal anatomical cross-sectional area (ACSAmax) and muscle volume of 15 thigh muscle groups/individual muscles. Postural conditions changed the ACSAmax of the quadriceps (range of postural-related changes: 1.0%-7.9%), hamstrings (0.8%-19.1%), and adductors (2.4%-19.2%). Regardless of measurement position, the total volume of thigh muscles decreased under compressed conditions (0.6%-3.8%). Quadriceps and adductors decreased in muscle volume under compressed conditions (0.9%-4.0% and 0.8%-6.6%), while hamstrings increased (1.4%-9.3%). Male weightlifters, who possessed the largest thigh muscle volume, showed greater postural-related changes in the muscle volume of quadriceps, hamstrings, and adductors than the other subgroups. Therefore, postural conditions during MRI substantially change thigh muscle size, and the magnitude of the change depends on muscle size. Our results provide in vivo evidence of the compressive behavior of thigh muscles and a new technical perspective for assessing thigh muscle size., (© 2024 The Author(s). Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Targeted resistance training stimulates hamstring muscle hypertrophy, but its effect on tendon-aponeurosis geometry is unknown. This study examined changes in hamstring muscle, free tendon, and aponeurosis geometry following a 10 week Nordic or hip extension exercise intervention. Thirty recreationally active males were randomly allocated (n = 10 per group) to a Nordic, hip extension, or control group. Magnetic resonance imaging of both thighs was acquired pre- and post-intervention. Changes in free tendon and aponeurosis volume for each hamstring muscle, biceps femoris long head (BFlh) aponeurosis interface area and muscle volume-to-interface area ratio were compared between groups. Regional changes in muscle CSA were examined via statistical parametric mapping. The change in semimembranosus free tendon volume was greater for the Nordic than control group (mean difference = 0.06 cm 3 , 95% CI = 0.02-0.11 cm 3 ). No significant between-group differences existed for other hamstring free tendons or aponeuroses. There were no between-group differences in change in BFlh interface area. Change in BFlh muscle volume-to-interface area ratio was greater in the hip extension than Nordic (mean difference = 0.10, 95% CI = 0.007-0.19, p = 0.03) and control (mean difference = 0.12, 95% CI = 0.03-0.22, p = 0.009) groups. Change in muscle CSA following training was greatest in the mid-portion of semitendinosus for both intervention groups, and the mid-portion of BFlh for the hip extension group. There was limited evidence for tendon-aponeurosis hypertrophy after 10 weeks of training with the Nordic or hip extension exercises. For the BFlh, neither intervention altered the interface area although hip extension training stimulated an increase in the muscle volume-to-interface area ratio, which may have implications for localized tissue strains. Alternative muscle-tendon loading strategies appear necessary to stimulate hamstring tendon adaptations., (© 2024 The Author(s). Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Passive hamstring stiffness varies proximo-distally, resulting in inhomogeneous tissue strain during stretching that may affect localized adaptations and risk of muscle injuries. The purpose of the present study was to determine the acute and chronic effects of static stretching (SS) on intramuscular hamstring stiffness. Thirty healthy active participants had acute changes in passive biceps femoris (BF), semimembranosus (SM), and semitendinosus (ST) stiffness measured at 25% (proximal), 50% (middle), and 75% (distal) muscle length, using shear-wave elastography, immediately after SS. Participants then completed 4 weeks of either a SS intervention (n = 15) or no intervention (CON, n = 15) with stiffness measured before and after the interventions. The acute and chronic effects of SS were compared between anatomical regions and between regions on the basis of their relative stiffness pre-intervention. Acutely, SS decreased stiffness throughout the BF and SM (p ≤ 0.05) but not the ST (p = 0.326). However, a regional effect of stretching was observed for SM and ST with greater reduction in stiffness occurring in stiffer muscular regions (p = 0.001-0.013). Chronically, SS increased BF and ST (p < 0.05), but not SM (p = 0.422) stiffness compared with CON, but no regional effect of stretching was observed in any muscle (p = 0.361-0.833). SS resulted in contrasting acute and chronic effects, acutely decreasing stiffness in stiffer regions while chronically increasing stiffness. These results indicate that the acute effects of SS vary along the muscle's length on the basis of the relative stiffness of the muscle and that acute changes in stiffness from SS are unrelated to chronic adaptations., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The aim of this study was to determine whether a 9-week resistance training program based on high load (HL) versus low load combined with blood flow restriction (LL-BFR) induced a similar (i) distribution of muscle hypertrophy among hamstring heads (semimembranosus, SM; semitendinosus, ST; and biceps femoris long head, BF) and (ii) magnitude of tendon hypertrophy of ST, using a parallel randomized controlled trial., Methods: A total of 45 participants were randomly allocated to one of three groups: HL, LL-BFR, and control (CON). Both HL and LL-BFR performed a 9-week resistance training program composed of seated leg curl and stiff-leg deadlift exercises. Freehand 3D ultrasound was used to assess the changes in muscle and tendon volume., Results: The increase in ST volume was greater in HL (26.5 ± 25.5%) compared to CON (p = 0.004). No difference was found between CON and LL-BFR for the ST muscle volume (p = 0.627). The change in SM muscle volume was greater for LL-BFR (21.6 ± 27.8%) compared to CON (p = 0.025). No difference was found between HL and CON for the SM muscle volume (p = 0.178).There was no change in BF muscle volume in LL-BFR (14.0 ± 16.5%; p = 0.436) compared to CON group. No difference was found between HL and CON for the BF muscle volume (p = 1.0). Regarding ST tendon volume, we did not report an effect of training regimens (p = 0.411)., Conclusion: These results provide evidence that the HL program induced a selective hypertrophy of the ST while LL-BFR induced hypertrophy of SM. The magnitude of the selective hypertrophy observed within each group varied greatly between individuals. This finding suggests that it is very difficult to early determine the location of the hypertrophy among a muscle group., (© 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

We aimed to determine whether the anatomical location (intramuscular tendon or T-Junction) of hamstring muscle injuries in professional men's rugby union associates with a prolonged time to return to full training and a higher rate of re-injury/subsequent injury. We reviewed the medical records of an Irish professional rugby union club to identify hamstring muscle injuries incurred across five seasons. Clinicians and players were not blinded to MRI results at the time of rehabilitation. A blinded musculoskeletal radiologist re-classified all included injuries (n = 91) according to the British Athletics Muscle Injury Classification framework. Players who sustained an injury with intramuscular tendon involvement required a longer time to return to full training compared to players who sustained an injury without intramuscular tendon involvement (78 days vs. 24 days). Players who sustained a biceps femoris injury with T-junction involvement did not require a longer time to return to full training compared to players who sustained a biceps femoris injury without T-junction involvement (29 days vs. 27 days). Injuries with either intramuscular tendon or T-junction involvement were not associated with an increased rate of re-injury/subsequent injury to the same limb (intramuscular tendon involvement - odds ratio = 0.96, T-junction involvement - odds ratio = 1.03). When a hamstring muscle injury involves the intramuscular tendon, the injured player and stakeholders should be made aware that a longer time to return to full training is likely required. T-junction involvement does not alter the expected clinical course of biceps femoris injuries., (© 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Large inter-individual variability of activation strategies is observed during hamstring strengthening exercises but their consequences remain unexplored. The objective of this study was to determine whether individual activation strategies are related to the distribution of damage across the hamstring muscle heads semimembranosus (SM), semitendinosus (ST), and biceps femoris (BF) after eccentric contractions. 24 participants performed 5 sets of 15 maximal eccentric contractions of knee flexors on a dynamometer, while activation of each muscle head was assessed using surface electromyography. Knee flexion maximal isometric strength was assessed before exercise and 48 h afterward. Shear modulus was measured using shear wave elastography before exercise and 30 min afterward to quantify the distribution of damage across the hamstring muscle heads. At 48 h, maximal knee flexion torque had decreased by 15.9% ± 16.9% (p < 0.001). Although no differences between activation ratios of each muscle were found during the eccentric exercise (all p > 0.364), we reported a heterogeneous distribution of damage, with a larger change in shear modulus of ST/Hams than SM/Hams (+70.8%, p < 0.001) or BF/Hams (+50.3%, p < 0.001). A large correlation was found between the distribution of activation and the distribution of damage for ST/Hams (r = 0.69; p < 001). This study provides evidence that the distribution of activation during maximal eccentric contractions has mechanical consequences for synergist muscles. Further studies are needed to understand whether individual activation strategies influence the distribution of structural adaptations after a training program., (© 2022 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Limited information is available on site-specific features of muscle stiffness and aponeurosis strain of the biceps femoris long head (BFlh) during contractions. Therefore, understanding of the mechanics and etiology of hamstring strain injuries remains difficult. As a first step to gain further insight into them, the present study aimed to identify whether active muscle stiffness and proximal aponeurosis strain during contractions are varied along the long axis of the BFlh. The BFlh muscle shear wave speed (proxy for stiffness) was measured in the proximal, central, and distal sites during 20%, 50%, and 80% of maximal voluntary isometric contraction (MVC) of knee flexion exerted with the hip and knee joints flexed at 40° and 30°, respectively, using ultrasound shear wave elastography. Further, a segmental strain of the BFlh proximal aponeurosis was assessed in the proximal, central, and distal sites during isometric knee flexion, using B-mode ultrasonography. The shear wave speed was significantly higher in the distal site than the proximal and central sites at 20% MVC (p ≤ .002, with a large effect size), whereas no significant difference was found between the three sites at 50% and 80% MVC. The BFlh proximal aponeurosis strain showed no significant difference between the proximal, central, and distal sites at any contraction intensity. These findings indicate that site-specific differences in muscle stiffness and proximal aponeurosis strain are substantially small and that muscle stiffness and proximal aponeurosis strain of the BFlh at moderate-to-high contraction intensity is not exceptional in the site where a sprinting-type hamstring strain typically occurs., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Hamstring strain injuries during sprinting or stretching frequently occur at long-muscle length. Yet, previous research has mainly focused on studying the effectiveness of eccentric hamstring strengthening at shorter muscle length on hamstring performance, morphology, and hamstring strain injury risk factors. Here, we evaluated the effects of 6-week eccentric hamstring training at long-muscle length on functional and architectural characteristics of the hamstrings. Healthy and injury-free participants (n = 40; age 23.7 ± 2.5 years) were randomly assigned to control or intervention group. Training intervention consisted of 12 sessions with two eccentric hamstring exercises in a lengthened position. Outcome measures included isokinetic and isometric knee flexion peak torque, Nordic hamstring exercise peak torque, voluntary activation level, and countermovement jump performance. Ultrasonography was used to determine muscle thickness, pennation angle, and fascicle length of biceps femoris long head (BFlh). A significant time × group interaction effect was observed for all measured parameters except countermovement jump performance and muscle thickness. The training intervention resulted in increased concentric and eccentric knee flexion peak torque at 60°/s (d = 0.55-0.62, P = .02 and .03) and concentric peak torque at 180°/s (d = 0.99, P = .001), increased isometric knee flexion peak torque (d = 0.73, P = .008) and Nordic hamstring exercise peak torque (d = 1.19, P < .001), increased voluntary activation level (d = 1.29, P < .001), decreased pennation angle (d = 1.31, P < .001), and increased fascicle length (d = 1.12, P < .001) of BFlh. These results provide evidence that short-term eccentric hamstring strengthening at long-muscle length can have significant favorable effects on various architectural and functional characteristics of the hamstrings., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Recent literature has reported intramuscular tendon (IT) disruption is associated with longer return to play (RTP) following acute hamstring injury., Objectives: Investigate whether an increase in hamstring injury severity involving high-grade IT disruption and proximal injury location is associated with longer RTP times in elite Australian Rules Football (AFL) players., Methods: Hamstring injury records and RTP times from one professional AFL club were obtained over six seasons. MRI of injuries was retrospectively reviewed by a musculo-skeletal radiologist blinded to RTP information. A simplified four-grade classification of acute hamstring injuries was developed based on IT disruption severity and proximodistal injury location. MR0 had no observable MRI tissue damage; MR1 involved muscle-tendon junction, myofascial and low-grade IT injuries; MR2 involved distal and/or single muscle high-grade IT injuries, and MR3 involved high-grade IT injuries of the proximal biceps femoris (BF) IT with concomitant injury to BF+ semitendinosus muscles., Results: Forty-one injuries were available for analysis. Median RTP times were as follows: MR0, 14 days; MR1, 21 days; MR2, 35 days; and MR3, 88 days. For MRI-positive injuries (MR1, MR2, MR3), there was a significant difference in the distributions of RTP, with increased injury severity associated with increased RTP times (P < .001). The distributions of RTP were significantly different between MR1 vs MR2 (P = .008), MR1 vs MR3 (P = .002), and MR2 vs MR3 (P = .012)., Conclusion: In elite AFL players, acute hamstring injuries with high-grade IT disruption identified on MRI were associated with increased times to RTP compared to injuries with low-grade or no IT disruption., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Eccentric strength training alters muscle architecture, but it is also an important factor for the prevention of hamstring injuries. The purpose was to determine the architectural adaptations of the biceps femoris long head (BFlh) after eccentric strength training with nordic hamstring exercise (NHE), followed by a subsequent detraining period. The participants in this intervention (n=23) completed a period of 13 weeks consisting of a first week of control and prior training, followed by 8 weeks of eccentric strength training with NHE, and concluding with a 4-week period of detraining. The architectural characteristics of the BFlh were measured at rest using two-dimensional ultrasound before (M1-week 1) and after (M2-week 9) the eccentric strength training, and at the end of the detraining period (M3-week 13). The muscle fascicle length significantly increased (t=-7.73, d=2.28, P<.001) in M2 compared to M1, as well as the muscle thickness (t=-5.23, d=1.54, P<.001), while the pennation angle presented a significant decrease (t=7.81, d=2.3, P<.001). The muscle fascicle length decreased significantly (t=6.07, d=1.79, P<.001) in M3 compared to M2, while the pennation angle showed a significant increase (t=-4.63, d=1.36, P<.001). The results provide evidence that NHE may cause alterations in the architectural conditions of the BFlh and may have practical implications for injury prevention and rehabilitation programs., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Excellence in either sprinting or endurance running requires specific musculo-skeletal characteristics of the legs. This study aims to investigate the morphology of the leg of sprinters and endurance runners of Caucasian ethnicity. Eight male sprinters and 11 male endurance runners volunteered to participate in this cross-sectional study. They underwent magnetic resonance imaging and after data collection, digital reconstruction was done to calculate muscle volumes and bone lengths. Sprinters have a higher total upper leg volume compared to endurance runners (7340 vs 6265 cm 3 ). Specifically, the rectus femoris, vastus lateralis, and hamstrings showed significantly higher muscle volumes in the sprint group. For the lower leg, only a higher muscle volume was found in the gastrocnemius lateralis for the sprinters. No differences were found in muscle volume distribution, center of mass in the different muscles, or relative bone lengths. There was a significant positive correlation between ratio hamstrings/quadriceps volume and best running performance in the sprint group. Sprinters and endurance runners of Caucasian ethnicity showed the greatest distinctions in muscle volumes, rather than in muscle distributions or skeletal measures. Sprinters show higher volumes in mainly the proximal and lateral leg muscles than endurance runners., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The purpose of this study was to examine whether the effects of hamstring stretching on the passive stiffness of each of the long head of the biceps femoris (BFl), semitendinosus (ST), and semimembranosus (SM) vary between passive knee extension and hip flexion stretching maneuvers. In 12 male subjects, before and after five sets of 90 s static stretching, passive lengthening measurements where knee or hip joint was passively rotated to the maximal range of motion (ROM) were performed. During the passive lengthening, shear modulus of each muscle was measured by ultrasound shear wave elastography. Both stretching maneuvers significantly increased maximal ROM and decreased passive torque at a given joint angle. Passive knee extension stretching maneuver significantly reduced shear modulus at a given knee joint angle in all of BFl, ST, and SM. In contrast, the stretching effect by passive hip flexion maneuver was significant only in ST and SM. The present findings indicate that the effects of hamstring stretching on individual passive muscles' stiffness vary between passive knee extension and hip flexion stretching maneuvers. In terms of reducing the muscle stiffness of BFl, stretching of the hamstring should be performed by passive knee extension rather than hip flexion., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The proximal musculo-tendinous junction (MTJ) is a common site of hamstring strain injury but the anatomy of this region is not well defined. A morphometric analysis of the proximal MTJs of biceps femoris long head (BFlh), semitendinosus (ST), and semimembranosus (SM) was undertaken from dissection of 10 thighs from five male cadavers and magnetic resonance imaging of 20 thighs of 10 active young men. The length, volume, and cross-sectional area of the proximal tendon, MTJ and muscle belly, and muscle-tendon interface area were calculated. In both groups, MTJs were reconstructed three-dimensionally. The proximal tendons and MTJs were expansive, particularly within SM and BFlh. Morphology varied between muscles although length measurements within individual muscles were similar in cadavers and young men. Semimembranosus had the longest proximal tendon (cadavers: mean 33.6 ± 2.0 cm; young men: mean 31.7 ± 1.6 cm) and MTJ (>20 cm in both groups) and the greatest muscle-tendon interface area, followed by BFlh and ST. Mean muscle belly volumes were more than three times greater in young men than elderly male cadavers (P < 0.001). These unique morphometric data contribute to a better understanding of hamstring anatomy, an important factor in the pathogenesis of hamstring strain injury., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study aimed to determine: (a) the spatial patterns of hamstring activation during the Nordic hamstring exercise (NHE); (b) whether previously injured hamstrings display activation deficits during the NHE; and (c) whether previously injured hamstrings exhibit altered cross-sectional area (CSA). Ten healthy, recreationally active men with a history of unilateral hamstring strain injury underwent functional magnetic resonance imaging of their thighs before and after six sets of 10 repetitions of the NHE. Transverse (T2) relaxation times of all hamstring muscles [biceps femoris long head (BFlh); biceps femoris short head (BFsh); semitendinosus (ST); semimembranosus (SM)] were measured at rest and immediately after the NHE and CSA was measured at rest. For the uninjured limb, the ST's percentage increase in T2 with exercise was 16.8%, 15.8%, and 20.2% greater than the increases exhibited by the BFlh, BFsh, and SM, respectively (P < 0.002 for all). Previously injured hamstring muscles (n = 10) displayed significantly smaller increases in T2 post-exercise than the homonymous muscles in the uninjured contralateral limb (mean difference -7.2%, P = 0.001). No muscles displayed significant between-limb differences in CSA. During the NHE, the ST is preferentially activated and previously injured hamstring muscles display chronic activation deficits compared with uninjured contralateral muscles., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)