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, 51 (2), 162-74

Clinical Practice Patterns and Beliefs in the Management of Hamstrings Strain Injuries


Clinical Practice Patterns and Beliefs in the Management of Hamstrings Strain Injuries

Andrea Di Trani Lobacz et al. J Athl Train.


Context: Hamstrings strain injuries (HSIs) are among the most commonly occurring injuries in sport and are top causes of missed playing time. Lingering symptoms, prolonged recovery, and a high reinjury rate (12%-34%) make HSI management a frustrating and challenging process for the athletic trainer (AT). The clinical practice patterns and opinions of ATs regarding HSI treatment and rehabilitation are unknown.

Objective: To examine the frequency of method use and opinions about current HSI management among ATs.

Design: Cross-sectional study.

Setting: Survey administered to registrants at the 2013 National Athletic Trainers' Association Clinical Symposia and AT Expo.

Patients or other participants: A total of 1356 certified ATs (691 men, 665 women; age = 35.4 ± 10.5 years, time certified = 11.92 ± 9.75 years).

Data collection and analysis: A survey was distributed electronically to 7272 registrants and on paper to another 700 attendees. Validity and reliability were established before distribution. Participants reported demographic information and rated their frequency of treatment and rehabilitation method use and agreement with questions assessing confidence, satisfaction, and desire for better clinical practice guidelines. Exploratory factor analysis and principal axis factor analysis were used. We also calculated descriptive statistics and χ(2) tests to assess practice patterns.

Results: The response rate was 17% (n = 1356). A 2-factor solution was accepted for factor analysis (r = 0.76, r = 0.70), indicating that ATs follow either a contemporary or traditional management style. Various practice patterns were evident across employment settings and years of clinical experience. Satisfaction with the current HSI management plan was high (73.6%), whereas confidence in returning an athlete to play was lower (62.0%). Rates of use were associated with belief in effectiveness for all methods assessed (P < .001). Higher confidence levels were associated with high use of several methods; we observed increased satisfaction (χ(2)2 = 22.5, P = .002) but not increased confidence levels in more experienced ATs.

Conclusions: Our study demonstrated the lack of consensus in HSI treatment and rehabilitation and the ATs' desire for better clinical practice guidelines. Future research in which multimodal strategies, including both traditional and contemporary methods, are studied is warranted for effective management of HSI.

Keywords: athletic trainer; muscle; reinjury.


Figure 1.
Figure 1.
Athletic trainers' responses to general practice questions. Abbreviation: HSI, hamstrings strain injury.
Figure 2.
Figure 2.
Use of A, Treatments, and B, Rehabilitation methods. a Graston Technique, Indianapolis, IN; Astym, Performance Dynamics, Inc, Muncie, IN.
Figure 3.
Figure 3.
Athletic trainers' responses to importance of return-to-play methods.

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