Therapeutic Interventions for Acute Hamstring Injuries: Abstract and Introduction

Therapeutic Interventions for Acute Hamstring Injuries: Abstract and Introduction

Abstract and Introduction

Abstract

Background Despite the high rate of hamstring injuries, there is no consensus on their management, with a large number of different interventions being used. Recently several new injection therapies have been introduced.
Objective To systematically review the literature on the effectiveness of therapeutic interventions for acute hamstring injuries.
Data sources The databases of PubMed, EMBASE, Web of Science, Cochrane Library, CINAHL and SPORTDiscus were searched in May 2011.
Study eligibility criteria Prospective studies comparing the effect of an intervention with another intervention or a control group without intervention in subjects with acute hamstring injuries were included.
Data analysis Two authors independently screened the search results and assessed risk of bias. Quality assessment of the included studies was performed using the Physiotherapy Evidence Database score. A best evidence synthesis was used to identify the level of evidence.
Main results Six studies were included in this systematic review. There is limited evidence for a positive effect of stretching, agility and trunk stability exercises, intramuscular actovegin injections or slump stretching in the management of acute hamstring injuries. Limited evidence was found that there is no effect of non-steroidal anti-inflammatory drugs or manipulation of the sacroiliac joint.
Conclusions There is a lack of high quality studies on the treatment of acute hamstring injuries. Only limited evidence was found to support the use of stretching, agility and trunk stability exercises, intramuscular actovegin injections or slump stretching. Further research is needed using an appropriate control group, randomisation and blinding.

Introduction

Acute hamstring injury is common in the athletic population. In different types of sport, such as football, Australian rules football and rugby, 12–16% of all injuries are hamstring injuries.^[1–5] These injuries have significant consequences for the performance of players and their clubs: a professional athlete with a hamstring injury cannot perform in match play for an average of 14–27 days.^{[3 6 7]} Despite the high injury rate, there is no consensus on the best management because of a lack of scientific evidence on effectiveness.^[8] This is underlined by the diversity of interventions used in the management of hamstring injuries: rest, ice, compression, elevation,^[9] use of non-steroidal anti-inflammatory drugs (NSAIDs),^[10] exercise therapy,^[11] mobilisation and manipulation therapy,^[12] injection therapies including corticosteroids,^[13] autologous blood products^{[14 15]} and traumeel/actovegin injections.^{[8 15]} Traumeel is a homoeopathic formulation containing botanical and mineral components to which anti-inflammatory effects are ascribed. Actovegin is a deproteinised haemodialysate obtained from filtered calf blood. It is suggested that it contains active components with muscle regenerating promoting effects.^{[8 15]} The most recent systematic review of management of hamstring injuries was published by Harris et al in 2011.^[16] Its subject was operative treatment compared with non-operative treatment in acute proximal hamstring ruptures. The most recent systematic review of conservative therapeutic interventions for acute hamstring injuries was published by Mason et al in 2007.^[17] It looked at rehabilitation interventions for hamstring injuries based on only three studies. Since the latter publication, additional studies on therapeutic interventions in hamstring injuries have been published, and new injection therapies have been introduced.^{[14 15]}

The purpose of this study is to systematically review the literature on the effectiveness of therapeutic interventions for acute hamstring injuries.