Research Paper Review - January

Research Paper Review - January

At this year’s Biomechanics Summer School in June, we will proudly welcome World-renowned Sports Physician, Professor Peter Brukner. Professor Brukner will be presenting and delivering workshops on a number of topics, although his specialism is sports injuries. This month we look at one of his papers focusing on hamstring injury in professional footballers.

Recurrent hamstring muscle injury:

applying the limited evidence in the professional football setting with a seven-point programme

Brukner, P., Nealon, A., Morgan, C., Burgess, D.

and Dunn, A. (2014)

British Journal of Sports Medicine 48:929-938.

Overview:

Hamstring injuries can be a recurrent problem in many elite football players. The aim of this paper was to use a clinical example, a 26 year old professional footballer who had sustained 5 hamstring injuries, and examine the available evidence for treatments.

What it all means:

This paper highlights that the injury was successfully managed with a 7-point research based programme. However, the authors conclude that it is impossible to determine what contributed most to the positive outcome. A combination of clinical experience and researched evidence is crucial.

Key points:

  • The 7 point management plan included the following with a comprehensive review of the evidence for each:
    • Biomechanical assessment and correction
    • Neurodynamics
    • Core stability/neuromuscular control/lumbar spine Strengthening
    • Increase strength in hamstrings with eccentric-biased Programme
    • Overload running programme
    • Injection therapies
    • Stretching/yoga/relaxation
    • “This gap between the evidence base and the reality of clinical practice and its variable outcomes intensifies the pressure on clinicians working in professional sport and invites the temptation of speculative interventions”.

Putting it into practice:

  1. Essentially, as with many other types of sports injury, good evidence is limited, and so clinical judgement and experience plays a large part. Keeping up to date with new research, as and when it comes along, is critical for best clinical outcomes.
  1. This paper discusses the role of orthoses to “correct asymmetry” for their player and that “they were immediately well tolerated and remain a component of the player’s overall management regimen even though their specific effect is incalculable.” It’s widely accepted now that the evidence for foot orthoses isn’t great and we also know that they probably don’t work by “correcting asymmetry”, but many clinicians who treat sports injuries will agree that orthoses work well inline with other treatment modalities even though we aren’t sure how.
  1. The 7-point programme described in this paper encourages a multi-disciplinary approach. Sharing your patients with other experienced health professionals who have specific expertise often results in better outcomes for the patient.

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