Hamstring muscle strain injuries: what can we learn from history?

Hamstring muscle strain injuries remain one of the most challenging issues facing sports medicine. 1 Over the past 100 years, there has been a gradual evolution in our understanding and management of hamstring injuries, but the challenge of optimising the management of the acutely injured hamstring remains. In recent years, increasingly high-quality studies have addressed the aetiology, risk factors and management of hamstring strains. 2–6 Paradoxically, many popular treatment options have little evidence and remain controversial. 7–10 The history of hamstring injury management is characterised as a longstanding dissociation between popular clinical techniques and a limited evidence base. Taking a historical perspective on the management of hamstring muscle strains, this study aims to place the current management strategies in a temporal perspective. " Those who cannot remember the past are condemned to repeat it ". By the mid-18th century, the importance of exercise for health was established, and the physical demands of different forms of exercise were rec-ognised, in a manner not dissimilar to descriptions 200 years later. 11 12 By the start of the 20th century , the Olympics had been re-invented, sport and exercise were recognised as a means of developing character 13 and maintaining health in a world experiencing an explosion in leisure time. 14–16 Given the limitations of the training methodology of the time, 17 it is possible that muscle strains were a common fi nding, but there is limited epidemiological literature available from the time. " In football we fi nd injuries occur in a poorly conditioned , a fatigued or dazed man, or in a team that is demoralised and receiving a severe beating. These individuals are slowing up, not coordinating, and are apt to be injured. " 18 Already in 1902, muscle injuries were recognised as occurring in sedentary individuals and those athletes lacking adequate preparation and warm-up. 19 While these assertions appear to have stood the test of time, with modern, professional, well-trained athletes routinely have hamstring injuries, it is now recognised that this is a dramatic oversim-plifi cation of the aetiological processes. 2–6 Muscle strains were recognised as occurring at either the musculo-tendinous or within the intramuscular components, 19 and there has been a gradual refi ne-ment of this understanding over the past 100 years. In 1966, Bass 20 distinguished between intramuscu-lar (poor prognosis) and intermuscular (good prognosis) injuries. Forty years on, this theme has been readdressed, with further evidence that …