Journal of Postgraduate Medicine, Education and Research

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  58 (2024)
Volume  57 (2023)
Volume  56 (2022)
Volume  55 (2021)
Volume  54 (2020)
Volume  53 (2019)
Volume  52 (2018)
Volume  51 (2017)
Volume  50 (2016)
Volume  49 (2015)
Volume  48 (2014)
Volume  47 (2013)
Volume  46 (2012)
Related articles

VOLUME 56 , ISSUE 4 ( October-December, 2022 ) > List of Articles

REVIEW ARTICLE

Neuromuscular Inhibition, Hamstring Strain Injury, and Rehabilitation: A Review

Karthik Badrinath, Robert G Crowther, Gregory A Lovell

Keywords : Hamstring, Inhibition, Muscle injury, Neuromuscular, Strain injury, Surface electromyography

Citation Information : Badrinath K, Crowther RG, Lovell GA. Neuromuscular Inhibition, Hamstring Strain Injury, and Rehabilitation: A Review. J Postgrad Med Edu Res 2022; 56 (4):179-184.

DOI: 10.5005/jp-journals-10028-1597

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Objective: The purpose of this review was to summarize the neuromuscular inhibition of the hamstring and lumbopelvic musculature following a hamstring strain injury (HSI) and its subsequent implications on the rehabilitation of the injury. Design: Narrative review. Results: A search of electronic databases and references within the articles found 18 articles suitable for review. A critical review of the literature revealed that despite returning to the sport, athletes demonstrated an impairment in the myoelectric activity in the hamstring muscle group, particularly the biceps femoris (BF). Additionally, altered activation patterns in the lumbopelvic musculature (gluteus medius and maximus, external and internal oblique, thoracic and lumbar erector trunci) of healthy athletes were also associated with increased HSI risk. Conclusion: Despite athletes completing evidence-based rehabilitation programs, there is persistent neuromuscular inhibition present in the hamstring and lumbopelvic musculature on return to sport. Clinicians should be aware of this phenomenon as a return of athletes to sport with neuromuscular inhibition may increase their risk of hamstring strain re-injury. Measures such as surface electromyography (EMG) may be a useful tool to detect neuromuscular changes following HSI and help guide clinicians in the return to play process following an HSI.

HTML PDF Share
  1. Orchard JW. Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med 2001;29(3):300–303. DOI: 10.1177/03635465010290030801
  2. Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 2011;45(7):553–558. DOI: 10.1136/bjsm.2009.060582
  3. Elliott MC, Zarins B, Powell JW, et al. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med 2011;39(4):843–850. DOI: 10.1177/0363546510394647
  4. Gissane C, Jennings D, Kerr K, et al. Injury rates in rugby league football: impact of change in playing season. Am J Sports Med 2003;31(6):954–958. DOI: 10.1177/03635465030310063501
  5. Roberts SP, Trewartha G, England M, et al. Epidemiology of time-loss injuries in English community-level rugby union. BMJ Open 2013;3(11):e003998. DOI: 10.1136/bmjopen-2013-003998
  6. Hickey J, Shield AJ, Williams MD, et al. The financial cost of hamstring strain injuries in the Australian Football League. Br J Sports Med 2014;48(8):729–730. DOI: 10.1136/bjsports-2013-092884
  7. Cuthbert M, Ripley N, McMahon JJ, et al. The effect of nordic hamstring exercise intervention volume on eccentric strength and muscle architecture adaptations: a systematic review and meta-analyses. Sports Med 2020;50(1):83–99. DOI: 10.1007/s40279-019-01178-7
  8. Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med 2016;50(3):145–148. DOI: 10.1136/bjsports-2015-095586
  9. Bourne MN, Timmins RG, Opar DA, et al. An Evidence-based framework for strengthening exercises to prevent h amstring injury. Sports Med 2018;48(2):251–267. DOI: 10.1007/s40279-017-0796-x
  10. Chumanov ES, Heiderscheit BC, Thelen DG. Hamstring musculotendon dynamics during stance and swing phases of high-speed running. Med Sci Sports Exerc 2011;43(3):525–532. DOI: 10.1249/MSS.0b013e3181f23fe8
  11. Ekstrand J, Healy JC, Waldén M, et al. Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med 2012;46(2):112–117. DOI: 10.1136/bjsports-2011-090155
  12. Askling CM, Tengvar M, Saartok T, et al. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med 2007;35(2):197–206. DOI: 10.1177/0363546506294679
  13. Wangensteen A, Almusa E, Boukarroum S, et al. MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: a prospective cohort of 180 male athletes. Br J Sports Med 2015;49(24):1579–1587. DOI: 10.1136/bjsports-2015-094892
  14. Kornberg C, Lew P. The effect of stretching neural structures on grade one hamstring injuries. J Orthop Sports Phys Ther 1989;10(12):481–487. DOI: 10.2519/jospt.1989.10.12.481
  15. Ishøi L, Krommes K, Husted RS, et al. Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport - grading the evidence: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med 2020;54(9):528–537. DOI: 10.1136/bjsports-2019-101228
  16. Ernlund L, Vieira LA. Hamstring injuries: update article. Rev Bras Ortop 2017;52(4):373–382. DOI: 10.1016/j.rboe.2017.05.005
  17. van Heumen M, Tol JL, de Vos RJ, et al. The prognostic value of MRI in determining reinjury risk following acute hamstring injury: a systematic review. Br J Sports Med 2017;51(18):1355–1363. DOI: 10.1136/bjsports-2016-096790
  18. Reiman MP, Loudon JK, Goode AP. Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review. J Orthop Sports Phys Ther 2013;43(4):223–231. DOI: 10.2519/jospt.2013.4343
  19. Blandford L, Theis N, Charvet I, et al. Is neuromuscular inhibition detectable in elite footballers during the nordic hamstring exercise? Clin Biomech (Bristol, Avon) 2018;58:39–43. DOI: 10.1016/j.clinbiomech.2018.07.009
  20. Petersen J, Thorborg K, Nielsen MB, et al. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med 2011;39(11):2296–2303. DOI: 10.1177/0363546511419277
  21. Freeman BW, Young WB, Talpey SW, et al. The effects of sprint training and the nordic hamstring exercise on eccentric hamstring strength and sprint performance in adolescent athletes. J Sports Med Phys Fitness 2019;59(7):1119–1125. DOI: 10.23736/S0022-4707.18.08703-0
  22. Oleksy Ł, Mika A, Pacana J, et al. Why Is hamstring strain injury so common in sport despite numerous prevention methods? Are there any missing pieces to this puzzle? Front Physiol 2021;12:586624. DOI: 10.3389/fphys.2021.586624
  23. Fyfe JJ, Opar DA, Williams MD, et al. The role of neuromuscular inhibition in hamstring strain injury recurrence. J Electromyogr Kinesiol 2013;23(3):523–530. DOI: 10.1016/j.jelekin.2012.12.006
  24. Areia C, Barreira P, Montanha T, et al. Neuromuscular changes in football players with previous hamstring injury. Clin Biomech (Bristol, Avon) 2019;69:115–119. DOI: 10.1016/j.clinbiomech.2019.07.010
  25. Konrad P., 2005 The ABC of EMG: A Practical Introduction to Kinesiological Electromyography Noraxon Inc. USA, version 1 0
  26. Buhmann R, Trajano GS, Kerr G, et al. Voluntary activation and reflex responses after hamstring strain injury . Med Sci Sports Exerc 2020;52(9):1862–1869. DOI: 10.1249/MSS.0000000000002327
  27. Buhmann R, Trajano GS, Kerr GK, et al. Increased short interval intracortical inhibition in participants with previous hamstring strain injury. Eur J Appl Physiol 2022;122(2):357–369. DOI:10.1007/s00421-021-04839-6
  28. Opar DA, Williams MD, Timmins RG, et al. Knee flexor strength and bicep femoris electromyographical activity is lower in previously strained hamstrings. J Electromyogr Kinesiol 2013;23(3):696–703. DOI: 10.1016/j.jelekin.2012.11.004
  29. Sole G, Milosavljevic S, Nicholson HD, et al. Selective strength loss and decreased muscle activity in hamstring injury. J Orthop Sports Phys Ther 2011;41(5):354–363. DOI: 10.2519/jospt.2011.3268
  30. Daly C, Persson UM, Twycross-Lewis R, et al. The biomechanics of running in athletes with previous hamstring injury: A case-control study. Scand J Med Sci Sports 2016;26(4):413–420. DOI: 10.1111/sms.12464
  31. Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers
  32. Avrillon S, Hug F, Guilhem G. Bilateral differences in hamstring coordination in previously injured elite athletes. J Appl Physiol (1985) 2020;128(3):688–697. DOI: 10.1152/japplphysiol.00411.2019
  33. Opar DA, Williams MD, Timmins RG, et al. Rate of torque and electromyographic development during anticipated eccentric contraction is lower in previously strained hamstrings. Am J Sports Med 2013;41(1):116–125. DOI: 10.1177/0363546512462809
  34. Higashihara A, Ono T, Tokutake G, et al. Hamstring muscles’ function deficit during overground sprinting in track and field athletes with a history of strain injury. J Sports Sci 2019;37(23):2744–2750. DOI: 10.1080/02640414.2019.1664030
  35. Silder A, Thelen DG, Heiderscheit BC. Effects of prior hamstring strain injury on strength, flexibility, and running mechanics. Clin Biomech (Bristol, Avon) 2010;25(7):681–686. DOI: 10.1016/j.clinbiomech.2010.04.015
  36. Crow J, Semciw A, Couch J, et al. Does a recent hamstring muscle injury affect the timing of muscle activation during high speed overground running in professional Australian Football players? Phys Ther Sport 2020;43:188–194. DOI: 10.1016/j.ptsp.2020.03.005
  37. Sole G, Milosavljevic S, Nicholson H, et al. Altered muscle activation following hamstring injuries. Br J Sports Med 2012;46(2):118–123. DOI: 10.1136/bjsm.2010.079343
  38. Franettovich Smith MM, Bonacci J, Mendis MD, et al. Gluteus medius activation during running is a risk factor for season hamstring injuries in elite footballers. J Sci Med Sport 2017;20(2):159–163. DOI: 10.1016/j.jsams.2016.07.004
  39. Schuermans J, Danneels L, Van Tiggelen D, et al. Proximal neuromuscular control protects against hamstring injuries in male soccer players: a prospective study with electromyography time-series analysis during maximal sprinting. Am J Sports Med 2017;45(6):1315–1325. DOI: 10.1177/0363546516687750
  40. Schuermans J, Van Tiggelen D, Witvrouw E. Prone hip extension muscle recruitment is associated with hamstring injury risk in amateur soccer. Int J Sports Med 2017;38(9):696–706. DOI: 10.1055/s-0043-103016
  41. Emami M, Arab AM, Ghamkhar L. The activity pattern of the lumbo-pelvic muscles during prone hip extension in athletes with and without hamstring strain injury. Int J Sports Phys Ther 2014;9(3):312–319.
  42. Bourne MN, Opar DA, Williams MD, et al. Muscle activation patterns in the nordic hamstring exercise: Impact of prior strain injury. Scand J Med Sci Sports 2016;26(6):666–674. DOI: 10.1111/sms.12494
  43. Opar DA, Williams MD, Timmins RG, et al. The effect of previous hamstring strain injuries on the change in eccentric hamstring strength during preseason training in elite Australian footballers. Am J Sports Med 2015;43(2):377–384. DOI: 10.1177/0363546514556638
  44. Woods C, Hawkins RD, Maltby S, et al. The Football Association Medical Research Programme: an audit of injuries in professional football–analysis of hamstring injuries. Br J Sports Med 2004;38(1):36–41. DOI: 10.1136/bjsm.2002.002352
  45. Hickey JT, Opar DA, Weiss LJ, et al. Current clinical concepts: hamstring strain injury rehabilitation. J Athl Train 2021;57(2):125–135. DOI: 10.4085/1062-6050-0707.20.
  46. Zambaldi M, Beasley I, Rushton A. Return to play criteria after hamstring muscle injury in professional football: a Delphi consensus study. Br J Sports Med 2017;51(16):1221–1226. DOI: 10.1136/bjsports-2016-097131
  47. Hocking S& AFL Doctors and Physiotherapists Association, 29th Annual AFL Injury Report: 2020
  48. Green B, Bourne MN, van Dyk N, et al. Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport. Br J Sports Med 2020;54(18):1081–1088. DOI: 10.1136/bjsports-2019-100983
  49. Garrett WE Jr, Safran MR, Seaber AV, et al. Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure. Am J Sports Med 1987;15(5):448–454. DOI: 10.1177/036354658701500504
  50. Mann RV. A kinetic analysis of sprinting. Med Sci Sports Exerc 1981;13(5):325–328.
  51. Van Hooren B, Bosch F. Is there really an eccentric action of the hamstrings during the swing phase of high-speed running? part I: a critical review of the literature. J Sports Sci 2017;35(23):2313–2321. DOI: 10.1080/02640414.2016.1266018
  52. Presland JD, Timmins RG, Maniar N, et al. Muscle activity and activation in previously strain-injured lower limbs: a systematic review. Sports Med 2021;51(11):2311–2327. DOI: 10.1007/s40279-021-01487-w
  53. Chumanov ES, Heiderscheit BC, Thelen DG. The effect of speed and influence of individual muscles on hamstring mechanics during the swing phase of sprinting. J Biomech 2007;40(16):3555–3562. DOI: 10.1016/j.jbiomech.2007.05.026
  54. van den Tillaar R, Solheim J, Bencke J. Comparison of hamstring muscle activation during high-speed running and various hamstring strengthening exercises. Int J Sports Phys Ther 2017;12(5):718–727. DOI: 10.16603/ijspt20170718
  55. Van Hooren B, Bosch F. Is there really an eccentric action of the hamstrings during the swing phase of high-speed running? Part II: implications for exercise. J Sports Sci 2017;35(23):2322–2333. DOI: 10.1080/02640414.2016.1266019
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.