Isokinetic conference 2015 London strength as a risk factor for hamstring injury

STRENGTH AS A RISK FACTOR FOR HAMSTRING STRAIN INJURY -Is it still a piece of the puzzle?

Nicol van DykRehabilitation Department

Contributing Authors

– Rod Whiteley

– Cristiano Eirale

– Bhavesh Kumar

– Bruce Hamilton

– Hans Tol

– Roald Bahr

– Erik Witvrouw

• Hamstring Strain Injuries (HSI) remain the most common muscle injury in football(Hagglund et al 2013, Ekstrand et al 2011, Eirale et al 2013)

Introduction

• Incidence 12-15% (Opar et al 2012)

• 37% of all muscle injuries (Ekstrand et al 2011)

Introduction

Introduction

Fatigue

Core Stability

Neuromuscular Control

FlexibilityStrength

Multifactorial Nature of HSI (Mendiguchia et al 2012)

Psychological Factors

Architecture

Introduction

Aim

Can Strength be identified as a risk factor for Hamstring

Injury?

All Teams in Qatar Stars

League (n=14 teams)

2010-2014

No isokinetic tests performed

(n=52 subjects)

Isokinetic Tests during Periodic Health Evaluation

(n=617 subjects) mean follow up of 2.24 years

Q Con 60°/s(n= 556)

H Con 60°/s(n= 555)

Q Con 300°/s(n= 556)

H Con 300°/s(n=556)

H Ecc 60°/s(n=562)

Materials & Methods

1050Isokinetic

Tests performed

Total Injuries 1871st time injuries

131

617 subjects

187 injuries

• Clustered Logistic Regression Analysis with repeated measures

Confounding Variables

Strength Variables

Statistical Analysis

Season

Q Con 60 BW H Ecc 60

BW

H Con 60 BW

Q Con 300 BW

Q Con 60/H Con 60

Q Con 300/ H Con 300

H Con 60/ H Ecc 60

Q Con 300/ H Ecc 60

H Con 300 BW

PositionPrevious

HSI

Results

Age 24.7 ± 4.7

Height 176.5cm ± 6.7

Weight 71.8 ± 9.1

Odds Ratio p-value 95% CI

Q Con 60 0.99 0.06 0.99 - 1.00

H Con 60 0.99 0.17 0.99 - 1.00

Q Con 300 0.99 0.97 0.99 - 1.00

H Con 300 0.99 0.20 0.99 - 1.00

H Ecc 60 0.99 0.12 0.99 - 1.00

Q Con 60 BW 0.71 0.03* 0.52 - 0.97

H Con 60 BW 0.75 0.29 0.43 -1.29

Q Con 300BW 1.10 0.87 0.56 - 1.89

H Con 300 BW 0.75 0.29 0.43 - 1.29

H Ecc 60 BW 0.73 0.04* 0.54 - 0.99

Q Con 60/ H Con 60 0.76 0.32 0.44 - 1.32

H Con 60/ H Ecc 60 1.08 0.90 0.34 - 3.40

Q Con 300/ H Con 300 1.46 0.26 0.76 - 2.79

Q Con 300/ H Ecc 60 1.46 0.35 0.66 - 3.25

Q Con 60 BW 0.71 0.03* 0.52 - 0.97

H Ecc 60 BW 0.73 0.04* 0.54 - 0.99

Results

Limitations

Population SpecificNo player exposure

Discussion

Hamstrings Eccentric

Quadriceps Concentric

are risk factorsfor HAMSTRING STRAIN INJURIES

Discussion

Q Con 60 234H Ecc 60 186

15%

Q Con 60 227

H Ecc 60 186

41%

Q Con 60 234H Ecc 60 179

36%

P(x)=1

1+𝑒_𝑧Probability of developing HSI

Q Con 60 227H Ecc 60 179

51%

Take Home Message

www.uwrf.edu

Quadriceps Concentric

StrengthCan Strength be identified as a risk factor for

HSI? Hamstrings Eccentric

Thank you