Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play

ObjectivesThe objective was to describe the typical duration of absence following the most common injury diagnoses in professional football.MethodsInjuries were registered by medical staff members of football clubs participating in the Union of European Football Association Elite Club Injury Study. Duration of absence due to an injury was defined by the number of days that passed between the date of the injury occurrence and the date when the medical team allowed the player to return to full participation. In total, 22 942 injuries registered during 494 team-seasons were included in the study.ResultsThe 31 most common injury diagnoses constituted a total of 78 % of all reported injuries. Most of these injuries were either mild (leading to a median absence of 7 days or less, 6440 cases = 42%) or moderate (median absence: 7–28 days, 56% = 8518 cases) while only few (2% = 311 cases) were severe (median absence of >28 days). The mean duration of absence from training and competition was significantly different (p < 0.05) between index injuries and re-injuries for six diagnoses (Achilles tendon pain, calf muscle injury, groin adductor pain, hamstring muscle injuries and quadriceps muscle injury) with longer absence following re-injuries for all six diagnosesConclusionsThe majority of all time loss due to injuries in professional football stems from injuries with an individual absence of up to 4 weeks. This article can provide guidelines for expected time away from training and competition for the most common injury types as well as for its realistic range.

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Return to play criteria after hamstring muscle injury in professional football: a Delphi consensus study

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097131 ◽

2017 ◽

Vol 51 (16) ◽

pp. 1221-1226 ◽

Cited By ~ 13

Author(s):

Mattia Zambaldi ◽

Ian Beasley ◽

Alison Rushton

Keyword(s):

Muscle Injury ◽

Return To Play ◽

Professional Football ◽

Hamstring Muscle ◽

Delphi Consensus

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Few training sessions between return to play and first match appearance are associated with an increased propensity for injury: a prospective cohort study of male professional football players during 16 consecutive seasons

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-100655 ◽

2019 ◽

Vol 54 (7) ◽

pp. 427-432 ◽

Cited By ~ 3

Author(s):

Håkan Bengtsson ◽

Jan Ekstrand ◽

Markus Waldén ◽

Martin Hägglund

Keyword(s):

Cohort Study ◽

Injury Risk ◽

Training Session ◽

Injury Rate ◽

Return To Play ◽

Professional Football ◽

Muscle Injuries ◽

Severe Injuries ◽

Injury Rates ◽

Rate Ratios

BackgroundIt has been hypothesised that injury risk after return to play following an injury absence is influenced by the amount of training completed before return to competition.AimTo analyse if the number of completed training sessions between return to play and the first subsequent match appearance was associated with the odds of injury in men’s professional football.MethodsFrom a cohort study, including 303 637 individual matches, 4805 first match appearances after return to play following moderate to severe injuries (≥8 days absence) were analysed. Rate ratios (RRs) were used to compare injury rates in the first match appearances with the average seasonal match injury rate. Odds ratios (ORs) were used to analyse associations between the number of completed training sessions and general (all injuries), muscle, and non-muscle injury odds.ResultsInjury rate in the first match after return to play was increased by 87% compared with the average seasonal match injury rate (46.9 vs 25.0/1000 hours, RR=1.87; 95% CI 1.64 to 2.14). The odds of injury dropped 7% with each training session before the first match (OR 0.93; 95% CI 0.87 to 0.98). The same association was found for muscle injuries (OR 0.87; 95% CI 0.79 to 0.95) but not for non-muscle injuries (OR 0.99; 95% CI 0.91 to 1.07).ConclusionsInjury rates in the first match after injury are higher than the average seasonal match injury rate, but the propensity for player injury is decreased when players complete more training sessions before their first match.

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Injury rates decreased in men’s professional football: an 18-year prospective cohort study of almost 12 000 injuries sustained during 1.8 million hours of play

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-103159 ◽

2021 ◽

pp. bjsports-2020-103159

Author(s):

Jan Ekstrand ◽

Armin Spreco ◽

Håkan Bengtsson ◽

Roald Bahr

Keyword(s):

Ligament Injury ◽

Football Players ◽

Injury Incidence ◽

Professional Football ◽

Muscle Injuries ◽

Time Loss ◽

Match Play ◽

Injury Rates ◽

Surveillance Programme ◽

Individual Player

BackgroundThe UEFA Elite Club Injury Study is the largest and longest running injury surveillance programme in football.ObjectiveTo analyse the 18-season time trends in injury rates among male professional football players.Methods3302 players comprising 49 teams (19 countries) were followed from 2000–2001 through 2018–2019. Team medical staff recorded individual player exposure and time-loss injuries.ResultsA total of 11 820 time-loss injuries were recorded during 1 784 281 hours of exposure. Injury incidence fell gradually during the 18-year study period, 3% per season for both training injuries (95% CI 1% to 4% decrease, p=0.002) and match injuries (95% CI 2% to 3% decrease, p<0.001). Ligament injury incidence decreased 5% per season during training (95% CI 3% to 7% decrease, p<0.001) and 4% per season during match play (95% CI 3% to 6% decrease, p<0.001), while the rate of muscle injuries remained constant. The incidence of reinjuries decreased by 5% per season during both training (95% CI 2% to 8% decrease, p=0.001) and matches (95% CI 3% to 7% decrease, p<0.001). Squad availability increased by 0.7% per season for training sessions (95% CI 0.5% to 0.8% increase, p<0.001) and 0.2% per season for matches (95% CI 0.1% to 0.3% increase, p=0.001).ConclusionsOver 18 years: (1) injury incidence decreased in training and matches, (2) reinjury rates decreased, and (3) player availability for training and match play increased.

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Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967116680344 ◽

2017 ◽

Vol 5 (1) ◽

pp. 232596711668034 ◽

Cited By ~ 9

Author(s):

Brian C. Werner ◽

Nicole S. Belkin ◽

Steve Kennelly ◽

Leigh Weiss ◽

Ronnie P. Barnes ◽

...

Keyword(s):

Relative Frequency ◽

National Football League ◽

Fluid Collection ◽

Magnetic Resonance Images ◽

Calf Muscle ◽

Return To Play ◽

Imaging Findings ◽

Muscle Injuries ◽

Lower Extremity Muscle ◽

Imaging Characteristics

Background: Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied. Purpose: To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all acute calf muscle injuries on a single NFL team from 2003 to 2015 was performed. Player demographics and return-to-play data were obtained from the medical records. All available magnetic resonance images (MRIs) were reviewed by a musculoskeletal radiologist for specific imaging findings that correlated with return to play. Results: A total of 27 calf injuries in 24 NFL players were reviewed, yielding an incidence of 2.3 acute calf injuries per year on a single NFL team. Of these 27 injuries, 20 (74%) were isolated injuries to the gastrocnemius muscle, 4 (15%) were isolated injuries to the soleus muscle, and the remaining 3 injuries (11%) involved both. Defensive players were more likely to sustain injuries ( P = .043). The mean time to return to play for all 27 players was 17.4 ± 14.6 days (range, 3-62 days). MRIs were available in 14 of the 27 injuries. The average size of the fascial defect ( P = .032) and the presence of a fluid collection ( P = .031) both correlated with return to play of longer than 2 weeks. Conclusion: Although less common than hamstring or quadriceps muscle injuries, calf muscle injuries occur with relative frequency in the NFL, and more so in defensive players. The majority of these injuries occur in the gastrocnemius and result in significant disability, with at least 2 weeks of missed playing time on average. MRI may have an important role in the evaluation of calf injuries in NFL players, as certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of a fluid collection, are associated with longer return-to-play times after injury.

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An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems

Joints ◽

10.11138/jts/2016.4.1.039 ◽

2016 ◽

Vol 04 (01) ◽

pp. 039-046 ◽

Cited By ~ 9

Author(s):

Alberto Grassi ◽

Alberto Quaglia ◽

Gian Canata ◽

Stefano Zaffagnini

Keyword(s):

Prognostic Value ◽

Muscle Injury ◽

Clinical Signs ◽

Classification Systems ◽

Soccer Players ◽

Muscle Injuries ◽

Mri Findings ◽

Professional Soccer ◽

Magnetic Resonance Imaging Mri ◽

Comprehensive Classification

Muscle injuries are recognized to be among the most frequent injuries occurring in the sporting and athletic population, and they account for more than 30% of all injuries in professional soccer players. Despite their considerable frequency and impact, there is still a lack of uniformity in the categorization, description and grading of muscle injuries.Dozens of systems based on clinical signs, ultrasound imaging (US) appearance or magnetic resonance imaging (MRI) findings have been proposed over the years. Most of them are three-grade systems that take into account pain, ROM limitation, swelling and hematoma, hypoechoic or hyperintense areas on US or MRI, and muscle gap or tendon involvement; however, they still lack evidence-based prognostic value. Recently, new comprehensive classification systems have been proposed, with the aim of developing uniform muscle injury terminology and giving each severity grade prognostic value.The systems that combine detailed MRI and US features with the clinical presentation, such as the Munich Muscle Injury Classification, the ISMuLT classification, and the British Athletic Classification, if used extensively, could improve the diagnosis, prognosis and management of muscle injuries.

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Intratendinous hamstring injuries: sequential MRIs as a tool to reduce the risk of reinjury in elite sport

BMJ Case Reports ◽

10.1136/bcr-2020-241365 ◽

2021 ◽

Vol 14 (11) ◽

pp. e241365

Author(s):

James Baldock ◽

Steve Wright ◽

Eugene McNally ◽

Thamindu Wedatilake

Keyword(s):

Tendon Healing ◽

Hamstring Tendon ◽

Return To Play ◽

Elite Sport ◽

Muscle Injuries ◽

Hamstring Injuries ◽

Increased Risk ◽

Mri Scans ◽

Standard Investigation

Hamstring injuries are the most common muscle injuries in elite football. Injuries involving the intramuscular tendon are considered more significant, with longer return to play (RTP) times and an increased risk of reinjury. MRI is the gold standard investigation for muscle injuries, but initial findings cannot accurately determine RTP times. The role of MRI in monitoring muscle and tendon healing is not well described. We present three cases of hamstring injuries with intramuscular tendon involvement, illustrating the changes seen on MRI during progressive tendon healing and describing how we utilised this information to inform safe rehabilitation progression. We conclude that intramuscular hamstring tendon healing can be accurately seen on sequential MRI scans and that this information, when combined with traditional rehabilitation markers in and elite sport environment, can be utilised by clinicians to determine the earliest but safe RTP.

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