Measurements of Injured Hamstring Muscle Volume Before and after Eccentric Exercises and Hamsprint Exercises with MR Observations
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Middle-East Journal of Scientific Research 12 (3): 376-381, 2012
ISSN 1990-9233
© IDOSI Publications, 2012
DOI: 10.5829/idosi.mejsr.2012.12.3.65105
Measurements of Injured Hamstring Muscle Volume Before and
after Eccentric Exercises and Hamsprint Exercises with MR Observations
1
Parastoo Shamsehkohan, 2Maziar Meghdadi, 3Mohammad Yadegari and 4Yaghoub Moradi
1
Department of Physical Education and Sport Sciences,
Sports Biomechanics, Islamic Azad University, Karaj, Iran
2
Department of Physical Education and Sport Sciences,
Sports Management, Tehran University, Tehran, Iran
3
Department of Physical Education and Sport Sciences,
Sport Pathology and Corrective Exercise, Kharazmi University, Tehran, Iran
4
Department of Physical Education and Sport Sciences,
Sport Pathology and Corrective Exercise, Razi University, Keramanshah, Iran
Abstract: Hamstring injuries occur frequently, with a high recurrence rate, in sports that require either
high-speed skilled movement. A previous hamstring injury is the greatest risk factor for a future hamstring
injury. 10 subjects performed the hamsprint exercises and 10 subjects performed the eccentric exercises for 1
month and 5 subjects which were control group did not do any special activity during this month. Athletes
underwent magnetic resonance imaging before and after 1-month. Hamstring muscle volumes were determined
for injured limbs using manual segmentation. One-way analysis of variance test was determined to comparison
of injured muscle volume of pre-test and post-test of all three groups and the results did not show a significant
difference. But, the results of this test showed a significant difference between the injured muscle volumes of
post-test in three groups. The results of this study showed the reduction of muscle injuries after eccentric
exercise program and hamsprint exercise program. In addition, the hamsprint exercise program was more
effective than eccentric exercise program. The HamSprint program allows athletes to return to sports at less risk
for acute re-injury than those who complete a more traditional isolated stretching and strengthening exercise
program. Collectively, the study indicates that a training program consisting of neuromuscular control and
proprioceptive, is a good way for recovery of hamstring strain.
Key words: Magnetic Resonance Imaging Muscle Injury Neuromuscular Control Proprioceptive
Training Programs
INTRODUCTION remains challenging, as evidenced by approximately 30%
of individuals experiencing a re-injury within the first year
Muscle strain injuries may account for 30% of sports after initial injury [10-12] and require more time away from
medicine practice [1-4], with hamstring injuries being sport than the initial injury [11, 12].
particularly frequent among individuals participating Magnetic resonance (MR) imaging provides an
in sprinting, kicking, or high-speed skilled movements objective standard for confirming the presence of an acute
[1, 4-8]. Various studies found that male athletes were 62% muscle strain injury [8]. Recent studies have shown that
more likely to sustain a hamstring injury than female the location and extent of abnormalities on MR images not
athletes and more common in field sports than in court only confirm the presence and severity of initial muscle
sports [4, 9]. Hamstring strains were the second most fiber damage, but can also provide a reasonable estimate
common injury, only surpassed by knee sprains in of the rehabilitation period [13-15]. In addition, re-injury
football [4, 10] and injury rates varied by position [4]. rates have been shown to be higher among individuals
The treatment and rehabilitation of hamstring injuries that sustain a more severe original injury [8].
Corresponding Author: Parastoo Shamsehkohan, Department of Physical Education and Sport Sciences, Sports Biomechanics,
Islamic Azad University, Karaj, Iran. Tel: +9-89353861420.
376Middle-East J. Sci. Res., 12 (3): 376-381, 2012
Various studies have investigated structural changes also shown benefits in reducing the incidence of
immediately following an acute hamstring strain injury hamstring strain injuries. Despite the benefit of these
[11-13, 16]. However, it is unclear how repair processes programs, they can have significantly low compliance
may alter musculotendon morphology. It has been rates [3]. There are also authors who are critical of the
hypothesized that scar tissue formation, along with training specificity of the Nordic curl, noting that it is a
weakness or atrophy of the previously injured muscle may bilateral movement that only generates movement from
be contributing factors to re-injury [11, 12]. The other risk the knees [20]. Cameron et al. [21] theorized that the
factors that predispose athletes to hamstring injury can be HamSprint program could be an effective hamstring injury
older age, decreased quadriceps flexibility and muscle prevention program.
imbalances of the thigh [4, 5, 17]. Studies have also find Therefore, it is totally unknown whether these
that a previous hamstring injury is a significant risk factor beneficial effect on hamstring strain during a certain
for recurrent injury, suggesting that post injury changes period or not. The purpose of this study was to use MR
to the muscle and altered movement patterns may persist imaging to investigate the changes in muscle and tendon
that contribute to this increased risk [3, 4]. morphology after a hamstring strain injury. And it will also
Most hamstring injuries occur along the proximal help the reader understand what happens anatomically
musculotendon junction, where the muscle fibrils intersect and physiologically after an acute hamstring injury.
with the tendon [14, 16]. In addition, atrophy and fatty These items provide practical applications for the sports
replacement within the previously injured or surrounding medicine and performance team that help return athletes
muscles may also occur as part of remodeling process to sport with reduced risk for recurrent injury.
[11, 12]. Like most acute strain injuries, hamstring strains
do not typically involve the muscle tearing away from the MATERIALS AND METHODS
tendon. In fact, it is the muscle tissue adjacent that is
damaged [16]. Immediately after injury, there is an acute Subjects: Twenty-five previously injured athletes were
inflammatory response that is followed by muscle and volunteered to participate in the study. All subjects had
collagen regeneration [11, 12]. An injury such as this can experienced a clinically diagnosed between 2-6 months
result in fibrous scar formation. Structural changes within prior hamstring strain injury (grade I or II) and
the muscle immediately after an acute hamstring strain required being away from sport. This study was a
injury have been investigated [4, 13]. The amount and quasi-experimental research with pre-test and post-test.
extent of edema and hemorrhage on magnetic resonance The subjects were randomized into three groups,
images can confirm the presence and severity of eccentrics exercise (n=10), hamsprint exercise group
initial muscle fiber damage and can also provide a (n=10) and control group (n=5). They were free of other
reasonable estimate of the rehabilitation period [4, 7, 13]. current or history of musculoskeletal impairments. Each
The significance of these persistent musculotendon subject provided written informed consent prior to
morphological changes to re-injury risk is not definitively participation in this study.
known at the present time [18]. Silder et al. [11, 12]
investigated the effect of scar tissue by assessing Experimental Approach to the Problem: The present
running kinematics at 4 speeds ranging from 60% to 100% study was designed to investigate the effects of 2 types
of maximum sprinting speed and showed that peak stretch of exercises for improving the hamstring strain injury.
of the hamstring muscles might be reduced in the By random, 10 subjects performed the hamsprint exercises
previously injured limb compared with the contralateral and 10 subjects performed the eccentric exercises for 1
side as a compensation for the modified tissue. month (4 times a week) and the other 5 subjects were
However, no significant asymmetries in overall hamstring control group. 4 did not complete the exercise programs.
musculotendon stretch were observed at any of the One subject was involved in a motor vehicle accident and
speeds tested [11, 12]. could not continue the exercise program. Three subjects
In response to eccentric exercise, an increase in serial did not follow up for their scheduled appointment.
sarcomeres has been suggested [19]. This would allow the Of these 4 subjects excluded due to noncompliance, 2
muscle-tendon unit to operate at longer lengths and were in the eccentrics group and 2 were in the hamsprint
decrease the magnitude of the stretch absorbed by group. Athletes underwent MR imaging before and after
each sarcomere and likely the corresponding strain. 1-month. Initial and final data obtained from MRI images
Clinical investigations involving eccentric training have were compared in each exercise and also with each other.
377Middle-East J. Sci. Res., 12 (3): 376-381, 2012
Materials: MR images were obtained of subjects on a 1.5 warm-up before training. The HamSprint program
Tesla MR scanner (SIEMENS AG 2006, Germany) and a were running, marching, skips, short stride cariocas,
flexible circularly polarized phased-array torso coil was side shuffles, leg cycling, leg pawing, ankle pops,
used with the patient in a supine position. At first, quick support running, forward falling running and
we acquired axial T1-weighted turbo spin-echo MR explosive starts [21]. And the eccentric exercises were the
images (TR/TE: 802/12, section thickness: 10 mm, FOV: 30- eccentric box drops, eccentric loaded lunge drops,
32 × 40-42.7 cm, echo-train length: 3, matrix: 213 × 512, eccentric forward pulls, split-stance Zerchers and single-
intersection gap: 20%, acquisitions: 2) and axial inversion leg dead lift [20]. The drills were repeated 10 times in
recovery T2-weighted turbo spin-echo images (TR/TE: both limbs (3 times) and running drills were 30 meters (3
5032/30, section thickness: 10 mm, FOV: 30-31.9 × 40-42.5 times).
cm, echo-train length: 7, matrix: 182 × 256, inversion time: After 1-month training program, all subjects had a 48
150 msec, intersection gap: 20%, acquisitions: 1). hours rest. Then the post-MR imagines were obtained, to
Additionally, we obtained sagittal T1-weighted turbo estimate the hamstring strain after training programs.
spin-echo images (TR/TE: 676/12, section thickness: 7 mm, Also the post-MR imagines were obtained from the
FOV: 24 × 32 cm, echo-train length: 3, matrix: 213 × 512, control group.
intersection gap: 20%, acquisitions: 2), sagittal inversion
recovery T2-weighted turbo spin-echo images (TR/TE: Statistical Analyses: Hamstring muscle volumes were
5000/30, section thickness: 7 mm, FOV: 24 × 32 cm, matrix: determined for injured limbs using manual segmentation
189 × 256, echo-train length: 7, inversion time: 150 msec, [22]. We quantified injured volumes of the biceps femoris
intersection gap: 20%, acquisitions: 1) and axial gradient- long head, biceps femoris short head, proximal conjoint
echo images (TR/TE: 610/18, flip angle: 20°, section biceps femoris and semitendinosus tendon and proximal
thickness: 10 mm, FOV: 30-31.4 × 40-41.9 cm, matrix: 192 × semimembranosus tendon by the prolate ellipsoid method
512, intersection gap: 20%, acquisitions: 1). based on the formula: volume = length x width x height x
Also a computer checked the signals and 0.52 on three dimensions [23]. Volumes were calculated as
converted them into 3 dimensions images which the product of the inter-slice distance and the summed
investigated in different directions (Symphony; syngo cross-sectional areas from all slices containing the muscle
MR A30). The patient should change to MR gown and of interest (Fig. 1). All measurements were conducted for
remove any clothing with any metal. all 3 groups.
SPSS 16.0 (SPSS, Inc., Chicago, IL, USA) was used
Protocol: MR imaging data were collected at the first of for all statistical procedures. To assess whether any
study. And then, 20 patients started their specific training significant differences existed in the pre-test scores
programs. Athletes incorporated a 10 minutes dynamic across the three groups, a one-way ANOVA was
Fig. 1: a) 24-year-old male sprint player with hamstring strain injury, b) Cronal T2-weighted turbo spin-echo MR image,
c) Axial T2-weighted turbo spin-echo MR image shows the injury in long head of biceps femoris muscle which
is marked by green.
378Middle-East J. Sci. Res., 12 (3): 376-381, 2012
calculated. This analysis was performed to assess The result of Shapiro-Wilk test showed a randomize
whether any significant difference existed between the distribution and the homogeneity of variances was
three groups prior to the initiation of the study. Next, a determined by Levine statistic test. One-way analysis of
one-way ANOVA was calculated across the post test variance test was determined to comparison of injured
scores of the three groups to assess if any difference muscle volume of pre-test and post-test of all three
existed in the posttest scores. This analysis was groups and the results did not show a significant
performed to assess whether any difference existed difference (P = 0.22) (Table 2).
between the three groups (including the control group). However, the results of this test showed a significant
Significance for all statistical tests and all follow-up difference between the injured muscle volumes of post-
tests was accepted at the 0.05 level of probability. All data test in three groups (p = 0.007). So post-hoc tukey test
were screened for normality assumptions using the was performed on each variable to find differences
Shapiro-Wilk test and Levine. between the groups and the results showed no significant
difference between control group and eccentric exercise
RESULTS program group and also eccentric exercise program group
and hamsprint exercise program group (p = 0.18, p = 0.15),
Table 1 showed baseline characteristics of the however there is a significant difference between control
subjects. There was no statistical significant difference group and hamsprint exercise program group (p = 0.006)
between three groups according to age, weight and height (Table 3). The difference of pre-test and post-test of the
period by one-way analysis of variance test. three groups are shown in Figure 2.
Table 1: Baseline characteristics of subjects
Statistical Parameters
-----------------------------------------------------------------------------------------------------------------------------------------------------
Variable Group N Mean Standard deviation
Age (year) Eccentric exercise program 8 27.50 5.61
Hamsprint exercise program 8 24.62 5.40
Control 5 24.60 3.21
Hieght (centimeter) Eccentric exercise program 8 1.75 7.80
Hamsprint exercise program 8 1.76 6.62
Control 5 1.78 4.57
Weight (kilogram) Eccentric exercise program 8 68.50 7.18
Hamsprint exercise program 8 71.12 10.25
Control 5 76.60 12.05
Table 2: The comparison of injured muscle volume between pre-test and post-test of the three groups
Pre-test Post-test
-------------------------------------------------------------------- --------------------------------------------------------------------
Eccentric Hamsprint Control Eccentric Hamsprint Control
(mean±SD) (mean±SD) (mean±SD) (mean±SD) (mean±SD) (mean±SD)
Injured muscle volume (mm3) 28.11±17.39 19.79±19.68 37.50±11.95 22.14±12.43 9.68±11.75 35.60±14.58
ANOVA Sig. 0.22 0.007
Table 3: The result of Tukey Post Hoc (Post-test)
Group
----------------------------------------------------------
I J Mean Difference Std. Error Sig.
Control Eccentric 13.46 7.23 0.18
Hamsprint *25.92 7.23 0.006
Eccentric Control -13.46 7.23 0.18
Hamsprint 12.46 6.34 0.15
Hamsprint Control *-25.92 7.23 0.006
Eccentric -12.46 6.34 0.15
*Statistical significance at P < 0.05
379Middle-East J. Sci. Res., 12 (3): 376-381, 2012
Fig. 2: The difference of pre-test and post-test of the three groups
DISCUSSION acute re-injury than those who complete a more traditional
isolated stretching and strengthening exercise program.
The main purpose of this study was to compare the In addition, doing a regular and moderate exercise is a
effect of eccentric exercises and hamsprint exercises on useful way for a rapid recovery of hamstring strain.
the athletes who had hamstring strain. The results of this Protection against muscle strain is provided not only by
study showed the reduction of muscle injuries after strong muscles but also by the appropriate timing and
eccentric exercise program and hamsprint exercise magnitude of neural control. Thus, according to the
program. In addition, the hamsprint exercise program was results of this study, it is suggested that the athletes who
more effective than eccentric exercise program, but there suffer hamstring strain, do hamsprint exercises or similar
were no significant differences between two exercise exercises which prevent a recurrent injury and keep
programs. The findings of this study about the effect of athletes in the game.
hamsprint exercises and eccentric exercises on hamstring
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