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Recalibrating the risk of hamstring strain injury (HSI) - A 2020 systematic review and meta-analysis of risk factors for index and recurrent HSI in sport
  1. Brady Green1,
  2. Matthew N Bourne1,2,
  3. Nicol van Dyk3,
  4. Tania Pizzari1
  1. 1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
  2. 2School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
  3. 3High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
  1. Correspondence to Brady Green, La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3086, Australia; B.Green2{at}latrobe.edu.au

Abstract

Objective To systematically review risk factors for hamstring strain injury (HSI).

Design Systematic review update.

Data sources Database searches: (1) inception to 2011 (original), and (2) 2011 to December 2018 (update). Citation tracking, manual reference and ahead of press searches.

Eligibility criteria for selecting studies Studies presenting prospective data evaluating factors associated with the risk of index and/or recurrent HSI.

Method Search result screening and risk of bias assessment. A best evidence synthesis for each factor and meta-analysis, where possible, to determine the association with risk of HSI.

Results The 78 studies captured 8,319 total HSIs, including 967 recurrences, in 71,324 athletes. Older age (standardised mean difference=1.6, p=0.002), any history of HSI (risk ratio (RR)=2.7, p<0.001), a recent HSI (RR=4.8, p<0.001), previous anterior cruciate ligament (ACL) injury (RR=1.7, p=0.002) and previous calf strain injury (RR=1.5, p<0.001) were significant risk factors for HSI. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with HSI risk. The risk of recurrent HSI is best evaluated using clinical data and not the MRI characteristics of the index injury.

Summary/conclusion Older age and a history of HSI are the strongest risk factors for HSI. Future research may be directed towards exploring the interaction of risk factors and how these relationships fluctuate over time given the occurrence of index and recurrent HSI in sport is multifactorial.

  • Hamstring
  • posterior thigh
  • biceps femoris
  • muscle strain
  • injury
  • sport
  • risk factors

https://doi.org/10.1136/bjsports-2019-100983

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    Footnotes

    • Twitter @BradyDGreen, @mbourne5, @NicolvanDyk, @DrTaniaPizzari

    • Contributors All authors made equal contributions to the work. All authors provided permission for the submission and publication of this version of the review.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.