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Hamstring Strength and Morphology Progression after Return to Sport from Injury


Medicine & Science in Sports & Exercise: March 2013 - Volume 45 - Issue 3 - p 448–454
doi: 10.1249/MSS.0b013e3182776eff
Basic Sciences

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°·s−1, P < 0.001) but not 6 months after. The knee flexion angle of peak torque decreased over time for both limbs (60°·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 < 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.

1Departments of Biomedical Engineering and Athletics University of Wisconsin-Madison, Madison, WI; 2Departments of Bioengineering and Orthopaedic Surgery Stanford University, Stanford, CA; 3Sports Rehabilitation University of Wisconsin Health Sports Medicine, Madison, WI; 4Department of Radiology University of Wisconsin-Madison, Madison, WI; and 5Department of Orthopedics and Rehabilitation University of Wisconsin-Madison, Madison, WI

Address for correspondence: Bryan C. Heiderscheit, PT, Ph.D., Department of Orthopedics and Rehabilitation, University of Wisconsin, 1300 University Ave., MSC 4120, Madison, WI 53706-1532; E-mail:

Submitted for publication June 2012.

Accepted for publication October 2012.

© 2013 American College of Sports Medicine