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Keywords

Autonomic nervous system, patient-reported outcomes, clinician-rated outcomes

Abstract

Hamstring injuries have an occurrence rate of 3.05 per 1000 athlete exposures in intercollegiate athletics. Current clinical practice recommendations for rehabilitation of hamstring injuries are based on pathoanatomical muscle tissue healing timeframes. The purpose of this study was to examine the effects of modulating the nervous system with Primal Reflex Release Technique (PRRT) in patients clinically diagnosed with functional neuromuscular hamstring muscle-related disorder (FNHD). In this a priori case series, PRRT was utilized in four patients participating in intercollegiate, National Collegiate Athletic Association Division II, athletics to evaluate Numeric Pain Rating Scale (NRS) for current pain, Disablement of the Physically Active (DPA) scale, modified Patient Specific Functional Scale (PSFS), and Active Knee Extension Test (AKET). The initial pre-treatment to post-treatment average difference for NRS (3.25±2.5 points) and AKET (11±2.16°) improved by an amount that satisfied MCID and MCD respectively. The pre-treatment to one-week follow-up average difference for NRS (5.5±2.3 points), PSFS (4.75±2.5 points), and AKET (20.5±14°) improved by an amount that satisfied MCID or MCD. The average timeline for discharge to full unrestricted activity was 2.75 days. In the four patients classified with a functional neuromuscular muscle disorder (FNMD), PRRT was utilized as the only manual therapy intervention. Through modulation of the nervous system, the outcomes reported by the patients were both meaningful and clinically significant. Based on the results and the current standard of care for similar patients, the need for further research into this paradigm is warranted. Hamstring injuries continue to be a significant clinical injury in the athletic patient population. A thorough evaluation and appropriate classification of muscle injury can help clinicians decided an effective treatment for the patient. Clinicians seeking to improve patient outcomes may benefit from considering a paradigm that modifies the neural allostatic loads.

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