TY - JOUR
T1 - London International Consensus and Delphi study on hamstring injuries part 3
T2 - rehabilitation, running and return to sport
AU - Paton, Bruce M.
AU - Read, Paul
AU - van Dyk, Nicol
AU - Wilson, Mathew G.
AU - Pollock, Noel
AU - Court, Nick
AU - Giakoumis, Michael
AU - Head, Paul
AU - Kayani, Babar
AU - Kelly, Sam
AU - Moore, James
AU - Moriarty, Peter
AU - Murphy, Simon
AU - Plastow, Ricci
AU - Stirling, Ben
AU - Tulloch, Laura
AU - Wood, David
AU - Haddad, Fares
AU - Kerkhoffs, Gino M. M. J.
N1 - Funding Information: We would like to thank the large number of hamstring experts who contributed their valuable time, effort and expertise in completing our surveys. The consensus process and meeting were cocreated and funded by the Institute of Sport Exercise and Health, London, UK and the Academic Centre for Evidence Based Sports Medicine, Amsterdam, the Netherlands. The consensus and the launch of PHAROS were partly made possible by a grant from the International Olympic Committee. We would like to thank also to Naomi Shah PT (India) and Magnus Hilmarsson PT (Iceland) who assisted with meeting days. Funding Information: This study was supported by IOC via Academic Centre for Evidence Based Sports Medicine, Amsterdam, the Netherlands and Institute of Sport Exercise and Health. Publisher Copyright: © 2023 Author(s) (or their employer(s)).
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.
AB - Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.
KW - consensus
KW - hamstring muscles
KW - hamstring tendons
KW - rehabilitation
KW - running
UR - http://www.scopus.com/inward/record.url?scp=85148307157&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bjsports-2021-105384
DO - https://doi.org/10.1136/bjsports-2021-105384
M3 - Article
C2 - 36650032
SN - 1473-0480
VL - 57
SP - 278
EP - 291
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 5
M1 - 105384
ER -