Hamstring Strength and Morphology Progression after Return to Sport from Injury

SANFILIPPO, J. L., A. SILDER, M. A. SHERRY, M. J. TUITE, and B. C. HEIDERSCHEIT. Hamstring Strength and Morphology Progression after Return to Sport from Injury. Med. Sci. Sports Exerc., Vol. 45, No. 3, pp. 448-454, 2013. Purpose: Hamstring strain reinjury rates can reach 30% within the initial 2 wk after return to sport (RTS). Incomplete recovery of strength may be a contributing factor. However, relative strength of the injured and unaffected limbs at RTS is currently unknown. The purpose was to characterize hamstring strength and morphology at the time of RTS and 6 months later. Methods: Twenty-five athletes who experienced an acute hamstring strain injury participated after completion of a controlled rehabilitation program. Bilateral isokinetic strength testing and magnetic resonance imaging (MRI) were performed at RTS and 6 months later. Strength (knee flexion peak torque, work, and angle of peak torque) and MRI (muscle and tendon volumes) measures were compared between limbs and over time using repeated-measures ANOVA. Results: The injured limb showed a peak torque deficit of 9.6% compared to the uninjured limb at RTS (60 degrees.s(-1), P < 0.001) but not 6 months after. The knee flexion angle of peak torque decreased over time for both limbs (60 degrees.s(-1), P < 0.001). MRI revealed that 20.4% of the muscle cross-sectional area showed signs of edema at RTS with full resolution by the 6-month follow-up. Tendon volume of the injured limb tended to increase over time (P = 0.108), whereas muscle volume decreased between 4% and 5% in both limbs (P G 0.001). Conclusions: Residual edema and deficits in isokinetic knee flexion strength were present at RTS but resolved during the subsequent 6 months. This occurred despite MRI evidence of scar tissue formation (increased tendon volume) and muscle atrophy, suggesting that neuromuscular factors may contribute to the return of strength.