Rehabilitation Procedures for Eccentric Hamstring Strength Exercise - Literature review Example

Literature Review: Rehabilitation Procedures for Eccentric hamstring strength exercise Name: Institution: Instructor: Course Code: Introduction Hamstring injuries, which are highly prevalent in sports activities such as soccer (12%), basketball (6%), rugby (15%), Australian football (16%) and American football (7.7%) (Sallay, et al, 2008), has attracted attention over the past decades from sports researchers and practitioners. These injuries which are often muscle strain or excessive muscle fibre stretch in the three hamstring muscles: biceps femoris, semimembranosus, and semitendinosus, at the back of the thighs, have been a primary concern for rehabilitation professionals. This is because they may result to debilitating injuries to an individual which may result to prolonged recovery periods, loss of functional performance or even higher probabilities of recurrences. Study has showed that recurrence of injury ranges from 12%-42% (Visser, Reijmen, Heijboer, and Bos, 2012). Research has shown that eccentric hamstring strength exercise are effective at rehabilitating and strengthening hamstring muscles hence preventing future recurrences (Arnason, et al, 2008; Granado and Dressendorfer, 2011).This paper presents a critical literature review on the rehabilitation procedures for eccentric hamstring strength exercise meant to strengthening hamstring muscles hence preventing future recurrences Overview on Hamstring injuries and Eccentric hamstring strength exercise Research shows that these muscle strains occur during rapid contraction of the muscles from eccentric to concentric. Eccentric contractions involve the lengthening of the muscle fibres where rise in speed of contraction also results to rise in force of contractions. On the other hand, concentric contractions are shortening of the muscle fibres where contractions decrease as speed increases. During such rapid contractions hamstrings are often lengthened and maximally loaded (Hibbert, et al, 2008; Schmitt, Tyler, & McHugh, 2012). There have been studies which have sought to identify factors which may predict the occurrence of hamstring strains. Various factors such as previous injury, age, low hamstring flexibility, hamstring weakness or muscle imbalance have been indentified to highly predict occurrence of hamstring injuries (Schache, 2011; Visser, Reijmen, Heijboer, and Bos, 2012). Other external factors such as inadequate warm ups or pre-trainings, and fatigue have also been linked to a higher risk of having hamstring strains (Warren, et al, 2010; O’Sullivan, Murray and Sainsbury, 2009). Of all these predictor factors, history of hamstring strain occurrence, though, is the one that is highly predictive that all the other factors (Visser, Reijmen, Heijboer, and Bos, 2012). A search through literature reveals that the best way to rehabilitate hamstring injuries and prevent recurrence of such injuries is through muscle strengthening. Such research has mainly focused on eccentric hamstring exercise which aims at increasing eccentric strength. The focus on eccentric exercise, Hibbert, et al (2008) notes is because most hamstring strains occur during eccentric contraction of the muscles where the muscles lengthen. Though research shows that eccentric exercise is effective in reducing long muscle lengths, it also may possibly result to delayed onset muscle soreness (DOMS) if not well executed (Hibbert, et al, 2008; Schmitt, Tyler, & McHugh, 2012). However, such soreness only last for a few days. Research has shown that eccentric hamstring strength exercise are effective at rehabilitating and strengthening hamstring muscles hence preventing future recurrences (Arnason, et al, 2008; Granado and Dressendorfer, 2011). Hence this research evaluates eccentric hamstring strength exercise procedures. Rehabilitation procedures for Eccentric hamstring strength exercise in hamstring injury Eccentric hamstring strength exercise is increasingly becoming an important area of interest to researchers with regard to rehabilitation of hamstring strains (Schmitt, Tyler, & McHugh, 2012; Brughelli and Cronin, 2007). Brughelli and Cronin (2007) in their research show that eccentric exercises play a crucial role in altering the length-tension tension that often impacts human movement and is also the central focus point of hamstring strains. It is only through multiple bouts of eccentric exercise that the length of tension in the muscles can be shifted to the optimal lengths in a manner that muscle contractions are more comfortable than painful and injurious. In the initial bouts of the exercise, people may often experience muscle soreness due to the nature of the exercise which basically seeks to optimize the muscle length to the tension encountered. In carrying out rehabilitation procedures for a hamstring injury, it is important that each procedure be customized according to the injury that each person has. Though no consensus has been reached among scholars on a certain protocol that may be followed in rehabilitating hamstring injuries, most authors agree that eccentric strengthening of the hamstring muscles need be included in such a rehabilitation program (Schmitt, Tyler, & McHugh, 2012; Brughelli and Cronin, 2007). Arguably, eccentric hamstring strengthening increases angle of the knee flexion which is essential in ensuring high performance in sports (Granado and Dressendorfer, 2011). However, it is essential that eccentric hamstring exercises be carried in later stages of a rehabilitation program so as to allow enough warm ups and stretching to make the hamstring flexible to such stretches (O’Sullivan, Murray, and Sainsbury, 2009). In acute hamstring injuries, the rehabilitation procedures need to focus on minimizing motion and protecting the injury as well saving strength. Therefore, key procedures would include gentle stretching , ice in lengthened sitting position with an active knee extension and flexion that is pain free, elevation and compression until the girth stabilizes, retrograde massage, and modalities such as laser and ice. At such an acute stage, pain free strengthening of the sub-maximal isometric at various angles is important in order to avoid separation of the muscle fibres and gain sufficient strength. In this procedure, the thigh girth is elevated and compressed with the foot being plantar flexed slowly while raised at 30 degrees progressively (Schmitt, Tyler, & McHugh, 2012; Ivan, 2012). This progresses to maximal hold and then stretching is done progressively across hip and knees with the stretch increasing towards full ROM. Indeed Schmitt, Tyler, and McHugh (2012) contend that this exercise need be completed as a contraction of knee flexion first at 30, then 60 and 90 degrees against the contra-lateral limb. At this point, the hamstring stretching need be pain free yet still be able to contract the strained hamstring (Brughelli, and Cronin, 2007; Sole, et al, 2012). Such exercise not only increase the strength of the lateral adhesion of hamstring muscle fibres, but also aligns them, preventing stump separation hence protecting the injured fibres (Arnason, et al, 2008).Schmitt, Tyler, and McHugh (2012) notes that the key aim of the exercise at such a point is to is to increase the strength of the knee flexion and normalize gait. With the above strengthening of the knee flexion and normalising of the gait attained, Schmitt, Tyler, and McHugh (2012) notes that eccentric strengthening is further attained through neuromuscular motion of the pelvis and hips, with each movement customised to sport specific movements. In this case, eccentric strength exercise may entail procedures such as Nordic hamstring exercise where the practitioner hold the patient’s feet as they are in a tall knee position, and while maintaining a neutral hip posture, the patient slowly falls forward until a point where descent cannot be controlled by the patient where upon he or she starts over again (Arnason, et al, 2008; Schmitt, Tyler, & McHugh, 2012). It may also include single leg windmills, straight leg dead lift or hamstring ball rolls (Schmitt, Tyler, & McHugh, 2012). In Hamstring ball rolls, the patients lay supine with a ball under their legs where while maintaining hip and trunk stability, they flex their legs to roll the ball towards their body (University of Delaware Sports and Orthopaedic Clinic, 2012). These exercises can be carried out progressively, and are meant to increase patient’s strength in hamstring muscles where the athlete is not able to experience any pain while doing their sport’s moves such as jogging back and forth. With the elimination of pain, eccentric hamstring strengthening can be completed in the end range lengthening state. In this, sports specific training as well as plyometric training is often done. The plyometric exercises are mainly aimed at regaining the neuromuscular properties while strengthening the hamstrings, such may include running knee highs, roller board hamstring pulls, leg swings and running butt kicks among others. The key focus of the exercises should focus on lengthening the hamstring. Schmitt, Tyler, and McHugh (2012) argue that in these exercises, it is imperative that while knee is extended, the hip be positioned in flexion so as to ensure that the hamstring muscles are effectively strengthened as the knee resists the motion. In a study investigating the impact of extensive stretching programs and eccentric strengthening on hamstring injuries among 30 elite soccer teams over a course of four seasons, Orchard, Marsden, Lord, and Garlick (cited in Granado and Dressendorfer, 2011) found that those teams which incorporate eccentric strengthening and in specific knee flexion contraction had lower incidences of hamstring strains than did those who only had stretching exercises. This evidence has been supported by various scholars such as Arnason et al (2008), O’Sullivan, Murray, and Sainsbury (2009), Hibbert, et al (2008) and Ivan (2012). Arnason, et al (2008) for instance found that using warm up stretching and Nordic hamstring lowers in eccentric strength exercise reduced the risk of hamstring injuries. Such evidence shows that the eccentric hamstring strengthening is important in ensuring sustainable protection from hamstring injuries. Conclusion In conclusion, it can therefore be noted that the procedures in eccentric hamstring strengthening not only work towards relieving the pain hamstring injury and strengthening of the knee flexion while normalising the gait, but also works towards ensuring that the hamstring muscles are strengthened enough to avoid future hamstring injuries. Indeed, evidence from various studies show that that eccentric hamstring strength exercise are effective at rehabilitating and strengthening hamstring muscles hence preventing future recurrences. References Arnason, A. A., Andersen, T. E., Holme, I. I., Engebretsen, L. L., & Bahr, R. R. (2008). Prevention of hamstring strains in elite soccer: an intervention study. Scandinavian Journal of Medicine & Science in Sports, 18(1): 40-48. doi:10.1111/j.1600-0838.2006.00634.x Brughelli, M. and Cronin, J. (2007). Altering the Length-Tension Relationship with Eccentric Exercise. Sports Medicine, 37(9): 807-826. Granado, M.J. and Dressendorfer, R. (2011). Hamstring Strain: Indexing Metadata/ Description. Clinical Review, October 14. Hibbert, O., Cheong, K., Grant, A., Beers, A., & Moizumi, T. (2008). A Systematic Review of the Effectiveness of Eccentric Strength Training in the Prevention of Hamstring Muscle Strains in Otherwise Healthy Individuals. North American Journal of Sports Physical Therapy, 3(2):.67-81. Ivan Z. (2012). Anatomy, physiology and biomechanics of hamstrings injury in football and effective strength and flexibility exercises for its prevention. Journal of Human Sport Exercise, 7(1):208-217 O’Sullivan, K., Murray, E., and Sainsbury, D. (2009). The Effect of Warm up, Static Stretching and dynamic Stretching on Hamstring Flexibility in Previously Injured Subjects. BMC Musculoskeletal Disorders, 10:37 doi: 10.1186/1471-2474-10-37. Sallay, P.I., Ballard, G., Hamersly, S. & Schrader, M. (2008). Subjective and Functional Outcomes Following Surgical Repair of Complete Ruptures of the Proximal Hamstring Complex. Orthopedics, 31, 11, pp. 1-8. Schache, A., Crossley, K.M., Macindoe, I.G., Fahrner, B.B., & Pandy, M.G. (2011). Can a Clinical Test of Hamstring Strength identify Football Players at Risk of Hamstring Strain? Sports Medicine, Knee Surgion Sports Traumatol Arthrosc, 19:38-41. Schmitt, B., Tyler, T., & McHugh, M. (2012). Hamstring Injury Rehabilitation and Prevention of Re-injury Using Lengthened State Eccentric Training: A New Concept. The International Journal of Sports Physical Therapy, 7(3):333-342 Sole, G., Milosavljevic, S., Nicholson, H., & Sullivan, J.S. (2012). Altered Muscle Activation Following Hamstring Injuries. British Journal of Sports Medicine, 46, pp.118-123. University of Delaware Sports and Orthopaedic Clinic (2012). Preventative Exercise Progression for Hamstring Strain. Hamstring Rehabilitation and Prevention Protocol. University of Delaware Sports and Orthopaedic Clinic. Retrieved 20 August 2012 from http://www.udel.edu/PT/PT%20Clinical%20Services/RehabGuidelines/HAMSTRING_EXERCISE_PROGRESSION.pdf Visser, H.M., Reijman, M., Heijboer, M.P., and Bos, P.K. (2012). Risk Factors of Recurrent Hamstring Injuries: A Systematic Review. British Journal Sports Medicine, 46: 124-130. Warren, P., Gabbe, B.J., Schneider-Kolsky, M., & Bennell, K. (2010). Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers. British Journal of Sports Medicine, 44: 415-419. Read More