Return to sport and beyond following intramuscular hamstring injury: a case report of an English Premier League football player

Review written by Dr Jarred Boyd info

Key Points

  1. Hamstring strain injuries, involving the intramuscular tendon, denoted as type 2c, may warrant different loading parameters than that of a free tendon injury.
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BACKGROUND & OBJECTIVE

Hamstring strain injuries, a common pathology in high-speed running sports, may sometimes involve the intramuscular tendon, resulting in a potentially more extensive time-loss injury than the free-tendon. Insult to the intramuscular tendon may require unique interventions and return to sport processes compared to the free tendon - particularly due to the mechanical differences in stiffness and compliance, respectively.

The intramuscular tendon serves as a primary strut, assisting muscle fibre attachment - thus deformation under load (i.e. strain) may result in muscular detachment and subsequent decrement in stiffness (1). Consequently, the inclusion of appropriate stimuli to reverse the trainable deficits, largely in the force generating capacity domain, necessitates discrete progressions alongside sport specific stressors.

The primary intent of this paper was to incite discussion around the “reconditioning periodization” process and relevant monitoring of physical qualities pertaining to intramuscular hamstring injury.

Insult to the intramuscular tendon may require unique interventions and return to sport processes compared to the free tendon.
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Load tolerance, load capacity, and load rate appear to be the overarching phases throughout the reconditioning process.

CASE SCENARIO:

This case report followed assessment, reconditioning process, and outcomes of a 23-year-old male central midfielder soccer player. The injury occurred instantaneously after a stretch induced mechanism with the following initial findings: positive SLR, painful resisted 90/90 hamstring loading, partial thickness

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