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.
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.