eduard alentorn geli - risk factors for rectus femoris muscle injuries
TRANSCRIPT
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RISK FACTORS FORRECTUS FEMORIS MUSCLE INJURIES
Eduard Alentorn Geli MD, MSc, PhD, FEBOT, FACGME
Consultant, Orthopedic Surgery
Fundación García CugatArtroscopia GC, Hospital Quirón
Mutualidad de FutbolistasBarcelona, Spain
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INTRODUCTION
Very common muscle injury (Ekstrand 2011)
Unique aspects: anatomy and pre-season incidence predominance
(Hasselman 1995; Orchard 2002; Woods 2002)
More missed games than other muscle injury locations
(Ekstrand 2011)
High re-injury rate 21% (Hagglund 2013)
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INTRODUCTION
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INTRODUCTION
RISK FACTORSINTRINSIC EXTRINSIC
PREVENTION
MODIFIABLE
RELEVANCE
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INTRODUCTION
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INTRODUCTION
PURPOSE:
To review the muscle-specific risk factors identified
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RISK FACTORSIntrinsic factors
• AGE:– Incidence of muscle injuries
in general increases with age (Ekstrand 2011)
– Calf and hamstrings only muscle groups with significant increase in incidence of injury with age (Ekstrand 2011; Orchard 2001).
– Age = not a risk factor for quadriceps injury (Ekstrand 2011; Orchard 2001: Hagglund 2013)
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RISK FACTORSIntrinsic factors
• PREVIOUS INJURY:– Previous quadriceps and hamstring muscle injury
increase risk RF injury in AF (Orchard 2001)
– HT injury reduced stride length as a protective mechanism, but might be harmful for RF
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RISK FACTORSIntrinsic factors
• PREVIOUS INJURY:– Previous injury not a risk factor in soccer: only 7
injuries (Fousekis 2011)
– Quadriceps injury the season before increased risk of injury in soccer: HR 3.10; 95% CI 2.21-4.36 (Hagglund 2013)
– Risk also increased for adductors and calf muscle injuries in the preceeding season in soccer (Hagglund 2013)
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RISK FACTORSIntrinsic factors
• ANTROPOMETRIC CHARACTERISTICS:– Heavier and shorter individuals had a trend towards
higher risk of quadriceps muscle injuries (Fousekis 2011).– Only 7 quadriceps injuries (only trend).
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RISK FACTORSIntrinsic factors
• ANTROPOMETRIC CHARACTERISTICS:– Height below 1.82cm increased risk of quadriceps
injury compared to taller players in AF (Orchard 2001)
– Body size is not associated with increased risk of quadriceps muscle injuries in soccer (Bradley 2007)
– Stature and body mass not associated with risk of quadriceps muscle injury in soccer (Hagglund 2013)
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RISK FACTORSIntrinsic factors
• DOMINANCE:– Significantly more quadriceps muscle injuries in the
dominant vs non-dominant leg in soccer players• 60% vs 33% (Ekstrand 2011)
• 63% vs 37% (Hagglund 2013)
– Quadriceps injuries more common in dominant kicking leg in AF (RR 2.13 1.59-28.6 95% CI) (Orchard 2001)
– No significant differences for hamstring, adductors, and calf muscles (Ekstrand 2011; Orchard 2001)
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RISK FACTORSIntrinsic factors
• DOMINANCE:– No differences in rate of dominant vs non-dominant
side injury between patients with or without quadriceps muscle injury in soccer players:• N=6 injuries (Bradley 2007)
• N=13 injuries (Witvrouw 2003)
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RISK FACTORSIntrinsic factors
• FLEXIBILITY:– Injured soccer players had lower pre-season
quadriceps muscle flexibility compared to non-injured players (Witvrouw 2003)
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RISK FACTORSIntrinsic factors
• FLEXIBILITY:– Trend towards quadriceps flexibility asymmetries in
injured soccer players (Fousekis 2011)
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RISK FACTORSIntrinsic factors
• FLEXIBILITY:– Quadriceps flexibility was not different between
quadriceps injured and non-injured soccer players (Bradley 2007)
– Only 6 quadriceps muscle injuries.
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RISK FACTORSIntrinsic factors
• STRENGTH:– Preseason concentric isokinetic knee extensors strength
not risk factor for quad injuries in soccer players (Fousekis 2011)
– Preseason eccentric isokinetic knee extensors strength differences in injured compared to uninjured: OR 5.01, 0.92-27.14 95% CI) (Fousekis 2011)
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RISK FACTORSExtrinsic factors
• SPORT:– Sprinting and kicking: not proven but most commonly
occur in these actions (Mendiguchia 2012)
– Champions League less risk than home leagues (Hagglund 2013)
• PLAYING POSITION:– Not a risk factor for knee extensors injury (Bradley 2007)
– Decreased risk in goalkeepers (Hagglund 2013)
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RISK FACTORSExtrinsic factors
• TIME OF THE SEASON:– More quadriceps injuries during pre-season: Rectus
femoris was the most common (29%) (Woods 2002)
– Significant differences between pre- and in-season incidence of rectus femoris and biceps femoris injuries (Woods 2002)
– No differences between in-season and pre-season in soccer (Hagglund 2013)
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RISK FACTORSExtrinsic factors
• FIELD:– Higher quadriceps injuries after low rainfall week
with dryer and harder field in AF (Orchard 2001)
– No differences between northern (marine west coast)/southern (Mediterranean) climates in European soccer (Hagglund 2013)
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RISK FACTORSExtrinsic factors
• FIELD:– More quadriceps injuries during pre-season: Rectus
femoris was the most common (29%) (Woods 2002)
– Ground condition was dry in 70% of cases in pre-season (Woods 2002)
– Not a risk factor analysis.
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
Previous injury 2 1 (1)
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
Previous injury 2 1 (1)
Shorter 1 2 (1)
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
Previous injury 2 1 (1)
Shorter 1 2 (1)
Heavier 0 3
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
Previous injury 2 1 (1)
Shorter 1 2 (1)
Heavier 0 3
Dominant 3 2 (2)
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
Previous injury 2 1 (1)
Shorter 1 2 (1)
Heavier 0 3
Dominant 3 2 (2)
Flexibility 1 2 (2)
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
Previous injury 2 1 (1)
Shorter 1 2 (1)
Heavier 0 3
Dominant 3 2 (2)
Flexibility 1 2 (2)
Strength (eccentric) - 1 (1)
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
Previous injury 2 1 (1)
Shorter 1 2 (1)
Heavier 0 3
Dominant 3 2 (2)
Flexibility 1 2 (2)
Strength (eccentric) - 1 (1)
Position 1 1 (1)
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
Previous injury 2 1 (1)
Shorter 1 2 (1)
Heavier 0 3
Dominant 3 2 (2)
Flexibility 1 2 (2)
Strength (eccentric) - 1 (1)
Position 1 1 (1)
Pre-season 1 1
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SUMMARY OF STUDIES
PARAMETER YES NO VEREDICTAge 0 3
Previous injury 2 1 (1)
Shorter 1 2 (1)
Heavier 0 3
Dominant 3 2 (2)
Flexibility 1 2 (2)
Strength (eccentric) - 1 (1)
Position 1 1 (1)
Pre-season 1 1
Dry field 1 1 (1)
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The RF risk factors modelBahr and Krosshaug, BJSM 2005
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The RF-RF modelAdapted from Bahr and Krosshaug, BJSM 2005
Fatigue
Warm-up
Contractile properties
Muscle imbalance
Intermuscular coordination
Core stability. . .
Previous injury
Anthropometrics Dominance
Flexibility Strength
PREDISPOSED ATHLETE
?
SUSCEPTIBLE
ATHLETE
DRY FIELD
INJURY
SPRINTINGKICKING
PositionPREVENTION
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CONCLUSIONS
EVIDENCE FOR QUADRICEPS
LIKELY•Previous injury•Shorter individuals•Dominant leg•Decreased flexibility•Side-to-side differences in eccentrinc isokinetic knee extensors strength•Dry field•Player position
DOUBTFUL•Heavier individuals•Side-to-side differences in concentric isokinetic knee extensors strength•Pre-season
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CONCLUSIONS
FURTHER RESEARCH
CONFIRM RISK FACTORS DISCOVER NEW ONES
REDUCE RECTUS FEMORIS INJURIES
PREVENTION PROGRAMS
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