腿筋损伤(HSIs)是跑步和旋转运动中最常见的运动损伤,但是尽管进行了大量的研究,在过去的20年里,受伤率没有下降。HSI经常复发,许多地区缺乏最佳康复的证据和指导。本研究旨在为恒生指数的管理形成国际专家共识。与国际专家小组一起使用了改进的德尔菲方法和共识程序,涉及两轮在线问卷和一轮涉及共识会议的中间轮。向46名国际专家发送了初步信息收集轮问卷,其中包括涵盖恒生指数决策领域的开放式问题。对答复的专题分析概述了关键领域,由一个较小的国际分组(n=15)进行评估,包括临床学术运动医学医师,物理治疗师和整形外科医生在一个共识会议。围绕每个域进行小组讨论后,准备了一系列共识声明,辩论和精炼。向112名国际腿筋专家发送了第2轮调查问卷,以对这些声明进行投票并确定协议水平。共识阈值先验设定为70%。专家反应率为35/46(76%)(第一轮),15/35(参加会议日的与会者/被邀请者)和99/112(88.2%)进行最终调查。关于康复的声明达成共识:运动选择和剂量(78.8%-96.3%的协议),动力链的影响(95%),进行锻炼的标准(73%-92.7%),康复中的跑步和短跑(83%-100%)和重返运动标准(RTS)(78.3%-98.3%)。灵活性(40%)和力量(66.1%)以及康复辅助(68.9%)的基准未达成一致。这个共识小组建议基于运动员的个性化康复,体育需求,涉及肌肉和损伤类型和严重程度(89.8%)。早期修复应避免高应变载荷和速率。负荷很重要,但对最佳进展和剂量的共识较少。该小组根据容量和症状建议康复进展,疼痛阈值取决于活动,除了支持短跑的无痛标准(85.5%)。专家在决定RTS的康复最终目标和时机(89.8%)时,重点关注比赛所需的需求和能力。这项研究的专家小组成员遵循了HSI后康复方面的证据,建议康复处方应该个性化,但澄清了缺乏证据的领域。需要额外的研究来确定最佳负荷剂量,HSI康复的时机和标准以及确定康复安全快速进展和安全RTS的监测和测试指标。进一步的研究将有利于优化:跑步和短跑的处方,附属物在康复和治疗动力链HSI因素中的应用。
Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert
consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a
consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of
consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement.
Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less
consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.