Diagnosis of a muscle injury is instrumental

costs.

#### **Therapeutic exercise**


**1.** Progression from phase 1 to phase 2 is allowed when the athlete showed a normal gait pattern, and can perform a pain-free isometric contraction against submaximal (60%-80%) resistance during prone knee flexion (90°) manual strength test.

### **PHASE 2 Goals: Start isotonic training Stretching training Cardiovascular training**

�**10' of low stationary biking with little resistance or 10' walking** 

**ԲStanding hip flexion with knee extension stretch with slow side to side rotation. Standing** 

**Բhamstring stretch sport position. 3 x 30 sec** 

**ԲProne or standing position knee flexion . 3 – 4 x 12 – 15** 

**ԲLight lunges in all planes ( foto 10) 5 x 15 sec** 

**2.** progression from phase2 to phase 3 is allowed when the athlete can perform all activities without pain.

**8.** Treatment(Tw)

**10.** "Therapeutics"(Mesh)

**12.** "Treatment outcome"(Mesh)

**14.** "Recovery of function"(Mesh)

**15.** "Evidence based medicine"(Mesh))

tion"(Mesh) OR "Evidence based medicine"(Mesh))

**13.** "Muscle strength"(Mesh)

**Appendix 2**

*Included studies*

Syst Rev. 2012 Dec 12;12:CD004575.

**9.** "Physical therapy modalities"(Mesh)

**11.** "Rehabilitation"(Mesh) OR "Rehabilitation programs"(TW) OR Treatment(Tw) OR

Conservative Treatment of Muscle Injuries: From Scientific Evidence to Clinical Practice

http://dx.doi.org/10.5772/56550

193

**16.** "Treatment outcome"(Mesh) OR "Muscle strength"(Mesh) OR "Recovery of func‐

**17.** "Athletic injuries"(Mesh) OR "Muscle, Skeletal/injuries"(Mesh) OR "Sprains and strains"(Mesh) OR Muscle injur\*(Tw) AND "Rehabilitation"(Mesh) OR "Rehabilitation programs"(TW) OR Treatment(Tw) OR "Physical therapy modalities"(Mesh) OR "Thera‐ peutics"(Mesh) AND "Treatment outcome"(Mesh) OR "Muscle strength"(Mesh) OR

**18.** "Athletic injuries"(Mesh) OR "Muscle, Skeletal/injuries"(Mesh) OR "Sprains and strains"(Mesh) OR Muscle injur\*(Tw) AND "Rehabilitation"(Mesh) OR "Rehabilitation programs"(TW) OR Treatment(Tw) OR "Physical therapy modalities"(Mesh) OR "Thera‐ peutics"(Mesh) AND "Treatment outcome"(Mesh) OR "Muscle strength"(Mesh) OR "Recovery of function"(Mesh) OR "Evidence based medicine"(Mesh))Filters: Randomized

**•** Mason DL, Dickens VA, Vail A. Rehabilitation for hamstring injuries. Cochrane Database

**•** Reurink G, Goudswaard GJ, Tol JL, Verhaar JA, Weir A, Moen MH. Therapeutic interven‐ tions for acute hamstring injuries: a systematic review. Br J Sports Med. 2012 Feb;46(2):103-9.

Controlled Trial; Systematic Reviews; Guideline; published in the last 10 years

"Recovery of function"(Mesh) OR "Evidence based medicine"(Mesh))

"Physical therapy modalities"(Mesh) OR "Therapeutics"(Mesh)


**Key:** All the exercises must be performed without pain. In a first phase low intensity, a velocity of movement that is less than or near that of normal walking; in a second phase moderate intensity, a velocity of movement greater than normal walking but not as great as sport; in a third phase high intensity, a velocity of movement similar to sport activity.

#### **Appendix 1: Search strategies**

#### *Pubmed/Medline*


**8.** Treatment(Tw)

**2.** progression from phase2 to phase 3 is allowed when the athlete can perform all activities

**PHASE 3 Goals: Stretch training Isotonic training**

**lunges in all planes with return to start position with different velocity 5 x 30 sec**

third phase high intensity, a velocity of movement similar to sport activity.

**Key:** All the exercises must be performed without pain. In a first phase low intensity, a velocity of movement that is less than or near that of normal walking; in a second phase moderate intensity, a velocity of movement greater than normal walking but not as great as sport; in a

**5.** "Athletic injuries"(Mesh) OR "Muscle, Skeletal/injuries"(Mesh) OR "Sprains and

�**10' of low stationary biking with little resistance or 10' walking** 

**ԲNon–weight-bearing ''foot catches'' 6 – 8 rep** 

**ԲSingle leg deadlifts 5 x 8 – 10 rep ԲSingle leg standing 2 x 6 – 8 rep ԲNordic hamstring exercise 2 x 6 rep** 

**Appendix 1: Search strategies**

**1.** "Athletic injuries"(Mesh)

**2.** "Muscle, Skeletal/injuries"(Mesh)

strains"(Mesh) OR Muscle injur\*(Tw)

**3.** "Sprains and strains"(Mesh)

**4.** Muscle injur\*(Tw)

**6.** "Rehabilitation"(Mesh)

**7.** "Rehabilitation programs"(TW)

*Pubmed/Medline*

without pain.

192 Muscle Injuries in Sport Medicine


#### **Appendix 2**

#### *Included studies*


**•** Copland ST, Tipton JS, Fields KB. Evidence-based treatment of hamstring tears. Curr Sports Med Rep. 2009 Nov-Dec;8(6):308-14.

**Author details**

, Massimo Bitocchi1

, Manuela Gervasi1

2 Department of Life, Health & Environmental Sciences, School of Medicine, University of

[2] Croisier J.L., Forthomme B., Namurois M.H., Vanderthommen M. and Crielaard J.M. (2002). Hamstring muscle strain recurrence and strength performance disorders. Am.

[3] Jarvinen TA, Jarvinen TL, KaariainenM, et al. Muscle injuries: biology and treatment.

[4] Verrall G.M., Slavotinek J.P., Barnes P.G., Fon G.T. and Spriggins A.J. (2001). Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging. Br. J. Sports Med. 35, 435-439; discussion

[5] Orchard J. and Best T. (2002). The management of muscle strain injuries: an early re‐

[6] Volpi P, Melegati G, Tornese D, et al. Muscle strains in soccer: a five-year survey of an Italian major league team. Knee Surg Sports TraumatolArthrosc 2004;12:482–5.

[7] Huard J, Li Y, Fu FH. Muscle injuries and repair: current trends in research. J Bone

[8] Ekstrand J, Gillquist J. Soccer injuries and their mechanisms: a prospective study.

[9] Verrall G, Slavotinek J, Barnes P, 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

[10] Brockett C, Morgan D, Proske U. Predicting hamstring strain injury in elite athletes.

turn versus the risk of recurrence. Clin. J. Sport Med. 12, 3-5.

1 Department of Physiotherapy, "Riabilita" Centre, Civitanova Marche (MC), Italy

[1] Garrett W.E. (1996). Muscle strain injuries. Am. J. Sports Med. 24, S2-S8.

, Gianni Secchiari1

Conservative Treatment of Muscle Injuries: From Scientific Evidence to Clinical Practice

and

http://dx.doi.org/10.5772/56550

195

Andrea Foglia1

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Angelo Cacchio2

L'Aquila, L'Aquila, Italy

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Med Sci Sports Exerc. 2004;36:379-387.

Sports Med. 2003;31:969-973.


#### *Excluded studies*

