Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice

Abstract

RationaleHamstring injuries are common in elite sports. Muscle injury classification systems aim to provide a framework for diagnosis. The British Athletics Muscle Injury Classification (BAMIC) describes an MRI classification system with clearly defined, anatomically focused classes based on the site of injury: (a) myofascial, (b) muscle–tendon junction or (c) intratendinous; and the extent of the injury, graded from 0 to 4. However, there are no clinical guidelines that link the specific diagnosis (as above) with a focused rehabilitation plan.ObjectiveWe present an overview of the general principles of, and rationale for, exercise-based hamstring injury rehabilitation in British Athletics. We describe how British Athletics clinicians use the BAMIC to help manage elite track and field athletes with hamstring injury. Within each class of injury, we discuss four topics: clinical presentation, healing physiology, how we prescribe and progress rehabilitation and how we make the shared decision to return to full training. We recommend a structured and targeted diagnostic and rehabilitation approach to improve outcomes after hamstring injury.

Ultrasound classification of medial gastrocnemious injuries

“…17 To perform an adequate clinical assessment, an accurate clinical and radiological examination is necessary as it will determine the most appropriate treatment. [18][19][20][21][22][23][24] To make a correct differential diagnosis of acute calf pain, high-resolution ultrasound is the imaging modality of choice to confirm medial and lateral gastrocnemius, plantaris, and Achilles tendon injuries, as well as other injuries affecting this region such as a Baker's cyst rupture, popliteal artery entrapment, deep venous thrombosis (which can also be concurrent with a gastrocnemious injuries), vascular pathology affecting the popliteal or posterior tibial artery or injuries to the structures of the deep compartment (tibialis posterior, flexor digitorum longus, and flexor hallicus longus). 13,25 Moreover, it is a good imaging technique to determine the presence and severity of an co-existing hematoma between the gastrocnemius and the underlying soleus.…”

Managing the return to sport of the elite footballer following semimembranosus reconstruction

“…15 18 19 We delayed integrating high strain eccentric exercises in the initial 2 weeks of reconditioning to avoid excessive mechanical strain on the healing structures. 20 Furthermore, post-injury inhibition is reported during bilateral eccentric loading, potentially compromising adaptations, 21 whereas maximal isometrics elicit higher voluntary muscle activation and lower inhibition. 22 With no pain reported (<2/10 NRS) following early isometric loading, we added dynamic strength exercises, coaching 'intent' 23 to move as explosively as possible to develop power, with the conceptual goals of promoting collagen synthesis, fibre alignment and improving tendon-tensile strength.…”

“… 15 18 19 We delayed integrating high strain eccentric exercises in the initial 2 weeks of reconditioning to avoid excessive mechanical strain on the healing structures. 20 Furthermore, post-injury inhibition is reported during bilateral eccentric loading, potentially compromising adaptations, 21 whereas maximal isometrics elicit higher voluntary muscle activation and lower inhibition. 22 …”

Acute Hamstring Muscle Tears in Climbers—Current Rehabilitation Concepts

“…Furthermore, it has been shown that high levels of finger strength can differentiate elite climbers from their nonelite counterparts. 31 Static trunk strength, upper limb strength, and power are moderately associated with elite 6 Specific hamstring exercises (eg, moderate-weight resistive bands, leg curl machines, and double-leg stiff leg lifting in a pain protected range of motion) [6][7][8][9] Begin regional upper-quadrant sports-specific muscle conditioning, including finger strengthening 10 Phase 2: Low velocity strengthening Low velocity concentric full range of motion hamstring-specific exercises with increasing resistive load using machines and free weights (eg, heavy elastic bands, knee curl machines, [6][7][8][9] and deadlifts 7 ) Phase 3: High load strengthening and functional reconditioning…”