Proximal Hamstring Tendinopathy: A Systematic Review of Interventions
# Background Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and field, long distance running and field-based sports. Management options need to be evaluated to direct appropriate clinica...
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| Format: | Article |
| Language: | English |
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North American Sports Medicine Institute
2021-04-01
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| Series: | International Journal of Sports Physical Therapy |
| Online Access: | https://doi.org/10.26603/001c.21250 |
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| _version_ | 1825197114980827136 |
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| author | Anthony Michael Nasser Bill Vicenzino Alison Grimaldi Jay Anderson Adam Ivan Semciw |
| author_facet | Anthony Michael Nasser Bill Vicenzino Alison Grimaldi Jay Anderson Adam Ivan Semciw |
| author_sort | Anthony Michael Nasser |
| collection | DOAJ |
| description | # Background
Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and field, long distance running and field-based sports. Management options need to be evaluated to direct appropriate clinical management.
# Purpose/Hypothesis
To evaluate surgical and non-surgical interventions used in managing proximal hamstring tendinopathy.
# Study design
Systematic review
# Methods
Electronic databases were searched to January 2019. Studies (all designs) investigating interventions for people with proximal hamstring tendinopathy were eligible. Outcomes included symptoms, physical function, quality of life and adverse events. Studies were screened for risk of bias. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Randomized Controlled Trials \[RCT\]) and the Joanna Briggs Institute Checklist (Case Series). Effect sizes (Standard mean difference or Standard paired difference) of 0.2, 0.5 and 0.8 were considered as small, medium and large respectively. Overall quality of evidence was rated according to GRADE guidelines.
# Results
Twelve studies (2 RCTs and 10 case series) were included (n=424; males 229). RCTs examined the following interventions: platelet-rich plasma injection (n=1), autologous whole-blood injection (n=1), shockwave therapy (n=1) and multi-modal intervention (n=1). Case series included evaluation of the following interventions: platelet-rich plasma injection (n=3), surgery (n=4), corticosteroid injection (n=2), multi-modal intervention + platelet-rich plasma injection (n=1). Very low-level evidence found shockwave therapy was more effective than a multi-modal intervention, by a large effect on improving symptoms (-3.22 SMD; 95% CI -4.28, -2.16) and physical function (-2.42 SMD; 95% CI-3.33, -1.50) in the long-term. There was very low-level evidence of no difference between autologous whole-blood injection and platelet-rich plasma injection on physical function (0.17 SMD; 95% CI -0.86, 1.21) to (0.24 SMD; 95% CI -0.76, 1.24) and quality of life (-0.04 SMD; 95%CI -1.05, 0.97) in the medium-term. There was very low-quality evidence that surgery resulted in a large reduction in symptoms (-1.89 SPD; 95% CI -2.36, -1.41) to (-6.02 SPD; 95% CI -8.10, -3.94) and physical function (-4.08 SPD; 95%CI -5.53, -2.63) in the long-term.
# Conclusions
There is insufficient evidence to recommend any one intervention over another. A pragmatic approach would be to initially trial approaches proven successful in other tendinopathies.
# Level of evidence
Level 2a |
| format | Article |
| id | doaj-art-ac175093123d453aa570490900de80f4 |
| institution | Kabale University |
| issn | 2159-2896 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | North American Sports Medicine Institute |
| record_format | Article |
| series | International Journal of Sports Physical Therapy |
| spelling | doaj-art-ac175093123d453aa570490900de80f42025-02-11T20:27:04ZengNorth American Sports Medicine InstituteInternational Journal of Sports Physical Therapy2159-28962021-04-01162Proximal Hamstring Tendinopathy: A Systematic Review of InterventionsAnthony Michael NasserBill VicenzinoAlison GrimaldiJay AndersonAdam Ivan Semciw# Background Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and field, long distance running and field-based sports. Management options need to be evaluated to direct appropriate clinical management. # Purpose/Hypothesis To evaluate surgical and non-surgical interventions used in managing proximal hamstring tendinopathy. # Study design Systematic review # Methods Electronic databases were searched to January 2019. Studies (all designs) investigating interventions for people with proximal hamstring tendinopathy were eligible. Outcomes included symptoms, physical function, quality of life and adverse events. Studies were screened for risk of bias. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Randomized Controlled Trials \[RCT\]) and the Joanna Briggs Institute Checklist (Case Series). Effect sizes (Standard mean difference or Standard paired difference) of 0.2, 0.5 and 0.8 were considered as small, medium and large respectively. Overall quality of evidence was rated according to GRADE guidelines. # Results Twelve studies (2 RCTs and 10 case series) were included (n=424; males 229). RCTs examined the following interventions: platelet-rich plasma injection (n=1), autologous whole-blood injection (n=1), shockwave therapy (n=1) and multi-modal intervention (n=1). Case series included evaluation of the following interventions: platelet-rich plasma injection (n=3), surgery (n=4), corticosteroid injection (n=2), multi-modal intervention + platelet-rich plasma injection (n=1). Very low-level evidence found shockwave therapy was more effective than a multi-modal intervention, by a large effect on improving symptoms (-3.22 SMD; 95% CI -4.28, -2.16) and physical function (-2.42 SMD; 95% CI-3.33, -1.50) in the long-term. There was very low-level evidence of no difference between autologous whole-blood injection and platelet-rich plasma injection on physical function (0.17 SMD; 95% CI -0.86, 1.21) to (0.24 SMD; 95% CI -0.76, 1.24) and quality of life (-0.04 SMD; 95%CI -1.05, 0.97) in the medium-term. There was very low-quality evidence that surgery resulted in a large reduction in symptoms (-1.89 SPD; 95% CI -2.36, -1.41) to (-6.02 SPD; 95% CI -8.10, -3.94) and physical function (-4.08 SPD; 95%CI -5.53, -2.63) in the long-term. # Conclusions There is insufficient evidence to recommend any one intervention over another. A pragmatic approach would be to initially trial approaches proven successful in other tendinopathies. # Level of evidence Level 2ahttps://doi.org/10.26603/001c.21250 |
| spellingShingle | Anthony Michael Nasser Bill Vicenzino Alison Grimaldi Jay Anderson Adam Ivan Semciw Proximal Hamstring Tendinopathy: A Systematic Review of Interventions International Journal of Sports Physical Therapy |
| title | Proximal Hamstring Tendinopathy: A Systematic Review of Interventions |
| title_full | Proximal Hamstring Tendinopathy: A Systematic Review of Interventions |
| title_fullStr | Proximal Hamstring Tendinopathy: A Systematic Review of Interventions |
| title_full_unstemmed | Proximal Hamstring Tendinopathy: A Systematic Review of Interventions |
| title_short | Proximal Hamstring Tendinopathy: A Systematic Review of Interventions |
| title_sort | proximal hamstring tendinopathy a systematic review of interventions |
| url | https://doi.org/10.26603/001c.21250 |
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