Can Clinical Evaluation Predict Return to Sport after Acute Hamstring Injuries? A Systematic Review

Abstract

Background

The current literature on the value of clinical evaluation for predicting time to return to sport (RTS) after acute hamstring injuries has not been systematically summarised.

Objectives

The aim of this study was to systematically review the literature on the prognostic value of clinical findings (patient history and physical examination) for time to RTS after acute hamstring injuries in athletes.

Data Sources

The databases PubMed, EMBASE, SPORTDiscus and Cochrane Library were searched between October 2014 and August 2015.

Study Eligibility Criteria

Studies evaluating patient history and/or physical assessment findings as possible predictors for time to RTS (described in days or weeks) following acute hamstring injuries in athletes were eligible for inclusion.

Data Analysis

Two authors independently screened the search results and assessed risk of bias using the modified Quality in Prognosis Studies (QUIPS) tool for quality appraisal of prognosis studies. We used a best-evidence synthesis to determine the level of evidence.

Results

Sixteen studies were included, of which one study had a low risk of bias and 15 had a high risk of bias. Moderate evidence for an association with time to RTS was found for three clinical findings (visual analogue scale; pain at time of injury, self-predicted time to RTS and clinician predicted time to RTS). There was limited evidence for an association with time to RTS for seven clinical findings (muscle pain during everyday activities, popping sound at injury, forced to stop within 5 min, visual bruising at the site of injury, width (cm) of tenderness to palpation, pain on trunk flexion and pain on active knee flexion initially after injury). The remaining clinical findings revealed either conflicting evidence or limited evidence for an association with time to RTS.

Conclusion

There is at present no strong evidence that any clinical finding at baseline provides a valuable prognosis for time to RTS after an acute hamstring injury. There is moderate evidence that visual analogue scale pain at time of injury and predictions for time to RTS by the patient and the clinician are associated with time to RTS. The methodological quality of the current literature is characterised by a substantial risk of bias and reporting of RTS definitions and criteria for RTS were inconsistent. We provide recommendations that can guide the design of future studies.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Yeung SS, Suen AMY, Yeung EW. A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor. Br J Sports Med. 2009;43:589–94. doi:10.1136/bjsm.2008.056283.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Feddermann-Demont N, Junge A, Edouard P, et al. Injuries in 13 international athletics championships between 2007–2012. Br J Sports Med. 2014;48:513–22. doi:10.1136/bjsports-2013-093087.

    Article  PubMed  Google Scholar 

  3. 3.

    Eirale C, Farooq A, Smiley FA, et al. Epidemiology of football injuries in Asia: a prospective study in Qatar. J Sci Med Sport. 2013;16:113–7. doi:10.1016/j.jsams.2012.07.001.

    Article  PubMed  Google Scholar 

  4. 4.

    Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39:1226–32. doi:10.1177/0363546510395879.

    Article  PubMed  Google Scholar 

  5. 5.

    Petersen J, Thorborg K, Nielsen MB, et al. Acute hamstring injuries in Danish elite football: a 12-month prospective registration study among 374 players. Scand J Med Sci Sports. 2009;20:588–92. doi:10.1111/j.1600-0838.2009.00995.x.

    Article  PubMed  Google Scholar 

  6. 6.

    Engebretsen AH, Myklebust G, Holme I, et al. Intrinsic risk factors for hamstring injuries among male soccer players: a prospective cohort study. Am J Sports Med. 2010;38:1147–53. doi:10.1177/0363546509358381.

    Article  PubMed  Google Scholar 

  7. 7.

    Arnason A, Gudmundsson A, Dahl HA, et al. Soccer injuries in Iceland. Scand J Med Sci Sports. 1996;6:40–5.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Elliott MCCW, Zarins B, Powell JW, et al. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med. 2011;39:843–50. doi:10.1177/0363546510394647.

    Article  PubMed  Google Scholar 

  9. 9.

    Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports Med. 2002;36:39–44.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Orchard JW, Seward H, Orchard JJ. Results of 2 decades of injury surveillance and public release of data in the Australian Football League. Am J Sports Med. 2013;41:734–41. doi:10.1177/0363546513476270.

    Article  PubMed  Google Scholar 

  11. 11.

    Brooks JHM. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med. 2006;34:1297–306. doi:10.1177/0363546505286022.

    Article  PubMed  Google Scholar 

  12. 12.

    de Visser HM, Reijman M, Heijboer MP, et al. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med. 2012;46:124–30. doi:10.1136/bjsports-2011-090317.

    Article  PubMed  Google Scholar 

  13. 13.

    Eirale C, Tol JL, Farooq A, et al. Low injury rate strongly correlates with team success in Qatari professional football. Br J Sports Med. 2013;47(12):807–8. doi:10.1136/bjsports-2012-091040.

    Article  PubMed  Google Scholar 

  14. 14.

    Hickey J, Shield AJ, Williams MD, et al. The financial cost of hamstring strain injuries in the Australian Football League. Br J Sports Med. 2014;48:729–30. doi:10.1136/bjsports-2013-092884.

    Article  PubMed  Google Scholar 

  15. 15.

    Kerkhoffs GMMJ, Es N, Wieldraaijer T, et al. Diagnosis and prognosis of acute hamstring injuries in athletes. Knee Surg Sports Traumatol Arthrosc. 2012;21:500–9. doi:10.1007/s00167-012-2055-x.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Koulouris G, Connell D. Imaging of hamstring injuries: therapeutic implications. Eur Radiol. 2006;16:1478–87. doi:10.1007/s00330-005-0075-3.

    Article  PubMed  Google Scholar 

  17. 17.

    Hallén A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sports Sci. 2014;32:1229–36. doi:10.1080/02640414.2014.905695.

    Article  PubMed  Google Scholar 

  18. 18.

    Ekstrand J, Healy JC, Waldén M, et al. Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med. 2012;46:112–7. doi:10.1136/bjsports-2011-090155.

    Article  PubMed  Google Scholar 

  19. 19.

    Wangensteen A, Almusa E, Boukarroum S, et al. MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: a prospective cohort of 180 male athletes. Br J Sports Med. 2015;49(24):1579–87. doi:10.1136/bjsports-2015-094892.

    Article  PubMed  Google Scholar 

  20. 20.

    Askling CM, Tengvar M, Saartok T, et al. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med. 2008;36:1799–804. doi:10.1177/0363546508315892.

    Article  PubMed  Google Scholar 

  21. 21.

    Reurink G, Brilman EG, de Vos R-J, et al. Magnetic resonance imaging in acute hamstring injury: can we provide a return to play prognosis? Sports Med. 2015;45:133–46. doi:10.1007/s40279-014-0243-1.

    Article  PubMed  Google Scholar 

  22. 22.

    Hayden JA, Côté P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144:427–37.

    Article  PubMed  Google Scholar 

  23. 23.

    Hayden JA, van der Windt DA, Cartwright JL, et al. Assessing bias in studies of prognostic factors. Ann Intern Med. 2013;158:280–6. doi:10.7326/0003-4819-158-4-201302190-00009.

    Article  PubMed  Google Scholar 

  24. 24.

    Reurink G, Goudswaard GJ, Tol JL, et al. Therapeutic interventions for acute hamstring injuries: a systematic review. Br J Sports Med. 2011;46:103–9. doi:10.1136/bjsports-2011-090447.

    Article  PubMed  Google Scholar 

  25. 25.

    Brooks JHM, Fuller CW, Kemp SPT, et al. Epidemiology of injuries in English professional rugby union: part 2 training injuries. Br J Sports Med. 2005;39:767–75. doi:10.1136/bjsm.2005.018408.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Walden M, Hagglund M, Ekstrand J. Injuries in Swedish elite football: a prospective study on injury definitions, risk for injury and injury pattern during 2001. Scand J Med Sci Sports. 2005;15:118–25. doi:10.1111/j.1600-0838.2004.00393.x.

    Article  PubMed  Google Scholar 

  27. 27.

    Heiderscheit BC. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40(2):67–81. doi:10.2519/jospt.2010.3047.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    van Tulder M, Furlan A, Bombardier C, et al. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine. 2003;28:1290–9. doi:10.1097/01.BRS.0000065484.95996.AF.

    PubMed  Google Scholar 

  29. 29.

    Hayden JA, Tougas ME, Riley R, et al. Individual recovery expectations and prognosis of outcomes in non-specific low back pain: prognostic factor exemplar review. Cochrane Database Syst Rev. John Wiley and Sons, Ltd; 2014. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011284/abstract. Accessed 7 Dec 2015.

  30. 30.

    Petersen J, Thorborg K, Nielsen MB, et al. The diagnostic and prognostic value of ultrasonography in soccer players with acute hamstring injuries. Am J Sports Med. 2014;42:399–404. doi:10.1177/0363546513512779.

    Article  PubMed  Google Scholar 

  31. 31.

    Ha MS, Ashril Y, Ma MR. Pattern of muscle injuries and predictors of return-to-play duration among Malaysian athletes. Singapore Med J. 2013;54:587–91. doi:10.11622/smedj.2013204.

    Article  Google Scholar 

  32. 32.

    Silder A. Clinical and morphological changes following 2 rehabilitation programs for acute hamstring strain injuries: a randomized clinical trial. J Orthop Sports Phys Ther. 2013;43(5):284–99. doi:10.2519/jospt.2013.4452.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Wetzel RJ, Patel RM, Terry MA. Platelet-rich plasma as an effective treatment for proximal hamstring injuries. Orthopedics. 2013;36:e64–70. doi:10.3928/01477447-20121217-20.

    Article  PubMed  Google Scholar 

  34. 34.

    Patel R, Wetzel RJ, Terry M. Platelet-rich plasma as an effective treatment for proximal hamstring injuries. Arthrosc J Arthrosc Relat Surg. 2013;10(Suppl):e103. doi:10.1016/j.arthro.2013.07.118.

    Article  Google Scholar 

  35. 35.

    Pizzari T, Taylor R, Coburn P. Emerging trends in hamstring injuries in the Australian Football League. J Sci Med Sport. 2013;Suppl 1:e64–5. doi:10.1016/j.jsams.2013.10.153.

    Article  Google Scholar 

  36. 36.

    Heiser TM, Weber J, Sullivan G, et al. Prophylaxis and management of hamstring muscle injuries in intercollegiate football players. Am J Sports Med. 1984;12:368–70.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Shiple BJ. Hamstring strains in elite footballers: predicting recovery and recurrence. Clin J Sport Med. 2011;21:372–3. doi:10.1097/01.jsm.0000399818.43062.24.

    Article  PubMed  Google Scholar 

  38. 38.

    Comin J, Malliaras P, Baquie P, et al. Return to competitive play after hamstring injuries involving disruption of the central tendon. Am J Sports Med. 2012;41:111–5. doi:10.1177/0363546512463679.

    Article  PubMed  Google Scholar 

  39. 39.

    Cohen SB, Towers JD, Zoga A, et al. Hamstring injuries in professional football players: magnetic resonance imaging correlation with return to play. Sports Health. 2011;3:423–30. doi:10.1177/1941738111403107.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Connell DA, Schneider-Kolsky ME, Hoving JL, et al. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. Am J Roentgenol. 2004;183:975–84.

    Article  Google Scholar 

  41. 41.

    Malliaropoulos N, Papalexandris S, Papalada A, et al. The role of stretching in rehabilitation of hamstring injuries: 80 athletes follow-up. Med Sci Sports Exerc. 2004;36:756–9. doi:10.1249/01.MSS.0000126393.20025.5E.

    Article  PubMed  Google Scholar 

  42. 42.

    Sherry MA, Best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther. 2004;34:116–25. doi:10.2519/jospt.2004.34.3.116.

    Article  PubMed  Google Scholar 

  43. 43.

    Levine WN, Bergfeld JA, Tessendorf W, et al. Intramuscular corticosteroid injection for hamstring injuries a 13-year experience in the National Football League. Am J Sports Med. 2000;28:297–300.

    CAS  PubMed  Google Scholar 

  44. 44.

    Kornberg C, Lew P. The effect of stretching neural structures on grade one hamstring injuries. J Orthop Sports Phys Ther. 1989;10:481–7.

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Rettig AC, Meyer S, Bhadra AK. Platelet-rich plasma in addition to rehabilitation for acute hamstring injuries in NFL players: clinical effects and time to return to play. Orthop J Sports Med. 2013;1:2325967113494354. doi:10.1177/2325967113494354.

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Jaadouni S, Bouvard M, Lippa A, et al. Apport des plasmas enrichis en plaquettes dans le traitement des lésions musculaires traumatiques: étude pilote à propos de 50 cas. J Traumatol Sport. 2014;31:3–11. doi:10.1016/j.jts.2013.11.004.

    Article  Google Scholar 

  47. 47.

    Warren P. Hamstring strains; is an MRI necessary? Comparing MRI with clinical assessment in AFL footballers with a hamstring strain. Sport Health. 2008;26:15.

    Google Scholar 

  48. 48.

    Hamilton B, Tol JL, Almusa E, et al. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. Br J Sports Med. 2015;49:943–50. doi:10.1136/bjsports-2015-094603.

    Article  PubMed  Google Scholar 

  49. 49.

    Reurink G, Goudswaard GJ, Moen MH, et al. Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study. Br J Sports Med. 2015;49(18):1206–12. doi:10.1136/bjsports-2014-094250.

    Article  PubMed  Google Scholar 

  50. 50.

    De Vos R-J, Reurink G, Goudswaard G-J, et al. Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not. Br J Sports Med. 2014;48(18):1377–84. doi:10.1136/bjsports-2014-093737.

    Article  PubMed  Google Scholar 

  51. 51.

    Cross KM, Saliba SA, Conaway M, et al. Days to return to participation after a hamstrings strain among American Collegiate soccer players. J Athl Train. 2015;50:733–41. doi:10.4085/1052-6050-50.2.12.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Sherry MA, Johnston TS, Heiderscheit BC. Rehabilitation of acute hamstring strain injuries. Clin Sports Med. 2015;34:263–84. doi:10.1016/j.csm.2014.12.009.

    Article  PubMed  Google Scholar 

  53. 53.

    Reurink G, Almusa E, Goudswaard GJ, et al. No association between fibrosis on magnetic resonance imaging at return to play and hamstring reinjury risk. Am J Sports Med. 2015;43:1228–34. doi:10.1177/0363546515572603.

    Article  PubMed  Google Scholar 

  54. 54.

    Tyler TF, Schmitt BM, Nicholas SJ, et al. Rehabilitation after hamstring strain injury emphasizing eccentric strengthening at long muscle lengths: results of long term follow-up. J Sport Rehabil. 2016;24:1–33 [Epub ahead of print].

    Google Scholar 

  55. 55.

    Nett MH, et al. MR findings at return to sport after indirect hamstring injury. Miami: Skeletal Radiology; 2012.

    Google Scholar 

  56. 56.

    Verrall GM, Slavotinek JP, Barnes PG, et al. Diagnostic and prognostic value of clinical findings in 83 athletes with posterior thigh injury: comparison of clinical findings with magnetic resonance imaging documentation of hamstring muscle strain. Am J Sports Med. 2003;31:969–73.

    PubMed  Google Scholar 

  57. 57.

    Askling C. Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Br J Sports Med. 2006;40:40–4. doi:10.1136/bjsm.2005.018879.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Askling CM, Tengvar M, Saartok T, et al. Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics. Am J Sports Med. 2007;35:1716–24. doi:10.1177/0363546507303563.

    Article  PubMed  Google Scholar 

  59. 59.

    Askling CM, Tengvar M, Saartok T, et al. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med. 2007;35:197–206. doi:10.1177/0363546506294679.

    Article  PubMed  Google Scholar 

  60. 60.

    Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2014;48(7):532–9. doi:10.1136/bjsports-2013-092165.

    Article  PubMed  Google Scholar 

  61. 61.

    Askling CM, Tengvar M, Tarassova O, et al. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2014;48:532–9. doi:10.1136/bjsports-2013-093214.

    Article  PubMed  Google Scholar 

  62. 62.

    Warren P, Gabbe BJ, Schneider-Kolsky M, et al. Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers. Br J Sports Med. 2010;44:415–9. doi:10.1136/bjsm.2008.048181.

    Article  PubMed  Google Scholar 

  63. 63.

    Malliaropoulos N, Papacostas E, Kiritsi O, et al. Posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med. 2010;38:1813–9. doi:10.1177/0363546510366423.

    Article  PubMed  Google Scholar 

  64. 64.

    Kilcoyne KG, Dickens JF, Keblish D, et al. Outcome of grade I and II hamstring injuries in intercollegiate athletes: a novel rehabilitation protocol. Sports Health. 2011;3:528–33. doi:10.1177/1941738111422044.

    Article  PubMed  PubMed Central  Google Scholar 

  65. 65.

    Guillodo Y, Here-Dorignac C, Thoribé B, et al. Clinical predictors of time to return to competition following hamstring injuries. Muscles Ligaments Tendons J. 2014;4:386–90.

    PubMed  PubMed Central  Google Scholar 

  66. 66.

    Moen MH, Reurink G, Weir A, et al. Predicting return to play after hamstring injuries. Br J Sports Med. 2014;48(18):1358–63. doi:10.1136/bjsports-2014-093860.

    CAS  Article  PubMed  Google Scholar 

  67. 67.

    Hamid MSA, Mohamed Ali MR, Yusof A, et al. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med. 2014;42:2410–8. doi:10.1177/0363546514541540.

    Article  Google Scholar 

  68. 68.

    Schneider-Kolsky ME. A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries. Am J Sports Med. 2006;34:1008–15. doi:10.1177/0363546505283835.

    Article  PubMed  Google Scholar 

  69. 69.

    Hamilton B, Valle X, Rodas G, et al. Classification and grading of muscle injuries: a narrative review. Br J Sports Med. 2015;49(5):306. doi:10.1136/bjsports-2014-093551.

    Article  PubMed  Google Scholar 

  70. 70.

    Pas HIMFL, Reurink G, Tol JL, et al. Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis. Br J Sports Med. 2015;49:1197–205. doi:10.1136/bjsports-2015-094879.

    Article  PubMed  Google Scholar 

  71. 71.

    Ardern CL, Bizzini M, Bahr R. It is time for consensus on return to play after injury: five key questions. Br J Sports Med. 2016;50(9):506–8. doi:10.1136/bjsports-2015-095475.

    Article  PubMed  Google Scholar 

  72. 72.

    Tabachnick BG, Fidell LS. Using multivariate statistics, 6th edn. Pearson Education; 2013.

  73. 73.

    Grimes DA, Schulz KF. Bias and causal associations in observational research. Lancet. 2002;359:248–52. doi:10.1016/S0140-6736(02)07451-2.

    Article  PubMed  Google Scholar 

  74. 74.

    Armitage P, Berry G, Matthews JNS. Statistical methods in medical research, 4th edn. Blackwell Science Ltd; 2008.

  75. 75.

    van der Horst N, van de Hoef S, Reurink G, et al. Return to play after hamstring injuries: a qualitative systematic review of definitions and criteria. Sports Med. 2016;46(6):899–912. doi:10.1007/s40279-015-0468-7.

    Article  PubMed  PubMed Central  Google Scholar 

  76. 76.

    Shrier I. Strategic assessment of risk and risk tolerance (StARRT) framework for return-to-play decision-making. Br J Sports Med. 2015;49:1311–5. doi:10.1136/bjsports-2014-094569.

    Article  PubMed  Google Scholar 

  77. 77.

    Proske U, Morgan DL, Brockett CL, et al. Identifying athletes at risk of hamstring strains and how to protect them. Clin Exp Pharmacol Physiol. 2004;31:546–50. doi:10.1111/j.1440-1681.2004.04028.x.

    CAS  Article  PubMed  Google Scholar 

  78. 78.

    Brockett CL, Morgan DL, Proske U. Predicting hamstring strain injury in elite athletes. Med Sci Sports Exerc. 2004;36:379–87.

    Article  PubMed  Google Scholar 

  79. 79.

    Creighton DW, Shrier I, Shultz R, et al. Return-to-play in sport: a decision-based model. Clin J Sport Med. 2010;20:379–85. doi:10.1097/JSM.0b013e3181f3c0fe.

    Article  PubMed  Google Scholar 

  80. 80.

    Ardern CL, Österberg A, Tagesson S, et al. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med. 2014;48:1613–9. doi:10.1136/bjsports-2014-093842.

    Article  PubMed  Google Scholar 

  81. 81.

    von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9. doi:10.1016/j.jclinepi.2007.11.008.

    Article  Google Scholar 

  82. 82.

    Calvert M, Blazeby J, Altman DG, et al. Reporting of patient-reported outcomes in randomized trials: the CONSORT PRO extension. JAMA. 2013;309:814–22. doi:10.1001/jama.2013.879.

    CAS  Article  PubMed  Google Scholar 

  83. 83.

    Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869.

    Article  PubMed  PubMed Central  Google Scholar 

  84. 84.

    Schulz KF, Altman DG, Moher D, et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author contributions

Lotte Schut and Arnlaug Wangensteen contributed equally to this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Arnlaug Wangensteen.

Ethics declarations

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Lotte Schut, Arnlaug Wangensteen, Jolanda Maaskant, Johannes L. Tol, Roald Bahr and Maarten Moen declare that they have no conflicts of interest relevant to the content of this review.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 36 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schut, L., Wangensteen, A., Maaskant, J. et al. Can Clinical Evaluation Predict Return to Sport after Acute Hamstring Injuries? A Systematic Review. Sports Med 47, 1123–1144 (2017). https://doi.org/10.1007/s40279-016-0639-1

Download citation

Keywords

  • Knee Flexion
  • Magnetic Resonance Imaging Finding
  • Electronic Supplementary Material Table
  • Physical Assessment
  • Ischial Tuberosity