Hamstring Muscle Strains A Common Injury Physical Education Essay

Hamstring muscle strains are one of the common problems for many athletes which results in significant loss of on-field time. These injuries tend to heel slowly. Hamstring injuries are more common in sprinters and athletes, as they perform high-speed skilled movements. Once hamstring injury occurs, without proper rehabilitation and rest the athlete is at high risk for recurrence.
Some pose complicated challenges remains after the injury rehabilitation, when returning the athletes quickly and safely to participate in sports. The most common soft tissue injuries in thigh occur in hamstrings; particularly at the musculo-tendinous junctions (Fox 1986, King and Robertson 1986). A 4 year study was conducted of injury rates for Memphis state university football team. The study showed that hamstring strains were the third most common injuries after knee and ankle injuries during sports.

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The re-injury rate was 12% for hamstring strains when compared with an average re-injury rate of 7% for all other injuries. The injury recurrence is at highest risk during first 2 weeks of return to sports. Moreover, following return to sport nearly one third of these injury recurrences appear within the first year. An author, in his study reported that out of 30 sprinters 15 suffered from preceding hamstring strains.
The commonly utilized rehabilitation programs for hamstring injuries may be insufficient at resolving reduced tissue extensibility, possible muscular weakness and altered movement patterns associated with injury suggests the high re-injury rates. The primary objective of the rehabilitation program for hamstring is to restore the athlete with the level of activities previously carried out with minimal risk of recurrence of the injury of their participation in sports.
ANATOMY
There are 3 hamstring muscles present in the posterior thigh: the semitendinosus, semimembranosus and biceps femoris. The semitendinosus originates at the ischial tuberosity and gets inserted at the pes anserine; the semimembranosus gets origin from the ischial tuberosity and inserts at the posterior medial tibia. The biceps femoris has two heads; a long head which originates at the ischial tuberosity and a short head originate at the postero-lateral femur. Both heads of biceps femoris gets inserted into the head of the fibula. The hamstring muscle acts as knee flexors and hip extensors.
ANATOMY OF HAMSTRING MUSCLE
MECHANISM OF INJURY:
A muscle is commonly strained or torn during rapid acceleration or deceleration movements. The most implicated cause of hamstring strains is the imbalance between the quadriceps and the hamstring muscles. The hamstring muscle group is a two joint muscle and thus the anatomical configuration of the muscle group is at increased risk and more susceptible for strains.
Clanton and Coupe (1998) describes about mechanism of injury. The underlying mechanism for hamstring strains is suggested to be the increased force generated during eccentric action of muscle as opposed to a concentric contraction suggested as. The most common 2 factors in hamstring injury are lack of adequate flexibility and strength imbalances in hamstring muscle group.
Eccentric contractions are characterized by active lengthening of muscle fibres. In eccentric contraction, as the speed of contraction increases the force of contraction also increases as well. Conversely, during concentric contractions shortening of muscle fibres occurs and inverse relationship between the speed and force of contraction. During late swing phase, the hip is flexed and the knee is extended which is suggested for injuries to occur. In a high speed running, the hamstring strain occurs during terminal swing phase of gait cycle. The greatest musculo-tendon stretch is incurred by the biceps femoris muscle, which is more often injured than the other two hamstring muscles (semimembranosus and semitendinosus) during high speed running.
MECHANISM OF INJURY
HAMSTRING MUSCLE INJURY
CLASSIFICATIONS OF MUSCLE INJURY:
Injuries to muscles and tendons of the hamstrings are generally classified into three categories. These injuries are mentioned as: the strains of first, second and third grade.
A first degree strain is less severe. It is the result of a minor stretch of the muscles and tendons, and is accompanied by a slight pain, stiffness and swelling. In general, very little loss of function is present after a first degree strain.
A second degree strain is the result of both stretching and some tearing of muscles and tendons. There is an increased pain and swelling accompanied with a strain in the second degree. A moderate loss of function of that exacting muscle will be present.
A third degree strain is the most rigorous of the three degrees of strains. Complete tear or rupture of one or more of the muscles and tendons is said to be third degree strain. It results in severe pain, massive swelling and gross instability.
GRADES OF MUSCLE STRAIN
RISK FACTORS:
While an athlete performing running or jumping activities in sport, hamstring injuries happens usually as a result of rapid acceleration or deceleration movements. There are some main modifiable risk factors which include:
* In-adequate warm-up leading to muscle fatigue
* Muscle tightness
* Imbalance of muscular strength with low hamstring to quadriceps ratio
* Previous injury.
SYMPTOMS AND SIGNS:
In Grade 1 (Mild) : Local pain over posterior thigh, mild spasm, swelling, ecchymosis, local tenderness, mild pain on passive stretch and active contraction of the involved muscle, minor disability with loss of function and strength.
In Grade 2 (Moderate) : Local pain, moderate spasm, swelling, ecchymosis, local tenderness, moderate pain on passive stretch and active contraction of the involved muscle, moderate disability with impaired muscle function and strength.
In Grade 3 (Severe): Severe pain, severe spasm, swelling, ecchymosis, haematoma, tenderness, loss of muscle function, palpable defect may be present.
STRETCHING:
Stretching is believed to increase the range of motion around a joint through a decrease in visco-elasticity and an increase in compliance of muscle. By improving force absorption for a given length of muscle, thereby making the muscle is limited as the positive effect was demonstrated in only minor injuries.
Stretching exercises can be carried out as an individual training to enhance the flexibility of a muscle or as a warm-up planned to avoid injury and prepare the body for workout to pursue. Stretching gently lengthens the muscles before and after other exercises and helps to improve tissue elasticity and flexibility. It is suggested that a person should warm-up previous to stretching to enhance the blood flow. In turn this improved blood circulation makes the muscles more flexible. It is also not compulsory that all static stretches are supposed for 15 seconds at least prior to being released in order to stretch the muscle efficiently.
STRENGTHENING EXERCISES:
The development of muscle strength is an integral component of most rehabilitation or conditioning programs for individuals of all ages and all ability levels.
Strengthening of the hamstrings is an essential role in rehabilitation after injury to obtain the muscles back to their complete strength. This strengthening program will also facilitate to prevent anymore upcoming injuries. The most common adaptation to heavy resistance exercise is an increase in the maximum force-producing capacity of muscle, that is, an increase in muscle strength, primarily as the result of neural adaptations and an increase in muscle fibre size.
PROGRESSIVE AGILITY EXERCISES:
Agility training is a great way to help develop speed as well as becoming agile. This kind of method in training an athlete is enormously beneficial.
The benefits of agility training can certainly give a progression to any athletes in their overall performance. The skill to execute on the field and yet off the field is also improved. It also increases the running speed because running is the supreme foundation of all athletics. These agility exercises are also worn to increase the speed and quickness in all sports kind. These agility training vary from conventional speed training in that they integrate a lot more lateral movement.
TRUNK STABILIZATION EXERCISES:
Trunk stabilization exercises give strong, flexible trunk muscles that support well-aligned bones. It refers to progressive conditioning of the musculature of the pelvis and hip girdle, lumbar spine, abdominal region and peri-scapular musculature particularly as the use of these muscles relates to the performance of specific dynamic tasks involving the trunk of extremities. These exercises will strengthen the lower back and abdomen. Strengthening the core is essential to prevent all forms of injury around the lower back area. The concept of core stability has a theoretical basis in the treatment and prevention of various musculo-skeletal conditions. Many therapists now include a component of core stability training in the rehabilitation of a wide variety of lower limb injuries.
This had led some physical therapists to make use of a variety of trunk stabilization and progressive agility exercises for hamstring rehabilitation programs.
OPERATIONAL DEFINITIONS:
Muscle Strain:
A muscle strain is defined as an excessive stretch, which leads to muscle fibre damage and disrupts the integrity of related vascular and connective tissue structures.
Stretching:
Stretching is a form of physical exercise in which a specific skeletal muscle (or muscle group) is deliberately elongated to its fullest length in order to improve the muscle’s felt elasticity and reaffirm comfortable muscle tone.
Strengthening:
Strength training is defined as a systematic procedure of a muscle or muscle group lifting, lowering or controlling heavy loads (resistance) for a relatively low number of repetitions or over a short period of time.
Agility:
Agility is the ability to perform a series of explosive power movements in rapid succession in opposing directions.
Trunk Stabilization:
There is no formally endorsed definition of trunk stabilization. It refers to the balanced development of the deep and superficial muscles that stabilize, align and move the trunk of the body, especially the abdominals and muscles of the back.
NEED FOR THE STUDY:
The athlete returning to sport at previous level of functional performance with a minimal risk of injury recurrence is the primary goal of a rehabilitation program following a hamstring strain injury. The high re-injury rate may be due to the use of inappropriate criteria for determining suitability for return to sport or, alternatively, that traditional rehabilitation methods are insufficient for reducing risk for re-injury.
The need for the study was to determine that improved coordination of the lumbo-pelvic region allows the hamstrings for its optimal function at safe lengths and loads during athletic movement, thereby reducing injury risk.
AIM:
The aim of this study is to compare the effectiveness of Stretching and Strengthening program with Progressive agility and trunk stabilization program in the rehabilitation of acute hamstring strains.
OBJECTIVES:
To compare the effectiveness of two rehabilitation programs for acute hamstring strains by evaluating the relationship between functional testing performances.
HYPOTHESIS:
Null hypothesis:
There is no significant difference between the Stretching and Strengthening program against Progressive agility and trunk stabilization program in the functional testing performance of the athletes for acute hamstring strains on the day of return to sports.
Alternate hypothesis:
There is a significant difference between the Stretching and Strengthening program against Progressive agility and trunk stabilization program in the functional testing performance of the athletes for acute hamstring strains on the day of return to sports.
2. REVIEW OF LITERATURE
Bryan C. Heiderscheit, Marc A. Sherry, Amy Silder, Elizabeth and Darryl G. Thelen (2010) In a study says that there is a mounting evidence that the risk of re-injury can be minimized by utilizing rehabilitation strategies that incorporate neuromuscular control exercises and eccentric strength training, combined with objective measures to assess musculo-tendon recovery and readiness to return to sport.
Mason DL.Dickens V.Vaila(2007) In their study suggested that there is only limited evidence for rate of recovery can be increased with an increased daily frequency of hamstring stretching exercises. While managing a hamstring injury, the lumbar spine, sacroiliac and pelvic alignment along with the postural control mechanisms also must be concentrated. Lumbar stability and pelvic muscle control may also be a factor in reducing the rate of recurrence of hamstring injury.
G.Verrall, J.Slavotinek and P.Barnes(2005) Increasing the amount of anaerobic interval training, stretching whilst the muscle is fatigued and implementing sport specific training drills resulted in a significant reduction in the number and consequences of hamstring muscle strain injuries.
Thelen. D.G, E.S. Chumanov, M.A. Sherry and B.C. Heiderscheit(2006) In this article shows that hamstring strains are a common and recurrent injury among sprinting athletes and describes about the mechanics of hamstring injury and the influence of muscle co-ordination on hamstring mechanics. These observations are important for establishing effective injury prevention and rehabilitation programs.
Clanton TO, Coupe KJ (1998) Hamstring strains are among the most common injuries in athletes. This muscle injury occurs mostly at the myo-tendinous junction, when the force is concentrated. Concurrent pain-free stretching and strengthening exercises are essential to regain flexibility and to prevent further injury.
Gabbe BJ, Brason R and Bennell KL (2006) Evaluated the effectiveness of a pre-season eccentric training program on 220 players for preventing hamstring injuries. Five exercise sessions are completed over 2 weeks. Their finding suggests that a simple program of eccentric exercise could reduce the incidence of hamstring injuries.
David J.Magee, James E.Zachazewski, William S.Quillen (2009) Strain or overload of the hamstring tissues also may be due to a pelvic alignment fault or mal-alignment that changes the length/tension relationship of the hamstrings. Athletes with hamstring strain often show an anterior in-nominate tilt on the affected side. Rehabilitation of hamstring strains using progressive agility and trunk stabilisation exercises has been found to be more effective than a program emphasizing isolated hamstring stretching and strengthening and enable to return to activity more quickly than those treated with more conservative measures.
Robert Donatelli (2007) According to the clinical experience of the author, patello-femoral pain, hamstring strains, lateral hip pain results from lower quadrant core muscle deficits. Leerun et al demonstrated that core stability played an important role in injury prevention. Mascal et al reported that strengthening the hip, pelvis and trunk musculature resulted in a significant improvement in lower-extremity kinematics and ability to return to their sporting activities.
Thomas E.Hyde, Marianne S.Gengenbach (2007) Muckel states that hypomobility of the lower lumbar spinal segments is a cause of repetitive hamstring strains. Anterior pelvic tilt causing increased stretching of the hamstring also has been incriminated as a cause.
Peter Brukner and Karim khan (2007) Core stability program have shown the positive benefit in the management of sporting injuries. Many physiotherapists now incorporate an element of core stability program in rehabilitation of a wide variety of lower limb injuries and prevention of various musculoskeletal conditions.
Paul Gamble(2009) Single-leg hop tests of the type of vertical jump test have seen application in the rehabilitation setting to evaluate functional performance of injured and uninjured leg.
Agre JC (1985) Many of the recurrent injuries to the hamstring musculo-tendinous unit are the result of inadequate rehabilitation following the initial injury. The treatment for hamstring injuries should include training to maintain and improve strength, flexibility, endurance, co-ordination, and agility.
Hopper DM, Strauss GR, Boyle JJ, Bell J(2008) The functional hop performance in subjects with an ACL reconstruction and the hop tests results showed different levels of imposed demands on the knee that could be used to assess functional recovery and readiness to resume sport.
Andrea Reid, Trevor B Birmingham, Paul W Stratford, Robert Giffin (2006) conducted a study with 42 patients during rehabilitation after ACL reconstruction. The results show that the described series of hop tests provide a reliable and valid performance based outcome measures. These results sustain the utilization and facilitation in interpretation of hop tests for research and clinical practice.
JW Orchard, P Farhart, C Leopold (2004) suggests that the lumbar spine region pathology is a factor in some of the players who find that they have recurrent hamstring and calf musculo-tendinous injuries despite regular preventing maintenance. This brief report prompts us to consider lower lumbar pathology as a source of hamstring and calf problems (probably strains).
Croisier JL (2004) The risk factors which are examined in the literature have been associated with injury. Inadequate warm-up, invalid structure and the content of training, muscle tightness or weakness, agonist/antagonist imbalances, underestimation of an extensive injury and incomplete or aggressive rehabilitation are said to be most likely.
Malliaropoulos N, Papalexandris S, Papalada A, Papacostas E (2004) a total of 80 athletes with hamstring muscle strains were recruited in the study and the effects of stretching in rehabilitation of hamstring injuries were assessed. The results imply that stretching is of great value in treating muscle strain injuries in that it improves the effectiveness of the rest rehabilitation program.
Young W, Russell a, Burge P, Clarke a, Cormack S, Stewart G (2008), In a study determined the relationships between split times within sprint tests over 30m and 40m. They suggested that sprint tests over 30m and 40m can be conducted to provide information about independent speed qualities in athletes and concluded that this test can be used to estimate maximum speed capabilities.
Allen Hedrick, Lt. Jason Sanderson (1996) evaluated the effectiveness of training program using heavy resistance in improving vertical jump ability. Many strength and conditioning programs use the vertical jump test to measure the physiological adaptations from the training. Vertical jump testing is commonly used to measure improvements in the vertical jump for sports and as a general measure of lower body power in sports that requires high levels of lower body power.
Bill foran (2001) functional performance is a representation of actual efficiency through specific testing of gross performance (power, speed, etc). 40 yard dash speed represents the efficiency of the body. It allows the athlete to demonstrate the ability to store energy, efficiency, co-ordination and momentum management.
3. MATERIALS AND METHODS
MATERIALS (TOOLS)
ƒ˜ Stop watch
ƒ˜ Measuring tape
Cone markers
Chalk or Ink
ƒ˜ Thera-bands
Free weights
Couch
Ice packs
Stationary bike
ƒ˜ Data collection sheet and recording sheet
METHODOLOGY
3.1 STUDY DESIGN
An Experimental study design of a pre-test and post-test.
24 athletes with an acute hamstring strain were randomly assigned to 2 rehabilitation groups.
Group A – 12 athletes were assigned to the protocol consisting of static stretching, isolated progressive hamstring resistance exercise and icing (STST group).
Group B – 12 athletes were assigned to the program consisting of progressive agility and trunk stabilization exercise and icing (PATS group).
3.2 STUDY SETTING
This study was carried out with the students in sports team of Sri Ramakrishna Matriculation School, Sri Ramakrishna Institute of Paramedical Sciences and SNR College, Coimbatore.
3.3 SAMPLING
All acute hamstring strain patients were included in this study, hence this will be a simple random sampling.
Each group were assigned with 12 Athletes.
A sample of 24 Athletes were randomly selected and divided into Group A (STST group) and Group B (PATS group).
Both groups were evaluated after the rehabilitation programs for their functional testing profile by hop test for height and sprint test on the day of return to sports.
3.4 DURATION OF THE STUDY
This study was carried out for the period of one year.
3.5 DURATION OF THE TREATMENT
Group A
Phase I – 40 minutes each session, 2 sessions per day.
Phase II – 60 minutes each session, 2 sessions per day.
Group B
Phase I – 40 minutes each session, 2 sessions per day.
Phase II – 60 minutes each session, 2 sessions per day.
3.6. INCLUSION CRITERIA
¶ 14 – 22 yrs of age
¶ Only males
¶ Acute hamstring strains (within past 10 days)
¶ Only first and second degree of injury
3.7 EXCLUSION CRITERIA
¶ Less than 14 yrs or more than 22 yrs of age
¶ Females
Non- acute hamstring injuries
Complete muscle disruption (Third degree injury)
Avulsion injuries
Recent other lower extremity injuries
Inguinal or femoral hernia
Radiculopathy
History of malignant disease
Incomplete healing
Rehabilitation of pelvis or lower extremity features
Nerve entrapment
Lack of daily compliance
Posterior thigh pain not consistent with hamstring
Any other impairment limiting participation in rehabilitation program.
3.8 PARAMETERS OF THE STUDY
a) Hop test for height (in centimetres).
b) Sprinting test (in seconds).
3.9 TECHNIQUE
Group A:
Athletes received the protocol consisting of static stretching, isolated progressive hamstring resistance exercise and icing.
Group B:
Athletes received the program consisting of progressive agility and trunk stabilization exercise and icing.
3.10 STATISTICAL TOOLS
In this experimental study, statistical method was used to show the effectiveness of functional testing profile in Group A and Group B was the dependent ‘t’ test.
The dependent ‘t’ test was calculated to find the difference between pre test and post test within the group, using the formula
Dependent ‘t’ test =
Where,
d = Difference of pre test and post test values.
N = Number of patients
Then the combined standard deviation is calculated using the formula
Combined standard deviation,
S =
Where,
X1 = Difference of post test values and pre test values of Group A
= Mean difference of Group A
X2 = Difference of post test values and pre test values of Group B
= Mean difference of Group B
n1 = Number of patients in Group A
n2 = Number of patients in Group B
With the combined standard deviation value ‘S’ obtained, and from the values of Group A and Group B, the independent ‘t’ test is performed to show the effectiveness. The obtained independent ‘t’ test values is compared with 22 degrees of freedom of two tailed table value. If the ‘t’ value is greater than table value of 22 degrees of freedom, we can reject the null hypothesis and accept the alternative hypothesis and show the effectiveness of the study.
Independent ‘t’ test was performed with the formula.
Independent ‘t’ test =
Where:
= Mean difference of Group A
= Mean difference of Group B
S = Combined standard deviation
n1 = Number of patients in Group A
n2 = Number of patients in Group B
4. TREATMENT TECHNIQUE
1. STRETCHING and STRENGTHENING (STST) GROUP:
The 4-phase program theorized that progressive stretching and strengthening of the injured tissue would help to remodel and align collagen fibres in the scar tissue. The acute phase (2-4 days) consisted of control of inflammation and early motion of the lower extremity in the sagittal plane. The sub acute period consisted of stationary biking, isolated hamstring progressive resistance exercises and pain-free stretching.
The re-modeling phase consisted of continued, isolated, hamstring progressive resistance exercises (PREs), with the addition of eccentric exercise and continued hamstring stretching. The functional phase included jogging, sprinting, sport-specific drills and continued hamstring strengthening and stretching.
Phase 1
Intensity
Low to moderate
Duration
40 minutes
ISOLATED HAMSTRING STRETCHING
Treatment protocol
Stationary biking with no resistance – 10 mins.
Supine hip flexion with knee extension stretch – 4Ã-20 sec.
Standing hip flexion with knee extension stretch with slow side to side rotation during stretch – 4Ã-20 sec.
Contract-relax hamstring stretch in standing with foot on stool – 4Ã-10 sec contraction, 4Ã-20 sec stretch.
Sub-maximal isometric hamstring sets – 10 repetitions.
Icing in long sitting for 20 mins.
Progression criteria:
Athletes were progressed from exercises in phase 1 to exercise in phase 2 when they could walk with a normal gait pattern and do a high knee march in place without pain.
Phase 2
Intensity
Moderate to high
Duration
60 minutes
STATIONARY BIKING
PRONE LEG CURLS
Treatment protocol:
Stationary biking – 15 mins.
Moderate velocity walk – 5 mins.
Supine hip flexion with knee extension stretch – 4Ã-20 secs.
Standing hip flexion with knee extension stretch with slow side to side rotation – 4Ã-20 secs.
Prone leg curls with ankle weight for resistance – 3Ã-10 repetitions.
Hip extension in standing with knee straight using theraband resistance – 3Ã-10 repetitions.
Non – weight bearing foot catches – 3Ã-30 secs.
Icing for 20 mins (only if there is any local fatigue or discomfort).
ICING IN LONG SITTING
2. PROGRESSIVE AGILITY and TRUNK STABILIZATION (PATS) GROUP:
Some other authors have described similar programs. As the pelvis is the origin attachment site for the hamstring muscles, it has been suggested that neuromuscular control of the lumbo-pelvic region, including anterior and posterior pelvic tilt, is needed to create optimal function of the hamstrings in sprinting and high-speed skilled movement. Changes in pelvic position could lead to changes in length tension relationships or force – velocity relationships.
This has led some clinicians to utilize various trunk stabilization and progressive agility exercises for hamstring rehabilitation programs.
Phase 1
Intensity
Low to moderate
Duration
40 minutes
Treatment protocol
Side stepping – 3Ã-1 min.
Grapevine stepping in both directions – 3Ã-1 min.
Steps forward and backward over a tape line while moving sideways – 2Ã-1 min.
Single leg stand progressing from eyes open to eyes closed – 4Ã-20 secs.
Prone abdominal body bridge – 4Ã-20 secs.
Supine Extension Bridge – 4Ã-20 secs.
SIDE STEPPING
GRAPEVINE STEPPING
Side Bridge – 4Ã-20 secs on each side.
Icing in long sitting for 20 mins.
Progression criteria:
Athletes were progressed from exercises in phase 1 to exercise in phase 2 when they could walk with a normal gait pattern and do a high knee march in place without pain.
Phase 2
Intensity
Moderate to high
Duration
60 minutes
Treatment protocol
Side stepping – 3Ã-1 min.
Grapevine stepping – 3Ã-1 min.
Steps forward and backward while moving sideways – 2Ã-1 min.
Single leg stand windmill touches of repetitive alternate hand touches – 4Ã-20 secs.
Push-up stabilization with trunk rotation – 2Ã-15 repetitions on each side.
Fast feet in place – 4Ã-20 secs.
Proprioceptive neuromuscular facilitation trunk pull-downs with theraband to the right and left – 2Ã-15 repetitions.
PRONE ABDOMINAL BODY BRIDGE
SUPINE EXTENSION BRIDGE
SIDE BRIDGE
Icing for 20 mins (if any symptoms of local fatigue or discomfort are present).
Criteria for return to sport:
Subjects were allowed to return to sports when they demonstrated 5/5 strength when manually resisting knee flexion in prone with the hip in neutral extension, had no palpable tenderness along the posterior thigh and when they demonstrated subjective readiness after completing agility and running tests.
5. DATA ANALYSIS AND INTERPRETATION
The calculations were tabulated for easier statistical calculations and better comprehension. The pre test and post test values of the functional testing profile are obtained by hop test for height and sprinting test were as follows:
6. RESULTS
The functional performance between pre-test and post-test of the individuals within the same group are calculated by using dependent ‘t’ test. For sprinting test, the mean difference obtained for group A is 2.27 and standard deviation is 0.471. Mean difference of group B is 2.65 and standard deviation is 0.393. In hop test for height, the pre and post test values are compared within the group and mean difference of group A is 13.6, where the standard deviation is 1.61. Mean difference of group B is 15.2 and its standard deviation is 1.94.
Performance on the functional testing profile was compared between the Stretching and strengthening program and progressive agility and trunk stabilization program and the t values are calculated using Independent ‘t’ test. In sprinting test, the calculated ‘t’ value is 2.18 with 22 degrees of freedom is greater than the table value, where p=0.05 respectively. In hop test for height, the ‘t’ value calculated is 2.16 with 22 degrees of freedom which is greater than the table value gives p=0.05. Hence, The p value is 0.05 in both sprinting test and hop test for height, it shows statistically significant difference between the two groups in their functional testing profile.
7. DISCUSSION
The purpose of this study is to show the effectiveness of STST group and PATS group for acute hamstring strains. In this study the rate of re-injury is hig
 

Injury Paper: Hamstring Strains

Injury Paper: Hamstring Strains

Located in the back of your thigh is a group of three muscles, the semimembranosus, semitendinosus, and biceps femoris muscles. These three muscles make up the hamstring. A hamstring injury occurs when you strain or tear at least one of your hamstring muscles. This type of injury is most common in sports that involve deceleration, acceleration, sprinting, and quick changes in direction. These types of sports include but are not limited to football, track, rugby, and soccer. Those types of movements can cause the hamstring to be placed in a position of extreme stretch. This type of movement is commonly known as eccentric contractions where the muscle is lengthened. Hamstrings act eccentrically when they slow down a movement. For example, when you are sprinting your hamstring will work to slow the forward extension of the leg to stop overextension of the knee. Stretching the muscles beyond their limits during these quick, explosive movements can easily injure the hamstring area, however hamstring injuries can also occur over a period of time, gradually and slowly due to overuse. The biceps femoris long head is most commonly injured when it comes to high-speed running. Outside factors that can lead to hamstring strains include, “muscle weakness, lack of flexibility, fatigue, inadequate warm-up, and poor lumbar posture.” (Predicting Hamstring Strain Injury in Elite Athletes) A study regarding posture in relation to hamstring injuries found that those with poor lower back posture were those with the hamstring injuries. (Sports Medicine) Nonetheless, there are underlying causes to hamstring strains that may not just arise from a sudden movement during physical activity. Instead you may strain your hamstring due to the fact that you didn’t properly stretch before your game, you have a weak core, or you never take the time to properly stretch and increase your flexibility.

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There are several signs and symptoms you can notice and look for when evaluating a hamstring strain. Most individuals that are experiencing a hamstring strain experience onset pain occurring in the posterior area of the thigh. Individuals may also describe their injury occurrence to be a hearable pop or they may specify that they have pain in their ischial tuberosity when they are in a sitting position. Tenderness and bruising can also be signs of a hamstring strain. It is very important to understand the occurrence of the injury to be able to properly diagnose and treat it. “The mechanism of injury and tissues injured have been shown to have important prognostic value in estimating the rehabilitation time needed to return to preinjury level of performance.” (Journal of Orthopaedic & Sports Physical Therapy) For example, injuries that involve the intramuscular tendon or the adjacent muscle fibers may have a shorter recovery period. This would be an example of the biceps femoris being injured during high-speed running. However, injuries involving the free tendon requires a longer recovery period. In summary, hamstring strains involving the free tendon requires a longer recovery period whereas hamstring injuries occurring within the muscle tissue do not need as long of a recovery period.

Once a hamstring injury is suspected a physical examination will be done to determine the location and severity of the injury. Hamstring strains can be classified into three categories. These categories are listed as mild (grade I), moderate (grade II), and severe (grade III) based on the extent of the injury. The extent is based off of the weakness, loss of motion, and the pain occurring. Mild would result in a small amount of damage and severe would results in a complete tear in the hamstring. With that being said, during the physical examination of the injury “strength in local and adjacent muscles, as well as range of motion at the hip and knee” need to be closely evaluated. (Journal of Orthopaedic & Sports Physical Therapy) Rehabilitation will be based of the type of hamstring strain you are dealing with. A mild or moderate hamstring strain will most likely heal on its own, however it is going to take time. Rest, ice, compression, and elevation are steps that can be taken when treating the injury. However, doing exercises to return to play can be the most important step to recovery. Unfortunately, hamstring strains are very known to reoccur. There has been a lot of speculation as to why hamstring strains have such as high recurrence rate. According to theory it is because of, “persistent weakness in the injured muscle, reduced extensibility of the musculotendon unit due to residual scar tissue, and adaptive changes in the biomechanics and motor patterns of sporting movements following the original injury.” (Journal of Orthopaedic & Sports Physical Therapy) A highly recommended form of rehabilitation is eccentric strength training. This is highly recommended because it is believed that reinjury can be caused from “a shorter optimum musculotendon length for active tension in the previously injured muscle.” (Journal of Orthopaedic & Sports Physical Therapy) Therefore, if you are rehabilitating using concentric exercises repetitively you could end up creating scar tissue at the musculotendon junction. Furthering, performing eccentric strength training after a hamstring injury has occurred it can help restore optimum musculotendon length. This can overall help reduce the chances of reinjuring the hamstring muscles.

In summary, hamstring strains can occur by stretching the muscles beyond their limits or by gradually straining the muscles over a period of time. The type of strain can range anywhere from a grade I to a grade III strain. It is a very common injury and the most common reoccurring injury. Understanding the mechanism of injury and discovering the location within the muscle is extremely important when planning your route to recovering for your hamstring strain. There are several different types of rehabilitation options when it comes to repairing a strained hamstring, however the most effective treatment process was eccentric strength training. It has been found that those who perform eccentric strength training are less likely to reinjure their hamstring. However, there are other methods. Eccentric strength training seems to be the most promising. Overall, hamstring strains can substantially change and limit your performance indefinitely if not properly diagnosed and treated.

Works Cited

Brockett, C. L., Morgan, D. L., & Proske, U. (n.d.). Predicting Hamstring Strain Injury in Elite Athletes. Retrieved from https://pdfs.semanticscholar.org/82bc/692b00a23631c3aaff10c62a42485ca9f0c8.pdf

Freckleton, G., & Pizzari , T. (n.d.). Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. Sports Medicine. Retrieved from https://bjsm.bmj.com/content/bjsports/47/6/351.full.pdf

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Judaism: History, Development and Strains

Judaism is a monotheistic religion which was developed amongst the ancient Hebrews. It was characterized by the belief of a transcendent God whom had been revealed to Abraham, Moses and Hebrew prophets also by the religious life they led which was in accordance to the scriptures and the traditions of the rabbinic (Graham, 2005). The Judaism way of life is a complex phenomenon as it comprises of law, innumerable cultural traditions and theology. Being formed over 4000 years ago, it is a religion that encompasses on the philosophies and cultures of the Jewish people as their direct expression of their covenant as the children of Israel.

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History is what provides key understandings to Judaism as its primal affirmations have appeared earlier in historical narratives. In the bible it is reported that contemporary events with activities were essential for religious purposes. Bible authors were deemed to have a divine presence which was only encountered in history. God’s presence was also experienced in the natural realm, though it was more immediate and intimate in disclosures occurring mostly in human actions (Kaplan and Scult, 2010). Although other communities in the times claimed to perceive a divided history, the Israelites understanding proved most influential as they claimed to have experienced God’s presence in events involving humans which led to the differentiation in development as per the Jewish thoughts.

In over 4000 years in history and development, the nature and character of the Jews has been displayed remarkably in their adaptability and continuity of their religion. As they encountered great civilizations of modern secular culture, did manage to assimilate the foreign elements in them enabling them to integrate them to their own religious and social systems hence being able to maintain a religion and a traditional culture that was unbroken. Furthermore, the Jewish heritage has been influenced by the combination of specific elements of its history which was left behind leading to developments which are as a result of adjustments and accretions occurring in each age (Graham, 2005). Its teachings have regarded on a central idea of a single creator which is monotheism. This has both universal and particular features where universally it is affirmed that God created and rules the world and at the end he will he will redeem Israel. Jewish people express themselves in messianism which is an idea of peace and justice in the political realm. Their life is also embraced by law in all domains which acts as a guide to conduct both religiously and ethnically.

Jewish history is divided into millennia periods which are independent of philosophical predilections. Christians in the world believe until Christianity rose, Judaism was a preparation of the gospel being followed by its manifestation which was revealed by Christ and the apostles (Stitskin, 2007). Theologically this was reconciled by the assumption that Christianity had been ordained before the world was created. In the 19th century biblical scholars made the decision to restore the kingdom of Judah to the Jews. This was asserted after the first fall of Jerusalem which was an ancient Israeli tic religion which gave it a new form of Judaism. These theories were later discarded after scholars got comprehensive knowledge of Middle East as a result of gradual development evolutionary in the beginning of the 20th century (Kaplan and Scult, 2010). As of today, Jewish groups either orthodox reform or conservative claim descent of direct spirituality from Pharisees and rabbinic sages. In any event the history of Judaism has been divided into the following major periods of biblical Judaism, Hellenistic, rabbinic and modern Judaism.

Biblical Judaism is the period designated by historians as that which was covered by the narratives of Tanakh being the primitive and last prophets of mankind in the century of 4th BCE. Tanakh follows the Hebrew nation during the experience cycles as they got favors and discipline from God. Here covenants were established with humanity (Abraham, Noah and Adam) where they were issued with an extensive set of laws via Moses where the Hebrews were set aside as God’s people. The patriarchs and Abraham, who is considered in the Jewish religion as the founder, promises his descendants a land in Canaan. Circumcision later became the defining mark of the religious community (Graham, 2005). Sacred altar was the place of prayer and sacrifice was made a practice. The patriarchs centered religion as the agreement between God and Abraham. Moses and the covenant in the bible are where under his leadership God rescued them from the bondage and at Mount Sinai a nation was established named Israel which was his grandson of Jacob. Mosaic religion later centered on the covenant of God and his people of Israel.

Practices such as worshiping of other gods were prohibited and this led to the establishment of rituals and festivals to celebrate God’s continuous provision (Kaplan and Scult, 2010). After the Canaan conquest Israel named its leaders as judges where it was described as the period they repeatedly fell into idolatry and apostasy. This covenant was carefully housed and protected in the Shiloh sanctuary and staffed by priests of the Eli’s family. A divided monarchy was experienced during Solomon’s reign where the nation is split into two north and southern kingdoms of Judah and Israel. The Hasmonaean kingdom succumbed as a result of civil war as the people didn’t want the governance of a king as they opted for theocratic clergy. Judeans began a revolt against the roman rules which led to the destruction of the temple in Jerusalem which contributed to Jews being denied entry to Jerusalem.

Hellenistic Judaism was a form of Jewish classical antiquity which was a combination of traditional elements of the Greek culture. It was known to exist in Jerusalem during the periods of the second temple during the conflict experienced between Hellenism and Judaizes. Hellenists were described as persons living the Greek way of life from language to outlook but were not from their ancestry. They were termed as specialist in language or culture of ancient Greece (Graham, 2005). As a result of contact between Semites and Greeks, Jews began to praise their writers as brave philosophical and self-disciplined. This Judaism included Jews who spoke and adopted Greek lifestyle as a result of conquests by Alexander where the Romans encompassed ending of the Islamic conquest during the byzantine period.

Rabbinic Judaism can be distinguished as the belief in Moses as the rabbi and as revealed by God in the Torah it is in two parts both in oral and written being known as the Mishnah. This came as a result of the destruction of the second temple that brought about a change in Judaism. During this period in Israel as the biblical and its co-texts were being edited and interpretation being done. This enabled rabbis to flourish due to the closure of Babylonian Talmud. Amongst the different Judaism in antiquity was rabbinic which was held at Mount Sinai (Graham, 2005). Classical bit of it is divided into different strata which are Tannaitic Amoraic and Saboraic. As interpreted in the Torah the opposition of priestly tradition which committed to written tradition of sacrificial cult in the temple led to the second destruction. However, as the formative period ended, it later became synthesized with interpretive and priestly traditions. Today it is represented as a normative form of Judaism where the Jews religiously express themselves as a substantial part of the international Jewish community (Stitskin, 2007).

Modern Judaism has been identified by the criteria dividing the history of Judaism and the Jews. Israeli scholars prefer to date it as from the late 17th century to the present. Social and political historians start it as from the French and American revolutions which led to the emancipation of Jews from laws which were discriminatory and segregative. The modern Jews as per scholars is characterized by a passive ending to the waiting of the messiah and the beginning of the active pursuit of both personal and national fulfilment of one’s lifetime on earth.

The philosophy of the modern culture was to reconcile it with traditional religion in the Jewish history. This has led to the rise of a movement known as Haskalah which meant enlightenment. Being centered in berlin it was hoped to improve the image of Judaism as it brought reforms. The merging of Wissenschaft and Halaskalah led to the alteration of the nature of Judaism which led to reforms. As a result of new cultural and political ideologies the movement took a more literal character which was later experienced in many forms such as Zionism, Bundism and diaspora nationalism. Secular Jewish culture is a phenomenal that will live on today in forms of klezmer music, Yiddish revival and other areas of Jewish arts (Meyer, 2005).

There are different sects within Judaism. Orthodox Judaism which is typically known to be strict observers of traditional Jewish rituals and laws where most of them shabbat should not involve driving working nor handling money as it is a day of rest.it is divided into subgroups which include Hasidic Jews who emphasize on a mystical experience that involves direct communion with God through worship and prayer. Chabad is amongst the well-known of the orthodox (Graham, 2005). In addition, Reform Judaism is considered as a liberal category where it values strict observance of ethical traditions where followers tend to promote the adoption of progressive ideas. Most of these Jews are found in the United States. Conservative Judaism is on which is considered to be between orthodox and reformed Judaism where typically the conservatives honor the Judaism traditions as they allow modernization.

Further, Reconstructionist Judaism is a sect that believes in religious civilization which is constantly evolving and is dated back to 1922 which was founded by the society of advancement of Judaism headed by Mordecai Kaplan. Humanistic Judaism was founded by Rabbi Sherwin wine in 1963 which celebrated Jewish culture and history without emphasis to God. Messianic Judaism is the most modern that combines beliefs of both Christianity and Judaism where Jesus Christ is the messiah but yet they follow their Jewish traditions (Meyer, 2005).

Jewish people observe events in history and several important days. For example, Passover which is a holiday lasting for seven or eight days meant to celebrate their freedom from Egypt slavery. Passover is referred in the bible as story where the God of the Hebrews saved their families and children during the plague which was to kill the first-born babies. Rosh Hashanah is meant to celebrate the birth of humanity and university. Yom Kippur is considered as the day of astonishment which is the holiest day of the year which is spent on prayer and fasting (Graham, 2005). The days of Awe are the 10 days which start from Rosh Hashanah and end at Yom Kippur and are considered as time for repentance. Hanukkah is a celebration lasting for 8 days which also goes by the name Festivals of Lights which commemorates the rededication of the temple in Jerusalem where the Syrian Greeks were defeated 2000 years ago. Purim is alight holiday of joy as it celebrates time which the Jews were saved in Persia from extermination. The religion has also witnessed a dark past of persecution for their religious beliefs in the following events. 1066 Granada Massacre which happened on the 30th of December where a Muslim mob in Granada stormed a royal palace killing over 1000 Jewish families and later kidnapped Joseph Naghrela who was at last crucified

Judaism being a religious tradition dates back to over 4000 years ago. It is rooted from ancient eastern Canaan region. Its origins were the beliefs and practices of the people of Israel, classical or rabbinic. Judaism heritage is traced from the covenant between God with Abraham’s lineage which was to make them sacred and later award them the Promised Land. The traditions were grounded both socially and in ethics and outlined in the Torah which in the Hebrews bible are the first five books. Their bible is referred to as Tanaka which was an acronym for texts in the Torah. They have four main movements which include orthodox, conservative, Reconstructionist and reform ranging from traditional, liberal to religiously progressive in the way they apply the Torah. As their views became diverse they continued to be unified based on the common connection to set sacred narratives which expressed the relationship with their God as people who were holy. They worshipped in synagogues where they emphasized to practice their beliefs. Their religious leaders were called Rabbis who oversaw the rituals and ceremonies essential to their religion.

References

Graham, I. (2005). Judaism. London: Chrysalis Children’s Books.

Kaplan, M. M., & Scult, M. (2010). Judaism as a civilization: Toward a reconstruction of American-Jewish life. Philadelphia: Jewish Publication Society.

Meyer, M. A. (2005). Response to modernity: A history of the Reform Movement in Judaism. Detroit: Wayne State University Press.

Stitskin, L. D. (2007). Judaism as a religion: A series of holiday sermons. New York: Bloch Pub. Co.