The development of a HAMstring InjuRy (HAMIR) index to mitigate injury risk through innovative imaging, biomechanics, and data analytics: protocol for an observational cohort study

Bryan C Heiderscheit, Silvia S Blemker, David Opar, Mikel R Stiffler-Joachim, Asheesh Bedi, Joseph Hart, Brett Mortensen, Stephanie A Kliethermes, HAMIR Study Group, Geoffrey Baer, Craig Buckley, Kyle Costigan, Shauna Drew, Duffy Eberhardt, Kurrel Fabian, Herman Feller, Erin Hammer, Danielle Heidt, Kenneth Lee, Brian Lund, Jack Martin, Michael Moll, Jennifer Sanfilippo, Shaun Snee, Claire Tanaka, Ty Taylor, John Wilson, Devin Woodhouse, Yi-Chung Lin, Jack Hickey, Nirav Maniar, Frances Taylor, Ryan Timmins, Matthew Cousins, Olivia DuCharme, Xue Feng, Scott Magargee, Craig Meyer, Anthony Nguyen, Lara Riem, Robin West, Steven Allen, Dain Allred, Anthony Beutler, Dustin Bruening, Darren Campbell, A Wayne Johnson, Camille Nguyen, Emma Remington, Annie A Smedley, Joshua K Sponbeck, David Berkoff, Josh Berkowitz, Thomas Birchmeier, Troy Blackburn, Malvika Choudhari, Mario Ciocca, Alessa Lennon, Caroline Lisee, Noah McCoy, David Mincberg, Scott Oliaro, Brian Pietrosimone, Luke Ross, Julie Titter, Sarah Sund, Bryan C Heiderscheit, Silvia S Blemker, David Opar, Mikel R Stiffler-Joachim, Asheesh Bedi, Joseph Hart, Brett Mortensen, Stephanie A Kliethermes, HAMIR Study Group, Geoffrey Baer, Craig Buckley, Kyle Costigan, Shauna Drew, Duffy Eberhardt, Kurrel Fabian, Herman Feller, Erin Hammer, Danielle Heidt, Kenneth Lee, Brian Lund, Jack Martin, Michael Moll, Jennifer Sanfilippo, Shaun Snee, Claire Tanaka, Ty Taylor, John Wilson, Devin Woodhouse, Yi-Chung Lin, Jack Hickey, Nirav Maniar, Frances Taylor, Ryan Timmins, Matthew Cousins, Olivia DuCharme, Xue Feng, Scott Magargee, Craig Meyer, Anthony Nguyen, Lara Riem, Robin West, Steven Allen, Dain Allred, Anthony Beutler, Dustin Bruening, Darren Campbell, A Wayne Johnson, Camille Nguyen, Emma Remington, Annie A Smedley, Joshua K Sponbeck, David Berkoff, Josh Berkowitz, Thomas Birchmeier, Troy Blackburn, Malvika Choudhari, Mario Ciocca, Alessa Lennon, Caroline Lisee, Noah McCoy, David Mincberg, Scott Oliaro, Brian Pietrosimone, Luke Ross, Julie Titter, Sarah Sund

Abstract

Background: The etiology of hamstring strain injury (HSI) in American football is multi-factorial and understanding these risk factors is paramount to developing predictive models and guiding prevention and rehabilitation strategies. Many player-games are lost due to the lack of a clear understanding of risk factors and the absence of effective methods to minimize re-injury. This paper describes the protocol that will be followed to develop the HAMstring InjuRy (HAMIR) index risk prediction models for HSI and re-injury based on morphological, architectural, biomechanical and clinical factors in National Collegiate Athletic Association Division I collegiate football players.

Methods: A 3-year, prospective study will be conducted involving collegiate football student-athletes at four institutions. Enrolled participants will complete preseason assessments of eccentric hamstring strength, on-field sprinting biomechanics and muscle-tendon volumes using magnetic-resonance imaging (MRI). Athletic trainers will monitor injuries and exposure for the duration of the study. Participants who sustain an HSI will undergo a clinical assessment at the time of injury along with MRI examinations. Following completion of structured rehabilitation and return to unrestricted sport participation, clinical assessments, MRI examinations and sprinting biomechanics will be repeated. Injury recurrence will be monitored through a 6-month follow-up period. HAMIR index prediction models for index HSI injury and re-injury will be constructed.

Discussion: The most appropriate strategies for reducing risk of HSI are likely multi-factorial and depend on risk factors unique to each athlete. This study will be the largest-of-its-kind (1200 player-years) to gather detailed information on index and recurrent HSI, and will be the first study to simultaneously investigate the effect of morphological, biomechanical and clinical variables on risk of HSI in collegiate football athletes. The quantitative HAMIR index will be formulated to identify an athlete's propensity for HSI, and more importantly, identify targets for injury mitigation, thereby reducing the global burden of HSI in high-level American football players. Trial Registration The trial is prospectively registered on ClinicalTrials.gov (NCT05343052; April 22, 2022).

Keywords: Eccentric strength; Muscle injury; Muscle volume; Risk prediction model; Sprint running.

Conflict of interest statement

Bryan Heiderscheit is a paid consultant to Biocore, has ownership interest in Science of Running Medicine LLC, is an advisory board member for Springbok Analytics (stock options) and has received research funding from the National Basketball Association and GE Healthcare. David Opar is listed as a co-inventor on a patent, filed by the Queensland University of Technology (QUT), for a field-testing device of eccentric hamstring strength, which is now known commercially as the NordBord. Dr Opar has received revenue distributions from QUT based on revenue that QUT has generated through the commercialization of his intellectual property. Dr Opar is a minority shareholder in Vald Performance Pty Ltd, the company responsible for commercialization of the NordBord, among other devices. Dr Opar has received research funding from Vald Performance, for work unrelated to the current manuscript. Dr Opar is also the Chair of the Vald Performance Research Committee, a role that is unpaid. Dr Opar has family members who are minor shareholders and/or employees of Vald Performance. Silvia Blemker is co-founder and Chief Scientific Officer of Springbok Analytics and has shares in the company. Asheesh Bedi is an advisory board member for Springbok Analytics (stock options) and ViewFi (shares), and receives consulting fees and royalties from Arthrex. Joseph Hart is co-founder and Scientific Advisor of Springbok Analytics. Lara Riem is employed by Springbok Analytics and has stock options. Xue Feng is the Chief Technology Officer for Springbok Analytics and has shares in the company. Matthew Cousins is employed by Springbok Analytics. Olivia DuCharme is employed by Springbok Analytics. Anthony Nguyen is employed by Springbok Analytics. Geoff Baer has received consulting fees from Conmed. Kenneth Lee has received research and grant support from the National Basketball Association, GE Healthcare and Supersonic Imagine, and receives royalties from Elsevier. John Wilson has received research and grant support from GE Healthcare and Depuy Synthes. The remaining authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Overall design of the 3-year HAMIR study. NCAA, National Collegiate Athletic Association
Fig. 2
Fig. 2
Annual injury tracking and data collection process. HaOS, Hamstring Outcome Score; FASH, Functional Assessment Scale for Acute Hamstring Injuries

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