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Weaver’s bottom, popularly known as ischial bursitis, is a highly unusual entity affecting adults and older populations. Ischial bursitis is an inflammation of the ischial bursa and fluid collection and associated changes in the hamstring muscle complex (HMC). The ischial bursa lies near the

Chen, CH, Chiu, CH, Tseng, WC, Wu, CY, Su, HH, Chang, CK, and Ye, X. Acute effects of combining dynamic stretching and vibration foam rolling warm-up on lower-limb muscle performance and functions in female handball players. J Strength Cond Res XX(X): 000-000, 2021-The purpose of this study was to compare the acute effects of 3 warm-up protocols on knee flexor and extensor muscles performance in elite female collegiate handball players. Ten female handball players with poor hamstring flexibility completed 3 randomly sequenced experimental visits. During each visit, a different warm-up protocol (general running warm-up [GW], dynamic stretching [DS], or DS combined with vibration foam rolling [DS + VR]) was delivered before the subsequent tests: quadriceps and hamstring muscle stiffness, knee extension and flexion range of motion (ROM), knee joint position sense, knee extension and flexion isokinetic strength with hamstring-quadriceps strength ratio, and muscle endurance during fatiguing exercise. Relative to the GW, the DS + VR protocol resulted in significantly greater knee flexion ROM (mean ± SD: DS + VR = 79.4° ± 7.7°; GW = 69.3° ± 9.6°) and lower hamstring muscle stiffness (DS + VR = 253.33 ± 36.20 N·m-1; GW = 292.89 ± 24.28 N·m-1). In addition, the DS + VR protocol also yielded greater hamstring muscle endurance than the other 2 protocols did (fatigue percentage: DS + VR = 30.24% ± 10.84%; GW = 41.40% ± 8.98%; DS = 42.22% ± 9.42%). Therefore, the results of this experiment suggest that it can be more beneficial for the female handball players to warm-up with the DS + VR, rather than the GW and DS protocols.

Purpose Proximal hamstring tendinopathy (PHT) presents as localised lower buttock pain with tasks such as squatting and sitting. It is a condition that occurs at all ages and levels of sporting participation and can cause disability with sport, work, and activities of daily living. This paper details a pilot trial protocol for investigating the effectiveness of individualised physiotherapy compared to extracorporeal shockwave therapy (ESWT) on pain and strength in people with PHT. Methods The study is an assessor-blinded, pilot randomised controlled trial (RCT). One hundred participants with PHT will be recruited from the local community and sporting clubs. Participants will be randomised to receive six sessions of either individualised physiotherapy or ESWT, with both groups also receiving standardised education and advice. Primary outcomes will be global rating of change on a 7-point Likert scale, and the Victorian Institute of Sport—Hamstring (VISA-H) scale, measured at 0, 4, 12, 26 and 52 weeks. Secondary outcomes will include sitting tolerance, the modified Physical Activity Level Scale, eccentric hamstring strength, modified Tampa scale for kinesiophobia, the Örebro Musculoskeletal Pain Screening Questionnaire Short Form (ÖMPSQ-SF), Numerical Pain Rating Scale (NPRS) for average and worst pain, participant adherence, the Pain Catastrophizing scale, satisfaction scores, and quality of life. Data will be analysed on an intention to treat basis, with between-group effects estimated using linear mixed models for continuous data and Mann Whitney U tests for ordinal data. Conclusions This pilot RCT will compare individualised physiotherapy versus ESWT for PHT. The trial will determine feasibility and estimated treatment effects to inform a definitive trial in the future. Trial registration The trial has been prospectively registered with the Australia & New Zealand Clinical Trials Registry (ACTRN12621000846820), registered 1 July 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373085

BACKGROUND: The cranio-cervical flexion exercise and sub-occipital muscle inhibition technique have been used to improve a forward head posture among neck pain patients with straight leg raise (SLR) limitation. However, little is known about the cranio-vertebral angle (CVA) and cervical spine range of motion (CROM) after applying stretching methods to the hamstring muscle. OBJECTIVE: To compare the immediate effects of static stretching and proprioceptive neuromuscular facilitation stretching on SLR, CVA, and CROM in neck pain patients with hamstring tightness. METHODS: 64 subjects were randomly allocated to the static stretching (n1= 32) or proprioceptive neuromuscular facilitation (n2= 32) stretching group. The SLR test was performed to measure the hamstring muscle’s flexibility and tightness between the two groups, with CROM and CVA also being measured. The paired t-test was used to compare all the variables within each group before and after the intervention. The independent t-test was used to compare the two groups before and after the stretching exercise. RESULTS: There were no between-group effects for any outcome variables (P> 0.05). However, all SLR, CVA, and CROM outcome variables were significantly improved within-group (P< 0.05). CONCLUSIONS: There were no between-group effects for any outcome variable; however, SLR, CVA, and CROM significantly improved within-group after the one-session intervention in neck pain patients with hamstring tightness.

To review the quality of reporting and identify the content of exercise interventions prescribed for hamstring strain injury (HSI) rehabilitation in the scientific literature from 2010 to 2020.Scoping review.We searched the bibliometric databases Web of Science, CINAHL, SPORTDiscus, Scopus, Cochrane Library, MEDLINE, and Embase.Original research articles (randomized controlled trials and cohort studies) published from 2010 to 2020 that described an exercise rehabilitation intervention for participants with acute HSIs were included. Injuries must have been confirmed within 7 days of occurrence via clinical assessment and/or diagnostic imaging.The quality of reporting, in terms of completeness of exercise intervention description, was evaluated using the Consensus on Exercise Reporting Template (CERT), and the content of interventions was categorized into exercise types.Fourteen studies were included; exercise intervention quality of reporting was moderate in 3 studies and low in 11 studies. Using the 19-item CERT, an average of 8.8 items (range, 4-14) were reported across all studies. Two studies reported sufficient exercise content and progression information to allow replication. Exercises categorized as hamstring flexibility, hamstring strength, running related, and non-hamstring specific were prescribed in 13, 11, 10, and 10 studies, respectively. Half of the included studies incorporated all 4 exercise types in their exercise interventions.There is a wide variety of exercise interventions applied in published research that has addressed HSI rehabilitation. Researchers must improve reporting quality to support other professionals in replicating exercise interventions and help practitioners to effectively implement research in practice.

Background Limited flexibility of the lower extremities, such as hamstring tightness, has long been suggested as a physical risk factor for low back pain among adolescent athletes. However, few prospective cohort studies have examined the direction of causality for this relationship. This prospective cohort study investigated the relationship between limited flexibility of the lower extremities and the occurrence of low back pain among high school baseball players. Methods Participants comprised 335 high school baseball players from 43 high school baseball teams who had undergone baseline medical evaluations (a self-completed questionnaire and physical examination). Occurrence of low back pain during a 1-year follow up, and associations with measurements of flexibility of the lower extremities such as straight-leg-raising angle (hamstring tightness), Thomas test (iliopsoas tightness), heel-buttock-distance (quadriceps tightness), and passive range of motion of the hip were investigated. Results In total, 296 players (88.4%) participated in the 1-year follow-up survey, with 147 of the 296 players (49.7%) reporting the occurrence of low back pain during follow-up. The number of players with low back pain during follow-up peaked in November, then decreased and was lowest in June. After adjusting for factors associated with low back pain using logistic regression modeling, a significant association between hamstring tightness on the non-throwing arm side and low back pain (odds ratio 2.86, 95% confidence interval 1.17–6.94; P = 0.018) was found. Conclusions Hamstring tightness on the non-throwing arm side was identified as a potential risk factor for low back pain in high school baseball players. These results may provide guidance in the development of future prevention programs.

Background Increased knee flexion at initial contact and in stance is a common problem for children with cerebral palsy. Surgical correction with percutaneous hamstring lengthening is an alternative to open hamstring lengthening; however, outcomes are less well documented, and there is concern about increasing anterior pelvic tilt. The purpose of this study was to evaluate the short-term outcomes of percutaneous hamstring lengthenings in children with cerebral palsy using comprehensive gait analysis techniques. Research Question Does percutaneous hamstring lengthening improve knee function, and do knee and anterior pelvic tilt outcomes vary by GMFCS level? Methods A convenience sample of 52 patients with both pre and post-surgical gait analyses was evaluated retrospectively for changes in gait function in terms of temporal-spatial parameters, kinematics and kinetics. Patients were divided into two GMFCS subgroups: GMFCS level I/II and III. Results The percutaneous hamstring lengthening results in statistically significant improvements in knee function during gait with increased knee extension at initial contact (mean 32° SD 13° to mean 21° SD 11°, p = 0.000) and improved mean knee flexion in stance (mean 23° SD 12° to mean 16° SD 11°, p = 0.000) for the total study cohort. Beneficial changes were found for knee function in both GMFCS level subgroups; however, there was an increase in pelvic tilt pre to post-surgery in the GMFCS level III subgroup (mean 21° SD 8° to mean 26° SD 6°, p = 0.012) but not the GMFCS level I/II subgroup (mean 18° SD 7° to mean 20° SD 8°, p = 0.427). Significance Percutaneous hamstring lengthening can improve knee function for all patients; however, the impact on anterior pelvic tilt varies by GMFCS level, with increasing anterior tilt for GMFCS level III only. This study highlights the importance of understanding differences in surgical outcomes by GMFCS level to better predict post-surgical function.

Context: Eccentric knee flexor strength assessments have a key role in both prevention and rehabilitation of hamstring strain injuries. Objective: To verify the reliability of a clinical test for measuring eccentric knee flexor strength during the Nordic hamstring exercise using a commercially available handheld dynamometer. Design: Reliability study. Setting: Physical Therapy Laboratory, Federal University of Health Sciences of Porto Alegre (Brazil). Participants: Fifty male amateur athletes (soccer or rugby players; 24 [3] y). Main Outcome Measures: Eccentric knee flexor strength. Results: When compared with a load cell–based device, the clinical test using a handheld dynamometer provided smaller force values (P P > .05) with only small effect sizes (.20–.27), moderate to good correlation (.67–.76), typical error of 23 to 24 N, and coefficient of variation of 9% to 10%. Conclusion: The clinical test with handheld dynamometer proposed by this study can be considered an affordable and relatively reliable tool for eccentric knee flexor strength assessment in the clinical setting, but results should not be directly compared with those provided by load cell–based devices.

Background Fatigue is a predisposing risk factor for injury commonly investigated in elite football populations. Little evidence advocates the most beneficial recovery strategies including contemporary cooling applications. The aim of the study was to examine immediate effects of the Game Ready® on physiological and biomechanical measures in a population of elite male academy footballers, following a fatiguing training session mid-competitive season. Methods Twenty, elite male footballers took part (180.2±8.7cm, 75.0±11.4kg, 18±0.5years). Following a normal fatiguing training session, players were randomly assigned to receive either cryotherapy (Game Ready®) (20-minutes at medium compression (5-55 mm Hg)) or passive recovery (PAS). Data was collected at match-day+1, immediately post-training and immediately post-intervention. Performance measures included countermovement jump (CMJ), isometric adductor strength (IAS), hamstring flexibility (HF), and skin surface temperature (Tsk). Results Significant main effects for group for CMJ data following exposure to cooling were displayed (p= 0.05). Tsk reduced significantly (p=

Background: Eccentric exercise increases muscle fascicle lengths; however, the mechanisms behind this adaptation are still unknown. This study aimed to determine whether biceps femoris long head (BFlh) fascicle length increases in response to 3 weeks of eccentric exercise training are the result of an in-series addition of sarcomeres within the muscle fibers. Methods: Ten recreationally active participants (age = 27 ± 3 years; mass = 70 ± 14 kg; height = 174 ± 9 cm; mean ± SD) completed 3 weeks of Nordic hamstring exercise (NHE) training on a custom exercise device that was instrumented with load cells. We collected in vivo sarcomere and muscle fascicle images of the BFlh in 2 regions (central and distal) by using microendoscopy and 3 dimension ultrasonography. We then estimated sarcomere length, sarcomere number, and fascicle length before and after the training intervention. Results: Eccentric knee flexion strength increased after the training (15%; p < 0.001; ηp2 = 0.75). Further, we found a significant increase in fascicle length (21%; p < 0.001; ηp2 = 0.81) and sarcomere length (17%; p < 0.001; ηp2 = 0.90) in the distal but not in the central portion of the muscle. The estimated number of sarcomeres in series did not change in either region. Conclusion: Fascicle length adaptations appear to be heterogeneous in the BFlh in response to 3 weeks of NHE training. An increase in sarcomere length, rather than the addition of sarcomeres in series, appears to underlie increases in fascicle length in the distal region of the BFlh. The mechanism driving regional increases in fascicle and sarcomere length remains unknown, but we speculate that it may be driven by regional changes in the passive tension of muscle or connective tissue adaptations.

To examine differences in knee strength outcomes after ACL reconstruction according to quadriceps tendon (QT) or hamstring tendon (HT) autograft in adolescents.Retrospective cohort.Surgical and clinical outcome data were collected. Analyses were conducted separately for female and male cohorts and grouped by graft type (HT or QT). A Mann-Whitney U test of independent samples was used to examine group differences according to graft type.107 females (age = 15.6 ± 1.5 years) and 94 males (age = 15.7 ± 1.5 years) were included. Mean time since surgery ranged from 7.2 to 7.9 months. Those with a QT autograft had decreased normalized isokinetic quadriceps peak torque on the involved limb compared to the HT group (p 0.01, ES = 0.71-0.89). Normalized isometric hamstring peak torque was decreased for those with HT autograft in the female cohort (p = 0.02, ES = 0.57).Normalized isokinetic quadriceps peak torque was reduced by 18-20% on the involved limb in those with a QT autograft. Normalized isometric hamstring peak torque was decreased by 13% for those with HT autograft in the female cohort. Method of strength testing may be an important consideration to fully appreciate strength deficits after ACL reconstruction according to graft type.

ObjectivesTo investigate the proportion of patients that pass a return to sport (RTS) test battery and assess changes in patient-reported outcomes and lower extremity muscle strength following three months of exericse-based rehabilitation in non-surgically treated patients with anterior cruciate ligament (ACL) injury.DesignProspective cohort study.SettingClinical environment (public municipal).ParticipantsThirty-nine ACL injured patients (54% female, median age (IQR) 28 years (24–35).Main outcome measuresThe Knee Injury and Osteoarthritis Outcome Score, Knee Outcome Survey Activities of Daily Living Scale, single hop for distance, crossover hop for distance, side hop test, the Agility T-test, and quadriceps and hamstrings isometric maximal voluntary contraction (MVC).ResultsFollowing 3 months of rehabilitation, patients had statistically significant improvements in all patients-reported outcomes and in quadriceps and hamstring MVC. Of 28 patients who completed all RTS tests, 11% passed six RTS criteria, 14% five criteria, 11% four criteria, 4% three criteria, 18% two criteria, 21% one criterion, and 21% none of the criteria.ConclusionsThe results suggest that three months of public municipal rehabilitation improves patient-reported outcomes and lower extremity muscle strength in non-surgically treated patients with ACL injury. However, only one in every 10 patients passed all RTS criteria.

BACKGROUND: Robotic exoskeleton (RE) enables individuals with lower extremity weakness or paralysis to stand and walk in a stereotypical pattern. OBJECTIVE: Examine whether people with chronic incomplete spinal cord injury (SCI) demonstrate a more typical gait pattern when walking overground in a RE than when walking without. METHODS: Motion analysis system synchronized with a surface electromyographic (EMG) was used to obtain temporospatial gait parameters, lower extremity kinematics, and muscle activity in ambulatory individuals with SCI and healthy adults. RESULTS: Temporospatial parameters and kinematics for participants with SCI (n = 12; age 41.4±12.5 years) with and without RE were significantly different than a typical gait (healthy adults: n = 15; age 26.2±8.3 years). EMG amplitudes during the stance phase of a typical gait were similar to those with SCI with and without RE, except the right rectus femoris (p = 0.005) and left gluteus medius (p = 0.014) when participants with SCI walked with RE. EMG amplitudes of participants with SCI during the swing phase were significantly greater compared to those of a typical gait, except for left medial hamstring with (p = 0.025) and without (p = 0.196) RE. CONCLUSIONS: First-time walking in a RE does not appear to produce a typical gait pattern in people with incomplete SCI.

Displaced bony avulsion of the hamstring origin is a rare condition that necessitates surgical treatment. This article describes the surgical treatment of acute apophyseal separation of the ischial tuberosity via open reduction and internal fixation with cortical screws., Technique Video Video 1 Technique of open reduction and internal fixation of bony avulsion of ischial tuberosity. Patient preparation may be considered the most important step of the operation. Under spinal anesthesia, the patient lies prone; the hip joint is in neutral position, and the knee is flexed. In this manner, traction forces on the fragment will be at a minimum, allowing an easier reduction. The orientation of the ischial tuberosity should be remembered for the future placement of the fixation material. The skin is marked to delineate the gluteal fold. One should note that it is usually more horizontal compared with the limit of the underwear. Use of a leg holder with a lateral extension permits the surgeon to keep the hip in an abducted position during sciatic nerve dissection and screw placement. Before draping, the placement of the patient on the table is verified with an image intensifier. After the skin incision, subcutaneous dissection is performed until the inferior border of the gluteus maximus muscle is reached. The muscle is elevated with blunt dissection, the ischial tuberosity is palpated, and a curved retractor is placed superior to the ischial tuberosity. Before deep dissection, the lower extremity is abducted to avoid nerve damage. The fragment is mobilized beginning from the medial side. Dissection of the lateral side is carried out longitudinally, with care, to the nerve fibers. As the fragment becomes more mobile, the bony fragment is handled with a sharp forceps to gain control of it. The interval between the sciatic nerve and the avulsed proximal hamstring origin may be dissected bluntly with a finger until all of the adhesions between the nerve and the fragment are removed. The ischium is cleaned of fibrotic tissues. A Hohmann retractor is placed on the ischial ramus and replaced by a glenoid retractor, which is more stable. This will provide a wider area of sight. The avulsed fragment is debrided to achieve good bone contact. When the fragment is well mobilized, the quality of reduction is checked. A Hohmann retractor is placed lateral to the ischial tuberosity to protect the sciatic nerve from the wires. One must pay attention to align the inferior border of the fragment with the ischium. Usually, it is needed to be fixed more proximally than it is presumed to be. Two provisional K-wires are applied. The quality of reduction is checked with the image intensifier. The orientation of the K-wires may be used to guide screw placement. The proximal screw is measured and inserted after drilling with a 3.5-mm drill bit. Screw tensioning must be performed gently and sequentially, preferably with 2 fingers, to avoid breakage of the fragment. The same procedure is repeated for the second screw, and the fixation is controlled with the image intensifier.

Background Anterior Cruciate Ligament (ACL) injuries have grown in adolescent population in the last decades, and if surgical reconstruction resulted safe in the short term, its impact in the long term is still unclear. The purpose of this study was to assess the long-term risk of failure, the rate of contralateral injury and the clinical reported outcomes in a cohort of high-school athletes after ACL reconstruction. Methods 54 consecutive patients (mean age 16.3 ± 1.4 years) underwent ACL reconstruction with a single-bundle plus lateral plasty hamstring technique between May 2006 and July 2009. The number of subsequent ipsilateral reoperations and contralateral ACL reconstruction, Lhysolm, KOOS, VAS for pain and Tegner Activity Level was determined at a minimum follow-up of 10 years. Results Ipsilateral ACL revision was performed in 8 (3.4%) patients, contralateral ACL reconstruction in 11 (21.1%). The average Lysholm score was 95.1 ± 9.2. The average KOOS was 96.5 ± 6.3 for the Pain subscale, 92.2 ± 9.0 for the Symptom subscale, 99.2 ± 1.8 for the ADL subscale, 94.1 ± 10.1 for the Sport subscale and 91.8 ± 14.5 for the Quality-of-life subscale. The average VAS for pain during activity was 1.7 ± 2.3. 90% returned to sport, 15% decreased the activity level, 61% of patients were still involved in sport, 35% at the same pre-injury level. Conclusion At long-term, single-bundle hamstring ACL-R plus lateral-plasty in a cohort of high school athletes resulted to have a comparable graft failure rate and contralateral ACL injury with other surgical techniques.

Background. Chronic nonspecific low back pain (LBP) is one of the common health issues. Hamstring tightness contributes to the development of LBP. This study aimed to investigate the acute and short-term effects of deep dry needling (DN) in patients with chronic nonspecific LBP and hamstring muscle tightness. Methods. A single-group pretest-posttest clinical study design was followed. The outcome measures were the visual analog scale (VAS), passive knee extension (PKE) test, finger-floor distance (FFD) test, and functional rating index (FRI). Patients underwent one session of deep DN of three points on both hamstring muscles, each point for one minute. Patients were assessed before (T0), immediately after (T1), and one week after DN (T2). The FRI was assessed at T0 and T2. Results. Ten women with a mean age of 21.1 years (SD = 1.6) participated in the study. Significant large effect sizes in VAS pain reduction (d = 1.25) and PKE hamstring tightness were obtained (hamstring: right, d = 0.82; left, d = 0.88) at T2. Medium effect sizes were obtained for FFD (d = 0.45) and FRI (d = 0.72) at T2. Conclusion. A single session of deep DN improved pain and function and increased hamstring flexibility. This pilot study supports the use of DN in patients with LBP and hamstring tightness; however, future research with a rigorous study design of randomized controlled trial is required to confirm the findings. This trial is registered with IRCT20180511039612N1.

Introduction: A normal flexibility is required for an appropriate posture and entire activity in daily life. Hamstring is the muscle that is more prone for tightness. It present in all age groups and it increases with age and more over it is the muscle that is most prone to injuries during sporting activities. With regard to various methods that contribute to increasing flexibility of hamstring muscles, the current study aimed at investigating immediate effects of static stretching and dynamic range of motion training on hamstring flexibility increasing muscle flexibility. Methodology: 30 patients, age range 21-50 years, diagnosed with the Population who had hamstring tightness and divided equally into two groups-Group A and Group B .In Group B-Static Stretch exercise and in Group A-Dynamic Range of Motion Training exercise. Result: Pre and post evaluation of active knee extension test was taken. Result shows that there was significant improvement noted in both the groups (GROUP A: P value .000, t value:-17.9) and (GROUP B: P value: .000, t value:-17.6) Conclusion: Both the static stretch and dynamic exercise can be considered as an effective method for increasing flexibility and improving functions with hamstring tightness patients. Key words: Hamstring flexibility, Dynamic range of motion, and static stretch.

Hamstring muscle injuries are common amongst athletes and can result in significant time away from sport. This review article evaluates and discusses the current literature on magnetic resonance imaging (MRI) vs. musculoskeletal ultrasound (US) for prevention, diagnosis, and management of hamstring muscle injuries. MRI has commonly been used for diagnosis of hamstring injuries and can offer prognostic information regarding return to play. US offers similar clinical information with some notable advantages over MRI. US is a valuable imaging modality that can be used for diagnosis and prognosis of hamstring injuries and also help guide return to play after injury.

Background: Variation in flexibility can put an unusual amount of annoyance on the framework of the musculoskeletal system. The hamstring muscles are restricted when they are short, which can interfere with everyday activities and is usually a cause for concern. The flexibility of the hamstrings increases as the suboccipital muscles' tone deteriorates,, which are is single neuronal pathway that goes through the dura mater and connects them and which is called as the superficial back line (SBL). Hence as an intervention suboccipital muscle inhibition technique and cranial cervical technique is less time and energy consuming with efficient amount of results. Aim and Objective: The aim of this study is to investigate the effect of suboccipital muscle inhibition technique verses cranial cervical technique for increasing hamstring flexibility. Methods: Here we will evaluate hamstring tightness and impact of suboccipital muscle inhibition technique verses cranial cervical technique as an intervention with duration of 2 weeks. As an outcome measure Sit and reach test is given to desired population .This study will be conducted in Ravi Nair Physiotherapy College, Sawangi, Meghe, Wardha. The duration of study will be two week. The study design is pre and post interventional study. Results: The data will be analysed using Student paired t test. Conclusion: The expected outcome includes detection of hamstring tightness and improvement in hamstring tightness using sit and reach test. Data analysis will be done using students paired t test and conclusion of the study will be published after the results are analysed.

PURPOSE National registry data have established Knee injury and Osteoarthritis Outcome Score (KOOS) functional recovery target values for adults after anterior cruciate ligament (ACL) reconstruction. However, the specificity of these target values for young athletes after ACL reconstruction is unclear. The purpose of this analysis was to (1) derive age- and activity-relevant KOOS functional recovery target values from uninjured young athlete data and (2) determine clinical measures at the time of RTS clearance associated with meeting the newly-derived functional recovery target values in young athletes following ACLR. METHODS Two hundred and twenty-two young athletes (56 uninjured controls, 17.2 ± 2.4 years, 73% female; 166 after ACL reconstruction, 16.9 ± 2.2 years, 68% female) were included in this cross-sectional analysis from a larger cohort study. Uninjured control participants completed the KOOS, and functional recovery target values were defined as the lower bound of the 95% confidence interval for KOOS subscales. ACL reconstruction participants completed testing within 4 weeks of return-to-sport clearance, including the KOOS, single-leg hop tests, and isometric quadriceps strength. In ACL reconstruction participants, logistic regression was used to determine predictors of meeting all KOOS functional recovery target values (primary outcome) among demographic/injury, hop, and strength data (α ≤ 0.05). RESULTS KOOS functional recovery target values for each subscale from uninjured athlete data were: Pain ≥ 94, Symptoms ≥ 92, Activities of Daily Living ≥ 97, Sport ≥ 92, and Quality-of-Life ≥ 92. At the time of return-to-sport clearance, ACL reconstruction participants met the KOOS functional recovery targets in the following proportions: Pain, 63%; Symptoms, 42%; Activities of Daily Living, 80%; Sport, 45%; Quality-of-Life, 24%; overall functional recovery (met all subscale targets), 17%. In ACL reconstruction participants, significant predictors of overall functional recovery (primary outcome) were: younger age, hamstring graft, pediatric ACL reconstruction, quadriceps strength limb-symmetry index > 90%, single-hop limb-symmetry index > 90%, and crossover-hop limb-symmetry index > 90%. CONCLUSIONS KOOS functional recovery target values derived from uninjured young athletes were higher than those previously reported. Small proportions of young athletes following recent RTS clearance after ACLR met these newly-derived functional recovery target values, and factors associated with meeting functional recovery target values included younger age, hamstring autograft and pediatric ACLR, and having > 90% LSI for quadriceps strength and single-leg hop tests. LEVEL OF EVIDENCE I.

OBJECTIVE To determine whether the lifetime prevalence and clinical characteristics of exercise-associated muscle cramping (EAMC) differ between runners entering a 21.1- versus 56-km road race. DESIGN Cross-sectional study. SETTING The 2012 to 2015 Two Oceans Marathon races (21.1 and 56 km), South Africa. PARTICIPANTS Participants were consenting race entrants (21.1 km = 44 458; 56 km = 26 962) who completed an online prerace medical screening questionnaire. INDEPENDENT VARIABLE A history of EAMC. MAIN OUTCOME MEASURES The main outcome variables were lifetime prevalence (%) and clinical characteristics (muscle groups affected, timing of occurrence, severity, frequency of serious EAMC, and self-reported treatment) of a history of EAMC. Differences between 56- and 21.1-km race entrants were explored (relative risk [RR]). RESULTS The lifetime prevalence of EAMC was 12.8%, which was higher in 56- (20.0%; 95% CI 19.5-20.6) versus 21.1-km race entrants (8.5%; 8.2-8.8) (P = 0.0001). In all entrants, the fourth quarter was the most common onset (46.4%), calf muscles were the most commonly affected (53.1%), and most EAMCs were of mild-to-moderate severity (95%). In 56- versus 21.1-km entrants, hamstring (RR = 1.7; 1.5-1.9) and quadriceps muscle groups (RR = 1.5; 1.3-1.7) were more frequently affected (P = 0.0001), the onset of EAMC during racing was less common in the first quarter (RR = 0.3; 0.2-0.4) (P = 0.0001), and serious EAMC was more frequent (RR = 1.6; 1.4-1.9) (P = 0.0001). CONCLUSIONS In 56- versus 21.1-km runners, a history of EAMC is 2 times more frequent and muscle groups affected, onset in a race, and severity of EAMC differed. The lifetime prevalence was lower than previously reported in other events. Risk factors associated with EAMC may differ between entrants for different race distances.

The Nordic Hamstring Exercise (NHE) improves the strength of the hamstring muscles, as well as prevents and rehabilitates the injuries of said muscles. However, the eccentric demand of NHE may influence the athlete's performance, making compliance with these programmes difficult. The aim is to analyse the acute impact on sprint performance after the passing of 24, 48, and 72 hours respectively since an NHE-based session (4 sets of 10 repetitions) had taken place. Participants were randomly divided into an experimental group (EG) (n = 12 male participants) who carried out an NHE session and a measurement of their 30 m sprint performance in each of the three subsequent days, and a control group (CG) (n = 12 male participants) who did not take part in the NHE session. The results show a significant reduction of maximum power within 24 hours (

Objective: The objectives of study are to compare Mobilization with Movement (MWM) and Mulligan knee taping (MT) on anterior knee pain, hamstring flexibility and Physical performance of lower limb. Methods: A randomized control trail was conducted from July to Dec 2019. Ethical approval from Riphah research ethical committee was taken. Total 34 participants of both genders, having Patellofemoral pain were recruited by purposive sampling technique. Randomly assignment into two groups; MWM and MT was done. Both groups were treated for 2 days per 2 consecutive weeks. Outcomes measures were Numeric pain rating scale(NPRS), Kujala pain rating scale, Active knee extension test(AKE) and Time up and go test(TUG). Assessment were taken at baseline, 2nd and 6th weeks after treatment. Data analysis was done through SPSS-21 version. Results: Between group analysis has shown statistically significant improvement (p< 0.000) in NPRS and Kujala score in MWM group whereas hamstring flexibility is significant in (p< 0.000) MT group. Within group analysis has shown a statistically significant differences (p< 0.000) for all outcome variable in both groups. Conclusion: It is concluded that Mulligan’s MWM is more effective in treatment of patellofemoral pain and associated knee functional performance. Clinical Trial Number: This clinical trail is prospectively registered at www.ClinicalTrails.gov(NCT04173468) Keywords: Anterior knee Pain. Patellofemoral pain Syndrome, Mobilizations with Movement, Mulligan knee taping, Kujala pain rating scale, Active knee extension test, Continuous....

Background and Objective: Preoperative information of hamstring graft size for anterior cruciate ligament reconstruction (ACL) is critical for making optimal graft selections. The aim of the present study was to view whether anthropometric parameters including height, weight, BMI and thigh circumference have any bearing on the size of hamstring tendon grafts used in anterior cruciate ligament replacement. Methods: Pre-operative anthropometric measurements were taken on 72 patients undergoing primary ACL reconstruction, including age, gender, height, weight, BMI, and thigh circumference. The Person correlation coefficient was used to assess the correlation of these anthropometric variables and simple logistic regression was used to evaluate the correlation of these anthropometric variables on the size of the graft that was acquired. Results: Gracilis tendon [GT] length correlates with height (r 1/4 0,432), and semitendinosus [ST] length correlates with thigh circumference (r 1/4 0,255). Women's graft diameter (7.16 ± 0.82 mm) smaller than that of men (7.39 ± 0.63 mm) (p > 0.05), although not statistically significant. The diameter of the autograft was shown to be strongly linked with parameters. Conclusion: As a consequence, our findings suggest that anthropometric measures can be used in the preoperative planning and prediction of hamstring graft length and diameter in anterior cruciate ligament reconstruction.

Cortical mechanisms may contribute to weakness in participants with previous hamstring strain injury. This study aims to examine intra-cortical inhibition (SICI) and corticospinal excitability in previously injured participants. In this cross-sectional study, TMS was used to examine SICI, silent period, silent period: MEP ratios and area under the stimulus response curve in the biceps femoris and medial hamstrings. Comparisons were made between participants with (n = 10) and without (n = 10) previous hamstring strain injury. Motor threshold and isometric knee flexor strength were also compared between participants and the relationship between strength and SICI in control and previously injured participants was examined. Isometric knee flexor strength was lower in previously injured limbs compared with control limbs (mean difference = − 41 Nm (− 26%) [95% CI = − 80 to − 2 Nm], p = 0.04, Cohen’s d = − 1.27) and contralateral uninjured limbs (mean difference = − 23 Nm (− 17%), [95% CI = − 40 to − 6 Nm], p = 0.01, Cohen’s d = − 0.57). Previously injured limbs exhibited smaller responses to paired pulse stimulation (i.e. greater levels of SICI) in the biceps femoris compared with control limbs (mean difference = − 19%, [95% CI = − 34 to − 5%], p = 0.007, Cohen’s d = − 1.33). Isometric knee flexor strength was associated with the level of SICI recorded in the biceps femoris in previously injured participants (coefficient = 23 Nm [95% CI = 7–40 Nm], adjusted R2 = 0.31, p = 0.01). There were no differences in markers of corticospinal excitability between previously injured and control limbs (all p > 0.24, all Cohen’s d

Purpose The use of allografts in primary anterior cruciate ligament reconstruction (ACLR) is increasing although they are still supposed to be associated to greater risk of re-rupture due to a slower and less efficient graft maturation. The aim of this prospective randomized controlled study was to compare the graft maturation after ACLR with allograft and autograft by MRI at 6- and 12-month follow-up and integrate these data with the functional and clinical results observed at 6-, 12- and 60-month follow-up. Methods Fifty patients with indication to primary ACLR were randomly and equally divided into hamstring autograft or allograft tendon groups. The graft maturation was measured at 6- and 12-month follow-up by the SNQ score and other radiological parameters on MRI scans. Clinical and functional recovery was evaluated by Lysholm score, Visual Analogues Scale, Tegner activity scale and modified Cincinnati knee rating system at 6, 12 and 60 months after surgery to estimate the predictive value of the radiological parameters for clinical outcomes. Return-to-sport (ACL-RSI) was measured 60 months after surgery. Results Three patients had retear of the neo-ligament (two from Auto group and one from Allo group). All the clinical/functional parameters significantly improved over time, with no statistically significant difference between the groups. At 6 months, the SNQ value was significantly higher in the Auto than in the Allo group (12.9 vs 7.9, p = 0.038), but at 12 months they were comparable (9.8 vs 10.4). The 6-month SNQ values did not correlate with the clinical scores, whereas the 12-month SNQ values significantly correlated with the Cincinnati score, Lysholm score and Tegner activity scale collected at 60-month follow-up. Conclusion No clinical or functional differences have been found between the two treatment groups, supporting the suitability of using allograft in primary ACLR, when available. The results at MRI scans showed a different graft maturation trend in the two groups, with allografts being more reactive in the first 6 months. MRI together with the subjective evaluation allows to evaluate objectively the status of the neo-ligamentization process and therefore helps the surgeon to dictate the individual time for return-to-sport. Level of evidence Level I. Supplementary Information The online version contains supplementary material available at 10.1007/s00167-021-06785-4.

Summary Objective To examine if relationships between knee osteoarthritis (OA) progression with knee moments and muscle activation during gait vary between patients with non-traumatic and post-traumatic knee OA. Design This longitudinal study included participants with non-traumatic (n = 17) and post-traumatic (n = 18) knee OA; the latter group had a previous anterior cruciate ligament rupture. Motion capture cameras, force plates, and surface electromyography measured knee moments and lower extremity muscle activation during gait. Cartilage volume change were determined over 2 years using magnetic resonance imaging in four regions: medial and lateral plateau and condyle. Linear regression analysis examined relationships between cartilage change with gait metrics (moments, muscle activation), group, and their interaction. Results Measures from knee adduction and rotation moments were related to lateral condyle cartilage loss in both groups, and knee adduction moment to lateral plateau cartilage loss in the non-traumatic group only [β = −1.336, 95% confidence intervals (CI) = -2.653 to −0.019]. Generally, lower levels of stance phase muscle activation were related to greater cartilage loss. The relationship between cartilage loss in some regions with muscle activation characteristics varied between non-traumatic and post-traumatic groups including for: lateral hamstring (lateral condyle β = 0.128, 95%CI = 0.003 to 0.253; medial plateau β = 0.199, 95%CI = 0.059 to 0.339), rectus femoris (medial condyle β = −0.267, 95%CI = −0.460 to −0.073), and medial hamstrings (medial plateau; β = −0.146, 95%CI = −0.244 to −0.048). Conclusion Findings indicate that gait risk factors for OA progression may vary between patients with non-traumatic and post-traumatic knee OA. These OA subtypes should be considered in studies that investigate gait metrics as risk factors for OA progression.

Even after anterior cruciate ligament (ACL) tear, its remnant retains the vascularized synovial sheets, fibroblasts, myofibroblasts, and various mechanoreceptors within it. The aim of preserving the remnant is to retain these components during ACL reconstruction. In the recent past, there has been an increasing trend towards preserving remnants during ACL reconstruction. Although preserving remnants have physiological advantages, cyclops lesion and extension loss were among the most feared complications. Cyclops and loss of extension are due to the fallback of the remnant into the notch. Moreover, the mechanoreceptors present in the remnant are not active when the remnant is lax. These mechanoreceptors are active when the remnant is in tension. Thus, rather than merely preserving the remnant, it is essential to tension it for more physiological functions. Although there are various techniques of remnant tensioning described in the literature, these techniques require tampering of the fixation devices or an extra fixation device adding to the cost of surgery. We describe our modification of the remnant-tensioning method during anatomic ACL reconstruction. In this technique, the sutures holding the remnant are pulled out through the anatomic femoral tunnel and fixed with an interference screw along with the hamstring graft. This technique is cost-effective, reproducible, and does not require tampering with the fixation devices. Moreover, the direction of remnant pull will be the same as that of the reconstructed graft making both the graft and remnant anatomical in orientation. Suture management and visibility of the intraarticular structures during this procedure are a few downsides of this technique. The only prerequisite of this technique is a good quality remnant to hold the sutures., Technique Video Video 1 Our technique tensions the loose remnant while performing anterior cruciate ligament (ACL) reconstruction with the hamstring graft. In this video, we demonstrate anatomic single-bundle ACL reconstruction along with remnant tensioning in a 24-year-old female patient. Her diagnostic arthroscopy revealed a tear from the femoral side with good quality of remnant. A cinch knot with number 2 BioFiber tape is applied at the center of the remnant using FIRSTPASS MINI. Both tails of fiber tape are passed one by one through the substance of the remnant such that it exits from the edge of the torn end. An anatomic inside-out 8mm femoral tunnel is made through the anteromedial portal with 25 mm of socket. Two different-colored sutures are pulled through the tunnel using a beath pin, leaving loops in the far anteromedial portal. One of these suture loops is used to pull the fiber tape libs into the femoral tunnel. A tibial tunnel is made at an anatomic location. Care is taken while perforating the intraarticular cortex of the tibia. The suture loop that remained in the far anteromedial portal is pulled out through the tibial tunnel. Using this suture loop, an 8 mm hamstring graft is pulled into the femoral tunnel. The graft is tensioned from both the tibial and femoral side, a sustained pull to tape is given to tension the remnant. Aperture fixation is done with a PEEK screw on the femoral side, maintaining the pull force. After cycling the knee, tibial fixation is also performed by a PEEK interference screw.

PURPOSE To investigate the effects of corrective kinesio taping applied on patellofemoral and foot joint in addition to a progressive neuromuscular exercise program in women with Patellofemoral Pain (PFP) on knee pain and muscle strength. METHODS Thirty females (20-45 years), diagnosed with unilateral PFP were randomly divided into two groups: the exercise (n = 15) and the exercise and taping (n = 15). Both groups performed three-stage progressive neuromuscular exercises for 12 weeks as home exercises. Plantar and knee corrective taping was additionally applied to the exercise and taping group. The knee pain was measured using the Visual Analogue Scale (VAS) during stair ascending and descending. Isokinetic dynamometer was used to evaluate the isokinetic muscle strength of the hamstring and quadriceps femoris muscles. All assessments were conducted before the treatment, at the end of the 6th-week treatment, and at the end of the 12th week of the treatment. RESULTS After intervention, pain, and muscles peak torque were improved in all groups (p ˂ 0.05). The decrease in pain and the increase in quadriceps and hamstring muscle peak tork were found to be significant for both groups (p

The aim of this study was to determine the impacts of anterior cruciate ligament reconstruction (ACLR) and recent (

This study investigated time-loss injury occurrence and patterns between the first season (2020/21, S2) completed during the Covid-19 pandemic (longer pre-season following cancellation of the 2019/20 season but shorter duration) and a regular season (2018/19, S1) in French Ligue 1 and 2 professional soccer clubs. Epidemiological data were prospectively recorded in a national injury database by each club's physician. In all clubs combined, the mean number of injuries per club was 31.5 and 36.6 in S2 and S1, respectively (-13.9%). Overall match injury incidence (per 1000 hours) in all clubs combined was lower in S2 versus S1 (22.23 vs 25.96, p

Introduction: Reduced endurance of trunk muscles as well as poor hamstring flexibility have been found in subjects with backache. Few studies have explored the variations in core endurance and hamstring flexibility in non-athlete subjects with low back pain and normal individuals in Indian community at large. This study aims at comparing the core endurance and hamstring flexibility of the healthy individuals and subjects with low back pain. Method: This cross-sectional study was conducted in physiotherapy department and community of Ahmedabad. Males and females of 18-65 years with low back pain of any duration and cause were included in Group: A. Subjects with acute/severe back pain where core endurance tests would flare up the pain, diagnosed psychiatric illness, neurological conditions, rheumatic diseases were excluded. Group B had subjects with no back pain. Exclusion criteria was the same for Group: B. Core endurance was assessed with McGill’s core endurance test. Hamstring flexibility was assessed using Sit and reach test. Comparison between the two groups was done using Mann Whitney test and t-test respectively. Results: Total 101 subjects were approached for the study out of which 96 participated in the study. Statistically significant difference was found between the core endurance [U=563.5, p

Background: Hamstring injuries are a common problem for athletes, and hamstring tightness has been found to be a contributing factor to these injuries. Dry needling is a growing trend that poses the possibility of increasing flexibility through several mechanisms; however, there is currently no review on all of the studies done concerning the effectiveness of dry needling for improving hamstring flexibility. Purpose: The purpose of this systematic review was to evaluate the effectiveness of dry needling on hamstring flexibility in people with hamstring tightness. Methods: Search terms included dry needling or intramuscular stimulation, flexibility or range of motion or ROM, and hamstring. The databases searched were PubMed, MEDLINE, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL.) Results: Ten articles were found from the initial search, and three remained after the removal of duplicates and screening the articles for abstracts and full text. Patients consisted of relatively young individuals with hamstring tightness. All studies used a stretching group for the comparison while interventions consisted of dry needling alone or dry needling with a stretching program. No studies showed a significant difference between dry needling and the control; however, all studies found that flexibility increased from baseline measurements following a dry needling treatment. Discussion: The results indicate that while dry needling may not be a better option than stretching, it could be used as a means for improving hamstring flexibility. Possible factors for the effectiveness of dry needling include increased blood flow and oxygen saturation to the muscle as well as the release of myofascial trigger points. Conclusion: Dry needling was not found to be significantly better than stretching, but poses a possibility as another method for improving hamstring flexibility. KEY WORDS: Hamstrings, Athletes, Flexibility, Tightness, Dry Needling, Stretching.

Purpose To evaluate factors affecting the risk of contralateral anterior cruciate ligament reconstruction (ACLR) within 5 years of primary ACLR. Methods Primary ACLRs performed at Capio Artro Clinic, Stockholm, Sweden, during the period 2005–2014, were reviewed. The outcome of the study was the occurrence of contralateral ACLR within 5 years of primary ACLR. Univariable and multivariable logistic regression analyses were employed to identify preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre-injury Tegner activity level], intraoperative [graft type, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [limb symmetry index (LSI) for quadriceps and hamstring strength and single-leg-hop test performance at 6 months] risk factors for contralateral ACLR. Results A total of 5393 patients who underwent primary ACLR were included. The incidence of contralateral ACLR within 5 years was 4.7%. Univariable analysis revealed that age ≥ 25 years, BMI ≥ 25 kg/m2, time from injury to surgery ≥ 12 months and the presence of a cartilage injury reduced the odds, whereas female gender, pre-injury Tegner activity level ≥ 6, quadriceps and hamstring strength and a single-leg-hop test LSI of ≥ 90% increased the odds of contralateral ACLR. Multivariable analysis showed that the risk of contralateral ACLR was significantly affected only from age ≥ 25 years (OR 0.40; 95% CI 0.28–0.58; P P = 0.001) and a single-leg-hop test LSI of ≥ 90% (OR 1.56; 95% CI 1.04–2.34; P = 0.03). Conclusion Older age (≥ 25 years) and delayed primary ACLR (≥ 12 months) reduced the odds, whereas a symmetrical (LSI ≥ 90%) 6-month single-leg-hop test increased the odds of contralateral ACLR within 5 years of primary ACLR. Knowledge of the factors affecting the risk of contralateral ACLR is important when it comes to the appropriate counselling for primary ACLR. Patients should be advised regarding factors affecting the risk of contralateral ACLR. Level of evidence Level III.

OBJECTIVES: This study aimed to examine the effects of COVID-19 confinement on hamstring eccentric strength, hip adduction-abduction strength, and posterior chain flexibility in professional male soccer players. We also aimed to investigate whether muscle strength and flexibility would change when the players returned to play after COVID-19 confinement. METHODS: Thirty professional male soccer (Age; 24.9 ± 4.8 yrs, BMI; 22.7 ± 1.4 kg/m2) players participated in this study. Hamstring eccentric strength, hip abduction-adduction strength and posterior chain flexibility (PCF) were measured before (time 1) and after the home confinement period (time 2) and after return to play (time 3). Repeated measures of ANOVA was used for statistical analysis. RESULTS: PCF decreased from time 1 to time 2 (p = 0.005) but it increased from time 2 to time 3 (p = 0.03). Hamstring eccentric strength decreased from time 1 to time 2 for both dominant (p = 0.002) and non-dominant (p = 0.04) limbs and no difference was observed between time 2 and time 3 (p > 0.05). Hip abductor and adductor strength did not change between time 1 and time 2 (p > 0.05) but they increased from time 2 and time 3 in the dominant limb (p

To determine the effect of a 7-week Hatha yoga intervention on hamstrings flexibility using a digital goniometer. It was hypothesized that hamstring flexibility will increase in a young healthy adult population.Thirty-one college-aged males and females (Mage= 21 ± 2.62) years participated in 110 minutes twice per week for a 7-week progressive yoga intervention. Pre and post-test measurements were taken to determine hamstring flexibility on the right and left leg using a digital goniometer.A paired samples t-test indicated a significant difference in the pre and post-test on hamstring flexibility (p.05). Results for the right leg pre-test (t(30) = -6.64, p0.05, 95% CI (-6.14, -3.25), d = 0.77. p0.05 as well as a significant difference in the left pre and post-ROM (t(30) = -6.93, p0.05, 95% CI (-2.97, -6.79), d = 0.52, p0.05 indicated an improvement after the intervention. Average range of motion increase was 4 degrees in both legs.Hamstring flexibility can be improved with a progressive 7-week Hatha yoga session and may be used as a modality to improve flexibility and function in activities of daily living as well and athletic performance.

Whyte, EF, Heneghan, B, Feely, K, Moran, KA, and O'Connor, S. The effect of hip extension and Nordic hamstring exercise protocols on hamstring strength: A randomized controlled trial. J Strength Cond Res 35(10): 2682-2689, 2021-Lower and between-limb asymmetrical eccentric hamstring isokinetic strength may be associated with hamstring injuries, which mainly affect the biceps femoris. The 45° hip extension exercise (HEE) strengthens the hamstrings in the lengthened position where the biceps femoris experiences greatest loading during high-speed running. However, the effect of an HEE program on eccentric hamstring isokinetic strength has not been investigated or compared with the Nordic Hamstring Exercise (NHE) program. Twenty-four male, varsity, Gaelic footballers (22.4 ± 2.7 years; 182.1 ± 6.0 cm; 84.4 ± 7.9 kg) were randomly allocated to an HEE or NHE 4-week program. Isokinetic (60°·s-1) eccentric peak torque, functional hamstring-to-quadriceps ratio, and between-limb eccentric strength (absolute and percentage) asymmetries were recorded before and after intervention. Muscle soreness scores were reported after exercise using a visual analogue scale. A mixed between-within analysis of variance investigated group (HEE vs. NHE) by time (pre vs. post) interaction effects, and any main effects. An independent-samples t-test compared muscle soreness scores between the NHE and HEE groups. No interaction or group main effects were found. Main effects for time were observed on dominant and nondominant limbs for eccentric peak torque (p0.001, η2 = 0.21, p = 0.01, η2 = 0.51, respectively) and functional hamstring quadriceps ratio (p = 0.03, η2 = 0.59, p0.0001, η2 = 0.26, respectively). There were no main effects for time between-limb eccentric peak torque or percentage asymmetries (p = 0.41, η2 = 0.03, p = 0.20, η2 = 0.07, respectively), or differences in muscle soreness scores (p0.05). A 4-week HEE program increases eccentric hamstring isokinetic strength similar to a NHE program, which may be useful as part of a hamstring injury prevention program.

Background: Although the Schroth exercise is widely used in idiopathic scoliosis, the Schroth exercise with kinesiotaping is not. And, little research has examined their effectiveness. Objectives: To investigate the effect of Schroth exercise with kinesiotaping on idiopathic scoliosis. Design: A randomized controlled trial. Methods: Participants with hamstring tightness were allocated into the Schroth exercise with kinesiotaping group (SETG, n=12) and the schroth exercise group (SEG, n=11). Participants groups performed Schroth exercise with kinesiotaping or Schroth exercise according to group assignment. To identify changes in spine alignment and balance were performed at pre- and postexercise. Results: Significant changes occurred in spine alignment, balance ability (X mean, LOS forward, LOS right) after exercise in SETG (P

Background: Hamstring strain injuries are the most common injuries in team sports. Biceps femoris long head architecture is associated with the risk of hamstring injury in soccer. To assess the overall predictive ability of architectural variables, risk factors need to be applied to and validated across different cohorts. Purpose: To assess the generalizability of previously established risk factors for a hamstring strain injury (HSI), including demographics, injury history, and biceps femoris long head (BFlh) architecture to predict HSIs in a cohort of elite Australian football players. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic, injury history, and BFlh architectural data were collected from elite soccer (n = 152) and Australian football (n = 169) players at the beginning of the preseason for their respective competitions. Any prospectively occurring HSIs were reported to the research team. Optimal cut points for continuous variables used to determine an association with the HSI risk were established from previously published data in soccer and subsequently applied to the Australian football cohort to derive the relative risk (RR) for these variables. Logistic regression models were built using data from the soccer cohort and utilized to estimate the probability of an injury in the Australian football cohort. The area under the curve (AUC) and Brier score were the primary outcome measures to assess the performance of the logistic regression models. Results: A total of 27 and 30 prospective HSIs occurred in the soccer and Australian football cohorts, respectively. When using cut points derived from the soccer cohort and applying these to the Australian football cohort, only older athletes (aged ≥25.4 years; RR, 2.7 [95% CI, 1.4-5.2]) and those with a prior HSI (RR, 2.5 [95% CI, 1.3-4.8]) were at an increased risk of HSIs. Using the same approach, height, weight, fascicle length, muscle thickness, pennation angle, and relative fascicle length were not significantly associated with an increased risk of HSIs in Australian football players. The logistic regression model constructed using age and prior HSIs performed the best (AUC = 0.67; Brier score = 0.14), with the worst performing model being the one that was constructed using pennation angle (AUC = 0.53; Brier score = 0.18). Conclusion: Applying cut points derived from previously published data in soccer to a dataset from Australian football identified older age and prior HSIs, but none of the modifiable HSI risk factors, to be associated with an injury. The transference of HSI risk factor data between soccer and Australian football appears limited and suggests that cohort-specific cut points must be established.

Background: Although it has been reported that both self-myofascial release (SMR) with foam rolling (FR) and active static hamstring stretching (e.g., jackknife stretching) are effective in improving hamstring flexibility, no study has compared the effects of these exercises. Objectives: To compare the effects of SMR with FR and jack-knife stretching on hamstring flexibility. Design: A Randomized controlled trial. Methods: Subjects with hamstring tightness were divided into the SMR with the FR group (n=12) and the jack-knife stretching group (n=12). Subjects groups performed SMR with FR or jack-knife stretching according to group assignment. To identify changes in hamstring flexibility, the finger-to-floor distance (FFD) test, active knee extension (AKE) test, and passive straight leg raising (PSLR) test were performed at pre- and post-exercise. Results: Significant increases occurred in knee extension angle during the AKE test and hip flexion angle during the PSLR test after exercise in both groups (P .05). Conclusion: Both SMR with FR and jack-knife stretching are effective in improving hamstring flexibility in subjects with hamstring tightness.

Background and objectives: Shortening of hamstring has a negative impact on the posture of the pelvic region. The increase in stiffness of the hamstring may serve as a cause of low back pain and is also thought to predispose athletes to injury. The objective of this study was to compare the immediate effect of neural mobilization and myofascial release of suboccipital muscle on hamstring length in younger adults. Methodology: This was a Comparative study conducted in a tertiary care hospital. A total 40 individuals between age group of 18-25 years having reduced hamstring length were included in this study. They were randomly divided into two groups by lottery method. Group 1 received neural mobilization and group 2 received myofascial release of suboccipital muscle. Ranges were recorded post treatment. Straight Leg Raise (SLR), Sit and Reach Test (SR) and Finger to Foot Test (FFT) were used to record pre treatment ranges Results: The result revealed that hamstring length significantly improved in both the groups further between the groups comparison demonstrated that non-significant difference existed in improvement scores of SLR, where as statistically not significant but clinically significant difference was existed in improvement of FFT. Furthermore between groups comparison demonstrated that statically and clinically significant difference existed in improvement scores of sit and reach, indicating that neural mobilization was more effective in improving hamstring length then myofascial release of suboccipital muscle in improving hamstring length. Conclusion: This study concluded that both neural mobilization and myofascial release of suboccipital muscle is effective in increasing length of hamstring muscle, where as neural mobilization was better when assessed with sit and reach test. Keywords: Hamstring length, neural mobilization, myofascial release, suboccipital muscle, sit and reach test, Straight leg raise, finger to foot test.

Despite increased awareness of the multifactorial nature of Hamstring Strain Injury (HSI), the role of running biomechanics remains unclear. The aim of this systematic review was to investigate whether an association exists between running biomechanics and HSI. Five databases were searched from inception to January 2021. Eligibility criteria included epidemiological studies that provide data on running biomechanics in athletes who have sustained a HSI (retrospectively or prospectively) and compared to control data. Searches yielded 4,798 articles. Twelve met the selection criteria. Biomechanical analysis differed considerably across studies, thus meta-analyses was not possible. Studies largely found either no differences or contradicting findings between running biomechanics of athletes who have sustained a HSI (retrospectively or prospectively) and controls, with the exception of lateral trunk kinematics and horizontal propulsive forces. It is important to note some concern regarding the quality of included studies, particularly sample size, increasing the risk of bias associated with results. Further research utilising validated methods of biomechanical analysis, is needed to determine if an association exists between running biomechanics and HSI. Until then, definitive conclusions cannot be drawn as to whether specific biomechanical interventions should be included in injury prevention and/or rehabilitation programmes.

Hamstring injuries (HSI) are common in a number of different sports and can confer a significant burden to both male and female athletes. Though research on HSIs in the female athlete population is lacking, current literature suggests male athletes are between two to four times more likely than female athletes to sustain an HSI. Despite this discrepancy, the role of intrinsic sex differences in HSI risk factors has not been previously explored. This review aims to summarize these sex-based differences in HSI risk factors and their influence on the lower rate of HSIs seen in female athletes as compared to male athletes. Women exhibit increased hamstring flexibility and decreased hamstring musculotendinous stiffness as compared to men; women are also shown to be more resistant to skeletal muscle fatigue. Sex differences in the hamstring to quadriceps ratio and certain lower limb morphologies may also contribute to the sex discrepancy in HSI rates. This remains an area for future research in order to understand the multifaceted nature of HSI injury risk factors and optimize HSI rehabilitation and prevention programs for both male and female athletes.

Purpose. The Nordic hamstring exercise (NHE) has been shown to be successful in reducing hamstring muscle injury (HMI), which is one of the most common non-contact injuries of the lower limbs. This is especially pertinent in sports that require acceleration, maximal sprints, and sudden changes in the direction of running and sprinting, such as soccer and rugby. This study aimed to evaluate the awareness, implementation, and opinions of athletes worldwide regarding the effectiveness of NHE in preventing hamstring injury. Materials and methods. A self-administered questionnaire was distributed to 1500 athletes from different sports. The survey consisted of six questions covering country, gender, type of sport, awareness, implementation, and opinions of athletes worldwide regarding the effectiveness of NHE in preventing hamstring injury. The survey was available in ten different languages. Results. A total of 1142 male and female athletes from different sports participated in the survey. More than half of the athletes 641 (56%) were aware of NHE, and only 519 (45.4 %) were implementing NHE in their current training routines. Athletes who implemented NHE reported a positive opinion regarding the program’s effectiveness with a score of 8.4 ± 1 out of 10. Conclusions. Many athletes were aware of NHE and implemented it in their training routine since they found it to be effective in decreasing hamstring injury rates. However, additional work must be done to educate athletes about the importance of implementing this exercise and its effectiveness in preventing hamstring injury.

Introduction In this review paper, graft failure rates of different graft types (hamstring tendon autografts, bone–patellar tendon–bone autografts, quadriceps tendon autografts and diverse allografts) that are used for surgical reconstruction of the anterior cruciate ligament are compared and statistically analysed. Methods Literature search was conducted in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria. A total of 194 studies, which reported graft failure rates of at least one of the anterior cruciate ligament reconstruction methods mentioned above, were included in this systematic review. To be able to compare studies with different follow-up periods, a yearly graft failure rate for each reconstruction group was calculated and then investigated for significant differences by using the Kruskal–Wallis test. Results Overall, a total of 152,548 patients treated with an anterior cruciate ligament reconstruction were included in the calculations. Comparison of graft types showed that hamstring tendon autografts had a yearly graft failure rate of 1.70%, whereas the bone–patellar tendon–bone autograft group had 1.16%, the quadriceps tendon autograft group 0.72%, and the allografts 1.76%. Conclusion The findings of this meta-data study indicate that reconstructing the anterior cruciate ligament using quadriceps tendon autografts, hamstring tendon autografts, patellar tendon autografts or allografts does not show significant differences in terms of graft failure rates.

Hamstring muscle injuries are the most prevalent among athletes who engage in sprinting activities. Their most frequent location is where the long head of the biceps femoris joins with the semitendinosus muscle to form the conjoint hamstring tendon. Just distal to this area, an additional group of fibers of the semitendinosus originate from medial aspect of biceps femoris. The objective of this study was to analyze the morphological characteristics of this union and to discuss its potential role in hamstring tears. Anatomical dissection was performed on 35 thighs. Samples obtained from this region were sectioned and stained with Masson's trichrome for further histological evaluation. A group of fibers from the semitendinosus muscle originating from the long head of the biceps femoris were observed in all 35 specimens. This origin was located 67 ± 12 mm from the ischial tuberosity and was 32 ± 14 mm in length. This group of muscle fibers had a width of 10.9 ± 5.3 mm and a thickness in the anteroposterior axis of 3.2 ± 1.4 mm. Its pennation angle was 9.2 ± 1.5 degrees. Microscopic examination showed muscle cells from both muscles contacting interposed tendinous tissue. In conclusion, fibers of the semitendinosus muscle consistently arise from the proximal aspect of the long head of biceps femoris. The morphological characteristics of this junction have functional implications. The horizontal component of the semitendinosus vector could pull the long head of the biceps femoris medially during its shortening-lengthening cycle, rendering it an intrinsic risk factor for hamstring injuries.

Background Diminished gluteus maximus muscle strength has been proposed to be contributory to various lower-limb injuries. As such, it is of clinical importance to perform hip extensor strength testing in a position that biases torque contribution of the gluteus maximus relative to the other hip extensors (i.e. hamstrings). Objectives To determine the relative torque contributions of the gluteus maximus and hamstring muscles in various hip extensor strength testing positions. Methods 13 Young, healthy participants performed maximum isometric hip extension on a dynamometer in 4 different positions that varied in terms of hip and knee flexion. Surface electromyography (EMG) was used to assess activation of gluteus maximus and hamstrings during the maximum isometric contractions. Normalized EMG data were used as an input to determine individual muscle contribution to hip extension torque production using SIMM modeling software. The gluteus maximus/hamstring torque contribution ratio was compared across the 4 positions using a one-way repeated-measures ANOVA. Results The highest gluteus maximus torque contribution value occurred in positions where the hip was flexed to 45°, while the highest hamstring torque contribution occurred in positions in which the knee was fully extended. The gluteus maximus/hamstring torque contribution ratio was highest at 0° of hip extension and 90° of knee flexion. Conclusion Testing isometric hip extensor strength at 0° of hip extension and 90° of knee flexion should be considered in order to bias torque production of the gluteus maximus relative to the hamstrings.

Persistent deficits in knee flexor strength following harvest of semitendinosus and gracilis for anterior cruciate ligament reconstruction are inconsistent in the literature. Variation in methodology, including measuring torque at higher knee flexion angles may partially explain these discrepant findings. The objective of this study was to determine whether positioning (seated vs supine), consideration of peak or joint-angle-specific torque or device (Isokinetic Dynamometer vs NordBord Hamstring Dynamometer) impact the magnitude of knee flexor strength differences between limbs. Participants (n = 31, 44.2 ± 10.7 years,) who were at 14 ± 4.4 years follow-up for unilateral ACL reconstruction with semitendinosus/gracilis grafts completed the ACL Quality of Life outcome and an assessment including isokinetic concentric knee extensor and flexor strength in seated and supine with peak torque and torque at 60° (T60) and 75° (T75) knee flexion measured, followed by an eccentric Nordic Hamstring Curl. Isokinetic concentric knee flexor torque was reduced in supine relative to seated, on the reconstructed limb against the unaffected, and at higher degrees of knee flexion relative to peak torque (T60 and T75 against peak torque). Limb symmetry varied by methodology (F(6,204) = 8.506, p = 0.001) with reduced symmetry in supine T75 against all measures (71.1 ± 16.5%, p

Objectives: 1. To assess the strength of hamstring and quadriceps in patients with knee OA with 1 RM. To compare the strength of hamstring and quadriceps with normal individuals. Research Design: Observational study. Introduction: Quadriceps and hamstring muscle weakness is commonly found in knee OA which may alter normal Quadriceps/Hamstrings ratio i.e. (2:1). So the purpose of the study was to check the strength of the quadriceps and hamstring muscle in OA knee patients and compare it with normal individual. Method: 20 diagnosed knee OA patients and 21 normal individuals were recruited. Quadriceps and hamstring muscle strength was measured in both case and normal group by using 1 RM method. Q/H ratio was obtained from the muscle strength and both were compared between two groups by using T test. Materials: Quadriceps table, Metal weight plate, Plinth, Sand bag. Results & Discussion: Quadriceps and hamstring strength were reduced significantly (p=