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David Opar 课程大纲
David Opar Course Outline

目录

前言3
Preface 3

腘绳肌拉伤的风险因素4
Risk Factors for Hamstring Strain 4

A.腘绳肌拉伤的关键风险因素腘绳肌拉伤的关键因素是什么?4
A. Key Risk Factors for Hamstring Strain What are the key risk factors for hamstring strain? 4

B.单独用北欧腘绳肌训练(NHE,Nordic Hamstring Exercise)力量作为变量是否能预测腘绳肌拉伤:5
B. Whether Nordic Hamstring Exercise (NHE) strength alone as a variable can predict hamstring strain: 5

C.针对运动员开展离心力量训练-有无明确标准?6
C. Eccentric strength training for athletes - are there clear standards? 6

D.跑步技术和腘绳肌拉伤的关系:9
D. The relationship between running technique and hamstring strain: 9

E.跑步速度与腘绳肌拉伤之间的关系10
E. What is the relationship between running speed and hamstring strain? 10

F.过去的损伤11
F. Past injury 11

加速腘绳肌拉伤康复的策略(理论)13
Strategies to Accelerate Recovery from Hamstring Strain (Theory) 13

A. RTP过程的难题:13
A. Problems with the RTP process: 13

B.腘绳肌拉伤加速RTP框架14
B. Hamstring Strain Accelerated RTP Framework 14

腘绳肌拉伤:目前的证据综合:19
Hamstring strains: current evidence synthesis: 19

腘绳肌拉伤机制:19
Hamstring strain mechanism: 19

高速跑步时的髋部、膝部和腘绳肌力学21
Hip, knee, and hamstring mechanics during high-speed running 21

HSI的诊断24
Diagnosis of HSI 24

主观病史24
Subjective medical history 24

触诊受伤部位25
Palpate the injured area 25

运动范围测试25
Range of motion test 25

康复28
Rehabilitation 28

运动干预29
Exercise Intervention 29

离心腘绳肌练习31
Eccentric Hamstring Exercises 31

跑步技术练习37
Running technique exercises 37

被动治疗38
Passive treatment 38

腘绳肌拉伤的风险因素:39
Risk factors for hamstring strain: 39

可改变的风险因素40
Modifiable risk factors 40

不可改变的风险因素41
Immutable risk factors 41

选择关键的康复干预措施还是有必要采取多因素方法?43
Selecting key rehabilitation interventions or is a multifactorial approach necessary? 43

我们可以评估重返运动后的再损伤风险吗?43
Can we assess the risk of reinjury upon return to sport? 43

回归运动标准:46
Return to Sports Standard: 46

回归运动标准2:47
Return to Sport Standard 2: 47

负荷管理与损伤预防50
Load Management and Injury Prevention 50

伤害预防和高运动表现之间的平衡:训练过多或训练不足50
The Balance Between Injury Prevention and High Performance: Overtraining or Undertraining 50

疲劳恢复在避免腘绳肌拉伤RTP后再损伤发生中的意义56
The significance of fatigue recovery in preventing reinjury after hamstring strain RTP 56

疲劳对腘绳肌拉伤的影响56
Effect of Fatigue on Hamstring Strain 56

核心知识点(take home massage)63
Core knowledge points (take home massage) 63

前言

腘绳肌拉伤 ( HSI )是高速跑步运动中最常见的非接触性肌肉损伤。针对不同职业运动员的研究表明,短跑运动员中,腘绳肌拉伤约占所有急性损伤的 1/3。足球和橄榄球中,腘绳肌拉伤也是最常见的损伤——每五到六次损伤中就有一次是腘绳肌拉伤。损伤的特点是大腿后部的急性疼痛,并伴有腘绳肌肌纤维的破坏。足球运动中的损伤率特别高,占所有肌肉相关损伤的 37% ,复发率为 12-33%。尽管该领域的研究焦点日益增多,但潜在的损伤机制尚未明确,近年来损伤发生率似乎保持不变,甚至有所增加。腘绳肌拉伤会影响整个队伍的运动表现和队员的长期发展,因此一直是运动医学研究领域的热点问题。
Hamstring strain injury (HSI) is the most common non-contact muscle injury in high-speed running. Studies of different professional athletes indicate that hamstring strains account for approximately 1/3 of all acute injuries in sprinters. Hamstring strains are also the most common injury in football and rugby - one in every five to six injuries is a hamstring strain. The injury is characterized by acute pain in the posterior thigh with destruction of the hamstring muscle fibers. Injury rates in football are particularly high, accounting for 37% of all muscle-related injuries, with recurrence rates of 12-33%. Despite increasing research focus in this area, the underlying mechanisms of injury have not yet been identified, and injury incidence appears to have remained constant or even increased in recent years. Hamstring strain will affect the sports performance of the entire team and the long-term development of the players, so it has always been a hot issue in the field of sports medicine research.

David Opar 教授是澳大利亚天主教大学运动表现、恢复、损伤和新技术 (SPRINT) 研究中心的主任,以及 SPRINT 损伤研究项目的负责人。SPRINT 的损伤研究项目在腘绳肌拉伤研究方面处于世界领先地位,开展的项目涵盖运动科学领域的多个学科。这些项目涵盖基于实验室的研究一直到训练场的应用。Opar教授和他的团队与国内和国际的专业体育团队密切协商,为其运动员群体提供循证的预防和治疗策略。根据他的研究,Opar 教授还共同发明了 NordBord,这是一种测量离心腘绳肌拉伤力量的现场测量方法,现已被世界各地的运动队使用。
Professor David Opar is Director of the Sports Performance, Recovery, Injury and New Technology (SPRINT) Research Center at Australian Catholic University and Head of the SPRINT Injury Research Programme. SPRINT's Injury Research Program is a world leader in hamstring strain research, conducting projects across multiple disciplines within the sports science field. These projects range from laboratory-based research all the way to training field applications. Professor Opar and his team consult closely with national and international professional sports teams to provide evidence-based prevention and treatment strategies for their athlete populations. Based on his research, Professor Opar also co-invented the NordBord, an in-field measurement of eccentric hamstring strain strength that is now used by sports teams around the world.

在接下来的课程中,Opar教授会分享基于最新证据和实践的腘绳肌拉伤风险因素讲解和加速腘绳肌拉伤康复的策略。
In the following course, Professor Opar will share an explanation of hamstring strain risk factors and strategies to accelerate hamstring strain recovery based on the latest evidence and practice.

腘绳肌拉伤的风险因素
Risk factors for hamstring strain

A.腘绳肌拉伤的关键风险因素腘绳肌拉伤的关键因素是什么?
A. Key Risk Factors for Hamstring Strain What are the key risk factors for hamstring strain?

关键风险因素:运动员同时股二头肌长头短和腘绳肌力量差,即quadrant of doom
Key risk factors: Athletes with both long and short heads of biceps femoris and poor hamstring strength (quadrant of doom)

David团队2016年的一项前瞻性队列研究指出:
A prospective cohort study by David's team in 2016 stated:

152名精英足球soccer)运动员中报告了27个腘绳肌拉伤。腘绳肌离心力量低于 337 N(RR=4.4;95% CI 1.1 至 17.5)和股二头肌长头肌束短于 10.56 cm(RR=4.1;95% CI 1.9 至 8.7)会显著增加腘绳肌拉伤的风险
Twenty-seven hamstring strains were reported among 152 elite soccer (soccer) athletes. Hamstring eccentric strength less than 337 N (RR=4.4; 95% CI 1.1 to 17.5) and biceps femoris long head fasciculus shorter than 10.56 cm (RR=4.1; 95% CI 1.9 to 8.7) were associated with significantly increased hamstring strength. Risk of hamstring strain.

测量方式:Nordbord测试腘绳肌力量;肌骨超声测试股二头肌长头长度
Measurement method: Nordbord test hamstring strength; musculoskeletal ultrasound test long head length of biceps femoris

The length of the long head of the biceps femoris muscle can be measured using ultrasonography. This method involves marking the muscle-tendon junction distances and acquiring sonograms with specific image widths. 股二头肌长头的长度可以使用超声检查来测量 。该方法涉及标记肌肉-肌腱连接处距离并获取具有特定图像宽度的超声图, 然后带入公式算出来
The length of the long head of the biceps femoris muscle can be measured using ultrasonography. The method involves marking the muscle-tendon junction distance and acquiring a sonogram with a specific image width, which is then calculated using a formula.

超声参数:two-dimensional,B-mode ultrasound (frequency 12 MHz; depth 8 cm; field of view (FOV) 14 ×47 mm) (品牌: Logiq E,GE Healthcare, IL, USA)

B.单独用北欧腘绳肌训练(NHE,Nordic Hamstring Exercise)力量作为变量是否能预测腘绳肌拉伤:
B. Whether using Nordic Hamstring Exercise (NHE, Nordic Hamstring Exercise) strength alone as a variable can predict hamstring strain:

Opar 2021年进行了系统综述,赛前对运动员进行NHE量化测试,在1100名运动员中,有156例腘绳肌拉伤。发现只有极为有限的证据证明发生腘绳肌拉伤的运动员NHE力量比没有腘绳肌拉伤的运动员要差。
Opar conducted a systematic review in 2021 and conducted quantitative NHE tests on athletes before competition. Among 1,100 athletes, there were 156 cases of hamstring strain. found only very limited evidence that athletes with hamstring strains had poorer NHE strength than athletes without hamstring strains.

绝对力量方面:发生腘绳肌拉伤的运动员平均力量比未发生损伤运动员低18N(95%CI = -40 to 4N)
In terms of absolute strength: the average strength of athletes with hamstring strain is 18N lower than that of athletes without injury (95%CI = -40 to 4N)

相对于体重,相差0.22N/kg-1 (95%CI = -0.54 to 0.10N.kg-1 )
Relative to body weight, the difference is 0.22N/kg-1 (95%CI = -0.54 to 0.10N.kg-1)

结论:根据现有证据,系统综述和荟萃分析表明,使用 NHE 量化的季前离心腘绳肌力量与未来的腘绳肌拉伤无关。无论力量是以绝对值表示、标准化为体重/力量比值还是以四肢间不对称表示,这一发现都是一致的。尽管该领域的早期工作前景广阔,但我们对 1100 名参与者的汇总分析表明,仅用腘绳肌NHE力量对未来腘绳肌拉伤的预测价值有限。
Conclusions: Based on the available evidence, a systematic review and meta-analysis suggests that preseason eccentric hamstring strength quantified using NHE is not associated with future hamstring strains. This finding was consistent whether strength was expressed as absolute values, normalized to a body weight/strength ratio, or as asymmetry between limbs. Although early work in this area is promising, our pooled analysis of 1100 participants suggests that hamstring NHE strength alone has limited predictive value for future hamstring strains.

这方面的内容会不会对Nordbord设备有影响?这部分内容是Opar带领自己团队做的研究,自己加入到PPT里的。在研究讨论中也指出实验中的NHE测试只是单纯测试了赛季前的力量,没有在赛季中对于腘绳肌力量进行追踪,也没有对运动员进行训练干预。不能反映赛季中进行训练,会不会改变腘绳肌拉伤的结果。此外,单纯测试腘绳肌NHE力量可能不能预测腘绳肌损伤,但是结合腘二头肌长度,力量弱肌肉短二者和腘绳肌拉伤的联系较为紧密。显示不能只关注力量数字,还应该关注训练以及训练的方法是否能有效改变肌肉长度。)
(Will this content have an impact on Nordbord equipment? This part of the content is research done by Opar led his team and added to the PPT himself. In the research discussion, it was also pointed out that the NHE test in the experiment was only a pre-season test. strength, there is no tracking of hamstring strength during the season, and there is no training intervention for athletes. It cannot reflect whether training during the season will change the results of hamstring strain. In addition, simply testing the hamstring NHE. Strength may not be able to predict hamstring injuries, but combined with the length of the hamstrings, weak muscles and short muscles are closely related to hamstring strains, which shows that you should not just focus on the strength numbers, but also the training and training methods. Can effectively change muscle length).

C.针对运动员开展离心力量训练-有无明确标准?
C. Eccentric strength training for athletes - are there clear standards?

回顾最新综述,没有关于腘绳肌离心力量训练(训练强度、频率、训练量)的明确标准。
Looking back at the most recent reviews, there are no clear standards regarding eccentric hamstring strength training (training intensity, frequency, and volume).

测量离心力量只能提供运动员发生腘绳肌拉伤风险的有限信息上面论文说了)
Measuring only eccentric strength can only provide limited information about an athlete's risk of hamstring strain (as stated in the paper above)

- 如何让运动员变得更强壮才是最重要的-即做何种训练
- How to make athletes stronger is the most important thing - that is, what kind of training they do

-向心训练和离心训练会产生不同的肌肉适应,向心训练会让肌肉有力但缩短/离心训练让肌肉有力且延长
-Concentric training and eccentric training will produce different muscle adaptations. Concentric training will make the muscles strong but shortening/eccentric training will make the muscles strong and lengthened.

- 力量训练通过其他机制产生 "保护 "作用
-Strength training produces a "protective" effect through other mechanisms

-进行离心飞轮干预的参与者在 6 周训练后,BFlh 筋膜长度显著增加了 14±5% (p<0.001,d=1.98)
- Participants who performed the eccentric flywheel intervention had a significant increase in BFlh fascia length of 14±5% after 6 weeks of training (p<0.001, d=1.98)

离心飞轮训练设备:Desmotec V系列,D系列
Centrifugal Flywheel Training Equipment: Desmotec V Series, D Series

相关研究:
Related research:

FUNCTIONAL AND CLINICAL SIGNIFICANCE

OF SKELETAL MUSCLE ARCHITECTURE

骨骼肌结构的功能和临床意义
Function and clinical significance of skeletal muscle structure

肌肉的发力能力和发生速度都受到肌肉结构的影响。在文献中描述时,肌肉结构涉及肌束长度 (FL)、羽状角度 (PA) 以及肌肉厚度 (MT)、生理横截面积 (PCSA) 或解剖横截面积 (ACSA)。肌肉的大小(MT、PCSA 或 ASCA)可能会受到 FL 和 PA 的影响,反之亦然,具体取决于训练模式。基于肥大的抗阻训练会增加肌肉大小,增加 PA 并降低 FL
The ability and speed of muscle force generation are affected by muscle structure. When described in the literature, muscle structure refers to fascicle length (FL), pennation angle (PA), and muscle thickness (MT), physiological cross-sectional area (PCSA), or anatomical cross-sectional area (ACSA). Muscle size (MT, PCSA or ASCA) may be affected by FL and PA and vice versa, depending on the training mode. Hypertrophy-based resistance training increases muscle size, increases PA and decreases FL.

Architectural, functional and molecular responses to concentric and eccentric loading in human skeletal muscle 人体骨骼肌对向心和离心负荷的结构、功能和分子适应

结论:

尽管 ECC 组的负荷增加了约 1.2 倍,但在抗阻训练之后,股外侧肌(VL)肌肉体积的增加(向心训练(CON 组为 +8%,离心训练(ECC 组为 +6%)和最大自主等长收缩的增加CON 组为 +9%,ECC 组为 +11%)相似。不过,ECC后肌束长度(Lf 的增加幅度大于 CON(+12 %对 +5%),而肌羽状角(PA的增加幅度 CON 大于 ECC(+30% 对 +5%)。ECC(+ECC +8% vs. +CON +2%使VL远端区域CON(ECC +7% vs. CON +11%)使VL中腹区域出现了不同的结构适应性偏好生长
Despite an approximately 1.2-fold increase in load in the ECC group, vastus lateralis (VL) muscle volume increased after resistance training (+8% in the concentric (CON) group and +6% in the eccentric (ECC) group). %) and increases in maximal voluntary isometric contraction (+9% in the CON group and +11% in the ECC group) were similar. However, the increase in muscle fascicle length (Lf ) after ECC was greater than CON (+12% vs. +5%), while the increase in muscle pennation angle (PA) was greater in CON than ECC (+30% vs. +5%). ECC (+ECC +8% vs. +CON +2%) caused different structural adaptive growth preferences in the VL distal region, and CON (ECC +7% vs. CON +11%) in the VL midventral region.

Impact of an isometric or eccentric hip extension exercise intervention on hamstring strength, architecture, and morphology: a randomised intervention trial等长或离心髋部伸展运动干预对腘绳肌力量、结构和形态的影响:随机干预试验

结果:离心髋部伸展训练显著增加了股二头肌长头BFlh 束长度(+19.7%;p<0.001;d=1.57)、离心膝关节屈曲扭矩(ECC60°.s -1;+12%;p<0.005;d=0.66; ECC180°.s -1;+8.3%;p<0.05;d=0.41)和 股二头肌长头(+13.3%;p<0.001;d=1.96)和半膜肌 (SM) 肌肉体积(+12.5%;p<0.001) ;d=2.25)。停止训练 4 周后,离心组的 BFlh 肌束长度显著减少回到基线(-14.8%;p<0.005;d=-1.25),而离心膝关节屈曲扭矩、BFlh 和 SM 体积则保持不变。等长髋部伸展训练显著增加等长膝关节屈曲扭矩(+10.4%;p<0.05;d=0.54)、等长髋部伸展力(+12.4%;p<0.05;d=0.41)和半腱肌(ST)体积( +15%;p=0.054;d=1.57)。任何其他结果指标均未观察到显著变化
Results: Eccentric hip extension training significantly increased the BFlh fascicle length of the long head of biceps femoris (+19.7%; p<0.001; d=1.57) and eccentric knee flexion torque (ECC60°.s -1; +12% ; p<0.005; d=0.66; ECC180°.s -1; +8.3%; p<0.05; d=0.41) and long head of biceps femoris (+13.3%; p<0.001; d=1.96) and half Membranosus (SM) muscle volume (+12.5%; p<0.001; d=2.25). After 4 weeks of cessation of training, the eccentric group showed a significant reduction in BFlh fascicle length back to baseline (-14.8%; p<0.005; d=-1.25), while eccentric knee flexion torque, BFlh, and SM volume remained unchanged. Isometric hip extension training significantly increased isometric knee flexion torque (+10.4%; p<0.05; d=0.54), isometric hip extension force (+12.4%; p<0.05; d=0.41) and semitendon Muscle (ST) volume (+15%; p=0.054; d=1.57). No significant changes were observed in any other outcome measures.

- 由于对腘绳肌长度和力量的作用,定期(每周)进行大负荷离心运动仍可能是减轻腘绳肌拉伤风险的最有效刺激措施
- Due to the effect on hamstring length and strength, regular (e.g. weekly) heavy eccentric exercise may still be the most effective stimulus to reduce the risk of hamstring strain

Initial high volumes of the NHE followed by lower volumes, as well as progressively increasing volumes, can elicit increases in BFlh FL and eccentric knee flexor strength. Low volumes of the NHE were insufficient to increase FL, although as few as 48 repetitions in 6 weeks did increase strength.

NHE 最初的高训练量,随后较低的训练量,以及逐渐增加的训练量,可以引起股二头肌长头和腘绳肌离心力量的增加。-The Dose-Response of the Nordic Hamstring Exercise on Biceps Femoris Architecture and Eccentric Knee Flexor Strength: A Randomized Interventional Trial
NHE's initial high training volume, followed by lower training volumes, and gradually increasing training volume can induce increases in eccentric strength of the long head of the biceps femoris and hamstrings. -The Dose-Response of the Nordic Hamstring Exercise on Biceps Femoris Architecture and Eccentric Knee Flexor Strength: A Randomized Interventional Trial

腘绳肌离心测试及训练设备:NordBord
Hamstring eccentric testing and training equipment: NordBord

D.跑步技术和腘绳肌拉伤的关系:
D. The relationship between running technique and hamstring strain:

目前缺乏足够的研究证明两者之间的关系,现有研究显示:
There is currently a lack of sufficient research to prove the relationship between the two. Existing research shows:

- 39 名参与者出现 8 次腘绳肌拉伤,3D运动分析显示:
- 39 participants, 8 hamstring strains, 3D motion analysis showed:

- 后摆时骨盆倾斜度更大(约 10 度)
- Greater pelvic tilt in backswing (approximately 10 degrees)

- 前摆时胸椎腰椎弯曲更多(约 8 度)
- The thoracic and lumbar spine bend more when swinging forward (about 8 degrees)

-有一种观点认为,跑步技术与未来的腘绳肌拉伤有关
-There is a belief that running technique is related to future hamstring strains

研究显示,发生腘绳肌拉伤的运动员与对照组的运动学差异很小(在没有三维运动捕捉的情况下无法区分
Studies have shown that the kinematic differences between athletes with hamstring strains and controls are minimal (indistinguishable without 3D motion capture).

- 除此之外,在涉及到腘绳肌拉伤时,对于什么是 "好的 "和 "坏的 "机制,还没有达成共识
- Beyond that, there's no consensus on what are the "good" and "bad" mechanisms when it comes to hamstring strains.

- 改变 "坏 "力学需要多少时间,是否会延续到训练/比赛中也没有明确结论。
- No clear conclusion on how long it will take to change the "bad" mechanics and whether this will carry over into training/matches.

代替3D运动捕捉系统分析跑步技术和动力学特征的两个设备:
Two devices that analyze running technique and kinetic characteristics in place of the 3D motion capture system:

Human trak和Oro muscle,可能起到如下作用:
Human trak and Oro muscle may play the following roles:

区分腘绳肌拉伤运动员和对照组的运动学差异,包括在多个平面内分析下肢运动偏移情况和跑步时分析下肢肌电激活情况(跑步机或者跑道上进行健侧患侧对比,或用于最大速度跑测试)。
Distinguish kinematic differences between athletes with hamstring strains and controls, including analysis of lower extremity motion excursions in multiple planes and analysis of lower extremity electromyographic activation during running (contrast the healthy side to the affected side on a treadmill or track, or For maximum speed running test).

通过运动学研究,找出健侧运动模式和患侧运动模式,或者受伤前后运动模式和肌肉激活模式的差异(使用Human trak进行功能测试)
Through kinematic studies, find out the difference between the movement pattern of the healthy side and the affected side, or the difference in movement pattern and muscle activation pattern before and after injury (use Human trak for functional testing)

通过评估-训练-再评估的模式纠正差异
Correct discrepancies through the assessment-train-reassessment model

- 考虑到不同速度对于腘绳肌肌肉-肌腱单位激活不同,进行最大速度跑训练可能是更合理的方法
- Considering that different speeds activate the hamstring muscle-tendon unit differently, maximal speed running training may be a more reasonable approach

最大速度跑训练的监控——Smartspeed
Monitoring of maximum speed running training - Smartspeed

E.跑步速度与腘绳肌拉伤之间的关系
E. What is the relationship between running speed and hamstring strain?

- 研究指出,从最大跑步速度的 80% 增加到 100% 时,腘绳肌肌肉肌腱单位MTU长度基本不变
- Research shows that when increasing from 80% to 100% of maximum running speed, the length of the hamstring muscle tendon unit (MTU) remains basically unchanged

- 腘绳肌肌肉肌腱单元力量输出接近线性关系即速度越快,力量输出越大
- The force output of the hamstring muscle tendon unit is close to a linear relationship, that is, the faster the speed, the greater the force output

- 从最大速度的 95% 到 100%,腘绳肌 MTU做功增加很大
- Hamstring MTU work increases significantly from 95% to 100% of maximum speed

- 突出了进行最大速度训练的重要性
- Highlights the importance of maximal speed training

腘绳肌拉伤逐渐恢复跑步训练示意图:
Schematic diagram of gradually returning to running training after hamstring strain:

在进行最大速度训练和使用站点进行跑步训练时都可以应用Smartspeed,在这方面体能教练更加专业,这里试着抛砖引玉:
Smartspeed can be applied when performing maximum speed training and using stations for running training. In this regard, physical coaches are more professional. Here is a suggestion:

图中展示了一种利用锥桶进行跑步训练的方法,图中的锥桶可以使用Smartspeed 代替。
The picture shows a method of using a cone barrel for running training. The cone barrel in the picture can be replaced by Smartspeed.

进行最大速度训练处于腘绳肌RTP训练的第三阶段,训练中进行40m最大速度冲刺跑。
Maximum speed training is in the third stage of hamstring RTP training, and 40m maximum speed sprinting is performed during training.

通过测试或者运动员受伤前历史数据,确定运动员最大冲刺速度
Determine the athlete's maximum sprint speed through testing or historical data before the athlete's injury

在起点处,40米处、80米处和100米终点处放置smartspeed光门(或者仅在40米处和80米处放置光门)
Place smartspeed light gates at the starting point, 40 meters, 80 meters and 100 meters end (or only place light gates at 40 meters and 80 meters)

运动员从起点出发,逐渐加速,在40米处达到最大冲刺速度,在80米处冲刺结束,缓冲减速到100米处停下。Smartspeed会自动记录40-80米处最大冲刺速度。通过该速度与测试速度或历史速度对比,可以监控运动员本次最大速度训练质量。
The athlete starts from the starting point, gradually accelerates, reaches the maximum sprint speed at 40 meters, ends at 80 meters, and slows down to a stop at 100 meters. Smartspeed will automatically record the maximum sprint speed at 40-80 meters. By comparing this speed with the test speed or historical speed, the quality of the athlete's maximum speed training can be monitored.

F.过去的损伤
F.Past injury

以前受过伤被认为是不可改变的风险因素
Previous injury considered an immutable risk factor

- 部分正确(你无法改变过去),但过去损伤可能导致对于可改变因素的不良适应
- Partly true (you can't change the past), but past damage can lead to maladaptations to modifiable factors

典型的不良适应:肌肉长度缩短,并在较短的肌肉长度出现峰力矩
Typical maladaptation: shortened muscle length and peak torque at shorter muscle length

肌肉长度测试:肌骨超声
Muscle Length Test: Musculoskeletal Ultrasound

肌肉激活程度测试:Oromuscle
Muscle activation test: Oromuscle

肌肉最大力量角度测试和峰力矩测试:等速,Dynamo
Muscle Maximum Strength Angle Test and Peak Torque Test: Isokinetic, Dynamo

肌肉最大力量角度和峰力矩测试的金标准就是等速测试。最大力量角度即峰力矩出现角度。
The gold standard for testing muscle maximum force angle and peak torque is the isokinetic test. The maximum force angle is the angle at which peak torque occurs.

在不具备等速条件时或户外情况下,使用便携式测力设备能够一定程度上替代等速测试作用。一般测试屈膝90度和0度位膝关节屈曲最大等长力量。
When constant velocity conditions are not available or in outdoor situations, the use of portable force measuring equipment can replace the isokinetic test to a certain extent. Generally, the maximum isometric strength of knee joint flexion at 90 degrees and 0 degrees of knee flexion is tested.

下肢RFD测试:Forcedeck
Lower limb RFD testing: Forcedeck

- 康复训练是将后续影响降至最低的关键时刻
- Rehabilitation is a critical time to minimize subsequent effects

- 从长远来看,过于谨慎的康复方法可能是有害的
- An overly cautious approach to recovery can be harmful in the long run

Opar-how to collect and interpret nordbord data(practical)

Opar-如何收集并解读nordbord数据(实践)
Opar-How to collect and interpret nordbord data (practical)

Day 2

Opar-Strategies to accelerate hamstring string injury rehabilitation(theory)

Opar-加速腘绳肌拉伤康复的策略(理论)
Opar - Strategies to Accelerate Recovery from Hamstring Strain (Theory)

RTP过程的难题:
Difficulties with the RTP process:

有腘绳肌拉伤史的运动员与未受伤的运动员相比,其肌肉在离心收缩过程中,受伤肢体和未受伤肢体的肌肉激活程度不同。相比控制组(未损伤组),股二头肌长头肌肉长度较短时激活程度较高,股二头肌长头肌肉长度拉长时肌肉激活程度较低
Athletes with a history of hamstring strain have different levels of muscle activation in the injured limb compared to uninjured athletes during eccentric contractions. Compared with the control group (uninjured group), the degree of muscle activation is higher when the length of the long head of the biceps femoris muscle is shorter, and the degree of muscle activation is lower when the length of the long head of the biceps femoris muscle is lengthened.

出处:先前受过拉伤的下肢的肌肉活动和激活:系统回顾Muscle activity and activation in previously strain-injured lower limbs: a systematic review
Source: Muscle activity and activation in previously strain-injured lower limbs: a systematic review

关于股二头肌长度和肌肉激活之间的关系,等速测试结果最直观。也可以使用Oro muscle等表面肌电测试测量不同活动度下的肌肉激活
Regarding the relationship between biceps femoris length and muscle activation, the isokinetic test results are the most intuitive. You can also use surface electromyography tests such as Oro muscle to measure muscle activation at different levels of activity.

也可以使用Dynamo在腘绳肌拉长位和缩短位进行测试
You can also use Dynamo to test your hamstrings in the lengthened and shortened position.

-受伤后的股二头肌有可能在肌肉长度较短时被更多地使用,因此股二头肌的 "过度激活 "似乎是腘二头肌受伤之后的特征→这可能与未来腘绳肌拉伤的风险有关
-It is possible that the biceps femoris is used more when the muscle is shorter in length after injury, so "hyperactivation" of the biceps femoris appears to be a characteristic of the biceps femoris after injury → this may be related to future hamstring risk of strain

-另一种假设是,腘绳肌拉伤股二头肌的 "舒适 "范围转移到较短的长度 → 在刺激中推动腘二头肌受伤后的适应 → 股二头肌长度下降后续股二头肌受伤风险增加
-An alternative hypothesis is that a hamstring strain shifts the "comfort" range of the biceps femoris to a shorter length → driving post-hamstring biceps injury adaptation during stimulation → decrease in biceps femoris length → follow-up Increased risk of biceps femoris injury.

B.腘绳肌拉伤加速RTP框架
B. Hamstring strain accelerated RTP framework

保守策略:根据康复阶段,在无痛情况下逐渐进阶无痛等长训练、中等长度的向心/离心训练,长肌肉长度下的向心和离心训练,最后阶段进阶到纯离心训练
Conservative strategy: According to the recovery stage, gradually advance to pain-free isometric training, medium-length concentric/eccentric training, concentric and eccentric training at long muscle length, and finally advance to pure eccentric training

加速RTP策略:
Accelerate RTP strategy:

在第一次康复课程中就加入中等长度的向心/离心训练,长肌肉长度下的向心和离心训练,最后阶段进阶到纯离心训练
In the first rehabilitation session, add concentric/eccentric training of medium length, concentric and eccentric training at long muscle length, and advance to pure eccentric training in the final stage.

出处:Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial

急性腘绳肌拉伤后无痛康复策略和疼痛阈值康复策略的对比——一项随机对照实验
Comparison of pain-free and pain-threshold rehabilitation strategies after acute hamstring strain—a randomized controlled trial

与保守腘绳肌拉伤RTP相比,加速RTP策略的特点是在康复早期就加入肌肉缩短状态、拉长状态的向心训练和离心训练,
Compared with conservative hamstring strain RTP, the accelerated RTP strategy is characterized by adding concentric training and eccentric training in muscle shortening and lengthening states in the early stage of recovery.

Hicky的随机对照实验应用了加速RTP训练框架,对比了无痛训练和控制疼痛阈值训练两种情况下腘绳肌拉伤RTP效果。
Hicky's randomized controlled trial applied an accelerated RTP training framework to compare the RTP effects of hamstring strain under two conditions: pain-free training and controlled pain threshold training.

传统框架下从腘绳肌拉伤到满足RTP条件平均超过21天
It takes an average of more than 21 days from hamstring strain to meeting RTP conditions under the traditional framework

加速RTP框架从腘绳肌拉伤2-5天后介入康复,无痛训练组平均15天达到RTP标准,疼痛阈值训练组平均17天达到 RTP标准。
The accelerated RTP framework intervenes in rehabilitation 2-5 days after hamstring strain. The pain-free training group reaches the RTP standard in an average of 15 days, and the pain threshold training group reaches the RTP standard in an average of 17 days.

与急性腘绳肌拉伤后遵守无痛限制相比,执行和推进标准化康复方案直至达到疼痛阈值虽然不会加速RTP。然而,疼痛阈值康复不会引起任何不良事件,并且可以更好地恢复等长腘绳肌,并更好地维持股二头肌外侧头肌束长度的改善。因此,腘绳肌拉伤康复期间避免疼痛的常规临床实践可能没有必要。
Implementing and advancing a standardized rehabilitation protocol until pain threshold is reached does not accelerate RTP compared with adhering to pain-free restrictions after an acute hamstring strain. However, pain threshold rehabilitation did not cause any adverse events and resulted in better isometric hamstring recovery and better maintenance of improvements in biceps femoris lateral head fasciculus length. Therefore, routine clinical practice of avoiding pain during hamstring strain rehabilitation may not be necessary.

重返赛场可否用此数据建立指标体系?
Can this data be used to establish an indicator system for returning to competition?

个人觉得这个问题可以拿来问David,但感觉应该不能够建立有效的重返赛场指标体系。因为研究是基于澳洲精英足球运动员(soccer)的腘绳肌数据,目前还没有针对其他国家和专项的此类研究。
Personally, I think this question can be asked to David, but I feel that it should not be possible to establish an effective return-to-play indicator system. Because the study is based on hamstring data from elite Australian soccer players, there are currently no such studies in other countries and specialties.

无痛加速RTP组和疼痛阈值RTP组同时在训练后表现出了腘绳肌力量和股二头肌肌束长度的改善,
The painless accelerated RTP group and the pain threshold RTP group also showed improvements in hamstring strength and biceps femoris muscle fascicle length after training.

出处:Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial

急性腘绳肌拉伤后无痛康复策略和疼痛阈值康复策略的对比——一项随机对照实验
Comparison of pain-free and pain-threshold rehabilitation strategies after acute hamstring strain—a randomized controlled trial

整合Desmotec设备和慧练设备:在腘绳肌拉伤加速框架中,强调当运动员活动疼痛在可控范围内(小于4分疼痛),应尽早加入不同肌肉长度的力量练习和离心练习。训练演示阶段,在有训练设备的条件下,可以对训练路径中的训练形式做一定修改。如臀冲训练可以在固定器械慧练-臀推机下进行,可以降低训练稳定性需求,(我们的慧练臀推机属于固定器械,运动员在机器上面只需要关注矢状面髋屈伸的活动,相比单腿臀桥或凳上臀推训练,还要额外考虑骨盆稳定等因素)更关注伸髋肌群发力。仰卧位腘绳肌滑动训练可以改为使用Desmotec,俯卧位进行腘绳肌离心训练。
Integration of Desmotec equipment and smart training equipment: In the hamstring strain acceleration framework, it is emphasized that when the athlete’s activity pain is within a controllable range (less than 4 points of pain), strength exercises and eccentric exercises of different muscle lengths should be added as early as possible. During the training demonstration phase, certain modifications can be made to the training format in the training path if training equipment is available. For example, hip thrust training can be performed with a fixed device, the Huilian Hip Thrust Machine, which can reduce training stability requirements. (Our Huilian Hip Thrust Machine is a fixed device. Athletes only need to focus on the sagittal plane hip flexion and extension activities on the machine. , compared with single-leg glute bridge or bench hip thrust training, additional factors such as pelvic stability must be considered) and more attention is paid to the hip extensor muscles. The hamstring slide training in the supine position can be changed to using the Desmotec, and the hamstrings can be performed eccentrically in the prone position.

腘绳肌拉伤:目前的证据综合:
Hamstring strains: current evidence synthesis:

腘绳肌拉伤机制:
Hamstring strain mechanism:

HSI 是在重复性的微观肌肉损伤累积后发生的,还是对超过肌肉肌腱单位极限的单个异常事件的反应,是有争议的。一些 HSI 可能是由于重复性损伤导致组织完整性持续下降所致,使运动员容易受到无害的刺激事件(例如,次最大速度跑步)的影响。在其他情况下,HSI 可能是由单一的巨大创伤事件(即强力且快速的髋关节屈曲)引起的,与潜在组织的完整性无关。无论哪种方式,HSI 机制可能涉及 (1) 高肌肉肌腱单位力(主动或被动),(2) 肌肉肌腱单位延长超过中等长度,以及 (3) 高速运动。这 3 个因素是否都是腘绳肌拉伤的必要因素,目前尚不清楚。尽管如此,在制定 HSI 预防和康复计划时,从业者应该首先考虑这些原因。
Whether HSI occurs following the accumulation of repetitive microscopic muscle injuries or is a response to a single abnormal event that exceeds the limits of the musculotendinous unit is controversial. Some HSIs may result from repetitive injury that results in a sustained decrease in tissue integrity, leaving the athlete vulnerable to innocuous stimulus events (e.g., running at submaximal speeds). In other cases, HSI may be caused by a single massive traumatic event (i.e., forceful and rapid hip flexion) independent of the integrity of the underlying tissue. Either way, HSI mechanisms may involve (1) high musculotendinous unit forces (active or passive), (2) musculotendinous unit prolongation beyond moderate lengths, and (3) high-velocity movements. It is unclear whether all 3 factors are necessary for a hamstring strain. Nonetheless, practitioners should consider these reasons first when developing HSI prevention and recovery plans.

在体育运动中,HSI 最常见的机制是高速跑步,其次是涉及强力和广泛的腘绳肌延长的运动,例如踢腿。高速跑步期间,摆动末期阶段被认为是最可能受伤的阶段。在摆动的后半段,腘绳肌活跃,迅速拉长,吸收能量,使肢体减速,为脚接触做好准备。当跑步速度从最大速度的 80% 增加到 100% 时,腘绳肌力量增加约 1.3 倍,并且股二头肌长头产生最大的肌肉肌腱单位拉伸。这些发现可以解释为什么股二头肌长头是最容易受伤的腘绳肌肌肉,且通常在高速跑步时受伤。
In sports, the most common mechanism of HSI is high-speed running, followed by sports involving strong and extensive hamstring lengthening, such as kicking. During high-speed running, the end-swing phase is considered the most likely to cause injury. During the second half of the swing, the hamstrings are active and rapidly lengthen, absorbing energy and slowing the limb in preparation for foot contact. When running speed increases from 80% to 100% of maximum speed, hamstring strength increases approximately 1.3-fold and the long head of the biceps femoris produces the greatest stretch of the musculotendinous unit. These findings may explain why the long head of the biceps femoris is the most injured hamstring muscle and is often injured while running at high speeds.

动物模型已被用来尝试和确定腘绳肌拉伤的一般机制,表明离心收缩或过度伸展导致的肌肉拉伤是腘绳肌拉伤的主要机制。已经描述了由损伤机制定义的两种特定的腿筋损伤类型:=拉伸型和冲刺型。
Animal models have been used to try and determine the general mechanisms of hamstring strains, suggesting that muscle strain due to eccentric contraction or hyperextension is the primary mechanism of hamstring strains. Two specific hamstring injury types defined by the mechanism of injury have been described: = stretch-type and sprint-type.

拉伸型腘绳肌损伤发生在涉及极度髋部屈曲和膝部伸展的运动(例如踢腿和舞蹈动作)中,而冲刺型损伤发生在最大速度或接近最大速度跑步动作期间。
Stretch-type hamstring injuries occur during movements that involve extreme hip flexion and knee extension, such as kicks and dance moves, while sprint-type injuries occur during running movements at or near maximum speed.

这两种机制都会导致拉伤;然而,拉伸型似乎发生在肌肉拉长时,而冲刺型可能发生在肌肉的正常工作范围内。
Both mechanisms can cause strains; however, the stretch type appears to occur when the muscle lengthens, while the sprint type may occur within the muscle's normal working range.

出处:腘绳肌拉伤:关于诊断、康复和损伤预防的建议-Heiderscheit B C, Sherry M A, Silder A, et al. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention[J]. journal of orthopaedic & sports physical therapy, 2010, 40(2): 67-81.

磁共振成像显示,拉伸型腘绳肌损伤被证明主要影响半膜肌。相比之下,冲刺型腿筋损伤主要涉及股二头肌长头(BFlh),且与远端区域相比,近端区域受累程度更大。肌腱连接处(腱膜和邻近的肌纤维)是最常见的损伤部位 。
Stretch-type hamstring injuries were shown to primarily affect the semimembranosus on magnetic resonance imaging. In contrast, sprint hamstring injuries primarily involve the long head of the biceps femoris (BFlh), with the proximal region being more involved than the distal region. The myotendinous junction (aponeurosis and adjacent muscle fibers) is the most common site of injury.

腘绳肌急性损伤相关研究:Askling, C.; Saartok, T.; Thorstensson, A. Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Br. J. Sports Med. 2006

Koulouris, G.; Connell, D. Evaluation of the hamstring muscle complex following acute injury. Skelet. Radiol. 2003

高速跑步时的髋部、膝部和腘绳肌力学
Hip, knee, and hamstring mechanics during high-speed running

大多数腘绳肌拉伤发生在最大速度或接近最大努力跑步期间,在探究其中损伤机制之前,应该描述跑步周期。
Most hamstring strains occur during maximal speed or near maximal effort running, and before exploring the mechanism of injury, the running cycle should be described.

一个完整的跑步周期包括两个主要阶段:站立阶段(脚与地面接触)和摆动阶段(脚不与地面接触)。这两个主要阶段可以进一步分为子阶段:支撑早期(制动)、支撑晚期(推进)、摆动早期和中期(恢复)和晚期摆动(预激活)。
A complete running cycle consists of two main phases: the stance phase (feet in contact with the ground) and the swing phase (feet not in contact with the ground). These two main phases can be further divided into sub-phases: early support (braking), late support (propulsion), early and mid swing (recovery), and late swing (preactivation).

全面描述了高速跑步时髋部、膝部和腘绳肌的力学,表明支撑阶段总关节扭矩主要来自肌肉扭矩(肌肉收缩产生)和外力(地面反作用力产生)。另一方面,在摆动阶段,总关节扭矩主要来自肌肉扭矩和运动相关扭矩(由节段的机械相互作用产生)。在支撑早期阶段,髋部由伸肌主导,并在支撑阶段的后半段转变为屈曲力矩。髋部在摆动阶段的前半段表现出较大的屈曲力矩,而膝盖则产生较小的伸展力矩。在摆动阶段的后半段,髋部表现出较大的伸展力矩,而膝部产生较小的屈曲力矩。此外,在整个高速跑步动作中,腘绳肌会经历拉伸-缩短循环(SSC)。股二头肌在摆动阶段的第一部分随着屈膝和髋关节从伸展到屈曲而缩短 。随后,随着髋部继续弯曲,同时膝关节在整个摆动期的后半段伸展,股二头肌会迅速延长。接下来,随着伸髋和屈膝,股二头肌开始缩短,为足部着地做准备。在整个支撑阶段,髋关节持续伸展,膝关节在支撑阶段的前半部分屈曲,后半部分伸展。虽然大多数研究表明股二头肌在整个支撑阶段都会缩短,但两项研究报告了在支撑末期腘绳肌延长。因此,股二头肌的长度变化可能取决于个体运动员表现出的髋部和膝部伸展程度。事实上,具体的运动模式会受到运动员的解剖变异性和特定的冲刺力学的影响。
A comprehensive description of hip, knee, and hamstring mechanics during high-speed running shows that total joint torque during the stance phase comes primarily from muscle torque (generated by muscle contraction) and external forces (generated by ground reaction forces). On the other hand, during the swing phase, the total joint torque comes mainly from muscle torque and movement-related torque (generated by the mechanical interaction of the segments). During the early phase of stance, the hip is dominated by the extensor muscles, which transition to a flexion moment during the second half of the stance phase. The hip exhibits a larger flexion moment during the first half of the swing phase, while the knee generates a smaller extension moment. During the second half of the swing phase, the hip exhibits a larger extension moment, while the knee produces a smaller flexion moment. Additionally, the hamstrings undergo stretch-shortening cycles (SSC) throughout high-speed running movements. The biceps femoris shortens during the first part of the swing phase as the knee and hip joint move from extension to flexion. The biceps femoris then rapidly lengthens as the hip continues to flex and the knee extends throughout the second half of the swing. Next, as you extend your hips and flex your knees, your biceps femoris begins to shorten in preparation for your foot to strike the ground. The hip joint continues to extend throughout the stance phase, and the knee joint flexes during the first half of the stance phase and extends during the second half. Although most studies showed that the biceps femoris shortened throughout the stance phase, two studies reported hamstring lengthening at the end of stance. Therefore, biceps femoris length changes may depend on the degree of hip and knee extension exhibited by the individual athlete. In fact, specific movement patterns are affected by the athlete's anatomical variability and specific sprint mechanics.

短跑中的肌肉活动-系统综述-Howard RM, Conway R, Harrison AJ. Muscle activity in sprinting: a review. Sports Biomech.

有研究指出,最常出现腘绳肌拉伤的跑步周期阶段是摆动末期和支撑早期。
Studies have shown that the phases of the running cycle where hamstring strains are most common are at the end of the swing and early in the stance.

在摆动末期和支撑早期,膝关节和髋关节处的大被动扭矩起到了拉长腘绳肌的作用。这两个阶段的膝关节屈曲肌肉扭矩和髋关节伸展肌肉扭矩值相当可观。在支撑初始阶段和摆动末期,主要由腘绳肌产生的主动肌肉扭矩抵消了腿部惯性(摆动期)和外部地面反作用力(支撑期)产生的被动效应。虽然不同的原因导致这两个阶段腘绳肌的高负荷,但我们可以将这两个阶段视为1个时期,即摆动-支撑过渡期,因为下肢的运动是连续的,腘绳肌的功能是在整个阶段中伸展髋部并弯曲膝盖。因此,在短跑或高速运动过程中,与短跑的任何其他阶段相比,在摆动-支撑转换期间,腿筋肌肉可能更容易受到拉伤。
The large passive torques at the knee and hip joints during late swing and early stance act to lengthen the hamstrings. The values ​​of knee flexion muscle torque and hip extension muscle torque in these two phases are considerable. During the initial phase of stance and the end of swing, the active muscle torque produced primarily by the hamstrings offsets the passive effects produced by leg inertia (swing phase) and external ground reaction forces (support phase). Although different reasons lead to high load on the hamstring muscles in these two stages, we can regard these two stages as one period, that is, the swing-support transition period, because the movement of the lower limbs is continuous and the function of the hamstring muscles is to extend the hips and bend the knees throughout the entire phase. Therefore, during sprinting or high-velocity movements, the hamstring muscles may be more susceptible to strain during the swing-to-branch transition than during any other phase of sprinting.

Liu, Y.; Sun, Y.; Zhu, W.; Yu, J. The late swing and early stance of sprinting are most hazardous for hamstring injuries. J. Sport Health Sci. 2017

大多数研究人员认为,摆动末期阶段可能是跑步周期中腘绳肌最容易受伤的点。在冲刺期间,最大肌电图(EMG)活动发生在摆动末期。Schache 等人确定了最大冲刺跑摆动末期阶段期间股二头肌、半腱肌和半膜肌的峰值肌肉肌腱应变、峰值肌肉肌腱力以及负功的发生。更具体地说,股二头肌显示最大的峰值肌肉肌腱应变(从支撑阶段位置长度增加 12.0%),半腱肌显示最大的肌肉肌腱延长速度,半膜肌产生最高的肌肉肌腱力,吸收并产生最多的肌肉-肌腱力量并执行最大量的正负功。此外,东原等人发现,在地面冲刺的摆动末期,峰值肌肉肌腱拉伸与股二头肌的峰值肌电图激活同步。随着跑步速度从 80% 增加到 100%,摆动末期的股二头肌活动平均增加 67%,而半腱肌和半膜肌仅增加 37%。
Most researchers agree that the late swing phase may be the point in the running cycle where the hamstrings are most susceptible to injury. During sprinting, maximum electromyography (EMG) activity occurs at the end of the swing. Schache et al determined the occurrence of peak musculotendinous strain, peak musculotendinous force, and negative work in the biceps femoris, semitendinosus, and semimembranosus muscles during the terminal phase of the maximal sprint swing. More specifically, the biceps femoris showed the greatest peak musculotendinous strain (12.0% increase in length from the stance position), the semitendinosus showed the greatest musculotendinous lengthening velocity, and the semimembranosus produced the highest musculotendinous force, absorbing and Generates the greatest amount of muscle-tendon force and performs the greatest amount of positive and negative work. Furthermore, Higashihara et al. found that peak muscle tendon stretch was synchronized with peak EMG activation of the biceps femoris during the late swing phase of ground sprinting. As running speed increased from 80% to 100%, biceps femoris activity increased by an average of 67% at the end of the swing, whereas semitendinosus and semimembranosus increased by only 37%.

据推测,最大跑步速度下对股二头肌的需求不成比例的增加也可能导致其在高速跑步过程中比其他腘绳肌肌肉更容易受伤。
It is hypothesized that the disproportionately increased demands on the biceps femoris at maximum running speeds may also render it more susceptible to injury than other hamstring muscles during high-speed running.

之前的腘绳肌拉伤对肌肉力量、柔韧性和跑步生物力学机制的影响:
Effects of previous hamstring strain on muscle strength, flexibility, and running biomechanics:

Silder, A.; Thelen, D.G.; Heiderscheit, B.C. Effects of prior hamstring strain injury on strength, flexibility, and running mechanics. Clin. Biomech. 2010
Silder, A.; Thelen, D. G.; Heiderscheit, B.C. Effects of prior hamstring strain injury on strength, flexibility, and running mechanics. Clin. Biomech. 2010

HSI的诊断
Diagnosis of HSI

当运动员因 HSI 的常见机制而出现急性发作的大腿后部疼痛时,临床检查更多的是关于康复需求或 RTS 预后,而不是诊断。 因非 HSI 典型机制或慢性发作而出现大腿后痛的运动员需要进行鉴别诊断,以确认或排除其他病理的存在(近端腘绳肌腱撕裂/近端腘绳肌腱病/腰椎放射痛/ 内收肌拉伤)。运动员 HSI 初步临床检查的重要特征有:
When an athlete presents with acute onset of hamstring pain due to a common mechanism of HSI, the clinical examination is more about rehabilitation needs or RTS prognosis than diagnosis.   Athletes who experience posterior thigh pain due to mechanisms not typical of HSI or chronic onset require a differential diagnosis to confirm or exclude the presence of other pathology (proximal hamstring tendon tear/proximal hamstring tendinopathy / radiating pain in the lumbar spine / adductor muscle strain). Important features of the initial clinical examination of HSI in athletes are:

主观病史
subjective medical history

根据集体临床经验,怀疑患有 HSI 的运动员通常会报告大腿后部突然疼痛,有时伴有声音或感觉上的爆裂声,导致活动立即停止。应要求运动员对疑似 HSI 时的疼痛进行评分,这与 RTS 预后相关 ,并且可用作在整个康复过程中监测症状时的参考点。在此事件发生之前记录运动员受伤的完整病史非常重要,因为之前的 HSI 会使未来发生 HSI 的风险增加 2.7 倍 ,并且 RTS 后几周内该部位复发很常见。还应注意其他部位同时或既往受伤的情况,特别是下背部、臀部或腹股沟和膝盖,因为这些发现可能会改变临床检查或康复方案。
Based on collective clinical experience, athletes with suspected HSI typically report sudden pain in the hamstring, sometimes accompanied by an audible or sensory popping sound, resulting in immediate cessation of activity. Athletes should be asked to rate their pain at the time of suspected HSI, which correlates   with RTS prognosis and can be used as a reference point when monitoring symptoms throughout recovery. It is important to take a complete history of the athlete's injury before this event occurs because prior HSI increases the risk of future HSI by 2.7 times   and recurrence of this site within weeks after RTS is common. Attention should also be paid to concurrent or previous injuries to other areas, particularly the lower back, hips or groin, and knees, as these findings may alter the clinical examination or rehabilitation protocol.

触诊受伤部位
Palpate the injured area

当运动员俯卧并且膝盖完全伸展时,医生可以触诊大腿后部以评估肌肉肌腱单元的缺陷,并通过确定最大疼痛激发点来确定可能的损伤部位。在整个康复过程中,应测量和监测从坐骨结节到触诊最大疼痛激发部位的距离以及可触痛的总长度。靠近坐骨结节或总长度较长的可触及疼痛与 HSI 康复持续时间的增加有一定关系。Whiteley R, van Dyk N, Wangensteen A, Hansen C. Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression. Br J Sports Med. 2018
With the athlete prone and with the knee fully extended, the physician can palpate the posterior thigh to assess for deficiencies in the musculotendinous unit and identify possible injury sites by identifying the point of maximum pain provocation. The distance from the ischial tubercle to the site of greatest palpation of the pain elicitor and the total length of palpable pain should be measured and monitored throughout the rehabilitation process. Palpable pain closer to the ischial tuberosity or greater in total length is associated with increased duration of HSI recovery. Whiteley R, van Dyk N, Wangensteen A, Hansen C. Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression. Br J Sports Med. 2018

运动范围测试
range of motion test

在临床检查过程中应评估髋关节屈曲和膝关节伸展运动范围(ROM),以确定腘绳肌的灵活性和对肌肉延长的耐受性。根据我们的经验,疼痛可能会限制对实际肌肉肌腱单位伸展性的准确评估,但与对侧未受伤肢体的 ROM 比较仍然可以提供 HSI 严重程度的指示。膝关节活动度的双侧对比差异和主动膝关节伸展测试期间的疼痛是提供 RTS 预后和整个 HSI 康复过程中跑步强度进展的有用指标。主动膝关节伸展测试可以在髋部弯曲至 90° 或每位运动员可能的最大弯曲角度的情况下进行
Hip flexion and knee extension range of motion (ROM) should be assessed during the clinical examination to determine hamstring flexibility and tolerance to muscle lengthening. In our experience, pain may limit accurate assessment of actual musculotendinous unit extensibility, but comparison with ROM of the contralateral uninjured limb can still provide an indication of HSI severity. Bilateral contrast differences in knee range of motion and pain during active knee extension testing are useful indicators of prognosis for RTS and progression of running intensity throughout HSI rehabilitation. The active knee extension test can be performed with the hip flexed to 90° or the maximum flexion angle possible for each athlete.

髋屈肌柔韧性和踝背屈活动度的评估也可能是必要的,因为这些措施与 HSI 风险存在一定关联。 在一项针对澳大利亚规则足球运动员的前瞻性研究中,在改良托马斯测试中,髋部屈曲每增加 1°,HSI 风险就会增加 15%。  Gabbe BJ, Bennell KL, Finch CF. Why are older Australian football players at greater risk of hamstring injury? J Sci Med Sport. 2006
Assessment of hip flexor flexibility and ankle dorsiflexion range of motion may also be necessary, as these measures have been associated with HSI risk.   In a prospective study of Australian rules football players, each 1° increase in hip flexion on the modified Thomas test was associated with a 15% increased risk of HSI. Gabbe BJ, Bennell KL, Finch CF. Why are older Australian football players at greater risk of hamstring injury? J Sci Med Sport. 2006

van Dyk 等人报告的平均背屈弓步测试距离发生 HSI 的足球运动员的平均背屈弓步测试距离 (9.8 ± 3.1 cm) 比未受伤的足球运动员 (11.2 ± 3.1 cm) 短。
The mean dorsiflexion lunge test distance reported by van Dyk et al was shorter in football players who developed HSI (9.8 ± 3.1 cm) than in uninjured football players (11.2 ± 3.1 cm).

van Dyk N, Farooq A, Bahr R, Witvrouw E. Hamstring and ankle flexibility deficits are weak risk factors for hamstring injury in professional soccer players: a prospective cohort study of 438 players including 78 injuries. Am J Sports Med. 2018

然而,从业者必须意识到,这些团体层面的指标在个人层面预测 HSI 的能力有限。
However, practitioners must be aware that these group-level indicators have limited ability to predict HSI at the individual level.

力量测试
strength test

通常在初次临床检查时在等长收缩期间评估腘绳肌力量,并且从业者应要求运动员在这些测试期间使用数字评分量表(范围 = 0-10)对疼痛进行评分。如果练习者能够使用手持式测力计、  称重传感器、或测力台等设备,则可以客观地测量力量。 无法使用此类设备的从业者可以考虑使用手动肌肉测试来主观表征力量,但我们鼓励探索相对便宜的替代品,例如可以客观测量力量的吊秤。
Hamstring strength is typically assessed during isometric contractions during the initial clinical examination, and practitioners should ask athletes to rate pain during these tests using a numeric rating scale (range = 0-10). If the practitioner has access to a device such as a handheld dynamometer,   load cell, or force plate, force can be measured objectively. Practitioners who do not have access to such equipment may consider using manual muscle testing to subjectively characterize strength, but we encourage exploration of relatively inexpensive alternatives such as hanging scales that can objectively measure strength.

鉴于腘绳肌的双关节性质,应在运动员俯卧和仰卧的情况下测试膝关节屈曲和髋部伸展力量,理想情况下腘绳肌处于拉长位置, 这对于 RTS 来说最有用预后位置 胫骨的内旋和外旋可以添加到膝关节屈曲力量测试中,以分别区分内侧和外侧腘绳肌拉伤。髋部伸展力量可以在膝盖弯曲的情况下进行评估,以确定在康复过程中需要加强的除腘绳肌以外的肌肉,例如臀大肌。练习者还可以考虑根据运动员的受伤史测试不涉及腘绳肌肌肉力量(例如,髋部和腹股沟疼痛的患者的髋部内收),这可以为康复期间的运动选择提供信息
Due to the biarticular nature of the hamstrings, knee flexion and hip extension strength should be tested with the athlete prone and supine, ideally in a lengthened position   This is important for RTS It is said to be the most useful prognostic position.   Internal and external rotation of the tibia can be added to the knee flexion strength test to differentiate between medial and lateral hamstring strains, respectively. Hip extension strength can be assessed with the knee flexed to identify muscles other than the hamstrings, such as the gluteus maximus, that need strengthening during rehabilitation. Practitioners may also consider testing muscle strength that does not involve the hamstrings based on the athlete's injury history (e.g., hip adduction in patients with hip and groin pain), which can inform exercise selection during rehabilitation.

除了所提到的主观和身体临床检查之外,磁共振成像 (MRI) 还可用于通过确定组织损伤的位置和程度来确认 HSI 诊断。几种基于 MRI 的肌肉损伤分类和分级系统已被提出并应用于 HSI 以提供 RTS 预后。当 MRI 扫描显示与无损伤相比有组织损伤的迹象,或者与完整的近端肌腱相比,近端肌腱被破坏时,可能会出现 HSI 后延长的 RTS。然而,根据 MRI 结果对 HSI 进行进一步详细的分类或分级,除了常规临床检查之外,其预后价值似乎可以忽略不计。
In addition to the subjective and physical clinical examination mentioned, magnetic resonance imaging (MRI) can be used to confirm the HSI diagnosis by determining the location and extent of tissue damage. Several MRI-based muscle injury classification and grading systems have been proposed and applied in HSI to provide RTS prognosis. Prolonged RTS after HSI may occur when MRI scans show signs of tissue damage compared with no damage, or when the proximal tendon is disrupted compared with intact proximal tendon. However, further detailed classification or grading of HSI based on MRI findings, beyond routine clinical examination, appears to have negligible prognostic value.

一项新的建议是,当 MRI 显示肌内肌腱受损时,HSI 康复应该更加保守,最初是基于对延长 RTS 的回顾性观察以及该诊断的更高复发率。 最近的前瞻性工作表明,当通过 MRI 诊断进行康复治疗时,所有类型的 HSI 的复发率都可以保持在同样低的水平,但肌内肌腱断裂的运动员的 RTS 时间至少延长 2 周。这种延长的 RTS 可能是由于 Pollock 等人的研究中离心腘绳肌负荷和跑步强度的进展延迟 2 周的结果,该离心负荷和跑步强度应用于肌内肌腱断裂的 HSI。然而,目前尚不清楚对于肌内肌腱断裂的 HSI 来说,延迟离心腘绳肌负荷和跑步强度的进展是否确实必要,因为康复医生并未对 MRI 结果视而不见。
An emerging recommendation that HSI rehabilitation should be more conservative when MRI shows intramuscular tendon damage was initially based on retrospective observations of prolonged RTS and the higher recurrence rate with this diagnosis.   Recent prospective work suggests that recurrence rates for all types of HSI can remain similarly low when rehabilitation is performed with MRI diagnosis, but that athletes with intramuscular tendon ruptures have at least a longer RTS Extended by 2 weeks. This prolonged RTS may be the result of a 2-week delay in the progression of eccentric hamstring loading and running intensity applied to HSI of intramuscular tendon rupture in the study by Pollock et al. However, it is unclear whether delayed progression of eccentric hamstring loading and running intensity is actually necessary for HSI with intramuscular tendon rupture because rehabilitation physicians are not blinded to MRI findings.

在一项对 MRI 结果进行盲目康复的前瞻性研究中,在比较 HSI 与未肌内肌腱断裂的情况时,RTS 时间和复发率没有差异。然而,与没有破坏的参与者(22.2 ± 7.4 天)相比,有全层肌内肌腱破坏的参与者(31.6 ± 10.9 天)以及有肌内肌腱波纹的参与者(30.2 ± 10.8 天)的 RTS 延长。没有波纹的(22.6 ± 7.5 天)。尽管如此,尽管在后续 MRI 扫描中持续出现肌内肌腱断裂迹象,运动员仍然可以成功进行 RTS,而不会增加再次受伤的风险。
In a prospective study with blinded rehabilitation to MRI findings, there were no differences in RTS time and recurrence rates when comparing HSI with those without intramuscular tendon rupture. However, RTS was higher in participants with full-thickness intramuscular tendon destruction (31.6 ± 10.9 days) and in participants with intramuscular tendon ripples (30.2 ± 10.8 days) compared with participants without destruction (22.2 ± 7.4 days). extend. without ripples (22.6 ± 7.5 days). Nonetheless, despite persistent signs of intramuscular tendon rupture on follow-up MRI scans, athletes can still successfully perform RTS without increasing the risk of reinjury.

根据目前的证据,可以转诊患者进行 MRI 的医生可能能够通过区分有和没有明显组织损伤或近端肌腱受累的 HSI,为 RTS 提供更准确的预后。尽管如此,纯粹根据其他 MRI 结果(例如肌内肌腱断裂)来改变康复和 RTS 决策的需要需要进一步调查,然后才能被推荐为标准做法。
Based on current evidence, physicians who can refer patients for MRI may be able to provide a more accurate prognosis for RTS by distinguishing between HSI with and without significant tissue damage or proximal tendon involvement. Nonetheless, the need to alter rehabilitation and RTS decisions purely based on other MRI findings, such as intramuscular tendon rupture, requires further investigation before it can be recommended as standard practice.

康复

一旦确诊 HSI,应立即实施旨在为运动员及时、安全、有效的 RTS 做好准备的康复干预措施。在本节中,我们讨论与 HSI 康复中使用的不同运动干预和被动治疗相关的当前证据及其实施的考虑因素。
Once HSI is diagnosed, rehabilitation interventions designed to prepare athletes for timely, safe, and effective RTS should be implemented immediately. In this section, we discuss the current evidence related to different exercise interventions and passive treatments used in HSI rehabilitation and considerations for their implementation.

运动干预
exercise intervention

逐渐恢复高速跑步计划
Gradually resume high-speed running plan

逐步恢复高速跑步和冲刺可能是康复最重要的方面,因为它是许多运动表现的基础,也是常见的 HSI 机制。下图提供了一个 3 阶段渐进跑步方案的示例,该方案基于集体临床经验、对跑步过程中腘绳肌的生物力学需求的理解 以及类似方案在 HSI 康复中的应用。 当运动员能够以最小的疼痛行走(例如,在 0 到 10 的数字评级量表上疼痛≤4)后,可以安全地引入第 1 阶段,从慢速慢跑(大约最大速度的 25%)进展到中度慢跑- 可以忍受的速度跑步(大约是最大速度的 50%)。当中速跑步可以耐受时,运动员可以逐渐进入第 2 阶段,但只有在可以无痛地进行高速跑步(约最大速度的 80%)时才应进入第 3 阶段,以最大程度地降低 HSI 风险。在第 3 阶段,向最大冲刺(最大速度的 100%)的进展应该以相对较小的进步幅度(大约 5%)进行,以应对在跑步强度 > 80% 时腘绳肌所需的被动做功(即离心)的大幅增加的最大速度。
Gradual return to high-speed running and sprinting is probably the most important aspect of recovery, as it is the basis of many athletic performances and is a common mechanism of HSI. The figure below provides an example of a 3-phase progressive running protocol based on collective clinical experience, understanding of the biomechanical demands of the hamstrings during running   and the application of similar protocols in HSI rehabilitation.   Once the athlete is able to walk with minimal pain (e.g., pain ≤ 4 on a numeric rating scale from 0 to 10), Phase 1 can be safely introduced, starting with slow jogging (approximately maximum speed of 25%) progress to moderate jogging - running at a tolerable pace (approximately 50% of maximum speed). Athletes can gradually advance to Phase 2 when moderate-speed running is tolerated, but should only proceed to Phase 3 when high-speed running (approximately 80% of maximum speed) can be performed without pain to minimize the risk of HSI. During Phase 3, progression toward maximal sprint (100% of maximal velocity) should occur in relatively small increments (approximately 5%) to account for the passive work required of the hamstrings at >80% running intensity ( i.e. centrifugal), a substantial increase in the maximum speed.

渐进式跑步训练最核心的关注因素是冲刺阶段的跑步速度。这方面Smartspeed和Vxsport都可以胜任。在此简述测试方法:
The core factor of progressive running training is running speed during the sprint phase. Both Smartspeed and Vxsport are competent in this regard. Here is a brief description of the test method: