RESUMEN
OBJECTIVE: To investigate early clinical predictors of time to return to competition and of recurrence following hamstring strain. DESIGN: Prospective observational study. SETTING: Elite level of Australian football competition. PARTICIPANT: 59 players who suffered a hamstring strain in 2002 season. PREDICTORS: Clinical assessment by a physiotherapist and questionnaire. MAIN OUTCOME MEASURES: Time taken to return to play and recurrence of hamstring injury within 3 weeks. RESULTS: Players taking more than 1 day to walk pain-free were significantly more likely (p=0.018) to take longer than 3 weeks to return to competition (adjusted odds ratio 4.0; 95% CI 1.3 to 12.6). Nine players (15.2%) experienced an injury recurrence, all involving the biceps femoris. Recurrence was more likely in players who reported a hamstring injury in the past 12 months (adjusted odds ratio 19.6; 95% CI 1.5 to 261.0; p=0.025). CONCLUSION: Time to walk pain-free and previous hamstring injury are predictors of time to return to competition and recurrence, respectively, and should be included in a clinical assessment to aid in prognosis.
Asunto(s)
Fútbol Americano/lesiones , Músculo Esquelético/lesiones , Esguinces y Distensiones/rehabilitación , Muslo/lesiones , Adolescente , Adulto , Traumatismos en Atletas/rehabilitación , Humanos , Masculino , Dolor/prevención & control , Estudios Prospectivos , Recuperación de la Función , Factores de Riesgo , Prevención Secundaria , Factores de Tiempo , Resultado del Tratamiento , Victoria , Adulto JovenRESUMEN
BACKGROUND: Physicians evaluating hamstring strains in professional football players are increasingly turning to magnetic resonance imaging to support the clinical diagnosis and management of the injury. However, little information is available to assess how magnetic resonance imaging compares with the clinical evaluation in establishing the duration of rehabilitation required. HYPOTHESIS: Magnetic resonance imaging of hamstring strains can be useful in determining duration of rehabilitation. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 1. METHODS: Fifty-eight professional football players with a diagnosis of hamstring injury made by the team physician were enrolled in the study. All players underwent magnetic resonance imaging and a clinical evaluation by an independent physical therapist within 3 days of the injury. Presence, type, and location of injury were recorded in each examination. The physical therapist estimated the time required until return to competition, and the radiologist used the length of the injury (coronal view) to establish rehabilitation duration. Both clinicians were blinded to the other modality. RESULTS: Clinical and magnetic resonance imaging assessments were in agreement in 38 of 58 cases (65.5%). In 18 cases (31.0%), a clinically positive diagnosis was made, but no abnormalities were evident on magnetic resonance imaging. In 2 cases (3.4%), magnetic resonance imaging detected an injury, whereas the clinical examination had negative or equivocal findings. Both clinical examination and magnetic resonance imaging findings were strongly correlated with the actual time required to return to competition (r = .69, P < .001 and r = .58, P < .001, respectively). The correlation coefficient between clinical predictions and magnetic resonance imaging findings was moderate (r = .36, P = .006). CONCLUSION: This study shows that magnetic resonance imaging is not required for estimating the duration of rehabilitation of an acute minor or moderate hamstring injury in professional football players.