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Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression
  1. Rod Whiteley1,
  2. Nicol van Dyk1,2,
  3. Arnlaug Wangensteen1,3,
  4. Clint Hansen1
  1. 1 Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
  3. 3 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Oslo, Norway
  1. Correspondence to Dr Rod Whiteley, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; rodney.whiteley{at}


Aim To investigate the association of daily clinical measures and the progression of rehabilitation and perceived running effort.

Methods A cohort of 131 athletes with an MRI-confirmed acute hamstring injury underwent a standardised criteria-based rehabilitation protocol. Descriptive and inferential statistics were used to investigate the association between daily clinical subjective and objective measures and both the progression of rehabilitation and perceived running effort. These measures included different strength, palpation, flexibility and functional tests. Inter-rater and intrarater reliability and minimal detectable change were established for the clinical measures of strength and flexibility by examining measures taken on consecutive days for the uninjured leg.

Results The progression of the daily measures was seen to be non-linear and varied according to the measure. Intra-rater reliability for the strength and flexibility measures were excellent (95% CI ≥0.85 for all measures). Strength (in the outer range position) and flexibility (in maximum hip flexion with active knee extension (MHFAKE) in supine) were best associated with rehabilitation progression and perceived running effort. Additionally, length of pain on palpation was usefully associated with rehabilitation progression. At lower perceived running effort there was a large variation in actual running speed.

Conclusion Daily physical measures of palpation pain, outer range strength, MHFAKE and reported pain during daily activity are useful to inform the progression of rehabilitation.

Trial registration number NCT01812564 and NCT02104258.

  • football
  • soccer
  • physiotherapy
  • rehabilitation
  • assessment

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  • Contributors RW conceived the study. RW, NvD and AW collected the data. All authors contributed to the analysis and writing of the paper, and have approved the submitted version.

  • Funding This study was internally funded by Aspetar Orthopaedic and Sports Medicine Hospital.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The studies were approved by the Ethics Committee of Aspetar Orthopaedic and Sports Medicine Hospital, and by either the Shafallah Medical Genetics Centre Ethics Committee (Growth Factor study) or the Anti-Doping Lab Qatar (Aspetar HAmstringRehabilitation study).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Patient-level data and/or full data set and/or technical appendix and/or statistical code are available from the corresponding author.