Schuermans Joke, Van Tiggelen Damien, Danneels Lieven, Witvrouw Erik
Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
Am J Sports Med. 2016 May;44(5):1276-85. doi: 10.1177/0363546515626538. Epub 2016 Feb 24.
Running-related hamstring strain injuries remain a delicate issue in several sports such as soccer. Their unremittingly high incidence and recurrence rates indicate that the underlying risk has not yet been fully identified. Among other factors, the importance of neuromuscular coordination and the quality of interplay between the different hamstring muscle bellies is thought to be a key determinant within the intrinsic injury risk. Muscle functional magnetic resonance imaging (mfMRI) is one of the tools that has been proven to be valid for evaluating intermuscular coordination.
To investigate the risk of sustaining an index or recurring soccer-related hamstring injury by exploring metabolic muscle characteristics using mfMRI.
Cohort study; Level of evidence, 2.
A total of 27 healthy male soccer players and 27 soccer players with a history of hamstring injuries underwent standardized mfMRI. The mfMRI protocol consisted of a resting scan, a strenuous bilateral eccentric hamstring exercise, and a postexercise scan. The exercise-related T2 change, or the signal intensity shift between both scans, was used to detect differences in metabolic characteristics between (1) the different hamstring muscle bellies and (2) the prospective cohorts based on the (re)occurrence of hamstring injuries during a follow-up period of 18 months.
The risk of sustaining a first hamstring injury was associated with alterations in the intermuscular hierarchy in terms of the magnitude of the metabolic response after a heavy eccentric effort, with the dominant role of the semitendinosus set aside for a higher contribution of the biceps femoris (P = .017). Receiver operating characteristic (ROC) curve analysis demonstrated that this variable was significantly able to predict the occurrence of index injuries with a sensitivity of 100% and a specificity of 70% when the metabolic activity of the biceps femoris exceeded 10%. The risk of sustaining a reinjury was associated with a substantial deficit in hamstring strength endurance (P = .031). Soccer players who sustained a reinjury were only able to perform prone leg curls for a mean duration of 146.50 ± 76.16 seconds, whereas those with an injury history but no recurrence during follow-up were able to continue for a mean of 237.45 ± 110.76 seconds (95% CI, 11.9-230.5 seconds; P = .031).
This was the first study to assess the causal relation between the intramuscular recruitment pattern and the risk of sustaining an index or secondary hamstring strain. Changes in intermuscular interplay seem to significantly increase the risk of sustaining index hamstring injuries in male amateur soccer players. Inadequate eccentric muscle endurance could be associated with an increased risk of sustaining a recurring hamstring injury.
在足球等多项运动中，与跑步相关的腘绳肌拉伤仍然是一个棘手的问题。其持续居高不下的发病率和复发率表明，潜在风险尚未完全明确。在诸多因素中，神经肌肉协调性的重要性以及不同腘绳肌肌腹之间相互作用的质量被认为是内在损伤风险的关键决定因素。肌肉功能磁共振成像（mfMRI）是已被证明可有效评估肌肉间协调性的工具之一。
通过使用mfMRI探索肌肉代谢特征，调查首次发生或复发性足球相关腘绳肌损伤的风险。
队列研究；证据等级，2级。
共有27名健康男性足球运动员和27名有腘绳肌损伤史的足球运动员接受了标准化的mfMRI检查。mfMRI检查方案包括静息扫描、剧烈的双侧腘绳肌离心运动以及运动后扫描。运动相关的T2变化，即两次扫描之间的信号强度变化，用于检测（1）不同腘绳肌肌腹之间以及（2）基于18个月随访期内腘绳肌损伤（再）发生情况的前瞻性队列之间代谢特征的差异。
首次发生腘绳肌损伤的风险与重负荷离心运动后代谢反应幅度方面的肌肉间层次结构改变有关，半腱肌的主导作用被股二头肌更高的贡献率所取代（P = 0.017）。受试者工作特征（ROC）曲线分析表明，当股二头肌的代谢活性超过10%时，该变量能够以100%的敏感性和70%的特异性显著预测首次损伤的发生。再次受伤的风险与腘绳肌力量耐力的显著不足有关（P = 0.031）。再次受伤的足球运动员只能进行俯卧腿弯举平均146.50±76.16秒，而有损伤史但在随访期间未复发的运动员能够持续平均237.45±110.76秒（95%CI，11.9 - 230.5秒；P = 0.031）。
这是第一项评估肌肉内募集模式与首次或继发性腘绳肌拉伤风险之间因果关系的研究。肌肉间相互作用的变化似乎显著增加了男性业余足球运动员首次发生腘绳肌损伤的风险。离心肌肉耐力不足可能与复发性腘绳肌损伤风险增加有关。
