Reliability of Ultrasound Imaging of the Trunk Musculature in Athletes with and without Hamstring Injuries

Document Type : RESEARCH PAPER

Authors

1 Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

2 Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

3 2 Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran 3 University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan

4 Department of Biostatistics, Social determinants of health and research center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

Abstract

Background: Trunk muscles play an important role in providing both mobility and stability during dynamic tasks in athletes.
The purpose of this study was to evaluate the within-day and between-day reliability of ultrasound (US) in measuring
abdominal and lumbar multifidus muscle (MF) thickness in athletes with and without hamstring strain injury (HSI).
Methods: Fifteen male soccer players (18-30 years old) with and without HSI were evaluated using two US probes (50
mm linear 7.5 MHZ and 70 mm curvilinear 5 MHz). The abdominal muscle thickness as well as the cross sectional area
(CSA) of the MF was measured. To determine within and between days reliabilities, the second and third measurements
were repeated with two hours and one week intervals, respectively.
Results: Intraclass correlation coefficients for athletes with and without HSI demonstrated good to high reliability
for the abdominal muscle thickness (0.82 and 0.93) and CSA of the MF muscle (0.84 and 0.89, respectively).
Conclusion: Our results indicated that US seemed to be a reliable instrument to measure abdominal and lumbar
multifidus muscle thickness in soccer players with and without HSI. However, further studies are recommended to
support the present study findings in other athletes.
Level of evidence: III

Keywords


1. Engebretsen AH, Myklebust G, Holme I, Engebretsen
L, Bahr R. Intrinsic risk factors for hamstring injuries
among male soccer players a prospective cohort
study. The American Journal of Sports Medicine.
2010;38(6):1147-53.
2. Heiderscheit BC, Sherry MA, Silder A, Chumanov
ES, Thelen DG. Hamstring strain injuries:
recommendations for diagnosis, rehabilitation, and
injury prevention. journal of Orthopaedic & Sports
Physical Therapy. 2010;40(2):67-81.
3. Hawkins R, Hulse M, Wilkinson C, Hodson A, Gibson M.
The association football medical research programme:
an audit of injuries in professional football. British
Journal of Sports Medicine. 2001;35(1):43-7.
4. Woods C, Hawkins R, Maltby S, Hulse M, Thomas A,
Hodson A. The Football association medical research
programme: an audit of injuries in professional
football—analysis of hamstring injuries. British
Journal of Sports Medicine. 2004;38(1):36-41.
5. Arnason A, Andersen T, Holme I, Engebretsen L, Bahr
R. Prevention of hamstring strains in elite soccer: an
intervention study. Scandinavian Journal of Medicine
& Science in Sports. 2008;18(1):40-8.
6. Marshall PW, Lovell R, Jeppesen GK, Andersen K,
Siegler JC. Hamstring muscle fatigue and central
motor output during a simulated soccer match. PloS
one. 2014;9(7):e102753.
7. De Visser H, Reijman M, Heijboer M, Bos P. Risk factors
of recurrent hamstring injuries: a systematic review.
British Journal of Sports Medicine. 2012;46(2):124-30.
8. Opar DA, Williams MD, Shield AJ. Hamstring strain
injuries: factors that lead to injury and reinjury. Sports
Medicine. 2012;42(3):209-26.
9. Sole G, Milosavljevic S, Sullivan SJ, Nicholson H. Runningrelated
hamstring injuries: a neuromuscular approach.
Physical Therapy Reviews. 2008;13(2):102-10.
10. Willardson JM. Core stability training: applications to
sports conditioning programs. The Journal of Strength
& Conditioning Research. 2007;21(3):979-85.
11. Willson JD, Dougherty CP, Ireland ML, Davis IM. Core 
stability and its relationship to lower extremity
function and injury. Journal of the American Academy
of Orthopaedic Surgeons. 2005;13(5):316-25.
12. Loram ID, Kelly SM, Lakie M. Human balancing
of an inverted pendulum: is sway size controlled
by ankle impedance? The Journal of Physiology.
2001;532(3):879-91.
13. Loram ID, Lakie M. Human balancing of an inverted
pendulum: position control by small, ballisticlike,
throw and catch movements. The Journal of
Physiology. 2002;540(3):1111-24.
14. Hides J, Stanton W, McMahon S, Sims K, Richardson
C. Effect of stabilization training on multifidus muscle
cross-sectional area among young elite cricketers
with low back pain. Journal of orthopaedic & sports
physical therapy. 2008;38(3):101-8.
15. Bergmark A. Stability of the lumbar spine: a study
in mechanical engineering. Acta Orthopaedica
Scandinavica. 1989;60(sup230):1-54.
16. Hodges PW, Richardson CA. Contraction of the
abdominal muscles associated with movement of the
lower limb. Physical Therapy. 1997;77(2):132-42.
17. Hodges PW, Richardson CA. Delayed postural
contraction of transversus abdominis in low back
pain associated with movement of the lower limb.
Clinical Spine Surgery. 1998;11(1):46-56.
18. Panjabi MM. The stabilizing system of the spine. Part I.
Function, dysfunction, adaptation, and enhancement.
Journal of Spinal Disorders & Techniques. 1992;
5(4):383-9.
19. Panjabi MM. The stabilizing system of the spine. Part
II. Neutral zone and instability hypothesis. Journal of
Spinal Disorders & Techniques. 1992;5(4):390-7.
20. Emami M, Arab AM, Ghamkhar L. The activity pattern
of the lumbo-pelvic muscles during prone hip
extension in athletes with and without hamestring
strain injury. International Journal of Sports Physical
Therapy. 2014;9(3):312.
21. Hides J, Stanton W. Predicting football injuries
using size and ratio of the multifidus and quadratus 
lumborum muscles. Scandinavian Journal of Medicine
& Science in Sports. 2017;27(4):440-7.
22. Hides JA, Stanton WR. Can motor control training
lower the risk of injury for professional football
players. Medicine and Science in Sports and Exercise.
2014;46(4):762-8.
23. Mohseni-Bandpei MA, Watson MJ, Richardson B.
Application of surface electromyography in the
assessment of low back pain: a literature review.
Physical therapy reviews. 2000;5(2):93-105.
24. Rahmani N, Mohseni-Bandpei MA, Vameghi R, Salavati
M, Abdollahi I. Application of ultrasonography
in the assessment of skeletal muscles in children
with and without neuromuscular disorders: a
systematic review. Ultrasound in medicine & biology.
2015;41(9):2275-83.
25. Vasseljen O, Fladmark AM. Abdominal muscle
contraction thickness and function after specific
and general exercises: a randomized controlled trial
in chronic low back pain patients. Manual therapy.
2010;15(5):482-9.
26. Teyhen D, Koppenhaver S. Rehabilitative ultrasound
imaging. Journal of physiotherapy. 2011;57(3):196.
27. Whittaker JL, Stokes M. Ultrasound imaging and
muscle function. Journal of Orthopaedic & Sports
Physical Therapy. 2011;41(8):572-80.
28. Hides JA, Stanton WR, Mendis MD, Smith MMF, Sexton
MJ. Small Multifidus Muscle Size Predicts Football
Injuries. Orthopaedic Journal of Sports Medicine.
2014;2(6):1-9.
29. Hides J, Stanton W, Freke M, Wilson S, McMahon S,
Richardson C. MRI study of the size, symmetry and
function of the trunk muscles among elite cricketers
with and without low back pain. British Journal of
Sports Medicine. 2008;42(10):809-13.
30. Hides JA, Stanton WR, Mendis MD, Gildea J, Sexton
MJ. Effect of motor control training on muscle size
and football games missed from injury. Medicine and
Science in Sports and Exercise. 2012;44(6):1141-9.
31. Cuellar W, Blizzard L, Callisaya M, Hides JA, Jones G,
Ding C, et al. Test-retest reliability of measurements of
abdominal and multifidus muscles using ultrasound
imaging in adults aged 50–79 years. Musculoskeletal
Science and Practice. 2017;28:79-84.
32. Linek P, Klepek A, Wolny T, MikoĊ‚ajowski G.
Reliability of the lateral abdominal muscle thickness 
measurements in idiopathic scoliosis patients.
Musculoskeletal Science and Practice. 2018;38:151-4.
33. Hägglund M, Waldén M, Bahr R, Ekstrand J. Methods
for epidemiological study of injuries to professional
football players: developing the UEFA model. British
journal of sports medicine. 2005;39(6):340-6.
34. Mannion AF, Pulkovski N, Gubler D, Gorelick M,
O’Riordan D, Loupas T, et al. Muscle thickness
changes during abdominal hollowing: an assessment
of between-day measurement error in controls and
patients with chronic low back pain. European Spine
Journal. 2008;17(4):494-501.
35. Nabavi N, Mosallanezhad Z, Haghighatkhah
HR, Bandpeid MAM. Reliability of rehabilitative
ultrasonography to measure transverse abdominis
and multifidus muscle dimensions. Iranian Journal of
Radiology. 2014;11(3).
36. Wallwork TL, Hides JA, Stanton WR. Intrarater
and interrater reliability of assessment of lumbar
multifidus muscle thickness using rehabilitative
ultrasound imaging. Journal of Orthopaedic & Sports
Physical Therapy. 2007;37(10):608-12.
37. Springer BA, Mielcarek BJ, Nesfield TK, Teyhen DS.
Relationships among lateral abdominal muscles,
gender, body mass index, and hand dominance.
Journal of Orthopaedic & Sports Physical Therapy.
2006;36(5):289-97.
38. Norasteh A, Ebrahimi E, Salavati M, Rafiei J,
Abbasnejad E. Reliability of B-mode ultrasonography
for abdominal muscles in asymptomatic and patients
with acute low back pain. Journal of Bodywork and
Movement Therapies. 2007;11(1):17-20.
39. Hides JA, Richardson CA, Jull GA. Magnetic resonance
imaging and ultrasonography of the lumbar multifidus
muscle. Comparison of two different modalities.
Spine. 1995;20(1):54-8.
40. Hides JA, Miokovic T, Belavý DL, Stanton WR,
Richardson CA. Ultrasound imaging assessment of
abdominal muscle function during drawing-in of
the abdominal wall: an intrarater reliability study.
journal of orthopaedic & sports physical therapy.
2007;37(8):480-6.
41. Richman J, Makrides L, B. P. Research methodology
and applied statistics, a seven part series, part 3:
Measurement procedures in research. Physiotherapy
Canada. 1980.