Search

Objective: To describe 3.0-Tesla (T) magnetic resonance imaging (MRI) findings of hamstring muscles in clinically recovered athletes who were cleared for return to play (RTP)., Design: Prospective observational study., Setting: Hospital., Participants: Athletes (amateur and professional) who were cleared for RTP after hamstring injury. Fifty-eight participants were included in the analysis., Independent Variables: 3-T MRI at baseline (within 7 days from initial injury) and MRI at RTP (within 10 days of RTP)., Main Outcome Measures: Injury location, grade of injury (modified Peetrons and British Athletics Muscle Injury Classification/BAMIC), presence and the extent of intramuscular signal abnormality, intramuscular tendon disruption, and thickness. Reinjuries within 1 year of RTP were recorded., Results: Magnetic resonance images at RTP showed that 55 (95%) participants had intramuscular increased signal intensity (edema) and 44 (76%) participants had intramuscular abnormal low-signal intensity (suggesting fibrosis) on MRI. There was an overall reduction of injury grades according to the modified Peetrons and BAMIC classification at initial injury to RTP. Three (5%) participants had no abnormal signal intensities (grade 0 or grade 0A) on MRI at RTP. Intramuscular tendon disruption, waviness, and tendon thickening were present at RTP in, respectively, 22 (38%), 15 (26%), and 36 (62%). We recorded 3 (5%) reinjuries., Conclusions: At RTP, 3.0-T MRI shows high percentages of MRI abnormalities (edema, fibrosis, and intramuscular tendon disruption and thickening). We conclude that complete normalization of 3.0-T MRI is not expected for RTP decision after a hamstring injury. Its possible association with reinjury risk has to be determined in larger cohorts., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Studies identifying clinical and MRI reinjury risk factors are limited by relatively small sample sizes. This study aimed to examine the association between baseline clinical and MRI findings with the incidence of hamstring reinjuries using a large multicentre dataset., Methods: We merged data from four prospective studies (three randomised controlled trials and one ongoing prospective case series) from Qatar and the Netherlands. Inclusion criteria included patients with MRI-confirmed acute hamstring injuries (<7 days). We performed multivariable modified Poisson regression analysis to assess the association of baseline clinical and MRI data with hamstring reinjury incidence within 2 months and 12 months of follow-up., Results: 330 and 308 patients were included in 2 months (31 (9%) reinjuries) and 12 months (52 (17%) reinjuries) analyses, respectively. In the 2-month analysis, the presence of discomfort during the active knee extension test was associated with reinjury risk (adjusted risk ratio (ARR) 3.38; 95% CI 1.19 to 9.64). In the 12 months analysis, the time to return to play (RTP) (ARR 0.99; 95% CI 0.97 to 1.00), straight leg raise angle on the injured leg (ARR 0.98; 95% CI 0.96 to 1.00), the presence of discomfort during active knee extension test (ARR 2.52; 95% CI 1.10 to 5.78), the extent of oedema anteroposterior on MRI (ARR 0.74; 95% CI 0.57 to 0.96) and myotendinous junction (MTJ) involvement on MRI (ARR 3.10; 95% CI 1.39 to 6.93) were independently associated with hamstring reinjury., Conclusions: Two clinical findings (the presence of discomfort during active knee extension test, lower straight leg raise angle on the injured leg), two MRI findings (less anteroposterior oedema, MTJ involvement) and shorter time to RTP were independently associated with increased hamstring reinjury risk. These findings may assist the clinician to identify patients at increased reinjury risk following acute hamstring injury., Trial Registration Numbers: NCT01812564; NCT02104258; NL2643; NL55671.018.16., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Our previous study has developed FIVE, futsal neuromuscular warm-up program to improve physical performance components and prevent the incidence of futsal injury. Experimental research was needed to verify the effect of FIVE program on physical performance components affecting injury, such as lower limb muscle strength. This study aimed to investigate the effect of FIVE program on the lower limb muscle strength among young futsal players., Methods: Ninety-five young male futsal players were recruited using purposive random sampling from futsal clubs in Indonesia. The players were randomized into 2 groups; 42 players were in the experimental (EXP) group, and 53 players were in the control (CON) group. The EXP group performed FIVE exercises in addition to their regular futsal training, and the CON group performed their regular futsal training only. Both groups performed the intervention three times per week within 6 weeks. All players completed pre-and post-intervention lower limb muscle strength tests comprising the isometric leg strength, isometric hip abduction strength, and isometric hip adduction. The strength test was conducted using dynamometer. Changes in performance (pre- vs. post-intervention) of each group were analyzed using paired t-test and Wilcoxon Test. The pre- and post-strength test changes (Δ post-pre) between EXP and CON group was compared using independent T-test and Mann Whitney test. Statistical significance was set to P<0.05. Thirty-one players dropped out in this study., Results: This study showed all measurements on lower limb muscle strength improved significantly in the EXP group (P<0.05) while hip abduction and hip adduction strength were significantly decreased in the CON group. Improvement of isometric hip abduction and adduction strength in the EXP group was significantly different from the CON group (P=0.00 and P=0.00, respectively)., Conclusions: Results suggest that FIVE could be an alternative warm-up program to improve lower limb muscle strength among young futsal players.

Introduction: Previous studies showed that the Nordic hamstring exercise (NHE) effectively prevents primary hamstring injury. However, no study investigated the secondary preventing effect of the NHE on hamstring reinjury. The primary purpose of this study is to investigate the effectiveness of the NHE for preventing hamstring reinjury after return to play (RTP) following a hamstring injury in football players. The secondary purpose is to determine the effect of the NHE on sprint and jump performance., Methods and Analysis: This is an international multicentre, prospective, parallel-group randomised controlled trial study. Subjects include male or female football players aged 18-40 years and within 1 week of RTP following a hamstring injury will be randomised into Nordics or a control group. Subjects in both groups continue their regular football training, but the Nordics group will perform an additional NHE programme. An online questionnaire will be sent to the subjects in both groups once per week within the first 10 weeks, then continued at months 6, 9 and 12. In a (performance) substudy, we will evaluate the effect of the NHE on sprint and vertical jump performance at three time points (at the beginning of the study, after 10 weeks and 12 months of follow-up).The primary outcomes are the incidence of hamstring reinjury within 2 and 12 months. The secondary outcomes are sprint and jump performance, adherence to the programme, duration of reinjury and reinjury burden., Ethics and Dissemination: This study is approved by the medical ethics committee of Amsterdam University Medical Center (UMC) in the Netherlands (METC 2021&#95;117), Faculty of Medicine Universitas Gadjah Mada in Indonesia (KE/FK/1248/EC/2021), Norwegian School of Sport Sciences in Norway (number 216-2 70 122) and Denmark (ethical submission in process). The study's findings will be disseminated in scientific peer-reviewed journals and presented at international conferences., Trial Registration Number: NL9711., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Studies showed that FIFA 11+, the football injury prevention program, can improve physical fitness components through resistance and neuromuscular exercise. Currently, resistance training using High Intensity Circuit Training (HICT) is considered beneficial in increasing physical fitness component, including maintaining cardiopulmonary fitness. The purpose of this study was to evaluate the effect of HICT modified- FIFA 11+ training on the physical fitness components and cardiovascular (CV) training intensity of young football players., Methods: Thirty-nine football players were recruited by purposive random sampling to the football academies in Yogyakarta, Indonesia. The players were randomized into two groups; 20 players were in the experiment (EXP) group and 19 players were in the control (CON) group. The EXP group performed HICT-modified FIFA 11+ exercise and the CON group performed standard FIFA 11+. HICT modification was performed in the EXP group only in part 2 of FIFA 11+ (strength, power, and balance training) while the other parts were regular. Both groups performed the intervention 3 times per week for 4 weeks. All players completed a pre- and post-intervention physical fitness tests comprising the core strength (plank test), leg strength (leg dynamometer) and agility (Illinois test). Heart rate (HR) was monitored in both groups while exercise was being implemented to measure the CV training intensity. Changes in performance (pre- versus post-intervention) of each group were analyzed using paired t-test and Wilcoxon test. Statistical significance was set to P<0.05. Twelve players dropped out in this research., Results: This study showed that core strength increased significantly in both groups (P=0.00). The EXP group had higher CV training intensity (HR max 91%; mean HR 74%) than the CON group (HR max 90%; mean HR 66%)., Conclusions: Results suggest that HICT modified FIFA 11+ can be implemented as an alternative program to increase the physical fitness components and also CV training intensity among young football players.