University of Wisconsin School of Medicine and Public Health, Department of Orthopedics and Rehabilitation, Madison, WI 53706-1532, USA.
J Orthop Sports Phys Ther. 2010 Feb;40(2):67-81. doi: 10.2519/jospt.2010.3047.
Hamstring strain injuries remain a challenge for both athletes and clinicians, given their high incidence rate, slow healing, and persistent symptoms. Moreover, nearly one third of these injuries recur within the first year following a return to sport, with subsequent injuries often being more severe than the original. This high reinjury rate suggests that commonly utilized rehabilitation programs may be inadequate at resolving possible muscular weakness, reduced tissue extensibility, and/or altered movement patterns associated with the injury. Further, the traditional criteria used to determine the readiness of the athlete to return to sport may be insensitive to these persistent deficits, resulting in a premature return. There is mounting evidence that the risk of reinjury can be minimized by utilizing rehabilitation strategies that incorporate neuromuscular control exercises and eccentric strength training, combined with objective measures to assess musculotendon recovery and readiness to return to sport. In this paper, we first describe the diagnostic examination of an acute hamstring strain injury, including discussion of the value of determining injury location in estimating the duration of the convalescent period. Based on the current available evidence, we then propose a clinical guide for the rehabilitation of acute hamstring injuries, including specific criteria for treatment progression and return to sport. Finally, we describe directions for future research, including injury-specific rehabilitation programs, objective measures to assess reinjury risk, and strategies to prevent injury occurrence.
Diagnosis/therapy/prevention, level 5.
由于腘绳肌拉伤的发生率高、愈合缓慢和持续存在症状，运动员和临床医生都面临着挑战。此外，近三分之一的此类损伤在重返运动后的第一年复发，随后的损伤通常比最初的损伤更严重。高复发率表明，常用的康复方案可能不足以解决与损伤相关的可能肌肉无力、组织延展性降低和/或运动模式改变的问题。此外，用于确定运动员重返运动准备情况的传统标准可能对这些持续存在的缺陷不敏感，导致过早重返。越来越多的证据表明，可以通过使用结合评估肌肉肌腱恢复和重返运动准备情况的客观措施的神经肌肉控制练习和离心力量训练的康复策略，将再受伤的风险降到最低。在本文中，我们首先描述了急性腘绳肌拉伤的诊断检查，包括讨论确定损伤部位在估计康复期持续时间方面的价值。然后根据当前可用的证据，我们为急性腘绳肌损伤的康复提出了临床指南，包括治疗进展和重返运动的具体标准。最后，我们描述了未来研究的方向，包括特定于损伤的康复计划、评估再受伤风险的客观措施以及预防损伤发生的策略。
诊断/治疗/预防，5 级。
