Return to Training and Return to Play Following Hamstring Injury

2021 ◽  
pp. 55-59
Author(s):  
Gian Nicola Bisciotti ◽  
Alessandro Corsini ◽  
Piero Volpi
Keyword(s):  
Return To Play ◽  
Hamstring Injury

scholarly journals Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making

2017 ◽  
Vol 51 (22) ◽  
pp. 1583-1591 ◽  
Author(s):  
Nick van der Horst ◽  
FJG Backx ◽  
Edwin A Goedhart ◽  
Bionka MA Huisstede
Keyword(s):  
Decision Making ◽  
Field Testing ◽  
Return To Play ◽  
Hamstring Injury ◽  
Feedback Report ◽  
Hamstring Injuries ◽  
Starting Point ◽  
Delphi Procedure ◽  
Hamstring Flexibility ◽  
The Moment

There are three major questions about return to play (RTP) after hamstring injuries: How should RTP be defined? Which medical criteria should support the RTP decision? And who should make the RTP decision? The study aimed to provide a clear RTP definition and medical criteria for RTP and to clarify RTP consultation and responsibilities after hamstring injury. The study used the Delphi procedure. The results of a systematic review were used as a starting point for the Delphi procedure. Fifty-eight experts in the field of hamstring injury management selected by 28 FIFA Medical Centres of Excellence worldwide participated. Each Delphi round consisted of a questionnaire, an analysis and an anonymised feedback report. After four Delphi rounds, with more than 83% response for each round, consensus was achieved that RTP should be defined as ‘the moment a player has received criteria-based medical clearance and is mentally ready for full availability for match selection and/or full training’. The experts reached consensus on the following criteria to support the RTP decision: medical staff clearance, absence of pain on palpation, absence of pain during strength and flexibility testing, absence of pain during/after functional testing, similar hamstring flexibility, performance on field testing, and psychological readiness. It was also agreed that RTP decisions should be based on shared decision-making, primarily via consultation with the athlete, sports physician, physiotherapist, fitness trainer and team coach. The consensus regarding aspects of RTP should provide clarity and facilitate the assessment of when RTP is appropriate after hamstring injury, so as to avoid or reduce the risk of injury recurrence because of a premature RTP.

Fifteen-week window for recurrent muscle strains in football: a prospective cohort of 3600 muscle strains over 23 years in professional Australian rules football

2020 ◽  
Vol 54 (18) ◽  
pp. 1103-1107 ◽  
Author(s):  
John W Orchard ◽  
Mohammad Chaker Jomaa ◽  
Jessica J Orchard ◽  
Katherine Rae ◽  
Daniel Tyler Hoffman ◽  
...  
Keyword(s):  
Risk Factor ◽  
Return To Play ◽  
Recent History ◽  
Hamstring Injury ◽  
Muscle Strain ◽  
Increased Risk ◽  
Australian Football ◽  
History Of ◽  
Muscle Strain Injury ◽  
Injury Recurrence

ObjectivesTo determine the rates of muscle strain injury recurrence over time after return to play in Australian football and to quantify risk factors.MethodsWe analysed Australian Football League player data from 1992 to 2014 for rates of the four major muscle strain injury types (hamstring, quadriceps, calf and groin) diagnosed by team health professionals. Covariates for analysis were: recent history (≤8 weeks) of each of the four muscle strains; non-recent history (>8 weeks) of each; history of hip, knee anterior cruciate ligament, knee cartilage, ankle sprain, concussion or lumbar injury; age; indigenous race; match level and whether a substitute rule was in place.Results3647 (1932 hamstring, 418 quadriceps, 458 calf and 839 groin) muscle strain injuries occurred in 272 759 player matches. For all muscle strains combined, the risk of injury recurrence gradually reduced, with recurrence risks of 9% (hamstring), 5% (quadriceps), 2% (calf) and 6% (groin) in the first match back and remaining elevated for 15 weeks after return to play. The strongest risk factor for each muscle injury type was a recent history of the same injury (hamstring: adjusted OR 13.1, 95% CI 11.5 to 14.9; calf OR 13.3, 95% CI 9.6 to 18.4; quadriceps: OR 25.2, 95% CI 18.8 to 33.8; groin OR 20.6, 95% CI 17.0 to 25.0), followed by non-recent history of the same injury (hamstring: adjusted OR 3.5, 95% CI 3.2 to 3.9; calf OR 4.4, 95% CI 3.6 to 5.4; quadriceps OR 5.2, 95% CI 4.2 to 6.4; groin OR 3.5, 95% CI 3.0 to 4.0). Age was an independent risk factor for calf muscle strains (adjusted OR 1.6, 95% CI 1.3 to 2.0). Recent hamstring injury increased the risk of subsequent quadriceps (adjusted OR 1.8, 95% CI 1.2 to 2.7) and calf strains (OR 1.8, 95% CI 1.2 to 2.6). During the ‘substitute rule’ era (2011–2014), hamstring (adjusted OR 0.76, 95% CI 0.67 to 0.86), groin (OR 0.78, 95% CI 0.65 to 0.93) and quadriceps (OR 0.70, 95% CI 0.53 to 0.92) strains were less likely than outside of that era but calf (OR 1.6, 95% CI 1.3 to 1.9) strains were more likely than before the substitute rule era.ConclusionRecent injury is the greatest risk factor for the four major muscle strains, with increased risk persisting for 15 weeks after return to play.

scholarly journals Return-to-Play Practices Following Hamstring Injury: A Worldwide Survey of 131 Premier League Football Teams

2019 ◽  
Vol 50 (4) ◽  
pp. 829-840 ◽  
Author(s):  
Gordon Dunlop ◽  
Clare L. Ardern ◽  
Thor Einar Andersen ◽  
Colin Lewin ◽  
Gregory Dupont ◽  
...  
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Return To Play ◽  
Hamstring Injury ◽  
Professional Football ◽  
Multiple Stakeholders ◽  
Related Factors ◽  
Beliefs And Practices ◽  
Premier League ◽  
Key Stakeholders

Abstract Purpose Return-to-play (RTP) is an on-going challenge in professional football. Return-to-play related research is increasing. However, it is unknown to what extent the recommendations presented within research are being implemented by professional football teams, and where there are gaps between research and practice. The purposes of this study were (1) to determine if premier-league football teams worldwide follow a RTP continuum, (2) to identify RTP criteria used and (3) to understand how RTP decision-making occurs in applied practice. Methods We sent a structured online survey to practitioners responsible for the RTP programme in 310 professional teams from 34 premier-leagues worldwide. The survey comprised four sections, based on hamstring muscle injury: (1) criteria used throughout RTP phases, (2) the frequency with which progression criteria were achieved, (3) RTP decision-making process and (4) challenges to decision-making. Results One-hundred and thirty-one teams responded with a completed survey (42%). One-hundred and twenty-four teams (95%) used a continuum to guide RTP, assessing a combination of clinical, functional and psychological criteria to inform decisions to progress. One-hundred and five (80%) teams reported using a shared decision-making approach considering the input of multiple stakeholders. Team hierarchy, match- and player-related factors were common challenges perceived to influence decision-making. Conclusions General research recommendations for RTP and the beliefs and practices of practitioners appear to match with, the majority of teams assessing functional, clinical and psychological criteria throughout a RTP continuum to inform decision-making which is also shared among key stakeholders. However, specific criteria, metrics and thresholds used, and the specific involvement, dynamics and interactions of staff during decision-making are not clear.

RETURN-TO-PLAY CRITERIA AFTER HAMSTRING INJURY: ACTUAL MEDICINE PRACTICE IN PROFESSIONAL SOCCER TEAMS

2013 ◽  
Vol 47 (10) ◽  
pp. e3.53-e3 ◽  
Author(s):  
François Delvaux ◽  
Pierre Rochcongar ◽  
Olivier Bruyère ◽  
Guillaume Bourlet ◽  
Christophe Daniel ◽  
...  
Keyword(s):  
Return To Play ◽  
Hamstring Injury ◽  
Professional Soccer ◽  
Soccer Teams

scholarly journals Evidence-Based Management and Factors Associated With Return to Play After Acute Hamstring Injury in Athletes: A Systematic Review

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110538
Author(s):  
Samuel S. Rudisill ◽  
Michael P. Kucharik ◽  
Nathan H. Varady ◽  
Scott D. Martin
Keyword(s):  
Knee Extension ◽  
Risk Of Bias ◽  
Return To Play ◽  
Hamstring Injury ◽  
Controlled Trials ◽  
Factors Associated ◽  
Randomized Controlled ◽  
Hamstring Injuries ◽  
Muscular Injury ◽  
Proximal Hamstring

Background: Considering the lengthy recovery and high recurrence risk after a hamstring injury, effective rehabilitation and accurate prognosis are fundamental to timely and safe return to play (RTP) for athletes. Purpose: To analyze methods of rehabilitation for acute proximal and muscular hamstring injuries and summarize prognostic factors associated with RTP. Study Design: Systematic review; Level of evidence, 4. Methods: In August 2020, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus were queried for studies examining management and factors affecting RTP after acute hamstring injury. Included were randomized controlled trials, cohort studies, case-control studies, and case series appraising treatment effects on RTP, reinjury rate, strength, flexibility, hamstrings-to-quadriceps ratio, or functional assessment, as well as studies associating clinical and magnetic resonance imaging factors with RTP. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials or the Methodological Index for Non-Randomized Studies (MINORS). Results: Of 1289 identified articles, 75 were included. The comparative and noncomparative studies earned MINORS scores of 18.8 ± 1.3 and 11.4 ± 3.4, respectively, and 12 of the 17 randomized controlled trials exhibited low risk of bias. Collectively, studies of muscular injury included younger patients and a greater proportion of male athletes compared with studies of proximal injury. Surgery for proximal hamstring ruptures achieved superior outcomes to nonoperative treatment, whereas physiotherapy incorporating eccentric training, progressive agility, and trunk stabilization restored function and hastened RTP after muscular injuries. Platelet-rich plasma injection for muscular injury yielded inconsistent results. The following initial clinical findings were associated with delayed RTP: greater passive knee extension of the uninjured leg, greater knee extension peak torque angle, biceps femoris injury, greater pain at injury and initial examination, “popping” sound, bruising, and pain on resisted knee flexion. Imaging factors associated with delayed RTP included magnetic resonance imaging-positive injury, longer lesion relative to patient height, greater muscle/tendon involvement, complete central tendon or myotendinous junction rupture, and greater number of muscles injured. Conclusion: Surgery enabled earlier RTP and improved strength and flexibility for proximal hamstring injuries, while muscular injuries were effectively managed nonoperatively. Rehabilitation and athlete expectations may be managed by considering several suitable prognostic factors derived from initial clinical and imaging examination.

scholarly journals Match High-Speed Running Distances Are Often Suppressed After Return From Hamstring Strain Injury in Professional Footballers

2020 ◽  
pp. 194173812096445
Author(s):  
Rodney Whiteley ◽  
Andrew Massey ◽  
Tim Gabbett ◽  
Peter Blanch ◽  
Matthew Cameron ◽  
...  
Keyword(s):  
High Speed ◽  
Rugby Union ◽  
Return To Play ◽  
Hamstring Injury ◽  
Professional Football ◽  
Linear Regression Models ◽  
Post Injury ◽  
Level Of Evidence ◽  
Running Performance ◽  
Hamstring Strain

Background: High-speed running is commonly implicated in the genesis of hamstring injury. The success of hamstring injury management is typically quantified by the duration of time loss or reinjury rate. These metrics do not consider any loss in performance after returning to play from hamstring injury. It is not known to what extent high-speed running is altered on return to play after such injury. Hypothesis: Match high-speed running distance will change after returning from hamstring injury. Study Design: Non-randomized cohort. Level of Evidence: Level 3. Methods: Match high-speed running distance in highest level professional football (soccer, Rugby League, Rugby Union, and Australian Rules) were examined for a minimum of 5 games prior and subsequent to hamstring strain injury for individual differences using a linear regression models approach. A total of 22 injuries in 15 players were available for analysis. Results: Preinjury cumulative high-speed running distances were strongly correlated for each individual ( r2 = 0.92-1.0; P < 0.0001). Pre- and postinjury high-speed running data were available for a median of 15 matches (range, 6-15). Variance from the preinjury high-speed running distance was significantly less ( P = 0.0005) than the post injury values suggesting a suppression of high-speed running distance after returning from injury. On return to play, 7 of the 15 players showed a sustained absolute reduction in preinjury high-speed running distance, 7 showed no change, and 1 player (only) showed an increase. Analysis of subsequent (second and third injury) return to play showed no differences to return from the index injury. Conclusion: Return to play was not associated with return to high-speed running performance for nearly half of the players examined, although the same number showed no difference. Persisting deficits in match high-speed running may exist for many players after hamstring strain injury. Clinical Relevance: Returning to play does not mean returning to (high-speed running) performance for nearly half of the high-level professional football players examined in this study. This suggests that successful return to play metrics should be expanded from simple time taken and recurrence to include performance.

scholarly journals Hamstring Injuries Prevention in Soccer: A Narrative Review of Current Literature

Joints ◽  
2020 ◽  
Author(s):  
Gian Nicola Bisciotti ◽  
Karim Chamari ◽  
Emanuele Cena ◽  
Giulia Carimati ◽  
Alessandro Bisciotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Risk ◽  
Epidemiological Data ◽  
Return To Play ◽  
Hamstring Injury ◽  
Apparent Paradox ◽  
Hamstring Injuries ◽  
High Incidence ◽  
Sport Activities ◽  
Injury Risk Factors

AbstractHamstring injuries and reinjuries are one of the most important sport lesions in several sport activities including soccer, Australian football, track and field, rugby, and in general in all sport activities requiring sprinting and acceleration. However, it is important to distinguish between the lesions of the biceps femoris and semitendinosus and semimembranosus. Indeed, three muscles representing the hamstring complex have a very different injury etiology and consequently require different prevention strategies. This fact may explain, at least in part, the high incidence of reinjuries. In soccer, hamstring injuries cause an important rate of time loss (i.e., in average 15–21 matches missed per club per season). The hamstring injury risk factors may be subdivided in three categories: “primary injury risk factors” (i.e., the risk factors mainly causing a first lesion), “recurrent injury risk factors” (i.e., the risk that can cause a reinjury), and bivalent injury risk factors” (i.e., the risk factors that can cause both primary injuries and reinjuries). The high incidence of hamstring lesions caused consequently an important increase in hamstring injury research. However, although the prevention has increased paradoxically, epidemiological data do not show a loss in injuries and/or reinjuries but, on the contrary, they show an increase in hamstring injuries. This apparent paradox highlights the importance both of the improvement in the prevention programs quality and the criteria for return to play after hamstring injury.

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