Return-to-play process after
hamstring muscle injury
François Delvaux, Jean-Louis Croisier
Introduction
Injury Optimal
performance
How can we optimize the RTP process after a hamstring injury?
10 Key parameters:
I. Early start
II. Criteria-based progression III. Target athletes risk factors IV. Pain tolerance
V. Progresive strengthening
VI. High degree of elongation stress in exercises VII. Hip and knee balance
VIII. Load management IX. RTP clearance
• RCT
• 50 amateur athletes
• 12 wks rehab for LL muscle injury • 1 year follow-up
« Early » group Start Day 2
« Delayed » group Start Day 9
Influence of early vs delayed rehab start on:
• Number of days until recovery? • Re-injury rate?
1 re-injury ≈ 0 re-injury
62,5 days
83 days ≠
3 weeks
II. Criteria-based progression
Stage 1
Stage 2
Stage 3
III. Target athletes risk factors
• Running technique
• Proximal neuromuscular control • Strength disorders
• Flexibility
• Fascicle length • Training errors • Fear of re-injury
• Fatigue/ability to repeat sprints • …
Non modifiable risk factors
Modifiable risk factors Previous HSI, age, …
IV. Pain tolerance Tolerated pain: 0/10 Tolerated pain: ≤ 4/10 ↑ Hamstring strength ↑ BFLH fascicle length
Muscle strengthening
Early stages Later stages
Aims: • Reduce inhibition
• Facilitate tissue adaptation
Mendiguchia et al. MSSE 2017 Aims: Develop high eccentric strength V. Progressive strengthening
Low intensity Medium intensity High intensity V. Progressive strengthening
VI. High degree of elongation stress in exercises 56 athletes with acute hamstring injuries Lengthening protocol (n=28) Conventional protocol (n=28)
49±26 days
86±34 days
VI. High degree of elongation stress in exercises
VII. Hip and knee balance
Knee dominant
exercises
Hip dominant
VIII. Load management Strength Running & sprints Pitch
• Individualised progression of load
IX. RTP clearance 5 main RTP criteria domains: • Functional perf • Strength • Flexibility • Pain • Athlete’s confidence
X. Communication
Accurate diagnostic
Weekly rehab and training content Treatment progression Specific assessments RTP decision … Information Doctor Physio Fitness coach Coach … Athlete
• Start early
• Progress according to specific criteria
• Target athletes risk factors
• Accept mild to moderate pain (≤4/10)
• Strengthen progressively but surely
• Include exercises at high elongation stress
• Find balance between hip- and knee exercises
• Manage the load
• Use relevant criteria for RTP decision
• Share communication
Conclusion
To optimize the RTP process after a hamstring muscle injury:
TITRE
SOUSTITRE
