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MRI: Muscle Still Intact in Most Hamstring Hurts

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Even mild hamstring injuries—ones that involve no muscle fiber disruption detectable by MRI—still force athletes to spend a lot of time on the bench.

That’s a conclusion of a freely available new study in the February issue of the British Journal of Sports Medicine. The journal devotes much of the issue to hamstring injuries, which it describes as the most common muscle injury in sports.

This particular study followed European professional football players (in the United States, we’d call them soccer players) from July 2007 through April 2011.

Of the 207 hamstring injuries for which full MRI data were available, 27 (13 percent) were grade 0 (negative MRI, no visible abnormality), 118 (57 percent) were grade 1 (swelling but no muscle fiber distortion), 56 (27 percent) were grade 2 (partial tear), and 6 (3 percent) were grade 3 (total muscle or tendon rupture). The study notes:

Two of three hamstring injuries were grade 0 or 1 injuries, showing no signs of muscle fibre disruption on MRI. Still, these injuries caused more than half of the absence days.

Weekend athletes sidelined by a “pulled hamstring” may take comfort in the fact that it happens to the pros too, even when there are no outward signs of injury.

Of the three hamstring muscles, the biceps femoris was by far the most likely to be injured. Of the 207 injuries scanned, 84 percent involved the biceps femoris, 11 percent involved the semimembranosus, and 5 percent involved the semitendinosus.

An accompanying editorial, also freely available, notes that rates of hamstring injury recurrence and reinjury have not improved over the past three decades. “This failure,” the editorial’s abstract says, “is most likely due to the following: (1) a lack of studies with high level of evidence into the identification and prevention of hamstring injuries and (2) a reductionist approach of the current literature.”

In other words, the causes of hamstring injuries are complicated and interrelated, and we need to study them more. Which we all probably already knew, but I guess sometimes it’s good to state the obvious.

Related seminar: Musculoskeletal MRI

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