The management of hamstring injury - Part 1: Issues in diagnosis

Hamstring injuries are the most prevalent muscle injury in sports involving rapid acceleration and maximum speed running. Injury typically occurs in an acute manner through an eccentric mechanism at the terminal stages of the swing phase of gait. Biceps femoris is most commonly injured. Re-injury rates are high and management is a challenge given the complex multi-factorial aetiology. The high rates of hamstring injury and re-injury may result from a lack of high-quality research into the aetiological factors underlying injury. Re-injury may also result from inaccuracy in diagnosis that results from the potential multi-factorial causes of these conditions. Inaccuracy in diagnosis could lead to multiple potential diagnoses that may result in the implementation of variable management protocols. Whilst potentially useful, such variability may also lead to the implementation of sub-optimal management strategies. Previous hamstring injury is the most recognized risk factor for injury, which indicates that future research should be directed at preventative measures. Much anecdotal and indirect evidence exists to suggest that several non-local factors contribute to injury, which may be addressed through the application of manual therapy. However, this connection has been neglected in previous research and literature. This paper will explore and speculate on this potential connection and offer some new contributive factors for hamstring injury management. This first paper of a two part series on hamstring injury will explore diagnostic issues relevant to hamstring injury and the second will investigate various established and speculative management approaches.