Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men's Soccer
Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men's SoccerAmerican Journal of Sports Medicine; 2011; 39(11): 2296-2303
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50 Danish male professional and amateur soccer teams (n=942) were cluster randomized to receive either eccentric strengthening of the hamstring muscle using the Nordic hamstring muscle exercise (intervention) or the usual training program (control). The results after the 10-week program concluded that the control groups had significantly higher rates of acute hamstring injury in comparison to intervention. In addition, the control group had a significantly higher proportion of recurrent injury rates in comparison to intervention.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
Inclusion / Exclusion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Hamstring injury accounts for 12% to 16% of all soccer related injuries, making it the most prevalent injury. Eccentric hamstring strength training exercises have undergone a series of developments with an advantage of capability to be done in the field without the use of any equipment. The effect of eccentric hamstring strength training on hamstring injuries have been incongruous in the literature, and this study explores it further.
What was the principal research question?
Does eccentric strengthening of the hamstring muscle lead to lower rates of overall, new, and recurrent acute hamstring injuries after a 10 week sessions, in comparison to control in athletes of professional and amateur soccer teams?
What were the important findings?
- Overall acute hamstring injury rates were 3.8 per 100 player seasons in the intervention group in comparison to 13.1 per 100 player seasons in control (adjusted rate ratio= 0.293; 95% confidence interval, 0.150-0.572; P<0.001)
- New injury rates were 3.1 per 100 player seasons in the intervention group in comparison to 8.1 per 100 player seasons in the control (RR, 0.410; 95% CI, 0.180-0.933; P=0.034)
- Recurrent injury rates were 7.1 per 100 player seasons in the intervention group in comparison to 45.8 per 100 player seasons in the control (RR, 0.137; 95% CI, 0.037-0.509; P=0.003)
What should I remember most?
The results indicate that eccentric training was effective in significantly decreasing the rate of acute hamstring injuries in soccer athletes.
How will this affect the care of my patients?
Based on the findings of this study, therapists should consider eccentric training to be a potentially viable exercise option.
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