The high frequency of re-injury after a hamstring strain (HS) represents a serious problem in explosive sports, which implies that Return-To-Play (RTP) decision after a first episode of HS is of crucial importance [1].
There is a lack of scientific evidence about the appropriate criteria for releasing patients to unrestricted sports activities. However, some guidelines have been recently developed and their implementation in daily medical practice are now possible [2].
The aim of this study was to analyze how sports physicians decide, in their daily practice, when a hamstring injured professional soccer player is fully able to get back to competitive soccer activities.
III. RESULTS
II. METHODS
According to physicians for professional soccer clubs, the most important RTP criteria after HS are: complete pain relief, normalized muscle
strength assessment, subjective feeling reported by the player, normalized flexibility and achievement of a specific soccer test. However, for
some of these elements, notably muscle strength assessment, we observed a lack of consensus about the choice of the assessment
parameters and the limit values allowing doctors to authorize or forbid RTP.
In conclusion, we recommend a systematic application, in daily medical practice, of RTP criteria that have been scientifically demonstrated or
suggested in the literature to lower re-injury rate.
IV. CONCLUSIONS
Thirty-seven physicians (46.3 ± 7.1 years old) for French (League 1 and 2) and Belgian (1st Division) professional clubs completed a questionnaire composed of three parts:
(1) RTP criteria used in daily medical practice (Yes or No – list of 14 criteria + sub-questions), (2) Ranking of RTP criteria, from the most important to the less important criterion,
(3) Consideration advice from professionals (physical therapist, …).
Nearly 80% of the questioned physicians declared to use at least seven criteria to assess player’s ability to return to full soccer (Figure 1).
I. INTRODUCTION
fdelvaux@ulg.ac.be François DELVAUX, Department of Sport and Rehabilitation Sciences, University of Liege, ISEPK, B21, 4000 Liège, BELGIUM
Return-To-Play criteria after hamstring injury:
actual medicine practice in professional soccer
teams
F. Delvaux¹
, P. Rochcongar², O. Bruyère³, G. Bourlet
¹
, C. Daniel
4, P. Diverse
5, JY. Reginster
3, JL. Croisier
¹
1
Department of Sport and Rehabilitation Sciences, ISEPK, University of Liege, Belgium
² Department of Biology and Sports Medicine, CHU Pontchaillou, Rennes, France; French Federation of Soccer – Professional Football League ³ Department of Public Health, Epidemiology and Health Economics, University of Liege, CHU of Liege, Liege, Belgium
4 Department of Orthopaedic Surgery, CHU of Liege, Liege, Belgium
5 Department of Orthopaedic Surgery, Saint-Elisabeth Hospital, Verviers, Belgium
REFERENCES
[1]
Creighton DW et al. Clin J Sport Med 20:379-385, 2010.
[2]
Croisier JL et al. Am J Sports Med 36:1469-1475,
2008.
B) Ranking ………1 ………2 ………5 ………3 ………….12 ………4 ………7 ………6 …………..10 …………..11 ………8 ………9 …………..13 ……….….14Figure 1: Answers to the following questions:
A) “In your daily medical practice, do you use the following criteria in order to determine when a soccer player, ending a rehabilitation after hamstring injury, is able to get back to competitive activities?” ("Yes" answers expressed in %).
B) “Rank from 1 to 14 all the previous criteria according to the importance you assign to them (1 = the most important criterion ; 14 = the less important criterion)”.
A) RTP criteria after hamstring injury
Muscle strength assessment
C B
A
Ninety-seven per cent of the physicians considered muscle strength performance assessment as an essential criterion; but the way to highlight a muscular abnormality often appears different among these physicians (Figure 2).
Figure 2: Strength assessment: (A) Muscle groups and contraction modes. – (B) Elements taken in consideration for determining that muscle strength is sufficient. – (C) Limits of strength differences between injured and uninjured sides.
