Hamstring Strain in High School Athletes

Hamstring strains are a significant problem for basketball athletes across levels of play for
both sexes. The impact of hamstring muscle strains (HSMS) is significant. Injuries typically
result in persistent symptoms and lengthy recovery periods which limit the athlete's practice
and play time. Even more significantly, HSMS have high rates of reinjury. It is estimated
that approximately one-third of hamstring strains are recurrent. Given the high incidence of
HSMS and the substantial tendency for injuries to recur, it has been advocated the greatest
impact may be achieved by the development of improved techniques for prevention of initial
injury.

Multiple risk factors for HSMS have been identified. Perhaps the strongest modifiable risk
factor associated with HSMS is an imbalance between quadriceps and hamstring strength,
specifically the eccentric hamstrings and concentric quadriceps strength ratio. The rationale
is that sufficient eccentric capacity of the hamstring muscles is necessary to offset the
concentric quadriceps contraction during the terminal swing phase of running. Not
surprisingly, prevention programs that emphasize eccentric hamstring strengthening have been
effective in reduction of HSMS injury rates.Prospective studies have demonstrated mixed
results regarding the relationship between hamstring flexibility and hamstring injury, and
the effectiveness of a flexibility program for reduction of the incidence of HSMS remains
controversial. Stretching duration, frequency, timing of stretching relative to sports
activities and the type of stretch being performed have been suggested as important factors
in the effectiveness of a flexibility program at reducing injury occurrence. In addition,
reduced hip flexor and quadriceps flexibility has been identified as a risk factor for HSMS.
Further investigation is necessary to determine if a flexibility program that addresses both
anterior and posterior thigh musculature reduces injury risk. The role of neuromuscular (NM)
deficits as a risk factor in HSMS injuries is unclear. Inclusion of NM exercises in a six
week training period improved lower extremity control and movement discrimination, which has
been suggested to contribute to HSMS injury prevention. However, the impact of a NM injury
prevention program on HSMS rates has not been established.

Sheer wave elastography (SWE) represents an emerging imaging technology. This real-time
imaging technique evaluates the local mechanical properties of muscles. Thus, SWE has the
potential to provide more sensitive insight into muscle stiffness than flexibility
assessment. Recent studies have utilized this technique to evaluate the effect of lower
extremity positioning on hamstring stiffness. The relationship between stiffness measures
obtained using SWE and HSMS has not, however, been established.

Key gaps in knowledge regarding HSMS injury prevention programs remain. Most critically, the
effectiveness of HSMS prevention programs among basketball athletes is unknown. Furthermore,
the comparative effectiveness of eccentric, flexibility, and NM training for reduction of
HSMS injuries is also unknown. Assessment of lower extremity strength, rate of power
production, flexibility, and stiffness (captured with SWE) may elucidate the mechanisms
underlying the effectiveness of injury prevention training, and aid in enhancement of injury
prevention programs. Thus, the potential impact of this proposal is profound as our
investigative team aims to fill these gaps in knowledge. Ultimately, the results of this
study have the potential to 1) reduce injuries among basketball athletes and consequently
enhance and lengthen athletic careers, 2) provide scientific rationale underlying the effects
of HSMS injury prevention training, and 3) determine if a novel ultrasound imaging technique
may be effective in determining risk for HSMS.

Inclusion criteria:

- member of high school basketball team

- school agreement to participate in study

Exclusion criteria:

- inability to ambulate independently

- lower extremity or back surgery within 1 year of study enrollment

- presence of neurological disease