The influence of prior hamstring injury on lengthening muscle tissue mechanics

Hamstring strain injuries often occur near the proximal musculotendon junction (MTJ) of the biceps femoris. Post-injury remodeling can involve scar tissue formation, which may alter contraction mechanics and influence re-injury risk. The purpose of this study was to assess the affect of prior hamstring strain injury on muscle tissue displacements and strains during active lengthening contractions. Eleven healthy and eight subjects with prior biceps femoris injuries were tested. All previously injured subjects had since returned to sport and exhibited evidence of residual scarring along the proximal aponeurosis. Subjects performed cyclic knee flexion-extension on an MRI-compatible device using elastic and inertial loads, which induced active shortening and lengthening contractions, respectively. CINE phase-contrast imaging was used to measure tissue velocities within the biceps femoris during these tasks. Numerical integration of the velocity information was used to estimate two-dimensional tissue displacement and strain fields during muscle lengthening. The largest tissue motion was observed along the distal MTJ, with the active lengthening muscle exhibiting significantly greater and more homogeneous tissue displacements. First principal strain magnitudes were largest along the proximal MTJ for both loading conditions. The previously injured subjects exhibited less tissue motion and significantly greater strains near the proximal MTJ. We conclude that localized regions of high tissue strains during active lengthening contractions may predispose the proximal biceps femoris to injury. Furthermore, post-injury remodeling may alter the in-series stiffness seen by muscle tissue and contribute to the relatively larger localized tissue strains near the proximal MTJ, as was observed in this study.