Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis. Issue 18 (21st July 2015)

• Record Type: Journal Article
• Authors: Pas, Haiko IMFL; Reurink, Gustaaf; Tol, Johannes L; Weir, Adam; Winters, Marinus; Moen, Maarten H
• Is Part Of: British journal of sports medicine. Volume 49:Issue 18(2015)
• Page Start: 1197
• Page End: 1205
• Publication Date: 2015-07-21
• Subjects: Hamstring -- Injuries -- Platelet-Rich Plasma -- Physiotherapy -- Review; Sports medicine -- Periodicals; 617.1027
• DOI: 10.1136/bjsports-2015-094879
• Languages: English
• ISSNs: 0306-3674

Abstract

Abstract : Background: Our 2012 review on therapeutic interventions for acute hamstring injuries found a lack of high-quality studies. The publication of new studies warranted an update. Objectives: To update and reanalyse the efficacy of conservative treatments for hamstring injury. Data sources: PubMed, EMBASE, Web of Science, Cochrane library, CINAHL and SPORTDiscus were searched till mid-February 2015. Study eligibility criteria: Randomised controlled trials (RCTs) on the effect of conservative interventions versus a control group or other intervention for hamstring injuries (HI) were included. Data analysis: The search results were screened independently by two authors. Risk of bias assessment was performed using a modified Downs and Black scale with a maximum score of 28. Meta-analysis was performed, where possible. Main results: 10 RCTs (526 participants), including 6 new RCTs, were identified. Two RCTs were of good/excellent quality, the rest were fair or poor (median Downs and Black score 16 (IQR 9)). Meta-analysis of two studies on rehabilitation (lengthening) exercises showed a significantly reduced time to return to play (HR 3.22 (95% CI 2.17 to 4.77), p<0.0001) but no difference in risk of re-injury. Meta-analysis of three studies investigating platelet-rich plasma (PRP) showed no effect when compared to control (HR 1.03 (95% CI 0.87 to 1.22), p=0.73). Limited evidence was found that progressive agility and trunk stability training may reduce re-injury rates. Conclusions: Meta-analysis showed superior efficacy for rehabilitation exercises. PRP injection had no effect on acute hamstring injury. Limited evidence was found that agility and trunk stabilisation may reduce re-injury rates. The limitations identified in the majority of RCTs should improve the design of new hamstring RCTs.