A return to play model for hamstring injuries helps standardise decision-making.

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An international panel of football medicine experts have defined criteria that can be used to help guide a successful return to play following hamstring injuries. It is hoped that by following these criteria we may be able to reduce the risk of injury recurrence.

Hamstring injuries are one of the most common injuries in football. They can cause significant frustration as they can result in substantial time away from football and have high rates of recurrence. As a result reducing the risk of re-injury is a key priority after a hamstring injury. More than half of all recurrences occur within the first month of return to play (RTP), which may be secondary to inadequate rehabilitation and/or a premature return to play.

The goal of this paper was to create a consensus on the definition, medical criteria and multidisciplinary decision making for RTP after hamstring injuries with a goal of improving outcomes and reducing recurrence. Fifty-eight international experts in the field of hamstring injury management were selected by twenty-eight FIFA Medical Centres of Excellence to participate. The Delphi method was used, involving the experts answering questionnaires, followed by analysis and anonymous feedback reports. This is based on the principle that decisions from a structured panel of experts are more accurate and will generally converge on the most ‘right’ answer. After four Delphi rounds consensus was achieved on RTP being 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 following medical criteria were agreed on 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;
  • psychological readiness.

The multidisciplinary decision for RTP should be made between the athlete, coach, sports physician, physical therapist and fitness trainer.

Consider these criteria when you are next faced with a return to play decision following a hamstring injury.

To learn more about the treatment of muscle injuries complete the ‘Thigh Injury’ module in the FIFA Diploma in Football Medicine. This has been written by the team at FC Barcelona.

References

van der Horst N, Backx F, Goedhart EA on behalf of HIPS-Delphi Group, et al. Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making. Br J Sports Med 2017;51:1583-1591.

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Ricardo Silva
25 January 2018 20:28

Thank you for the recommendations!
I’m Football Fitness and Rehab Coach and these criteria are very helpful.
Regards to FIFA researchers and followers.
Ricardo da Silva

Doc Meraz
25 January 2018 21:25

hello, what about recurrent hamstring injuries, the treatment involve osteobiologics injections ?

Michael Biller
26 January 2018 15:21

There are also a lot of good studies talking about hamstring injuries and recurrence by Dr. Eric Witvrouw. Also here is another study: (Shuermans et al, AJSM 2016) that talks about muscle activation patterns. In this study the authors talk about a timed eccentric prone leg curl test and suggested a cut off point of 4 minutes 30 seconds as a risk factor for re-injury. According to most researchers the biceps femoris is the primary hamstring muscle injured so physios should include exercises that elicit bicep femoris muscle vs. medial hamstrings. Look at the article : Bourne et al, BJSM… Read more »

Charles Cruz
28 January 2018 23:35

Thanks for the new platform where we can exchange information about sports.

Ali Saghandian
01 February 2018 19:21

interesting, being in contact with experts, in a friendly environment

Bangoura
26 October 2018 12:46

Les lésions au niveau des ischio jambiers sont très récurrentes au niveau des sportifs de haut niveau en général et le FOOTBALL en particulier.la gravité dépend de la nature de la lésion. C est une véritable problématique entre ENTRAÎNEUR MEDECIN ENCADREUR SPORTIF.. Les lésions des ischio sont divisées comme suit 1.ÉLONGATION 2DECHIRURE MUSCULAIRE 3RUPTURE MUSCULAIRE. Le temps de guérison est fonction du degré de la lésion et de la nature des soins. Faire une bonne immagerie(ÉCHOGRAPHIE. IRM). Médecin PHYSIOTHERAPEUTE masseur kinésithérapeute chacun doit jouer sa partition pour un bon retour aux activités sportives des athlètes blessés. Le temps de repos… Read more »

Charles Cruz
28 January 2018 23:35

Thanks for the new platform where we can exchange information about sports.

Mark Fulcher
31 January 2018 9:33
Reply to  Charles Cruz

Look forward to more feedback Charles. Glad you are enjoying it.

Michael Biller
26 January 2018 15:21

There are also a lot of good studies talking about hamstring injuries and recurrence by Dr. Eric Witvrouw. Also here is another study: (Shuermans et al, AJSM 2016) that talks about muscle activation patterns. In this study the authors talk about a timed eccentric prone leg curl test and suggested a cut off point of 4 minutes 30 seconds as a risk factor for re-injury. According to most researchers the biceps femoris is the primary hamstring muscle injured so physios should include exercises that elicit bicep femoris muscle vs. medial hamstrings. Look at the article : Bourne et al, BJSM… Read more »

Mark Fulcher
31 January 2018 9:32
Reply to  Michael Biller

Thanks for the good links Mike. Great stuff.

Doc Meraz
25 January 2018 21:25

hello, what about recurrent hamstring injuries, the treatment involve osteobiologics injections ?

Mark Fulcher
26 January 2018 4:39
Reply to  Doc Meraz

A good question. These criteria are relevant for all hamstring injuries. Unfortunately the evidence for biologics (like PRP) is limited. Have a look at this well designed trial . Best option is to try to prevent recurrence via eccentric strengthening. An 85% reduction in re-injury rates with Nordic Hamstring exercises. Have a look at the Thigh module for more information.

Yannette
20 June 2020 4:48

En el área deportiva y en especial cuando se trata de la realización de deportes de conjunto es importante considerar todas las complicaciones que pueda tener la práctica de este deporte de contacto, así como la participación del equipo multidisciplinario en el abordaje integral del jugador.