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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Autores principales:	Anthony Michael Nasser, Bill Vicenzino, Alison Grimaldi, Jay Anderson, Adam Ivan Semciw
Formato:	article
Lenguaje:	EN
Publicado:	North American Sports Medicine Institute 2021
Materias:	Sports medicine RC1200-1245
Acceso en línea:	https://doaj.org/article/ac175093123d453aa570490900de80f4
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spelling	oai:doaj.org-article:ac175093123d453aa570490900de80f42021-12-02T16:01:46ZProximal Hamstring Tendinopathy: A Systematic Review of Interventions10.26603/001c.212502159-2896https://doaj.org/article/ac175093123d453aa570490900de80f42021-04-01T00:00:00Zhttps://ijspt.scholasticahq.com/article/21250-proximal-hamstring-tendinopathy-a-systematic-review-of-interventions.pdfhttps://doaj.org/toc/2159-2896# 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 2aAnthony Michael NasserBill VicenzinoAlison GrimaldiJay AndersonAdam Ivan SemciwNorth American Sports Medicine InstitutearticleSports medicineRC1200-1245ENInternational Journal of Sports Physical Therapy, Vol 16, Iss 2 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Sports medicine RC1200-1245
spellingShingle	Sports medicine RC1200-1245 Anthony Michael Nasser Bill Vicenzino Alison Grimaldi Jay Anderson Adam Ivan Semciw Proximal Hamstring Tendinopathy: A Systematic Review of Interventions
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
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
title	Proximal Hamstring Tendinopathy: A Systematic Review of Interventions
title_short	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_sort	proximal hamstring tendinopathy: a systematic review of interventions
publisher	North American Sports Medicine Institute
publishDate	2021
url	https://doaj.org/article/ac175093123d453aa570490900de80f4
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Proximal Hamstring Tendinopathy: A Systematic Review of Interventions

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