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 量化的赛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).
只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。基于肌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 肌束长度（+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（如每周）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，腘绳肌拉伤将股二头肌的 "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 来说是最有用预后位置。 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的肌肉力量（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:
图中的锥桶可以使用Smartspeed 代替，以第三阶段的冲刺跑为例，训练中进行40m最大速度冲刺跑。
The cone in the picture can be replaced by Smartspeed. Taking the sprint in the third stage as an example, sprint at a maximum speed of 40m 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。通过该速度与历史数据对比，可以逐渐进阶跑步强度和速度，或根据运动员耐受情况调整跑步速度。
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 historical data, you can gradually increase the running intensity and speed, or adjust the running speed according to the athlete's tolerance.
当实现高速跑步和冲刺后，HSI 康复和 RTS 期间的后续暴露应根据每位运动员的需要进行个体化。在可能的情况下，应避免高速跑步的大幅峰值，以降低后续腘绳肌拉伤风险。 可穿戴传感器（例如，GPS、惯性测量装置）和其他技术（例如，计时门、智能手机应用程序）的出现和可用性使得在 HSI 康复期间量化渐进式跑步变得更加容易。从业者可以使用这些方法收集 RTS 的结果测量，以客观地个性化跑步进展，安全地将运动员重新融入常规训练，并为他们的运动表现做好准备。
Once high-speed running and sprinting is achieved, HSI recovery and subsequent exposure during RTS should be individualized to the needs of each athlete. Where possible, large spikes in high-speed running should be avoided to reduce the risk of subsequent hamstring strain. The emergence and availability of wearable sensors (e.g., GPS, inertial measurement units) and other technologies (e.g., timing gates, smartphone apps) have made it easier to quantify progressive running during HSI rehabilitation . Practitioners can use these methods to collect outcome measures of RTS to objectively personalize running progress, safely reintegrate athletes into regular training, and prepare them for athletic performance.
离心腘绳肌练习
Eccentric hamstring exercises
离心腘绳肌练习是一种常见的 HSI 康复干预措施，旨在让运动员为高速跑步的需求做好准备，并解决力量和肌肉结构的缺陷。 Askling L 方案主要强调离心动作和通过伸展器、潜水员和滑翔机练习来延长腘绳肌，与传统的干预措施和多因素干预措施相比，减少了 RTS 时间。然而，Askling L 方案练习中没有一项在离心腘绳肌收缩过程中对腘绳肌施加高强度负荷，并且高强度负荷似乎是干预措施的关键组成部分，事实证明可增加腘绳肌力量、延长股二头肌长头肌束，降低腘绳肌拉伤风险。 由于 RTS 后会出现腘绳肌力量和股二头肌长头肌束长度的缺陷， 康复期间应实施渐进式离心负荷，例如北欧腘绳肌锻炼 (NHE)。
Eccentric hamstring exercises are a common HSI rehabilitation intervention designed to prepare athletes for the demands of high-speed running and address strength and muscle structure deficits. The Askling L protocol primarily emphasizes eccentric movements and hamstring lengthening with extender, diver, and glider exercises, resulting in reduced RTS time compared to traditional and multifactorial interventions. However, none of the Askling L protocol exercises place high-intensity loads on the hamstrings during eccentric hamstring contractions, and high-intensity loading appears to be a key component of the intervention and has been shown to increase hamstring strength, lengthening The long head of the biceps femoris muscle bundle reduces the risk of hamstring strain. Because deficits in hamstring strength and long head of biceps femoris fasciculus length occur after RTS, progressive eccentric loading, such as Nordic hamstrings, should be implemented during rehabilitation Exercise(NHE).
尽管离心负荷经常被推荐作为一种康复干预措施，但从业者面临的挑战是知道如何以及何时安全地引入 HSI 后的 NHE 等练习。在 HSI 康复的早期阶段，通常会避免离心腘绳肌锻炼，只有在膝关节等长屈曲期间的疼痛和四肢间力量缺陷解决后才进行离心腘绳肌腘绳肌锻炼。 然而，无论急性 HSI 后等长膝关节屈曲期间的疼痛和四肢间力量缺陷如何，都可以根据个人运动表现安全地进行离心腘绳肌负荷。例如，次最大双边离心腘绳肌滑块练习可以在 HSI 康复一开始就引入，当运动员可以通过完整的 ROM 进行此练习时，他们可以进展到单侧变化并开始 NHE。这种渐进式离心腘绳肌负荷方法已被证明可以在急性 HSI 后相对较短的康复期内增加腘绳肌力量和股二头肌长头肌束长度。下图提供了这些离心腘绳肌腘绳肌练习的示例，以及在 HSI 康复期间何时应在个人基础上引入和进行这些练习的说明。
Although eccentric loading is often recommended as a rehabilitation intervention, the challenge for practitioners is knowing how and when to safely introduce exercises such as NHE after HSI. Eccentric hamstring exercises are typically avoided in the early stages of recovery from HSI and performed only after pain and interlimb strength deficits during isometric knee flexion have resolved. However, regardless of pain and interlimb strength deficits during isometric knee flexion after acute HSI, eccentric hamstring loading can be performed safely based on individual athletic performance. For example, submaximal bilateral eccentric hamstring slide exercises can be introduced at the beginning of HSI rehabilitation, and when the athlete can perform this exercise through full ROM, they can progress to unilateral variations and initiate NHE. This progressive eccentric hamstring loading method has been shown to increase hamstring strength and long head of biceps femoris fasciculus length within a relatively short recovery period after acute HSI. The image below provides examples of these eccentric hamstring hamstring exercises, along with instructions for when these exercises should be introduced and performed on an individual basis during HSI recovery.
髋部伸肌强化
Hip extensor strengthening
除了离心腘绳肌练习之外，还应该使用髋部伸展练习来在较长的肌肉长度上对腘绳肌施加负荷。次极限运动，例如 潜水式 ，可以在 HSI 康复开始时引入，然后再进行腘绳肌桥、45° 髋部伸展（山羊凳挺髋）、 或罗马尼亚硬拉。除了腘绳肌之外，如果临床检查显示臀大肌和大收肌等单关节髋伸肌无力，则应将这些肌肉作为目标，因为它们是冲刺加速期间产生水平力的关键因素。 在 HSI 康复过程中，通过进行具有更大膝关节屈曲角度的髋部伸展练习，这些单关节肌肉可能会优先承受受伤腘绳肌的负荷。可以在康复开始时引入双侧自重臀桥，然后发展为单侧、负重和爆发力进阶，这与增加未受伤运动员的髋部伸肌力量和改善短跑表现有关。
In addition to eccentric hamstring exercises, hip extension exercises should be used to load the hamstrings over a longer muscle length. Sub-maximal exercises, such as dives , can be introduced at the beginning of HSI rehabilitation, followed by hamstring bridges, 45° hip extensions (goat bench hip thrusts), Or the Romanian deadlift. In addition to the hamstrings, if clinical examination reveals weakness in the single-joint hip extensor muscles such as the gluteus maximus and adductor magnus, these muscles should be targeted because they are key contributors to horizontal force generation during sprint acceleration. During HSI rehabilitation, these single-joint muscles may preferentially bear the load on the injured hamstrings by performing hip extension exercises with greater knee flexion angles. Bilateral bodyweight glute bridges can be introduced at the beginning of rehabilitation and then progressed to unilateral, weight-bearing, and explosive progressions, which have been associated with increased hip extensor strength and improved sprint performance in non-injured athletes.
动作示范：臀冲训练
Action demonstration: hip thrust training
训练初期：使用短肌肉长度髋关节伸肌训练1，双侧自重臀桥，仰卧位双膝关节与髋关节屈曲90度以上，无负重伸髋到0度。10-12次/组*3组
Early stage of training: Use short muscle length hip extensor training 1, bilateral self-weight glute bridge, flex both knees and hip joints above 90 degrees in the supine position, and extend the hips to 0 degrees without weight. 10-12 times/group*3 groups
当患侧腿能够完成全范围训练，且全程疼痛≤4分时，进阶到单腿自重臀桥
When the affected leg can complete the full range of training and the pain during the whole process is ≤4 points, advance to the single-leg self-weight glute bridge.
仰卧位膝关节与髋关节屈曲90度以上，抬起健侧腿，患侧腿单腿无负重伸髋到0度。10-12次/组*3组
In the supine position, bend the knee and hip joints to more than 90 degrees, lift the unaffected leg, and extend the hip of the affected leg to 0 degrees without bearing any weight. 10-12 times/group*3 groups
当患侧腿能够完成单腿臀桥，且全程疼痛≤4分时，进阶到负重单侧臀冲和双侧臀冲
When the affected leg can complete a single-leg hip bridge and the pain is ≤4 points throughout the process, progress to weight-bearing unilateral hip thrusts and bilateral hip thrusts.
基于速度训练的负重臀冲训练处方-目前不清楚慧练臀冲计算公式和训练公式，根据文献内容总结：
Weight-bearing hip thrust training prescription based on speed training - it is currently unclear the calculation formula and training formula of Huilian hip thrust, summarized based on the literature content:
杠铃臀冲是一种越来越多地用于针对髋部伸肌的练习。直接和间接测量1次重复最大值（1RM）来确定每次练习的相对负荷是耗时的；因此，练习者可能更倾向于通过基于速度的预测模型来监测速度并确定锻炼的相对负荷。本研究Predicting Loading Intensity Measuring Velocity in Barbell Hip Thrust Exercise旨在评估杠铃髋部推力练习中不同相对训练负荷 (%1RM) 下平均速度 (MV) 和平均推进速度 (MPV) 之间的关系。 120 名男性运动科学学生对杠铃髋部推力练习执行增量 1RM 测试方案，并使用线性位置传感器测量杠铃的 MV 和 MPV。 1RM 在 0.25 ± 0.03 m·s-1 处达到，用于估计相对载荷的回归模型显示出可接受的估计标准误差（MV 和 MPV 分别为 7.01 ± 1.05% 1RM 和 7.36 ± 1.05% 1RM）具有非常大的解释方差 (R2 = 0.94)。这些结果对于髋部推力辅助运动的处方和监测可能具有重要的实际应用，以监测训练负荷并预测 1RM，而无需进行 RM 测试。
The barbell hip thrust is an exercise increasingly used to target the hip extensors. Direct and indirect measurements of 1-repetition maximum (1RM) to determine the relative load of each exercise are time-consuming; therefore, practitioners may prefer to monitor velocity and determine the relative load of an exercise through velocity-based predictive models. This study, Predicting Loading Intensity Measuring Velocity in Barbell Hip Thrust Exercise, aimed to evaluate the relationship between mean velocity (MV) and mean propulsion velocity (MPV) at different relative training loads (%1RM) during barbell hip thrust exercises. 120 male exercise science students performed an incremental 1RM testing protocol on a barbell hip thrust exercise and measured barbell MV and MPV using a linear position sensor. 1RM is reached at 0.25 ± 0.03 m·s-1, and the regression model used to estimate relative loads shows acceptable estimation standard errors (7.01 ± 1.05% 1RM and 7.36 ± 1.05% 1RM for MV and MPV, respectively) with very large The explained variance (R2 = 0.94). These results may have important practical applications in the prescription and monitoring of hip thrust-assisted exercises to monitor training load and predict 1RM without the need for RM testing.
另一篇文献显示，女性臀冲练习的最小速度阈值约为0.25±0.07 m·s-1，男性最小速度阈值约为0.31±0.06 m·s-1 。
Another literature shows that the minimum speed threshold for hip thrust exercises is about 0.25±0.07 m·s-1 for women and about 0.31±0.06 m·s-1 for men.
如果采取发展一般力量的训练处方，即控制在70-85%1RM速度范围，6-12次重复训练次数，在30%-45%的速度损失停止，根据臀冲训练的速度曲线，男士完成速度在0.44±0.06 m·s-1到0.58±0.05 m·s-1速度范围，速度损失30%以上停止训练，女士完成速度在0.42±0.04m·s-1到0.60±0.04m·s-1速度范围， 速度损失30%以上停止训练。发展爆发力训练处方同理。
If you take a training prescription to develop general strength, that is, control the speed range between 70-85% of 1RM, repeat the training for 6-12 times, and stop at a speed loss of 30%-45%, according to the speed curve of hip thrust training, men’s completion speed In the speed range of 0.44±0.06 m·s-1 to 0.58±0.05 m·s-1, stop training if the speed loss exceeds 30%, and the women’s completion speed is between 0.42±0.04m·s-1 and 0.60±0.04m·s-1 Speed range, stop training when speed loss exceeds 30%. The same goes for developing explosive training prescriptions.
训练目标
training objectives | %1RM (m·s-1) | 重复 | 休息时间
Break time | 速度损失
speed loss |
一般力量（男）
General Strength (Male) | 70%-85% 0.58-0.44 | 6-12次
6-12 times | 1.5-3min | 30-45% |
一般力量（女）
General strength (female) | 70%-85% 0.60-0.42 | 6-12次
6-12 times | 1.5-3min | 30-45% |
爆发力（男）
Explosive power (male) | 35-55% 0.88-0.71 | 1-6次
1-6 times | 1-2.5min | 5-10% |
爆发力（女）
Explosive power (female) | 35-55% 0.82-0.65 | 1-6次
1-6 times | 1-2.5min | 5-10% |
重复2-4组
Repeat 2-4 sets
腘绳肌灵活性练习
Hamstring flexibility exercises
在康复期间定期进行旨在提高腘绳肌灵活性的练习，以解决 HSI 后立即出现的髋关节屈曲和膝关节伸展 ROM 的缺陷。然而，这些急性 ROM 缺陷通常会在 HSI 后的前两周内恢复，可能不需要直接干预。然而，如果康复期间缺陷持续存在，则可能需要进行腘绳肌灵活性练习，因为 RTS 时主动膝关节伸展 ROM 的更大缺陷与随后 HSI 的风险增加有关。从 HSI 后 48 小时开始，与每天一次相比，每天 4 次被动腘绳肌拉伸可以稍微加速主动膝关节伸展 ROM 的恢复。HSI 康复中规定的其他腘绳肌灵活性练习包括仰卧主动膝关节伸展运动和动态腘绳肌灵活性练习，尽管这些干预措施的有效性尚不清楚。
Exercises designed to improve hamstring flexibility are performed regularly during rehabilitation to address deficits in hip flexion and knee extension ROM that occur immediately after HSI. However, these acute ROM deficits typically resolve within the first two weeks after HSI and may not require direct intervention. However, if deficits persist during rehabilitation, hamstring mobility exercises may be necessary, as greater deficits in active knee extension ROM during RTS are associated with an increased risk of subsequent HSI. Starting 48 hours after HSI, passive hamstring stretches 4 times per day slightly accelerated recovery of active knee extension ROM compared with once per day. Other hamstring mobility exercises prescribed in HSI rehabilitation include supine active knee extension exercises and dynamic hamstring mobility exercises, although the effectiveness of these interventions is unknown.
渐进式敏捷性和躯干稳定性练习
Progressive Agility and Trunk Stability Exercises
在 HSI 康复期间，与相对保守的腘绳肌强化和拉伸干预相比，旨在提高敏捷性和躯干稳定性的练习被证明可以减少再次受伤，因此受到关注。在随后的 HSI 康复研究中，渐进式敏捷性和躯干稳定性 (PATS) 练习与强调渐进式跑步和离心强化的干预措施之间的 RTS 时间和再受伤率没有差异。PATS 练习据称的好处是，它们通过额状面运动促进受控的早期负荷，同时避免腘绳肌拉长。还有人认为，PATS 练习针对的是腰盆区域的其他肌肉，这可以减少高速跑步期间对腘绳肌的拉伸，至少根据生物力学模型是这样。尽管在实施 PATS 练习后尚未直接研究这些潜在益处，但在实现及时 RTS 和可接受的复发率方面的相对成功，强化了将其纳入 HSI 康复的理论依据。
During HSI rehabilitation, exercises designed to improve agility and trunk stability are of interest as they have been shown to reduce reinjury compared with relatively conservative hamstring strengthening and stretching interventions. In a subsequent HSI rehabilitation study, there were no differences in RTS times and reinjury rates between progressive agility and trunk stability (PATS) exercises and an intervention emphasizing progressive running and eccentric strengthening. The purported benefit of PATS exercises is that they promote controlled early loading through frontal plane movement while avoiding hamstring lengthening. It has also been suggested that PATS exercises target other muscles in the lumbar pelvic area, which could reduce the stretch on the hamstrings during high-speed running, at least according to biomechanical models. Although these potential benefits have not been studied directly following implementation of PATS exercises, the relative success in achieving timely RTS and acceptable relapse rates strengthens the rationale for their inclusion in HSI rehabilitation.
出处：Silder A, Sherry MA, Sanfilippo J, Tuite M, Hetzel SJ, Heiderscheit BC. Clinical and morphological changes following 2 rehabilitation programs for acute hamstring strain injuries: a randomized clinical trial. J Orthop Sports Phys Ther方法
最近遭受腘绳肌拉伤的个体被随机分配到 2 个康复计划中的 1 个：(1) 渐进敏捷性和躯干稳定性或 (2) 渐进跑步和离心强化。康复前后均进行 MRI 和体检。
Individuals who had recently sustained a hamstring strain were randomly assigned to 1 of 2 rehabilitation programs: (1) progressive agility and trunk stability or (2) progressive running and eccentric strengthening. MRI and physical exams were performed before and after recovery.
跑步技术练习
Running technique exercises
练习者可以在 HSI 康复的早期阶段进行可耐受的跑步技术训练，在降低强度和受控环境下进行。跑步技术训练被认为可以减少潜在的不必要的运动，例如骨盆过度前倾，由于该位置的腘绳肌长度增加，这通常与 HSI 风险相关。一些前瞻性证据表明，冲刺时骨盆前倾较大、躯干侧屈或更少的臀大肌和躯干肌肉激活的运动员，HSI 风险较高。然而，与 PATS 练习类似，没有直接证据支持使用技术练习来降低 HSI 风险、提高跑步表现或改变任何其他康复结果。因此，技术训练应被视为渐进式跑步的非必要附属部分，如果提供了合理的临床或以表现为导向的基本原理，则可以实施技术训练。结论
Practitioners can perform running technique training as tolerated during the early stages of HSI recovery, at reduced intensity and in a controlled environment. Running technique training is thought to reduce potentially unnecessary motion, such as excessive anterior pelvic tilt, which is often associated with HSI risk due to increased hamstring length in this position. Some prospective evidence suggests that athletes with greater anterior pelvic tilt, lateral trunk flexion, or less gluteus maximus and trunk muscle activation during sprinting are at higher risk for HSI. However, similar to PATS exercises, there is no direct evidence to support the use of technique exercises to reduce HSI risk, improve running performance, or alter any other rehabilitation outcomes. Therefore, technical training should be considered a non-essential adjunct to progressive running and may be implemented if a sound clinical or performance-oriented rationale is provided. in conclusion
本研究中采用的 2 个康复计划在重返运动时的腘绳肌肌肉恢复和功能方面产生了相似的结果。尽管临床检查显示体力和功能正常，但康复完成后仍有肌肉持续愈合的证据。
The 2 rehabilitation programs used in this study produced similar results in terms of hamstring muscle recovery and function upon return to sport. Although clinical examination showed normal strength and function, there was evidence of continued muscle healing after rehabilitation was completed.
被动治疗
passive treatment
富血小板血浆注射液
Platelet Rich Plasma Injection
一些运动员可能会在 HSI 康复期间接受富血小板血浆注射治疗，具体取决于他们获得的资源以及参与管理的医务人员的做法。富含血小板的血浆注射被认为可以增强组织愈合，并且已经在急性肌肉损伤的治疗中得到了评估，多项研究包括患有 HSI 的运动员。在最近的一项荟萃分析中，Seow 等人显示，在 HSI 康复期间将富含血小板血浆注射添加到运动干预措施中，RTS 时间或再损伤率没有减少。他们还报告称，对于富血小板血浆注射的时间、体积和成分缺乏共识，并且有可能导致肌肉酸痛，从而影响运动康复。注射富含血小板的血浆充其量看来是一种无害但在加速 RTS 或减轻随后的 HSI 风险方面无效的治疗方法。
Some athletes may be treated with platelet-rich plasma injections during recovery from HSI, depending on the resources they have access to and the practices of the medical staff involved in their management. Platelet-rich plasma injections are thought to enhance tissue healing and have been evaluated in the treatment of acute muscle injuries, with multiple studies including athletes with HSIs. In a recent meta-analysis, Seow et al showed no reduction in RTS time or re-injury rates when adding platelet-rich plasma injections to exercise interventions during recovery from HSI. They also reported a lack of consensus on the timing, volume, and composition of platelet-rich plasma injections and the potential to cause muscle soreness that could interfere with exercise recovery. Injection of platelet-rich plasma appears to be a harmless treatment at best but ineffective in accelerating RTS or mitigating the risk of subsequent HSI.
手法治疗
manual therapy
支持手法治疗作为 HSI 后康复干预措施的证据很少。对最近患有 HSI 的个体进行骶髂关节松动后，观察到腘绳肌扭矩急剧增加，但这些发现受到接受和未接受这种治疗的患者之间干预前差异的限制。腰椎小关节松动和软组织按摩包含在多因素 HSI 康复算法中；与 Askling L 方案运动干预相比，再次受伤的情况有所减少，但 RTS 略有延长。Mendiguchia 等人没有评估通常被认为受到手法治疗（例如疼痛或 ROM）影响的结果，并且康复算法的广泛性使得很难知道这些被动干预措施是否具有任何价值。在缺乏明确证据的情况下，从业者需要考虑在 HSI 康复期间实施手法治疗的潜在时间成本与这些干预措施的任何感知益处。
Evidence supporting manual therapy as a rehabilitation intervention after HSI is sparse. Dramatic increases in hamstring torque were observed following sacroiliac joint mobilization in individuals with recent HSI, but these findings are limited by preintervention differences between patients who did and did not receive this treatment. Lumbar facet joint mobilization and soft tissue massage were included in the multifactorial HSI rehabilitation algorithm; re-injury was reduced but RTS was slightly prolonged compared with the Askling L protocol exercise intervention. Mendiguchia et al did not evaluate outcomes commonly thought to be affected by manual therapy (such as pain or ROM), and the broad nature of the rehabilitation algorithm makes it difficult to know whether these passive interventions have any value. In the absence of clear evidence, practitioners need to consider the potential time costs of implementing manual therapy during HSI rehabilitation versus any perceived benefits of these interventions.
腘绳肌拉伤的风险因素：
Risk factors for hamstring strain:
腘绳肌拉伤风险因素有很多，文献 Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport。对腘绳肌拉伤因素做了全面回顾，
内容：我们调查了超过 71,000 名运动员的 8,319 个 HSI 数据集中的 179 个潜在危 险因素， 其中包括 967 个复发因素。荟萃分析显示， 年龄较大和既往受伤史是 HSI 的最强危险因素。有任何 HSI 病史的运动员维持 HSI的可能性是没有 HSI 病史的运动员的 2.7 倍， 如果之前的 HSI 发生在同一赛季（约 5 次）他们面临的风险甚至更大。这些不可改变因素的影响在各个研究中并不一致，突 出显示了其他因素对风险的潜在调节作用，例如运动员的身体特征（例如，力量 素质） 、暴露于负荷（例如，高负荷）。速度和比赛跑步负荷） 以及进行运动相关活动时的机械功能（例如跑步运动学）。在最佳证据综合中，与运动表现和比赛 、跑步和力量相关的因素与 HSI 的相关性最为一致。
Content: We investigated 179 potential risk factors, including 967 recurrence factors, in a dataset of 8,319 HSIs in over 71,000 athletes. Meta-analyses show that older age and previous injury are the strongest risk factors for HSI. Athletes with any history of HSI were 2.7 times more likely to sustain an HSI than athletes with no history of HSI, and they were at even greater risk if previous HSIs occurred during the same season (approximately 5). The effects of these non-modifiable factors are not consistent across studies, highlighting the potential moderating role of other factors on risk, such as athlete physical characteristics (e.g., strength fitness), exposure to load (e.g., high load). speed and race running loads) and mechanical function when performing sport-related activities (e.g. running kinematics). In the best evidence synthesis, factors related to athletic performance and competition, running, and strength were most consistently associated with HSI.
In the best evidence synthesis, factors related to sports performance and match play, running and strength were most consistently associated with HSI.
综合最佳证据，运动表现、比赛时的表现、跑步和力量因素与腘绳肌拉伤的风险关系最大。这句话是对讨论内容的总结，其中，运动表现和比赛表现指的是运动员在实际比赛中暴露在负荷中的情况，如训练或比赛让运动员腘绳肌遭受高负荷（高速度跑步、踢球等情况）。跑步因素指运动员跑步速度以及是否面临突然跑步量的增加，力量因素指腘绳肌力量与离心力量。
Based on the best evidence, athletic performance, competition performance, running, and strength factors are most associated with the risk of hamstring strain. This sentence is a summary of the discussion, in which athletic performance and competition performance refer to the situation in which the athlete is exposed to loads during actual competition, such as training or competition that subjects the athlete's hamstring muscles to high loads (high-speed running, kicking, etc.). ball, etc.). The running factor refers to the athlete's running speed and whether he or she faces a sudden increase in running volume, and the strength factor refers to the hamstring strength and eccentric strength.
可改变的风险因素
Modifiable risk factors
力量和柔韧性素质是研究最多的 HSI 可改变风险因素 。虽然在许多研究中基线力量缺陷与 HSI 的较高风险相关，但灵活性 、活动度和运动范围作为独立风险 因素的价值有限。力量和柔韧性品质会随着时间的推移而变化，并因暴露（即疲劳）而波动。使用单次基线评估的数据来前瞻性评估与后续 HSI 的关联可能无效。测试程序可以更好地作为持续监测的一部分而不是基线筛查进行，并且定期用作 HSI 指标临床管理的一部分以避免复发。
Strength and flexibility qualities are the most studied modifiable risk factors for HSI. Although baseline strength deficits have been associated with a higher risk of HSI in many studies, flexibility, mobility, and range of motion have limited value as independent risk factors. Strength and flexibility qualities change over time and fluctuate due to exposure (i.e. fatigue). Using data from a single baseline assessment to prospectively assess associations with subsequent HSI may not be valid. Testing procedures may be better performed as part of ongoing surveillance rather than baseline screening and used regularly as part of clinical management of HSI indicators to avoid relapse.
这对于易受影响的运动员尤其重要， 例如年龄较大 、有 HSI 病史和腘绳肌力量不足的运动员。
This is especially important for susceptible athletes, such as those who are older, have a history of HSI, and have insufficient hamstring strength.
跑步暴露是 HSI 的另一个可改变的风险因素。对于承受较大高速跑步负荷的运动 员， 随后发生 HSI 的风险会升高， 尤其是突然增加的负荷（即在之前 7-14 天 内）。由于快速跑步活动引起的疲劳和离心性肌肉损伤，这些运动员可能容易患HSI 。分级暴露也可能有利于增强对冲刺等损伤机制的恢复能力 。必须在诱导预防 HSI 的积极适应与增加 HSI 易感性的过度暴露之间找到平衡。从HSI运动员RTP的角度，可以参照上文的渐进式跑步运动处方。从运动员预防HSI角度，目前文献里面没有直接提供预防性分级暴露跑步方案，可能也适合逐渐增加跑量。
Running exposure is another modifiable risk factor for HSI. The risk of subsequent HSI is increased in athletes who undergo heavy high-velocity running loads, especially if the load is suddenly increased (i.e., within the preceding 7-14 days). These athletes may be susceptible to HSI due to fatigue and eccentric muscle damage caused by fast running activities. Graded exposure may also be beneficial in enhancing recovery from injury mechanisms such as sprinting. A balance must be found between inducing positive adaptations that protect against HSI and overexposure that increases susceptibility to HSI. From the perspective of RTP of HSI athletes, you can refer to the progressive running exercise prescription above. From the perspective of athletes preventing HSI, the current literature does not directly provide a preventive graded exposure running program, which may also be suitable for gradually increasing running volume.
不可改变的风险因素
immutable risk factors
年龄较大且有伤病史的运动员往往未来受伤的风险更大 。“年龄较大”很难定义，年龄会影响 24 岁运动员的 HSI 风险。年龄可能与暴露程度相关：随着时间的推移（即年龄较大），运动员会承受更大的机械负荷， 遇到损伤机制的可能性也会增加。年龄上的微小差异可能代表着精英运动经历的 巨大差异。与年龄相关的身体变化也可能通过影响结构（例如，改变的结构、纤 维类型群、横截面积 、刚度）和神经系统（例如，高阈值的去神经支配）而使年长运动员易患 HSI。
Athletes who are older and have a history of injuries tend to be at greater risk for future injuries. "Older" is difficult to define, and age affects the risk of HSI in a 24-year-old athlete. Age may be related to exposure: as time passes (i.e., older), athletes are exposed to greater mechanical loads and the likelihood of encountering injury mechanisms increases. Small differences in age can mean huge differences in elite sport experience. Age-related physical changes may also predispose older athletes to HSI by affecting the structure (e.g., altered structure, fiber type population, cross-sectional area, stiffness) and nervous system (e.g., high-threshold denervation).
先前的肌肉损伤也会导致受伤肌肉内的结构（股二头肌束长度缩短、萎缩、疤痕 组织） 和神经（随意激活减少） 适应不良
Previous muscle injury can also lead to structural (shortened length of biceps femoris fasciculus, atrophy, scar tissue) and neural (reduced voluntary activation) maladaptation within the injured muscle.
这可以解释 HSI 后腘绳肌力量降低以及在较短的肌肉肌腱单位长度处向峰值膝屈肌扭矩产生的转变。（腘绳肌收缩峰力矩在受伤后转为在较短的肌肉肌腱单位长度产生）。持续的缺陷可能会降低腘绳肌承受高度压力和应变的能力， 从而导致复发风险升高。
This may explain the reduced hamstring strength after HSI and the shift toward peak knee flexor torque production at shorter musculotendinous unit lengths. (Peak hamstring contraction torque is shifted to production at shorter muscle-tendon unit lengths after injury). Persistent deficits may reduce the hamstrings' ability to withstand high levels of stress and strain, leading to an increased risk of recurrence.
一项新发现是， 有 ACL 损伤史的运动员患 HSI 的风险增加 70%， 而有小腿拉伤损伤患HSI的风险增加 50%。ACL 损伤后风险增加的机制尚不清楚，但本体感觉减少、力量不足和步态改变可能有所影响。ACL 重建后对 HSI的易感性也可能与所使用的移植物导致的持续腘绳肌缺陷有关。运动员在小腿拉伤后更有可能遭受HSI，因为在小腿受伤减少跑步一段时间后，腘绳肌对损伤机制和高速跑步负荷的耐受能力较差。这凸显了整体康复的重要性，以及当运动员从这些伤病中恢复比赛时更多地考虑随后发生 HSI的风险。
A new finding is that athletes with a history of ACL injury have a 70% increased risk of HSI, while those with a calf strain injury have a 50% increased risk of HSI. The mechanisms underlying the increased risk after ACL injury are unclear, but reduced proprioception, strength deficits, and gait changes may play a role. Susceptibility to HSI after ACL reconstruction may also be related to persistent hamstring deficit due to the graft used. Athletes are more likely to suffer HSI after a calf strain because the hamstrings are less able to tolerate the mechanism of injury and high-speed running loads after a calf injury reduces running for a period of time. This highlights the importance of overall rehabilitation and greater consideration of the risk of subsequent HSI when athletes return to play from these injuries.
出处：前十字韧带重建后1-10 年内，精英女足球运动员出现离心膝屈肌无力
Source: Eccentric knee flexor weakness in elite female soccer players 1 to 10 years after anterior cruciate ligament reconstruction.
Bourne MN et al . Eccentric knee flexor weakness in elite female footballers 1-10 years following anterior cruciate ligament reconstruction. Phys Ther Sport 2019
半腱肌移植重建前交叉韧带后 1-6 年，腘绳肌的激活和形态发生显著改变
Hamstring muscle activation and morphology are significantly altered 1-6 years after ACL reconstruction with semitendinosus graft
Messer DJet al . Hamstring muscle activation and morphology are significantly altered 1-6years after anterior cruciate ligament reconstruction with semitendinosus graft. Knee Surg Sports Traumatol Arthrosc 2020
选择关键的康复干预措施还是有必要采取多因素方法？
Selecting key rehabilitation interventions or is a multifactorial approach necessary?
考虑腘绳肌拉伤风险和运动表现的已知和潜在因素过多，多因素康复的概念是合乎逻辑的。实施多种干预类型可以增加降低 腘绳肌拉伤 风险和提高运动员表现的可能性，但在康复期间需要更多时间来实施，这可能会延迟 RTS 。时间有限的从业者需要优先考虑积极有助于改善运动员成果的康复干预措施，而不是那些可能没有什么好处的康复干预措施。然而，当这些干预措施仅作为多因素康复方法的一部分实施时，可能很难确定最有效的干预措施。未来，研究人员需要更好地描述腘绳肌拉伤康复的各个组成部分，以确定关键干预措施及其最小有效剂量，以改善运动员的成绩。
Considering the plethora of known and potential factors for hamstring strain risk and athletic performance, the concept of multifactorial rehabilitation is logical. Implementing multiple intervention types can increase the likelihood of reducing hamstring strain risk and improving athlete performance, but requires more time to implement during recovery, which may delay RTS. Practitioners with limited time need to prioritize rehabilitation interventions that actively contribute to improved athlete outcomes over those that may have little benefit. However, when these interventions are implemented only as part of a multifactorial rehabilitation approach, it can be difficult to identify the most effective interventions. In the future, researchers need to better characterize the various components of hamstring strain recovery to identify key interventions and their minimum effective doses to improve athlete performance.
我们可以评估重返运动后的再损伤风险吗？
Can we assess the risk of reinjury upon return to sport?
腘绳肌拉伤的另一个挑战是，在进行康复训练评估时，还不确定哪些可改变的变量（如果有的话） 与再损伤风险有关 。腘绳肌结构和功能的限制在重返运动时， 甚至在腘绳肌受伤后都会被观察到，但目前几乎没有证据表明这些变量是否与再 损伤有关。在 RTS 时进行测量，再损伤风险随着主动膝关节伸展 ROM 和等长腘绳肌力量的双侧不平衡增加而增加，但有研究指出，磁共振成像扫描或等速力量测试显示的组织愈合缺陷或不对称却不会改变再损伤风险 。 这些结果仅限于相对较小的样本量， 突出表明有必要进行多站点研究，并在数年内使用一套标准的 RTS 评估来确定与再损伤风险相关的变量。
Another challenge with hamstring strains is that it is uncertain which modifiable variables, if any, are associated with risk of reinjury when evaluating for rehabilitation. Hamstring structural and functional limitations are observed upon return to sport and even after hamstring injury, but there is currently little evidence to indicate whether these variables are related to reinjury. Reinjury risk increases with increasing bilateral imbalances in active knee extension ROM and isometric hamstring strength, measured at RTS, but studies have noted that tissue healing demonstrated by magnetic resonance imaging scans or isokinetic strength testing Defects or asymmetries do not alter the risk of reinjury. These results, limited to a relatively small sample size, highlight the need for multisite studies using a standard set of RTS assessments over several years to identify variables associated with risk of reinjury.
相关论文：
Related papers:
1.Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play 核磁共振成像下腘绳肌肌肉肌腱结构缺损完全消失并不是成功重返运动的必要条件
1.Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play
2.At return to play following hamstring injury the majority of professional football players have residual isokinetic deficits.在腘绳肌受伤后重返赛场时，大多数职业足球运动员都会残留等速运动功能障碍。
2.At return to play following hamstring injury the majority of professional football players have residual isokinetic deficits.
3. Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not重返比赛后的临床发现可预测腘绳肌的再次损伤，但核磁共振成像的基线发现却无法预测
3. Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not
在研究运动员重返比赛后的损伤风险时，研究人员必须认识到可用的证据有限。如果采取务实的启发式方法来看，运动员在重返赛场时，需要能够 (1) 研究指出的初始损伤因素（例如，股二头肌长头肌束长度）在重返比赛训练过程中超过受伤前的水平。如果对腘绳肌再损伤风险进行前瞻性研究，需要将可能的初始损伤因素解决掉。 （2） 解决因病理而产生的身体不对称（例如， ROM 和力量不对称）， （ 3 ） 确保充分了解最大化 RTS 性能（例如，高速跑）所需的关键变量。尽管缺乏与 RTS 相关的明确共识， 但疼痛的解决 、ROM 和力量测试的对称性（ <10% – 15% 不对 称）、完成现场表现和功能测试以及确认心理准备是最实用的考虑因素。此外， 人们普遍认为， RTS 流程应涉及球员 、球队医务人员（医生 、运动训练师 、物 理治疗师） 以及力量和表现教练之间的共同决策。
When studying injury risk after athletes return to competition, researchers must recognize that the available evidence is limited. If we take a pragmatic heuristic, when returning to play, athletes need to be able to (1) study the initial injury factors (e.g., long head of biceps femoris fasciculus length) that exceed the injury during return-to-play training; previous level. If the risk of hamstring reinjury is prospectively studied, possible factors of initial injury need to be addressed. (2) Address body asymmetries resulting from pathology (e.g., ROM and strength asymmetries), and (3) ensure a full understanding of the key variables required to maximize RTS performance (e.g., high-speed running). Although clear consensus related to RTS is lacking, resolution of pain, symmetry of ROM and strength testing (<10% – 15% asymmetry), completion of field performance and functional testing, and confirmation of psychological readiness are the most practical considerations. Additionally, it is generally accepted that the RTS process should involve shared decision-making between the player, team medical staff (physicians, athletic trainers, physical therapists), and strength and performance coaches.
完成现场表现和功能测试以及确认心理准备是最实用的考虑因素这部分内容引用自2016 年伯尔尼第一届世界运动物理治疗大会关于重返体育运动的共识声明，具体说明如下：
Completion of on-site performance and functional testing and confirmation of psychological readiness are the most practical considerations. This section is quoted from the Consensus Statement on Return to Sport from the 1st World Congress of Sports Physiotherapy in Bern 2016, as follows:
评估 RTS 的准备情况
Assess readiness for RTS
大多数功能测试程序都是基于封闭技能任务（例如，单跳或三跳、T 型训练、8 字形跑），但运动除了封闭技能外还需要开放技能。开放技能具有执行运动任务的反应元素，往往出现在计划之外，发生在运动员疲劳状态。因此，仅依靠封闭技能任务来确定 RTS 的准备情况并不是最佳选择。逐步和顺序地引入针对特定运动的训练可以用作功能测试，其中包括受保护的反应性决策的元素（最好是针对具体情况）。即模拟运动员在赛场上的情况进行RTP测试。任何评估运动员对 RTS 准备情况的测试都应考虑开放式和封闭式技能，尽管在某些临床环境中，由于时间、空间和资源等因素，这可能很困难。如果是这种情况，结合其他基于损伤和功能参数的封闭技能评估可为临床医生和运动员提供最低水平的 RTS 决策信息。
Most functional testing procedures are based on closed skill tasks (e.g., single or triple jumps, T-drills, figure-8 runs), but sports require open skills in addition to closed skills. Open skills have a reactive element in performing a motor task and often occur unplanned and occur when the athlete is fatigued. Therefore, relying solely on closed skill tasks to determine readiness for RTS is not optimal. The gradual and sequential introduction of sport-specific training can serve as a functional test that includes an element of protected reactive decision-making (preferably situation-specific). That is to simulate the situation of athletes on the field for RTP testing. Any test that assesses an athlete's readiness for RTS should consider both open and closed skills, although in some clinical settings this may be difficult due to factors such as time, space, and resources. If this is the case, a closed skills assessment combined with other impairment- and functional parameters-based assessments can provide clinicians and athletes with a minimum level of information for RTS decision-making.
身体检查历来在 RTS 决策中受到最多关注，但心理准备也是最佳 RTS 的重要因素。情绪（包括担心再次受伤）和认知因素（包括自我效能和动机）会影响 RTS。恢复运动的损伤心理准备量表是基于证据的量表，可以帮助临床医生评估运动员受伤后对 RTS 的心理准备情况。
Physical examinations have historically received the most attention in RTS decisions, but mental preparation is also an important factor in optimal RTS. Emotional (including fear of reinjury) and cognitive factors (including self-efficacy and motivation) influence RTS. The Psychological Readiness to Return to Sports Injury Scale is an evidence-based scale that can help clinicians assess an athlete's psychological readiness for RTS following an injury.
回归运动标准：
Return to sport criteria:
出处：Return to Play After Hamstring Injuries: A Qualitative Systematic Review of Definitions and Criteria
腘绳肌损伤后重返赛场：定义和标准的系统综述
Return to play after hamstring injury: a systematic review of definitions and criteria
1.疼痛消失
1.The pain disappears | 触诊时无痛
Painless on palpation 控制条件下冲刺无痛
Painless sprinting under controlled conditions 在基于特定运动的功能性活动时无痛
Pain-free during movement-specific functional activities 没有疼痛/局部过于敏感
No pain/local hypersensitivity 进行Illinois 敏捷测试时无痛
Painless Illinois Agile Testing 进行主动伸膝测试时无痛
No pain when performing active knee extension test 进行腘绳肌拉伸测试时无痛
No pain during hamstring stretch test 进行腘绳肌力量测试时无痛
No pain during hamstring strength test 在主动直腿上抬末端范围静态收缩时无痛
Painless during static contraction at end range of active straight leg raise 直腿抬高时无痛
Painless with straight leg raise 2英里耐力跑测试无痛
2-Mile Endurance Run Test Painless |
2.相似的力量
2. The power of similarity | 两侧相同的HQ（腘绳肌/股四头肌力量）比值
Same HQ (hamstring/quadriceps strength) ratio on both sides HQ比值大于等于0.55
HQ ratio is greater than or equal to 0.55 两侧相同的最大膝关节屈曲角度
The same maximum knee flexion angle on both sides 膝关节屈曲峰力矩出现在小于28度的活动范围
Peak knee flexion moment occurs in a range of motion less than 28 degrees 双侧腿部屈曲峰力矩出现角度差异小于8度
The angle difference between the peak flexion moments of the legs on both sides is less than 8 degrees. 相同的外展力量
same outreach power 力量完全回复
Full recovery of strength 力量达到基线标准的95%
Strength reaches 95% of baseline standards 受累侧等速力量测试结果与未受伤侧差值小于5%-10%
The difference between the isokinetic strength test results on the affected side and the uninjured side is less than 5%-10% 肌肉等张收缩力量回到之前的80%
Muscle isotonic contraction strength returns to 80% of previous value
受累侧腿的离心力量与未受伤侧的差异小于10%
The difference in eccentric strength of the affected leg from the uninjured leg is less than 10% 双侧伸髋力量相同
Hip extension strength is the same on both sides |
3.相似的柔韧性
3. Similar flexibility | 双腿关节活动度相同
Both legs have the same range of motion 双腿达到相同的柔韧性
Both legs achieve the same flexibility |
4.功能表现
4. Functional performance | 在最佳时机参赛
Enter at the best time 自我感知腘绳肌力量
Self-perceived hamstring strength 基于足球专项的表现测试
Football-specific performance tests 跑步步态分析
Running gait analysis 基础体能
Basic physical fitness 平衡控制能力评估
Balance control ability assessment 三连单脚跳评估，双侧差异小于10%
Evaluation of three consecutive single-leg jumps, the difference between the two sides is less than 10% 全速跑步
running at full speed 合适的敏捷性
The right agility 全速冲刺训练达到之前90%水平
Full speed sprint training reaches 90% of the previous level 参加5天的团队训练
Attend 5 days of team training |
5.医疗团队许可
5. Medical team permission | 不受限制完成康复计划
Completion of rehabilitation program without restrictions 基于特定专项运动的进阶康复计划
Advanced rehabilitation programs based on specific sports 医疗团队准许重返运动
Medical team gives permission to return to sports |
6.其他
6.Others | 考虑理论上的停赛期
Consider the theoretical suspension period 影像学检查因素
Imaging examination factors 大脑对肌肉的控制能力达到标准
The brain’s ability to control muscles reaches standard 对腘绳肌和股四头肌进行肌电分析
EMG analysis of hamstrings and quadriceps 纠正骶髂关节或腰椎功能障碍
Correct sacroiliac joint or lumbar spine dysfunction |
负荷管理与再损伤预防
Load management and reinjury prevention
损伤预防和高运动表现之间的平衡：训练过多或训练不足
The Balance Between Injury Prevention and High Performance: Overtraining or Undertraining
成功的运动队比不成功的球队受伤率更低，球员的可用性更高。虽然将更大的训练负荷与高受伤率联系起来的证据是令人信服的，但关注训练的负面方面会损害训练过程中产生的许多积极的适应。此外，有几个原因可以解释为什么将高训练负荷与损伤联系起来的结果应该结合与运动相关的广泛表现问题来考虑。用被子把球员抱起来不会带来场上的成功。如何帮助教练将球员训练到理想水平（最大限度地提高表现，同时保持非接触性软组织损伤的低风险）？
Successful sports teams have lower injury rates and higher player availability than unsuccessful teams. While the evidence linking greater training loads to higher injury rates is compelling, focusing on the negative aspects of training undermines the many positive adaptations that occur during training. Furthermore, there are several reasons why results linking high training load to injury should be considered in the context of broader sport-related performance issues. Covering players with blankets will not lead to success on the field. How can coaches be helped to train players to the ideal level (maximizing performance while maintaining a low risk of non-contact soft tissue injuries)?
尽管研究表明训练负荷与损伤之间存在正相关关系，但也有证据表明训练对损伤具有保护作用。在评估高训练负荷对受伤风险的影响时应考虑这些研究的结果：
Although research shows a positive relationship between training load and injury, there is also evidence that training has a protective effect against injury. The results of these studies should be considered when assessing the impact of high training loads on injury risk:
在首次受伤之前进行超过 18 周训练的团体运动运动员，后续受伤的风险会降低。很多研究一致表明表明长期高训练量可能会降低受伤风险。例如，在加入精英青少年足球队之前进行更多的训练可以降低腹股沟疼痛的风险。
Team sport athletes who train for more than 18 weeks before their first injury have a reduced risk of subsequent injury. Many studies have consistently shown that high training volume over time may reduce the risk of injury. For example, more training before joining an elite youth soccer team can reduce the risk of groin pain.
其次，在各种运动中，良好的身体素质与降低受伤风险有关。显然，为了让运动员发展提供预防伤害所需的身体能力，他们必须做好刻苦训练的准备。
Second, good physical fitness is associated with a reduced risk of injury in a variety of sports. Clearly, in order for athletes to develop the physical capabilities needed to provide injury prevention, they must be prepared to train hard.
重要的是，有证据表明过度训练和训练不足可能会增加受伤风险。例如，板球快速投球手每周投球次数较少且在比赛之间恢复程度较高的投球手受伤的风险会增加，而每周投球次数较多且比赛之间恢复较少的投球手受伤的风险也会增加受伤。棒球和橄榄球联盟也有类似的发现。这些数据显示训练负荷与受伤之间的“U”形关系表明，训练负荷不足和过度都与受伤有关。
Importantly, there is evidence that overtraining and undertraining may increase the risk of injury. For example, cricket fast bowlers who bowl fewer bowls per week and recover less between matches are at increased risk of injury, whereas bowlers who bowl more bowls per week and recover less between matches are at increased risk of injury. There is also an increased risk of injury. Similar findings were found in baseball and football leagues. These data show a "U"-shaped relationship between training load and injury, suggesting that both under- and over-training load are associated with injury.
总的来说，这些结果强调，减少训练量可能并不总是防止受伤的最佳方法。练习者如何找到训练负荷的“最佳点”？
Overall, these results highlight that reducing training volume may not always be the best way to prevent injury. How does a practitioner find the “sweet spot” for training load?
更聪明、更努力的训练——可能支持这些发现的机制
Train smarter, harder—mechanisms that may underpin these findings
尽管高训练负荷与较高的受伤率相关，但结果是模棱两可的，最近的证据也证明了高长期训练负荷的保护作用。研究显示，进行大量超高速跑步的运动员遭受非接触性软组织损伤的可能性是其他跑步负荷较低运动员的 2.7 倍。鉴于较大的跑步负荷会带来较高的受伤风险，因此很容易建议运动员在训练中避免非常高速的跑步，以尽量减少受伤的风险。然而，通过限制跑步负荷来降低受伤风险，在比赛的关键阶段，当球员需要发挥最大作用时，他们可能会因为准备不足而无意中面临更大的受伤风险。
Although high training loads are associated with higher injury rates, the results are equivocal and recent evidence supports the protective effects of high long-term training loads. Studies have shown that athletes who do a lot of ultra-high speed running are 2.7 times more likely to suffer non-contact soft tissue injuries than other athletes with lower running loads. Given that greater running loads carry a higher risk of injury, it is tempting to advise athletes to avoid running at very high speeds in training to minimize the risk of injury. However, by limiting the risk of injury by limiting running load, players may inadvertently be exposed to a greater risk of injury due to lack of preparation during key phases of the game when they need to perform their best.
大量超高速跑步可能会增加受伤风险，但有证据（来自同一数据集）表明，当运动员进行大量低强度活动和短时间加速时，受伤风险较低。足球、篮球和橄榄球等高强度团队运动要求运动员进行短时间（2-3 秒）加速，随后进行较长时间的低强度活动。在比赛中，较长的高速努力并不常见。
Extensive running at very high speeds may increase the risk of injury, but there is evidence (from the same data set) that the risk of injury is lower when athletes perform high volumes of low-intensity activity and short bursts of acceleration. High-intensity team sports such as football, basketball, and rugby require athletes to accelerate for short periods (2-3 seconds) followed by longer periods of lower-intensity activity. In competition, longer high-speed efforts are uncommon.
鉴于高训练负荷可以通过不同的方式实现（即训练量、强度和频率，以及所进行的训练活动的平衡），因此认为所有“高训练负荷”都具有相同的受伤风险是不合适的。明确地说，“高训练负荷”本身可能不是导致受伤风险增加的最大因素，但规定的“高训练负荷”类型可能是受伤的重要预测因素。大量短时间、高强度的加速训练和针对特定比赛的有氧活动可以为团队运动运动员提供适当的身体素质，不仅可以提高训练水平，还可以防止受伤。
Given that high training loads can be achieved in different ways (i.e. training volume, intensity and frequency, and the balance of training activities performed), it is inappropriate to assume that all “high training loads” carry the same risk of injury. To be clear, "high training load" itself may not be the biggest factor in increased risk of injury, but the type of "high training load" prescribed may be an important predictor of injury. Extensive short, high-intensity acceleration training and game-specific aerobic activity can provide team sport athletes with the proper conditioning to not only improve training but also prevent injury.
训练负荷模型对于预测非接触性软组织损伤既敏感又具体。然而，伤害预测模型在识别何时不太可能发生伤害（即真阴性）方面比预测伤害方面要好得多。这些发现是直观的；如果运动表现工作人员专注于伤害预防，并通过“管理运动员远离训练”来预防伤害，那么与训练负荷相关的伤害数量可能会减少，因为运动员不太可能进行足够的训练量或强度来产生伤害。
The training load model is both sensitive and specific for predicting non-contact soft tissue injuries. However, injury prediction models are much better at identifying when injuries are unlikely to occur (i.e., true negatives) than at predicting injuries. These findings are intuitive; if performance staff focus on injury prevention and prevent injuries by "managing athletes away from training," the number of injuries related to training load may be reduced because athletes are less likely to perform adequate training volumes. or intensity to produce damage.
精英团队运动运动员的训练负荷、训练阶段和受伤可能性之间的关系。使用感知疲劳分级来测量训练负荷。在 3000-5000 任意单位的训练负荷范围内，球员有 50-80% 的可能性在季前赛受伤。在赛季的竞争阶段（由箭头和曲线向左移动表示），这些训练负荷“阈值”大大降低（1700-3000 任意单位）。在季前训练负荷-受伤曲线的陡峭部分（由灰色阴影区域表示），训练负荷的微小变化会导致受伤风险的巨大变化。季前赛模型：受伤可能性=0.909327/(1+exp(−(训练负荷−2814.85)/609.951))。早期竞赛模型：受伤可能性=0.713272×(1−exp(−0.00038318×训练负荷))。后期比赛模型：受伤可能性=0.943609/(1+exp(−(训练负荷−1647.36)/485.813))。
The relationship between training load, training phase, and injury likelihood in elite team sport athletes. Training load was measured using perceived fatigue ratings. At a training load range of anywhere from 3000-5000 units, players have a 50-80% chance of getting injured in pre-season. During the competitive phase of the season (indicated by the arrow and curve shifting to the left), these training load "thresholds" are significantly lower (1700-3000 arbitrary units). In the steep portion of the preseason training load-injury curve (represented by the gray shaded area), small changes in training load can lead to large changes in injury risk. Preseason model: Injury probability=0.909327/(1+exp(−(training load−2814.85)/609.951)). Early competition model: Injury probability = 0.713272×(1−exp(−0.00038318×training load)). Late game model: Injury probability = 0.943609/(1+exp(−(training load−1647.36)/485.813)).
如上图所示，在训练负荷-损伤曲线的陡峭部分，训练负荷的微小变化（增加或减少）会导致损伤风险（在各自的方向上）发生较大变化。研究中没有强调的是，由于曲线的 S 形性质，在大训练负荷下，训练负荷与损伤的关系几乎是平的。这一部分，训练负荷的较大变化导致受伤风险的变化非常小。因此，如果运动员能够安全地通过曲线的“高风险”部分进行训练（例如，使用急性：慢性负荷比模型——
As shown in the figure above, in the steep portion of the training load-injury curve, small changes (increases or decreases) in training load result in larger changes in injury risk (in the respective direction). What is not emphasized in the research is that at high training loads the training load-injury relationship is nearly flat due to the S-shaped nature of the curve. In this section, large changes in training load result in very small changes in injury risk. Therefore, if an athlete can safely train through the "high risk" portion of the curve (e.g., using an acute:chronic load ratio model -
急性：慢性负荷比率 (ACWR) 是过去 7 天内完成的训练负荷（急性训练负荷）与过去 28 天内执行的平均每周训练负荷（慢性训练负荷）之间的比率。换句话说，就是上周与上个月相比执行了多少训练量。
The Acute:Chronic Load Ratio (ACWR) is the ratio between the training load performed in the last 7 days (acute training load) and the average weekly training load performed in the last 28 days (chronic training load). In other words, how much training volume was performed last week compared to the previous month.
ACWR 比率的计算方法是将急性训练量（疲劳）除以慢性训练量（健康）。例如，如果一名运动员在过去 7 天内跑了 30 公里（急性训练量），而在过去 4 周（28 天）中，他们平均跑了 28.5 公里*，那么您只需将急性训练量（30 公里）除以慢性训练量（28.5 公里）即可，ACWR 为 1.05。换句话说，与过去 4 周相比，运动员在过去一周完成了 105% 的工作量，这意味着他们的总工作量增加了 5%），那么他们可能会发展出更大的恢复力和训练耐受力。
ACWR ratio is calculated by dividing acute training volume (fatigue) by chronic training volume (fitness). For example, if an athlete ran 30km (acute training volume) in the past 7 days, and over the past 4 weeks (28 days) they averaged 28.5km*, then you would simply add the acute volume (30km ) divided by the chronic training volume (28.5 kilometers), the ACWR is 1.05. In other words, if an athlete performed 105% of their workload in the past week compared to the past 4 weeks (meaning their total workload increased by 5%), then they are likely to develop greater recovery and training Tolerance.
尽管损伤预测模型可能具有足够的预测准确性，足以保证在精英团队运动项目中系统使用，但训练、训练不足和过度训练之间存在良好的平衡。训练计划必须适合生理和心理，以便运动员能够应对比赛的要求。考虑到这一点，有人可能会说，利用季前训练和训练营规定高训练负荷（注意，不要过多）来确定哪些球员在身体压力情况下最容易受伤（这些球员很可能不会受伤，但不太能够忍受比赛的强度和疲劳），以及哪些球员在身体紧张的情况下不易受伤（这些球员更有可能忍受比赛的强度和疲劳）。
Although injury prediction models may have sufficient predictive accuracy to warrant systematic use in elite team sports, there is a fine balance between training, undertraining, and overtraining. Training programs must be physically and psychologically appropriate so that athletes can cope with the demands of competition. With this in mind, one might argue that using pre-season training and training camps to impose high training loads (not too much, mind you) will determine which players are most susceptible to injury in physically stressful situations (those players will most likely not get injured, but less able to tolerate the intensity and fatigue of a game), and which players are less susceptible to injury under physical strain (these players are more likely to tolerate the intensity and fatigue of a game).
训练新观——对抗伤病的“疫苗”！
A new outlook on training – the “vaccine” against injuries!
艰苦（且适当）的身体训练可以防止受伤。毫无疑问，高训练负荷通常与更好的体能发展和良好的表现相关。高训练负荷的代价之一通常被认为是软组织损伤风险。为了解决这一风险，可以减少训练负荷以降低受伤发生率，但低训练负荷（以减少训练量的形式）也与增加受伤风险有关；让球员接受低训练负荷可能会使他们面临进一步受伤的风险。一旦球员进入康复过程，训练者面临的挑战是让他们承受适当的负荷，以增强身体素质，从而提供针对受伤的保护作用，并防止球员恢复全面训练时负荷“激增”。因此，球队中经常出现“康复者”的情况并不少见——一名球员因为训练负荷不够高，无法适应比赛要求而反复崩溃（可能有不同的伤病） 。数据表明，可控的高训练负荷可以提高体能水平，进而提供针对受伤的保护作用，最终导致（1）更大的体能输出和比赛适应力，以及（2）更大比例的运动每周都有可供选择的阵容。
Hard (and appropriate) physical training can prevent injuries. There is no doubt that high training loads are generally associated with better physical development and good performance. One of the costs of high training loads is often considered to be the risk of soft tissue injury. To address this risk, training load can be reduced to reduce the incidence of injury, but low training load (in the form of reduced training volume) is also associated with an increased risk of injury; subjecting players to a low training load may put them at risk of further injury . Once players enter the rehabilitation process, the challenge for trainers is to subject them to the appropriate load to enhance conditioning, thereby providing protection against injury and preventing load "surges" when players return to full training. As a result, it's not uncommon to have "recoveries" in teams - a player who breaks down repeatedly (perhaps with different injuries) because the training load isn't high enough to adapt to the demands of the game. Data suggest that high, controllable training loads increase fitness levels, which in turn provide protection against injury, ultimately leading to (1) greater physical output and competition adaptability, and (2) a greater proportion of exercise per week Lineup to choose from.
Drew 等人提出了基于证据的指南，供从业者在为运动员规定训练负荷时遵循。其中包括 (1) 建立适度的长期训练负荷，(2) 尽量减少训练负荷每周的变化，(3) 避免超过运动的安全上限，(4) 确保维持最低训练负荷， (5) 避免不一致的负荷模式，(6) 确保训练负荷与运动需求成比例，以及 (7) 在整个潜伏期内监测运动员（即在施加负荷或负荷“峰值”之后）。
Drew et al present evidence-based guidelines for practitioners to follow when prescribing training loads for athletes. These include (1) establishing appropriate long-term training loads, (2) minimizing weekly variations in training loads, (3) avoiding exceeding safe upper limits for exercise, (4) ensuring that minimum training loads are maintained, and (5) avoiding inconsistent loads mode, (6) ensure that training load is proportional to exercise demands, and (7) monitor athletes throughout the latency period (i.e. after load application or load “peak”).
Gabbett TJ
Gabbett T.J.
The training—injury prevention paradox: should athletes be training smarter and harder?
British Journal of Sports Medicine 2016
British Journal of Sports Medicine 2016
Drew MK, Cook J, Finch CFSports-related workload and injury risk: simply knowing the risks will not prevent injuries: Narrative reviewBritish Journal of Sports Medicine 2016
疲劳恢复在避免腘绳肌拉伤RTP后再损伤发生中的意义
The significance of fatigue recovery in preventing reinjury after hamstring strain RTP
疲劳对腘绳肌拉伤的影响
Effect of fatigue on hamstring strain
由于疲劳的肌肉在达到拉伸极限之前似乎能够吸收较少的能量，因此疲劳可能会直接增加受伤的风险。
Because fatigued muscles appear to be able to absorb less energy before reaching their stretch limit, fatigue may directly increase the risk of injury.
疲劳在急性肌肉拉伤易感性的作用-Mair, S.D.; Seaber, A.V.; Glisson, R.R.; Garrett, W.E. The role of fatigue in susceptibility to acute muscle strain injury. Am. J. Sports Med. 1996,
疲劳会影响最大冲刺跑期间的肌肉激活模式，从而导致神经肌肉协调在疲劳条件下发生改变。有人认为，这可能会给邻近组织带来过多的负荷，从而导致过度的拉伸剪切应力，并可能增加受伤风险。
Fatigue affects muscle activation patterns during maximal sprint running, resulting in altered neuromuscular coordination under fatigue conditions. It has been suggested that this may place excessive loads on adjacent tissues, causing excessive tensile shear stresses and potentially increasing the risk of injury.
股二头肌和半腱肌：队友还是竞争对手？
Biceps femoris and semitendinosus: teammates or competitors?
Schuermans, J.; Van Tiggelen, D.; Danneels, L.; Witvrouw, E. Biceps femoris and semitendinosus--teammates or competitors? New insights into hamstring injury mechanisms in male football players: A muscle functional MRI study. Br. J. Sports Med. 2014
肌肉激活模式的差异也与下肢运动变化有关。在腘绳肌特异性疲劳运动后进行的冲刺中，冲刺周期内股直肌激活提前减少以及半腱肌和股二头肌提前激活。研究人员认为这促进了运动学变化，包括摆动阶段最大膝关节伸展时髋关节屈曲的减少和膝关节伸展的增加，足部着地前的腿部角速度的降低以及躯干、大腿和小腿的角位移的减少。观察到的躯干、大腿和腿部在摆动期后期角位移的减少归因于摆动期最大膝关节伸展时髋关节屈曲的减少和膝关节伸展的增加。
Differences in muscle activation patterns are also associated with changes in lower limb movement. In sprints performed after hamstring-specific fatiguing exercise, there was an early decrease in rectus femoris activation and an early activation of the semitendinosus and biceps femoris during the sprint cycle. The researchers believe this promotes kinematic changes, including a decrease in hip flexion and an increase in knee extension at maximum knee extension during the swing phase, a decrease in leg angular velocity before foot strike, and an increase in angular displacement of the trunk, thigh, and calf. reduce. The observed decrease in angular displacement of the trunk, thighs, and legs during the late swing phase has been attributed to a decrease in hip flexion and an increase in knee extension at maximum knee extension during the swing phase.
Small等人在模拟足球比赛的生理和力学需求后研究了冲刺力学的变化，并观察到在摆动后期最大髋关节屈曲和膝关节伸展角度减少，骨盆前倾增加和下肢节段运动速度增加。骨盆前倾的增加有可能在跑步时增加股二头肌的长度，因为股二头肌直接附着在骨盆的坐骨结节上。因此，控制臀部运动和骨盆位置的肌肉可能会影响跑步过程中的相对股二头肌长度。腿部角速度的增加，被认为与腘绳肌有效减速下肢的能力下降有关。这些发现表明，在最长的腘绳肌长度处，力的吸收能力可能会特别降低，这可能会增加运动员对腘绳肌拉伤的脆弱性，因为冲刺跑中的力量产生高度依赖于弹性组织反冲能量的利用。
Small et al. studied changes in sprint mechanics after simulating the physiological and mechanical demands of a football game and observed a decrease in maximum hip flexion and knee extension angles, an increase in anterior pelvic tilt, and an increase in lower limb segmental motion velocity during the late swing. Increased anterior pelvic tilt has the potential to increase biceps femoris length during running because the biceps femoris attaches directly to the ischial tuberosity of the pelvis. Therefore, the muscles that control hip movement and pelvic position may influence relative biceps femoris length during running. The increase in leg angular velocity is thought to be related to a decrease in the hamstrings' ability to effectively decelerate the lower limb. These findings suggest that force-absorbing capacity may be particularly reduced at the longest hamstring length, which may increase an athlete's vulnerability to hamstring strains because force production in sprinting is highly dependent on elastic tissue. Utilization of recoil energy.
Small, K.; McNaughton, L.R.; Greig, M.; Lohkamp, M.; Lovell, R. Soccer fatigue, sprinting and hamstring injury risk. Int. J. Sports Med. 2009
Small, K.; McNaughton, L.R.; Greig, M.; Lohkamp, M.; Lovell, R. Soccer fatigue, sprinting and hamstring injury risk. Int. J. Sports Med. 2009
腘绳肌在动态膝关节稳定性和控制中发挥着至关重要的作用，有助于保持关节完整性。连同其他一些复杂的韧带和肌腱结构（例如，髂胫束、股二头肌短头、外侧副韧带、腘肌/复合体、腓肠肌外侧腱、关节囊/中第三外侧囊韧带、外侧半月板的冠状韧带，斜腘韧带和豆腓韧带），远端股二头肌肌腱形成膝关节后外侧复合体的一部分，因为它附着在腓骨骨头和胫骨外侧髁上。后外侧复合体是下肢稳定性的关键要素。据此，Cleather最近的一项研究为以下理论提供了支持：腘绳肌肌肉在动态膝关节稳定性和控制中发挥着重要作用，从而在水平面上建立了胫骨的旋转稳定性。因此，据推测，膝关节稳定性要求的增加（例如，变向动作）和疲劳的存在可能会给腘绳肌肌肉带来更大的负荷，从而增加它们对拉伤的脆弱性。
The hamstrings play a vital role in dynamic knee stability and control, helping to maintain joint integrity. Along with several other complex ligamentous and tendon structures (e.g., iliotibial band, short head of biceps femoris, lateral collateral ligament, popliteus/complex, lateral gastrocnemius tendon, capsular/mid-third lateral capsular ligament, lateral meniscus of the coronary, oblique-popliteal, and pistillofibular ligaments), the distal biceps femoris tendon forms part of the posterolateral complex of the knee as it attaches to the fibular head and lateral tibial condyle. The posterolateral complex is a key element of lower extremity stability. Accordingly, a recent study by Cleather provides support for the theory that the hamstring muscles play an important role in dynamic knee stability and control, thereby establishing rotational stability of the tibia in the horizontal plane. Therefore, it is hypothesized that increased knee stability demands (e.g., change of direction movements) and the presence of fatigue may place greater loads on the hamstring muscles, thereby increasing their vulnerability to strains.
腘绳肌的重要作用是在垂直跳跃过程中对胫骨施加内外侧旋转力矩：Cleather, D.J. An important role of the biarticular hamstrings is to exert internal/external rotation moments on the tibia during vertical jumping. J. Theor. Biol. 2018
在疲劳的拉伸-缩短循环（SSC）练习中观察到的下肢肌肉硬度降低会导致下肢储存和重复使用的弹性势能的减少。莱纳特等人发现在进行 90 分钟的足球专项训练后，腿部硬度（在重复的两腿跳跃中测量到的髋部、膝盖和踝关节屈曲减少）和反应力量（在跳跃中测量到的飞行与接触时间比）显著降低。此外，根据比赛中的加速度计数据和每周对澳大利亚足球运动员跳跃表现的监测，Cormack 等人提出神经肌肉疲劳与随后比赛中垂直加速度的降低有关，并推测这一结果是由于神经肌肉系统无法维持垂直刚度所致。这些变化反过来促进了“Groucho”的跑步模式，这是一种膝盖在整个跑步过程中保持弯曲的运动形式。这减少了垂直地面反作用力（包括冲击力），但最大限度地减少身体的弹性反弹，增加了运动的能量成本，因此通常会带来跑步速度降低、降低的加速度相关/减速能力和更大的氧气消耗。这种跑步运动学的改变，运动效率的降低和力矩的增大与收缩肌肉单位的负荷增加有关，理论上增加了拉伤风险。
The decrease in lower limb muscle stiffness observed during fatiguing stretch-shortening cycling (SSC) exercises results in a reduction in elastic potential energy stored and reused in the lower limb. Leinart et al found that following 90 minutes of soccer-specific training, leg stiffness (reduction in hip, knee, and ankle flexion measured during repeated two-legged jumps) and reaction strength (flight measured during jumps (compared with contact time) is significantly reduced. Furthermore, based on in-game accelerometer data and weekly monitoring of jumping performance of Australian football players, Cormack et al proposed that neuromuscular fatigue is associated with a decrease in vertical acceleration during subsequent games and hypothesized that this result was due to an inability of the neuromuscular system to maintain due to vertical stiffness. These changes in turn facilitate the "Groucho" running pattern, a form of movement in which the knees remain bent throughout the run. This reduces vertical ground reaction forces (including impact forces), but minimizes elastic rebound of the body, increases the energetic cost of movement, and therefore generally results in reduced running speed, reduced acceleration-related/deceleration capabilities and greater Oxygen consumption. This change in running kinematics, the reduction in movement efficiency and the increase in torque are related to the increased load on contractile muscle units, theoretically increasing the risk of strain.
神经肌肉疲劳对精英澳式橄榄球运动员加速度计负载的影响
Effects of neuromuscular fatigue on accelerometer loading in elite Australian rules football players
Cormack, S.J.; Mooney, M.G.; Morgan, W.; McGuigan, M.R. Influence of neuromuscular fatigue on accelerometer load in elite Australian football players. Int. J. Sports Physiol. Perform. 2013
McMahon, T.A.; Valiant, G.; Frederick, E.C. Groucho running. J. Appl. Physiol. 1987
此外，相对于行走距离的肌电图评估表明，在高速而非低速跑步期间，腘绳肌和股直肌疲劳发生早于其他下肢肌肉，如股外侧肌、腓肠肌和胫骨前肌。这可能与跑步速度增加时这些肌肉更高的激活有关，而股二头肌在髋部伸展中的主导作用以及髋部伸肌在短跑期间产生水平力的重要性支撑了这一点。与此相一致的是，在跑步机上进行令人疲劳的重复冲刺方案会导致冲刺加速度（最大功率输出）和水平力产生降低。除此之外，研究人员还发现（i）疲劳状态下水平力产生和伸髋肌的向心峰力矩有关，（ii）疲劳后水平力产生减少与摆动阶段结束时臀大肌活动的小幅度减少有关，并且（iii）虽然膝关节屈曲期间的腘绳肌肌肉扭矩与非疲劳状态下的水平力产生有关，但这种关联在疲劳状态下没有观察到这种现象。作者认为，疲劳状态下最大功率输出的下降可能与水平力的下降而不是总力输出的下降有关，这部分是由于腘绳肌肌肉功能下降所致，这同时促进了其他髋部伸肌的激活，例如臀大肌。
Furthermore, electromyographic assessment relative to walking distance demonstrated that hamstring and rectus femoris fatigue occurs earlier than other lower limb muscles such as vastus lateralis, gastrocnemius, and tibialis anterior during high-speed but not low-speed running. This may be related to higher activation of these muscles as running speed increases, supported by the dominant role of the biceps femoris in hip extension and the importance of the hip extensor muscles in generating horizontal force during sprinting. Consistent with this, a fatiguing repetitive sprint regimen on a treadmill results in reduced sprint acceleration (maximum power output) and horizontal force production. In addition, the researchers found that (i) horizontal force production during fatigue was related to the centripetal peak moment of the hip extensor muscles, and (ii) the reduction in horizontal force production after fatigue was related to a small reduction in gluteus maximus activity at the end of the swing phase. related, and (iii) although hamstring muscle torque during knee flexion is related to horizontal force production in the non-fatigued state, this association is not observed in the fatigued state. The authors suggest that the decrease in maximum power output under fatigue may be related to a decrease in horizontal force rather than a decrease in total force output, which is partly due to a decrease in hamstring muscle function, which also promotes the activation of other hip extensor muscles. , such as gluteus maximus.
腘绳肌肌肉功能的改变也可能与前面提到的疲劳引起的“Groucho 模式”有关，导致股二头肌中肌肉-肌腱单位能量转移效率较低，并增加对邻近结构和/或协同肌肉（如臀大肌）的需求。还有越来越多的证据表明腰部-骨盆控制功能可能在降低腘绳肌拉伤风险中发挥重要作用。事实上，疲劳的存在已被证明会促进足球运动员骨盆前倾，由于股二头肌相对长度的增加，可能会增加他们受伤的风险。此外，众所周知，离心膝屈肌力量训练干预可以降低腘绳肌拉伤风险，而 Delextra 等人表明，强调力量-耐力的训练显着减少了与模拟比赛相关的腘绳肌离心峰值扭矩的下降。此外，有回顾性证据表明，先前的腘绳肌拉伤与力量耐力缺陷相关，前瞻性证据表明，腘绳肌特定力量耐力测试（单腿腘绳肌桥）的测试分数较弱与更大的腘绳肌风险相关。因此，腘绳肌及其协同肌的力量耐力训练干预对腘绳肌风险的影响值得进一步研究。
Alterations in hamstring muscle function may also be related to the previously mentioned fatigue-induced "Groucho pattern," resulting in less efficient muscle-tendon unit energy transfer in the biceps femoris and increased stress on adjacent structures and/or synergistic muscles ( Such as gluteus maximus) needs. There is also growing evidence that lumbo-pelvic control may play an important role in reducing the risk of hamstring strain. In fact, the presence of fatigue has been shown to promote anterior pelvic tilt in football players, potentially increasing their risk of injury due to the increased relative length of the biceps femoris. Additionally, eccentric knee flexor strength training interventions are known to reduce the risk of hamstring strain, and Delextra et al showed that training with an emphasis on strength-endurance significantly reduced the decline in eccentric peak hamstring torque associated with simulated competition. Additionally, there is retrospective evidence that prior hamstring strain is associated with strength endurance deficits and prospective evidence that weaker test scores on a hamstring-specific strength endurance test (single-leg hamstring bridge) are associated with greater Hamstrings risk associated. Therefore, the impact of strength-endurance training interventions on the hamstrings and their synergists on hamstring risk deserves further study.
从疲劳对腘绳肌拉伤生物力学机制的影响角度，有以下方式可以降低RTP后再损伤发生概率：
From the perspective of the impact of fatigue on the biomechanical mechanism of hamstring strain, there are the following ways to reduce the probability of reinjury after RTP:
从膝关节稳定性下降角度，由于腘绳肌，尤其是股二头肌长头及膝关节后外侧复合体在膝关节稳定性方面的重大作用，通过重复性离心训练，提升股二头肌力量耐力与肌束长度，能够一定程度上避免疲劳后带来的膝关节稳定性下降。这部分指标可以用nordbord 监控。
From the perspective of decreased stability of the knee joint, due to the important role of the hamstrings, especially the long head of the biceps femoris and the posterolateral knee complex in knee joint stability, repeated eccentric training can improve the strength of the biceps femoris. Endurance and muscle bundle length can, to a certain extent, avoid the decrease in knee joint stability caused by fatigue. These indicators can be monitored using nordbord.
从腿部硬度下降角度，运动员下肢在专项运动后产生疲劳，可以用反应力量作为相应监控指标。使用Forcedeck等测力板，通过纵跳、反向纵跳测试拉伸缩短循环表现情况，可以作为RTP后的重要指标。
From the perspective of reduced leg hardness, athletes' lower limbs experience fatigue after special sports, and reaction strength can be used as a corresponding monitoring indicator. Use Forcedeck and other force measuring plates to test the performance of the stretch-shortening cycle through vertical jumps and reverse vertical jumps, which can be used as an important indicator after RTP.
从肌肉肌腱能量传递下降角度，在RTP之前，需要通过治疗和康复训练，排除关节活动度限制因素，避免运动员出现Groucho步态。同时当运动员在赛场或训练场表现处Groucho步态时及时关注疲劳状态。肌肉肌腱能量传递提升也需要循序渐进的最大跑步速度训练。
From the perspective of decreased muscle-tendon energy transfer, treatment and rehabilitation training are required before RTP to eliminate factors that limit joint mobility and prevent athletes from developing Groucho gait. At the same time, when athletes perform Groucho gait on the playing field or training ground, pay attention to their fatigue status in time. Improving muscle-tendon energy transfer also requires progressive training at maximum running speed.
从腰椎骨盆控制角度，使用FMS、FMS、Reconditioning等功能动作评估体系对于腰椎骨盆控制的相应指标对运动员该项能力进行筛查、评估和管理可能会有帮助。对于运动员在疲劳状态下表现出的该项能力不足，需要在功能训练中逐渐加强。
From the perspective of lumbar pelvic control, it may be helpful to use functional movement assessment systems such as FMS, FMS, and Reconditioning to screen, evaluate, and manage athletes' abilities based on corresponding indicators of lumbar pelvic control. Athletes' deficiencies in this ability under fatigue need to be gradually strengthened during functional training.
附录：回归运动标准
Appendix: Return to Sport Standards
Criteria for Return-to-Play Clearance
No pain on palpation of the injured muscle
No pain during the active knee extension or passive straight leg raise test, with range of motion at 90% or greater of that of the contralateral, uninjured leg
No pain during maximal-effort isometric knee flexor contraction at 0°/0° and 90°/90° of hip/knee flexion
No pain or apprehension during sprinting at 100% of perceived maximal running intensity
恢复比赛标准
Restoring competition standards
-触诊受伤肌肉时无疼痛感
-No pain when palpating injured muscles
-在主动伸膝或被动直腿抬高测试中无疼痛，活动范围为对侧未伤腿的 90% 或以上
-No pain during active knee extension or passive straight leg raise testing, and range of motion is 90% or more of the contralateral uninjured leg
-在髋关节/膝关节屈曲 0°/0° 和 90°/90° 处进行最大力量等长膝关节屈曲收缩时无疼痛感
-No pain during maximal isometric knee flexion contractions at 0°/0° of hip/knee flexion and 90°/90°
-以最大跑步强度的 100%进行冲刺时无疼痛或恐惧感
- Sprint at 100% of maximum running intensity without pain or fear
核心知识点（take home massage）
Core knowledge points (take home massage)
在腘绳肌拉伤风险因素中，腘绳肌离心力量差和股二头肌肌束短跟腘绳肌拉伤关系最为密切。
Among the risk factors for hamstring strain, poor eccentric strength of the hamstring and short biceps femoris muscle fascicle are most closely related to hamstring strain.
怎样增加腘绳肌力量比单纯训练腘绳肌力量更重要，离心训练同时能够增加股二头肌肌束长度和增加腘绳肌力量。
How to increase hamstring strength is more important than simply training hamstring strength. Eccentric training can also increase the length of the biceps femoris muscle bundle and increase hamstring strength.
跑步技术与腘绳肌拉伤之间关系尚不明确，跑步速度与腘绳肌拉伤有很大关系，需要进行最大速度训练
The relationship between running technique and hamstring strain is not clear. Running speed is closely related to hamstring strain, and maximum speed training is required.
腘绳肌拉伤加速RTP框架相比传统康复框架显著缩短了康复时间，促进腘绳肌结构发生良性适应。可以尝试在康复训练早期加入长肌肉长度下的向心和离心训练
Compared with the traditional rehabilitation framework, the accelerated RTP framework for hamstring strain significantly shortens the recovery time and promotes benign adaptation of the hamstring muscle structure. You can try to add concentric and eccentric training to increase muscle length in the early stage of rehabilitation training.
沉浸式翻译