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Palermi S, Vittadini F, Vecchiato M, Corsini A, Demeco A, Massa B, Pedret C, Dorigo A, Gallo M, Pasta G, Nanni G, Vascellari A, Marchini A, Lempainen L, Sirico F. Managing Lower Limb Muscle Reinjuries in Athletes: From Risk Factors to Return-to-Play Strategies. J Funct Morphol Kinesiol 2023; 8:155. [PMID: 37987491 PMCID: PMC10660751 DOI: 10.3390/jfmk8040155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
Muscle injuries and subsequent reinjuries significantly impact athletes, especially in football. These injuries lead to time loss, performance impairment, and long-term health concerns. This review aims to provide a comprehensive overview of the current understanding of muscle reinjuries, delving into their epidemiology, risk factors, clinical management, and prevention strategies. Despite advancements in rehabilitation programs and return-to-play criteria, reinjury rates remain alarmingly high. Age and previous muscle injuries are nonmodifiable risk factors contributing to a high reinjury rate. Clinical management, which involves accurate diagnosis, individualized rehabilitation plans, and the establishment of return-to-training and return-to-play criteria, plays a pivotal role during the sports season. Eccentric exercises, optimal loading, and training load monitoring are key elements in preventing reinjuries. The potential of artificial intelligence (AI) in predicting and preventing reinjuries offers a promising avenue, emphasizing the need for a multidisciplinary approach to managing these injuries. While current strategies offer some mitigation, there is a pressing need for innovative solutions, possibly leveraging AI, to reduce the incidence of muscle reinjuries in football players. Future research should focus on this direction, aiming to enhance athletes' well-being and performance.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | | | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | | | - Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Bruno Massa
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Diagonal, 08950 Barcelona, Spain;
| | - Alberto Dorigo
- Radiology Unit, Casa di Cura Giovanni XXIII, 31050 Monastier, Italy
| | - Mauro Gallo
- Radiology Unit, Casa di Cura Giovanni XXIII, 31050 Monastier, Italy
| | | | | | | | | | - Lasse Lempainen
- FinnOrthopaedics, Hospital Pihlajalinna, 20520 Turku, Finland;
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
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Pulici L, Certa D, Zago M, Volpi P, Esposito F. Injury Burden in Professional European Football (Soccer): Systematic Review, Meta-Analysis, and Economic Considerations. Clin J Sport Med 2022; 33:00042752-990000000-00071. [PMID: 36730365 DOI: 10.1097/jsm.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to evaluate the injury burden and the related economic cost in European professional male football players. DATA SOURCES Multiple database research was performed up to August 5, 2022 (PubMed, EMbase, Scopus, Cochrane Library), including only studies that reported severity in the number of days of absence for each injury, incidence reported in the number of injuries/1000 hours, or reported number of injuries and exposure time and adult male football players, professionals from European clubs. Two reviewers extracted data and assessed paper quality with the Strengthening the Reporting of Observational Studies in Epidemiology statement and the Newcastle-Ottawa Scale. MAIN RESULTS Twenty-two studies have reported incidence, severity, and burden of injuries in professional football. The highest injury burden was found for ligament-joint injuries (37.9 days/1000 hours; 222 397 €/1000 hours) and for muscle injuries (34.7 days/1000 hours; 203 620 €/1000 hours). Injury locations with high burden were knee injuries (34.8 days/1000 hours; 20 4206 €/1000 hours)-mainly anterior cruciate ligament injuries (14.4 days/1000 hours; 84 499 €/1000 h)-followed by thigh injuries (25.0 days/1000 hours; 146 700 €/1000 hours), hamstrings injuries (15.4 days/1000 hours; 90 367 €/1000 hours), hip-and-groin injuries (16.1 days/1000 hours; 94 475 €/1000 hours), primarily adductor muscles injuries (9.4 days/1000 hours; 55 159€/1000 hours), and ankle injuries (13.1 days/1000 h; 76 871 €/1000 hours) with ankle sprains (7.4 days/1000 hours; 43 423 €/1000 hours). CONCLUSIONS Being exposed to injury risk has serious consequences for individual and club performance and economy. This review identified the most relevant targets in injury management, compared their injury data with reference values, and provided economic evidence when trying to gain buy-in from the key decision makers.
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Affiliation(s)
| | - Denis Certa
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; and
| | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; and
| | - Piero Volpi
- Knee Surgery and Sport Traumatology Unit, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; and
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Shah S, Collins K, Macgregor LJ. The Influence of Weekly Sprint Volume and Maximal Velocity Exposures on Eccentric Hamstring Strength in Professional Football Players. Sports (Basel) 2022; 10:sports10080125. [PMID: 36006091 PMCID: PMC9414047 DOI: 10.3390/sports10080125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Hamstring strains are the most common moderate-major severity injuries in football. The majority of hamstring injuries occur during sprinting, with low eccentric hamstring strength being associated with an elevated risk. Objective: To examine the relationship between sprinting and eccentric hamstring strength by monitoring total weekly sprint distance and weekly efforts > 90% and >95% of maximum velocity. Methods: Fifty-eight professional male footballers were observed over one-and-a-half seasons. Players’ running was monitored during training and matches using GPS, and eccentric hamstring strength was measured weekly. Results: Weekly sprint distance (ρ = −0.13, p < 0.01) and weekly efforts >90% of maximum velocity (ρ = −0.08, p = 0.01) both displayed significant inverse relationships with the percentage change in eccentric hamstring strength; weekly efforts >95% of maximum velocity showed no relationship with hamstring strength (ρ = −0.02, p = 0.45). Only weekly efforts >90% of maximum velocity significantly influenced the mean percentage change in eccentric hamstring force, F(3,58) = 3.71, p = 0.01, with significant differences occurring when comparing 7−8 sprint efforts with 0−2 efforts (0.11%, p = 0.03) and 5−6 efforts (0.12%, p = 0.03). Conclusions: Eccentric hamstring strength levels significantly decrease when 7−8 weekly sprint efforts are completed at >90% of maximum velocity. Monitoring weekly sprint loading at velocities > 90% of maximum velocity may be valuable to help to reduce the risk of hamstring injuries in professional football.
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Affiliation(s)
- Sunnan Shah
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Kieran Collins
- Gaelic Sports Research Centre, Institute of Technology Tallaght, D24 FKT9 Dublin, Ireland
| | - Lewis J. Macgregor
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
- Correspondence: ; Tel.: +44-(0)178646-6475
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Valle X, Mechó S, Alentorn-Geli E, Järvinen TAH, Lempainen L, Pruna R, Monllau JC, Rodas G, Isern-Kebschull J, Ghrairi M, Yanguas X, Balius R, la Torre AMD. Return to Play Prediction Accuracy of the MLG-R Classification System for Hamstring Injuries in Football Players: A Machine Learning Approach. Sports Med 2022; 52:2271-2282. [PMID: 35610405 DOI: 10.1007/s40279-022-01672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Muscle injuries are one of the main daily problems in sports medicine, football in particular. However, we do not have a reliable means to predict the outcome, i.e. return to play from severe injury. The aim of the present study was to evaluate the capability of the MLG-R classification system to grade hamstring muscle injuries by severity, offer a prognosis for the return to play, and identify injuries with a higher risk of re-injury. Furthermore, we aimed to assess the consistency of our proposed system by investigating its intra-observer and inter-observer reliability. METHODS All male professional football players from FC Barcelona, senior A and B and the two U-19 teams, with injuries that occurred between February 2010 and February 2020 were reviewed. Only players with a clinical presentation of a hamstring muscle injury, with complete clinic information and magnetic resonance images, were included. Three different statistical and machine learning approaches (linear regression, random forest, and eXtreme Gradient Boosting) were used to assess the importance of each factor of the MLG-R classification system in determining the return to play, as well as to offer a prediction of the expected return to play. We used the Cohen's kappa and the intra-class correlation coefficient to assess the intra-observer and inter-observer reliability. RESULTS Between 2010 and 2020, 76 hamstring injuries corresponding to 42 different players were identified, of which 50 (65.8%) were grade 3r, 54 (71.1%) affected the biceps femoris long head, and 33 of the 76 (43.4%) were located at the proximal myotendinous junction. The mean return to play for grades 2, 3, and 3r injuries were 14.3, 12.4, and 37 days, respectively. Injuries affecting the proximal myotendinous junction had a mean return to play of 31.7 days while those affecting the distal part of the myotendinous junction had a mean return to play of 23.9 days. The analysis of the grade 3r biceps femoris long head injuries located at the free tendon showed a median return to play time of 56 days while the injuries located at the central tendon had a shorter return to play of 24 days (p = 0.038). The statistical analysis showed an excellent predictive power of the MLG-R classification system with a mean absolute error of 9.8 days and an R-squared of 0.48. The most important factors to determine the return to play were if the injury was at the free tendon of the biceps femoris long head or if it was a grade 3r injury. For all the items of the MLG-R classification, the intra-observer and inter-observer reliability was excellent (k > 0.93) except for fibres blurring (κ = 0.68). CONCLUSIONS The main determinant for a long return to play after a hamstring injury is the injury affecting the connective tissue structures of the hamstring. We developed a reliable hamstring muscle injury classification system based on magnetic resonance imaging that showed excellent results in terms of reliability, prognosis capability and objectivity. It is easy to use in clinical daily practice, and can be further adapted to future knowledge. The adoption of this system by the medical community would allow a uniform diagnosis leading to better injury management.
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Affiliation(s)
- Xavier Valle
- FC Barcelona Medical Department, Barcelona, Spain. .,Hospital Universitari Dexeus (ICATME), Barcelona, Spain. .,PhD Student at the "Departament de Cirurgia i Ortopèdia", Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Sandra Mechó
- FC Barcelona Medical Department, Barcelona, Spain.,Department of Radiology, Hospital de Barcelona, SCIAS, Barcelona, Spain
| | - Eduard Alentorn-Geli
- Instituto Cugat, Barcelona, Spain.,Fundación García Cugat, Barcelona, Spain.,Mutualidad Española de Futbolistas, Delegación Cataluña, Federación Española de Fútbol, Barcelona, Spain
| | - Tero A H Järvinen
- Tampere University and Tampere University Hospital, Tampere, Finland
| | - Lasse Lempainen
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
| | - Ricard Pruna
- FC Barcelona Medical Department, Barcelona, Spain
| | - Joan C Monllau
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital del Mar I L'Esperança, Barcelona, Spain.,ICATME, Hospital Universitari Dexeus, Bellaterra, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Gil Rodas
- FC Barcelona Medical Department, Barcelona, Spain
| | - Jaime Isern-Kebschull
- Musculoskeletal Imaging Specialist, Barcelona, Spain.,Department of Radiology at Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Mourad Ghrairi
- FIFA Medical Centre of Excellence, Dubai, United Arab Emirates
| | | | - Ramon Balius
- Catalan Sports Council, Generalitat de Catalunya, Barcelona, Spain.,Department of Sports Medicine, Clínica Diagonal, Barcelona, Spain
| | - Adrian Martinez-De la Torre
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
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Yamaguchi T, Kubota M, Naruse H, Kuwatsuru K, Miyazaki T. Injuries and Illnesses Observed in Athletes from Beginner to Elite Levels at the 18th National Sports Festival for Persons with Disabilities in Japan. Prog Rehabil Med 2021; 6:20210032. [PMID: 34514182 PMCID: PMC8385550 DOI: 10.2490/prm.20210032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 12/26/2022] Open
Abstract
Objectives : This study aimed to describe the injuries and illnesses that occurred at the 18th
National Sports Festival for Persons with Disabilities in Japan, which was attended by
more than 3000 athletes from beginner to elite levels. Methods : Records from medical stations set up at the venues for each sport were reviewed. The
incidence rates (IRs) were calculated as the number of medical station visits per 1000
athlete-days. The backgrounds of injuries and illnesses were investigated. Results : In total, 3277 athletes attended the festival, and 134 eligible medical station
visits were analyzed. Overall, 102 athletes complained of injuries. For the whole
schedule of the festival, IRs were 15.5 for injuries and illnesses and 11.8 for injuries
alone. For injuries and illnesses, high IRs were seen in soccer (39.8), basketball
(25.6), and foot baseball (22.4); for injuries alone, high IRs were also seen in soccer
(33.6), basketball (25.6), and foot baseball (16.8). The most frequent symptoms were
internal symptoms (n=32), contusions (n=30), and wounds (n=24). Joint sprains occurred
in various sports, whereas muscle strains happened mainly in disciplines demanding
sprinting or high agility. Of the 55 cases that occurred during events or public
rehearsals, 45 were traumatic, whereas the relation to sports activities was not
described in 51 cases. Of participants with internal symptoms, 11 were suggested to have
viral infections. We identified 21 injuries caused by falls. Conclusions : Minor trauma and viral infection were the most frequently observed symptoms among
injuries and illnesses, respectively. Structured medical records and organized
surveillance systems should be utilized to improve data collection and understand the
onset of injury and illness.
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Affiliation(s)
- Tomoko Yamaguchi
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Masafumi Kubota
- Department of Physical Therapy; Graduate Course of Rehabilitation Science; School of Health Sciences; College of Medical, Pharmaceutical, and Health Sciences; Kanazawa University; Kanazawa; Japan
| | - Hiroaki Naruse
- Division of Physical Therapy and Rehabilitation, University of Fukui Hospital, Fukui, Japan
| | | | - Tsuyoshi Miyazaki
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Incidence of Acute Hamstring Injuries in Soccer: A Systematic Review of 13 Studies Involving More Than 3800 Athletes With 2 Million Sport Exposure Hours. J Orthop Sports Phys Ther 2021; 51:27-36. [PMID: 33306929 DOI: 10.2519/jospt.2021.9305] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the incidence and recurrence rates of acute hamstring injuries in all levels of soccer. DESIGN Epidemiology systematic review. LITERATURE SEARCH We searched the PubMed (including MEDLINE), CINAHL, SPORTDiscus, Embase, and Cochrane Central Register of Controlled Trials electronic databases. STUDY SELECTION CRITERIA We included prospective studies of all levels of adult soccer players that registered acute hamstring injuries and provided a description of incidence of acute hamstring injuries per 1000 playing hours (or available data to calculate this). DATA SYNTHESIS Due to heterogeneity, we synthesized the data descriptively. RESULTS Thirteen studies including 3868 players met the inclusion criteria. Two of 13 included studies reported on hamstring injuries in women, and all reported the same in men. The incidence of acute hamstring injury ranged from 0.3 to 0.5 per 1000 exposure hours in women and 0.3 to 1.9 per 1000 exposure hours in men. Hamstring injuries accounted for 5% to 15% of all soccer-related injuries. Hamstring injury recurrence rates ranged from 4% to 68%, depending on the injury definition. Certainty of evidence ranged from moderate to very low. CONCLUSION The incidence of acute hamstring injury in soccer was 0.3 to 1.9 per 1000 exposure hours. The recurrence rate was 4% to 68%. The strength of the evidence was limited by a lack of methodological rigor, the use of varying definitions for acute hamstring injury, and heterogeneous methods of reporting on acute hamstring injuries. J Orthop Sports Phys Ther 2021;51(1):27-36. Epub 11 Dec 2020. doi:10.2519/jospt.2021.9305.
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7
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Evaluation of Muscle Injuries in Professional Football Players: Does Coach Replacement Affect the Injury Rate? Clin J Sport Med 2020; 30:478-483. [PMID: 30113968 DOI: 10.1097/jsm.0000000000000640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the incidence and characteristics of muscle injuries in professional football players and to assess if coach dismissal may be related with muscle injuries within 1-month period from the dismissal. DESIGN Prospective cohort study during 3 consecutive seasons. SETTING Turkish Super League football teams. PARTICIPANTS One hundred eighteen male football players. MAIN OUTCOME MEASURES Data on time-loss muscle injuries confirmed using magnetic resonance imaging were recorded, including type, body part, duration, and lay-off time, and training session and match exposure times. The muscle injury rate was evaluated at 2 weeks and 30 days after coach dismissal. RESULTS In total, 124 muscle injuries were recorded, with injury incidences of 2.3 muscle injuries per 1000 hours of exposure overall, 1.2 in training sessions, and 13.6 in matches. Injury time loss ranged from 3 to 67 days (median, 13 days). Eighteen percent of the injuries (n = 23) were recurrent; no association was found between recurrence rate and the player's age or position (P = 0.15, P = 0.27, respectively). Recurrent injuries caused more severe injuries (26.1%, P = 0.02) and longer median lay-off time (P = 0.01). During the study, teams A and B replaced 7 and 3 coaches, respectively. The injury incidence increased to 5.3 per 1000 hours of exposure in the 2 weeks after the coach dismissal, and decreased to 4.5 within 1 month of coach dismissal. CONCLUSION Given the link between coach dismissal and increased rates of muscle strain injuries, increased attentiveness to preventing muscle injuries during coaching transitions and to the impact of new training regimens is required by trainers and medical teams.
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Yoshida K, Itoigawa Y, Maruyama Y, Kaneko K. Healing Process of Gastrocnemius Muscle Injury on Ultrasonography Using B-Mode Imaging, Power Doppler Imaging, and Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3239-3246. [PMID: 31165497 DOI: 10.1002/jum.15035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Muscle injury often occurs in sports activity. To avoid reinjury, it is important to determine the appropriate period until return to play after injury. The purpose of this study was to evaluate characteristics of the healing process for gastrocnemius muscle injury by B-mode imaging, power Doppler (PD) imaging, and shear wave elastography (SWE). METHODS Twenty patients with acute calf musculotendinous injury were enrolled. Scar thickness on B-mode imaging, new vessels according to PD grades, and SWE values in the muscle, musculotendinous junction, and tendon of the medial head of gastrocnemius were measured at 4, 8, and 12 weeks after injury. RESULTS Scar thickness was significantly larger at 8 and 12 weeks compared with 4 weeks (P < .01 for both). Power Doppler grades at 4 and 8 weeks were significantly higher compared with 12 weeks (P < .01 for both). Shear wave elastographic values in the muscle on the injury side were significantly higher at 8 and 12 weeks compared with 4 weeks (P < .01 for both), whereas those in the musculotendinous junction on the injury side were significantly higher at 12 weeks compared with 4 and 8 weeks (P < .01; P = .01, respectively). CONCLUSIONS B-mode imaging, PD imaging, and SWE can measure the healing process after musculotendinous injury of the gastrocnemius medial head.
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9
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Bisciotti GN, Volpi P, Alberti G, Aprato A, Artina M, Auci A, Bait C, Belli A, Bellistri G, Bettinsoli P, Bisciotti A, Bisciotti A, Bona S, Bresciani M, Bruzzone A, Buda R, Buffoli M, Callini M, Canata G, Cardinali D, Cassaghi G, Castagnetti L, Clerici S, Corradini B, Corsini A, D'Agostino C, Dellasette E, Di Pietto F, Enrica D, Eirale C, Foglia A, Franceschi F, Frizziero A, Galbiati A, Giammatei C, Landreau P, Mazzola C, Moretti B, Muratore M, Nanni G, Niccolai R, Orizio C, Pantalone A, Parra F, Pasta G, Patroni P, Pelella D, Pulici L, Quaglia A, Respizzi S, Ricciotti L, Rispoli A, Rosa F, Rossato A, Sannicandro I, Sprenger C, Tarantola C, Tenconi FG, Tognini G, Tosi F, Trinchese GF, Vago P, Zappia M, Vuckovich Z, Zini R, Trainini M, Chamari K. Italian consensus statement (2020) on return to play after lower limb muscle injury in football (soccer). BMJ Open Sport Exerc Med 2019; 5:e000505. [PMID: 31673400 PMCID: PMC6797382 DOI: 10.1136/bmjsem-2018-000505] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2019] [Indexed: 12/19/2022] Open
Abstract
Return to play (RTP) decisions in football are currently based on expert opinion. No consensus guideline has been published to demonstrate an evidence-based decision-making process in football (soccer). Our aim was to provide a framework for evidence-based decision-making in RTP following lower limb muscle injuries sustained in football. A 1-day consensus meeting was held in Milan, on 31 August 2018, involving 66 national and international experts from various academic backgrounds. A narrative review of the current evidence for RTP decision-making in football was provided to delegates. Assembled experts came to a consensus on the best practice for managing RTP following lower limb muscle injuries via the Delphi process. Consensus was reached on (1) the definitions of 'return to training' and 'return to play' in football. We agreed on 'return to training' and RTP in football, the appropriate use of clinical and imaging assessments, and laboratory and field tests for return to training following lower limb muscle injury, and identified objective criteria for RTP based on global positioning system technology. Level of evidence IV, grade of recommendation D.
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Affiliation(s)
| | - Piero Volpi
- Humanitas Clinical Institute, Rozzano, Milano, Italy.,FC Internazionale Milano, Milano, Milano, Italy
| | - Giampietro Alberti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | | | - Alessio Auci
- UOS Angiografia e Radiologia Interventistica, Ospedale delle Apuane, Massa Carrara, Massa Carrara, Italy
| | | | | | | | | | | | | | - Stefano Bona
- Humanitas Clinical Institute, Rozzano, Milano, Italy
| | | | | | - Roberto Buda
- Dipartimento di Scienze Biomediche e Neuromotorie, Università Bologna, Bologna, Italy
| | | | | | - Gianluigi Canata
- Ospedale Koelliker, Torino, Italy.,Istituto di Medicina dello Sport di Torino, Torino, Italy
| | | | | | | | | | | | | | | | | | | | | | - Cristiano Eirale
- Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Paris St Germain FC, Paris, France
| | - Andrea Foglia
- Physiotherapy, Studio Riabilita, Civitanova Marche, Italy
| | | | | | | | | | | | | | - Biagio Moretti
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università di Bari, Bari, Italy
| | | | - Gianni Nanni
- FIFA Medical Centre of Excellence, Bologna, Isokinetic Medical Group, Bologna, Italy.,Bologna FC, Bologna, Italy
| | | | | | - Andrea Pantalone
- Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Italy.,Ospedale SS Annunziata, Chieti, Italy
| | | | - Giulio Pasta
- Parma Calcio, Parma, Italy.,Studio Radiologico Pasta, Parma, Italy
| | | | | | - Luca Pulici
- FC Internazionale Milano, Milano, Milano, Italy
| | - Alessandro Quaglia
- Humanitas Clinical Institute, Rozzano, Milano, Italy.,FC Internazionale Milano, Milano, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | - Fabio Tosi
- FC Internazionale Milano, Milano, Milano, Italy
| | | | - Paola Vago
- Universita Cattolica del Sacro Cuore, Milano, Italy
| | | | | | - Raul Zini
- Villa Maria Cecilia, Cotignola, Italy
| | | | - Karim Chamari
- Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Lab, National Center of Science and Sports Medicine Tunis, Tunis, Tunisia
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10
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Thompson R, Watson T. Is a professional soccer player’s dominant lower limb at higher risk of injury than their non-dominant lower limb? A systematic review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1662206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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11
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Cochrane DJ. The inclusion of vibration therapy in rehabilitating a gastrocnemius tear: a case study in master athlete. J Phys Ther Sci 2019; 31:738-742. [PMID: 31631947 PMCID: PMC6751049 DOI: 10.1589/jpts.31.738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/15/2019] [Indexed: 12/26/2022] Open
Abstract
[Purpose] The aim of this case study was to determine if VT could be included into a
rehabilitation programme by monitoring the progress of muscle pain, range of motion and
muscle strength. [Participant and Methods] An international male master hockey player
sustained a medial gastrocnemius 5 cm tear prior to the World Cup. VT was applied early in
the rehabilitation programme where 9 sessions of VT were performed during the first 16
days. Other conventional rehabilitative exercises were included. [Results] Twenty-eight
days post-injury the athlete returned to full playing. Calf pain had subsided by day 8
with a change of 12° in ankle dorsi flexion range of motion. Grade 5 calf strength was
attained by day 16, which was equivalent to the unaffected limb’s strength. There were no
residual side effects of including VT into the rehabilitation programme and it did not
compromise the athlete’s recovery. [Conclusion] To ensure optimal loading of VT, 9
sessions were implemented and progressively increased; consequently, there was no
detrimental effect on the rehabilitative process. The athlete reported no side effects of
using VT and its ease and time efficient application has a role to complementing soft
tissue injury rehabilitation.
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Affiliation(s)
- Darryl J Cochrane
- School of Sport, Exercise and Nutrition, Massey University: Private Bag 11 222, Palmerston North, New Zealand
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12
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Valle X, Alentorn-Geli E, Tol JL, Hamilton B, Garrett WE, Pruna R, Til L, Gutierrez JA, Alomar X, Balius R, Malliaropoulos N, Monllau JC, Whiteley R, Witvrouw E, Samuelsson K, Rodas G. Muscle Injuries in Sports: A New Evidence-Informed and Expert Consensus-Based Classification with Clinical Application. Sports Med 2018; 47:1241-1253. [PMID: 27878524 DOI: 10.1007/s40279-016-0647-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Muscle injuries are among the most common injuries in sport and continue to be a major concern because of training and competition time loss, challenging decision making regarding treatment and return to sport, and a relatively high recurrence rate. An adequate classification of muscle injury is essential for a full understanding of the injury and to optimize its management and return-to-play process. The ongoing failure to establish a classification system with broad acceptance has resulted from factors such as limited clinical applicability, and the inclusion of subjective findings and ambiguous terminology. The purpose of this article was to describe a classification system for muscle injuries with easy clinical application, adequate grouping of injuries with similar functional impairment, and potential prognostic value. This evidence-informed and expert consensus-based classification system for muscle injuries is based on a four-letter initialism system: MLG-R, respectively referring to the mechanism of injury (M), location of injury (L), grading of severity (G), and number of muscle re-injuries (R). The goal of the classification is to enhance communication between healthcare and sports-related professionals and facilitate rehabilitation and return-to-play decision making.
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Affiliation(s)
- Xavier Valle
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain. .,Sports Medicine School, Universitat de Barcelona, Barcelona, Spain. .,Mapfre Centre for Tennis Medicine, Barcelona, Spain. .,Department de Cirurgia de la Facultat de Medicina, 'Universitat Autònoma de Barcelona', Barcelona, Spain.
| | - Eduard Alentorn-Geli
- Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA
| | - Johannes L Tol
- Department of Sports Medicine, Aspetar, Doha, Qatar.,Department of Sports Medicine, The Sports Physician Group, OLVG-West, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Bruce Hamilton
- Department of Sports Medicine, Aspetar, Doha, Qatar.,High Performance Sport NZ, Millenium Institute of Sport and Health, Auckland, New Zealand
| | - William E Garrett
- Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA
| | - Ricard Pruna
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain
| | - Lluís Til
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain.,High Performance Centre, Health Consortium of Terrassa, Barcelona, Spain
| | - Josep Antoni Gutierrez
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain.,Sport Catalan Council, Generalitat de Catalunya, Barcelona, Spain
| | | | - Ramón Balius
- Mapfre Centre for Tennis Medicine, Barcelona, Spain.,Sport Catalan Council, Generalitat de Catalunya, Barcelona, Spain
| | - Nikos Malliaropoulos
- Musculoskeletal Department, Thessaloniki Sports Medicine Clinic, Thessaloníki, Greece.,Department of Rheumatology, Sports Clinic, Mile End Hospital, Barts Health NHS Trust, London, UK
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar-Hospital del Mar and Hospital de l'Esperança, Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital Universitari Dexeus (ICATME), Barcelona, Spain
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Erik Witvrouw
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Kristian Samuelsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Göteburg, Sweden
| | - Gil Rodas
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain
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13
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McKenna M, Cowan DT, Stevenson D, Baker JS. Neophyte experiences of football (soccer) match analysis: a multiple case study approach. Res Sports Med 2018; 26:306-322. [PMID: 29506415 DOI: 10.1080/15438627.2018.1447473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mark McKenna
- Institute for Clinical Exercise and Health Science, School of Science and Sport, University of the West of Scotland, Hamilton, UK
| | - Daryl Thomas Cowan
- Institute for Clinical Exercise and Health Science, School of Science and Sport, University of the West of Scotland, Hamilton, UK
| | | | - Julien Steven Baker
- Institute for Clinical Exercise and Health Science, School of Science and Sport, University of the West of Scotland, Hamilton, UK
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14
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Green B, Pizzari T. Calf muscle strain injuries in sport: a systematic review of risk factors for injury. Br J Sports Med 2017; 51:1189-1194. [PMID: 28259848 DOI: 10.1136/bjsports-2016-097177] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review the literature to identify risk factors for calf strain injury, and to direct future research into calf muscle injuries. DESIGN Systematic review DATA SOURCES: Database searches conducted for Medline, CINAHL, EMBASE, AMED, AUSPORT, SportDiscus, PEDro and Cochrane Library. Manual reference checks, ahead of press searches, citation tracking. From inception to June 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating and presenting data related to intrinsic or extrinsic risk factors for sustaining future calf injury. RESULTS Ten studies were obtained for review. Subjects across football, Australian football, rugby union, basketball and triathlon were reported on, representing 5397 athletes and 518 calf/ lower leg muscle injuries. Best evidence synthesis highlights chronological age and previous history of calf strain are the strongest risk factors for future calf muscle injury. Previous lower limb injuries (hamstring, quadriceps, adductor, knee) show some limited evidence for an association. Numerous factors lack evidence of an association, including height, weight, gender and side dominance. SUMMARY/CONCLUSION Increasing age and previous calf strain injury are the most predictive of future calf injury. The overall paucity of evidence and the trend for studies of a high risk of bias show that further research needs to be undertaken.
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Affiliation(s)
- Brady Green
- Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Tania Pizzari
- Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
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15
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Yoshida K, Itoigawa Y, Maruyama Y, Saita Y, Takazawa Y, Ikeda H, Kaneko K, Sakai T, Okuwaki T. Application of shear wave elastography for the gastrocnemius medial head to tennis leg. Clin Anat 2016; 30:114-119. [DOI: 10.1002/ca.22788] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/21/2016] [Accepted: 08/29/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Keiichi Yoshida
- Department of Orthopaedic Surgery; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yoshitomo Saita
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Yuji Takazawa
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Hiroshi Ikeda
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Tatsuo Sakai
- Department of Anatomy; Juntendo University; Tokyo Japan
| | - Toru Okuwaki
- Department of Sports Medicine; Japan Institute of Sports Science; Tokyo Japan
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16
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Svensson K, Alricsson M, Eckerman M, Magounakis T, Werner S. The correlation between the imaging characteristics of hamstring injury and time required before returning to sports: a literature review. J Exerc Rehabil 2016; 12:134-42. [PMID: 27419106 PMCID: PMC4934955 DOI: 10.12965/jer.1632558.279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/20/2016] [Indexed: 11/22/2022] Open
Abstract
Injuries to the hamstring muscles are common in athletes. Track and field, Australian football, American football and soccer are examples of sports where hamstring injuries are the most common. The purpose of this study was to investigate whether there is a correlation between a hamstring injury prognosis and its characteristics of imaging parameters. The literature search was performed in the databases PubMed and CINAHL, and eleven articles were included. Seven out of the 11 articles showed a correlation between the size of the hamstring injury and length of time required before returning to sports. Different authors have reported contrasting results about length of time required before returning to sports due to location of injury within specific muscle. Majority of the articles found hamstring strain correlated to an extended amount of time required before returning to sports.
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Affiliation(s)
- Kjell Svensson
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marie Alricsson
- Swedish Winter Sport Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden; Department of Sports Science, Linnaeus University, Kalmar, Sweden
| | - Mattias Eckerman
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Suzanne Werner
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Capio Artro Clinic, Stockholm, Sweden
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17
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Schuermans J, Van Tiggelen D, Danneels L, Witvrouw E. Biceps femoris and semitendinosus--teammates or competitors? New insights into hamstring injury mechanisms in male football players: a muscle functional MRI study. Br J Sports Med 2015; 48:1599-606. [PMID: 25388959 PMCID: PMC4267196 DOI: 10.1136/bjsports-2014-094017] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The hamstring injury mechanism was assessed by investigating the exercise-related metabolic activity characteristics of the hamstring muscles using a muscle functional MRI (mfMRI) protocol. METHODS 27 healthy male football players and 27 football players with a history of hamstring injuries (recovered and playing fully) underwent standardised mfMR Imaging. The mfMRI protocol consisted of a resting scan, a strenuous bilateral eccentric hamstring exercise and a postexercise scan. The exercise-related T2 increase or the signal intensity shift between both scans was used to detect differences in metabolic activation characteristics (1) between the different hamstring muscle bellies and (2) between the injury group and the control group. RESULTS A more symmetrical muscle recruitment pattern corresponding to a less economic hamstring muscle activation was demonstrated in the formerly injured group (p<0.05). The injured group also demonstrated a significantly lower strength endurance capacity during the eccentric hamstring exercise. CONCLUSIONS These findings suggest that the vulnerability of the hamstring muscles to football-related injury is related to the complexity and close coherence in the synergistic muscle recruitment of the biceps femoris and the semitendinosus. Discrete differences in neuromuscular coordination and activity distribution, with the biceps femoris partly having to compensate for the lack of endurance capacity of the semitendinosus, probably increase the hamstring injury risk.
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Affiliation(s)
- Joke Schuermans
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
| | - Damien Van Tiggelen
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium Department of Physiotherapy, Aspetar, Doha, Qatar
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18
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Brown SR, Brughelli M. Determining return-to-sport status with a multi-component assessment strategy: a case study in rugby. Phys Ther Sport 2014; 15:211-5. [PMID: 24768343 DOI: 10.1016/j.ptsp.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/06/2013] [Accepted: 01/20/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The effectiveness of rehabilitation programmes are often distorted by the athlete's desire to return and can result in injury recurrence. Athletic assessments allow for objective and reliable measurements to track rehabilitation progress. This case study used a multi-component assessment strategy to assess a rugby player's lower-extremity strength and symmetry as a primary determinate of their return-to-sport status. CASE DESCRIPTION A professional rugby league player was assessed for lower-extremity isokinetic strength and sprint kinetics pre- and 10-weeks post-rehabilitation programme following two consecutive knee injuries involving surgical intervention. OUTCOMES Pre-testing analysis showed clinical and functional strength deficits in the injured leg as high as 34% compared to the non-injured leg. Pre- to post-testing showed: increases in peak torque (49%) and decreased asymmetries by 50%; unilateral horizontal force increased (injured: 50%, non-injured: 19%) during sprinting; force production asymmetries decreased up to 18%. DISCUSSION The rugby player showed clinical and functional strength deficiencies return to normal ranges following a rehabilitation programme. A return-to-sport decision was made by the athlete's supporting health team based on the sizeable asymmetry decreases and return-to-normative ranges for knee and hip strength and sprint kinetics. The athlete returned to the 2013 National Rugby League season without any major injuries.
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Affiliation(s)
- Scott R Brown
- Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium, Auckland University of Technology, 17 Antares Place, Level 2, Rosedale, Auckland 0632, New Zealand.
| | - Matt Brughelli
- Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium, Auckland University of Technology, 17 Antares Place, Level 2, Rosedale, Auckland 0632, New Zealand.
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19
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The role of neuromuscular inhibition in hamstring strain injury recurrence. J Electromyogr Kinesiol 2013; 23:523-30. [DOI: 10.1016/j.jelekin.2012.12.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 11/29/2012] [Accepted: 12/14/2012] [Indexed: 11/22/2022] Open
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20
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Kerkhoffs GMMJ, van Es N, Wieldraaijer T, Sierevelt IN, Ekstrand J, van Dijk CN. Diagnosis and prognosis of acute hamstring injuries in athletes. Knee Surg Sports Traumatol Arthrosc 2013; 21:500-9. [PMID: 22622781 PMCID: PMC3549245 DOI: 10.1007/s00167-012-2055-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 05/10/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Identification of the most relevant diagnostic and prognostic factors of physical examination and imaging of hamstring injuries in (elite) athletes. METHODS A literature search was conducted in MEDLINE and EMBASE for articles between 1950 and April 2011. A survey was distributed among the members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, which focused on physical examination, prognosis, imaging and laboratory tests of hamstring injuries in (elite) athletes. RESULTS Medical history, inspection and palpation of the muscle bellies and imaging are most valuable at the initial assessment according to the literature. Experts considered medical history, posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing, referred pain tests and imaging to be most important in the initial assessment of hamstring injuries. Magnetic resonance imaging (MRI) is preferred over ultrasonography and should take place within 3 days post-trauma. Important prognostic factors are injury grade, length of the muscle tear on MR images, MRI-negative injuries and trauma mechanism. CONCLUSIONS Posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing and referred pain tests within 2 days post-trauma were identified as the most relevant diagnostic factors. LEVEL OF EVIDENCE Literature review and expert opinion, Level V.
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Affiliation(s)
- Gino M M J Kerkhoffs
- ESSKA Sports Committee, Department of Orthopedic Surgery, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands.
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21
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Hägglund M, Waldén M, Ekstrand J. Risk factors for lower extremity muscle injury in professional soccer: the UEFA Injury Study. Am J Sports Med 2013; 41:327-35. [PMID: 23263293 DOI: 10.1177/0363546512470634] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Muscle injury is the most common injury type in professional soccer players. Despite this, risk factors for common lower extremity injuries remain elusive. PURPOSE To evaluate the effects of various player- and match-related risk factors on the occurrence of lower extremity muscle injury in male professional soccer. STUDY DESIGN Cohort study; level of evidence, 2. METHODS Between 2001 and 2010, 26 soccer clubs (1401 players) from 10 European countries participated in the study. Individual player exposure and time loss muscle injuries in the lower extremity were registered prospectively by the club medical staffs during 9 consecutive seasons. Hazard ratios (HRs) were calculated for player-related factors from simple and multiple Cox regression, and odds ratios (ORs) were calculated for match-related variables from simple and multiple logistic regression, presented with 95% confidence intervals (CIs). RESULTS There were 2123 muscle injuries documented in the major lower extremity muscle groups: adductors (n = 523), hamstrings (n = 900), quadriceps (n = 394), and calf (n = 306). Injuries to the adductors (56%; P = .015) and quadriceps (63%; P< .001) were more frequent in the kicking leg. Multiple analysis indicated that having a previous identical injury in the preceding season increased injury rates significantly for adductor (HR, 1.40; 95% CI, 1.00-1.96), hamstring (HR, 1.40; 95% CI, 1.12-1.75), quadriceps (HR, 3.10; 95% CI, 2.21-4.36), and calf injuries (HR, 2.33; 95% CI, 1.52-3.57). Older players (above mean age) had an almost 2-fold increased rate of calf injury (HR, 1.93; 95% CI, 1.38-2.71), but no association was found in other muscle groups. Goalkeepers had reduced injury rates in all 4 muscle groups. Match play on away ground was associated with reduced rates of adductor (OR, 0.56; 95% CI, 0.43-0.73) and hamstring injuries (OR, 0.76; 95% CI, 0.63-0.92). Quadriceps injuries were more frequent during preseason, whereas adductor, hamstring, and calf injury rates increased during the competitive season. CONCLUSION Intrinsic factors found to increase muscle injury rates in professional soccer were previous injury, older age, and kicking leg. Injury rates varied during different parts of the season and also depending on match location.
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Affiliation(s)
- Martin Hägglund
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden.
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22
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Gharaibeh B, Chun-Lansinger Y, Hagen T, Ingham SJM, Wright V, Fu F, Huard J. Biological approaches to improve skeletal muscle healing after injury and disease. ACTA ACUST UNITED AC 2012; 96:82-94. [PMID: 22457179 DOI: 10.1002/bdrc.21005] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Skeletal muscle injury and repair are complex processes, including well-coordinated steps of degeneration, inflammation, regeneration, and fibrosis. We have reviewed the recent literature including studies by our group that describe how to modulate the processes of skeletal muscle repair and regeneration. Antiinflammatory drugs that target cyclooxygenase-2 were found to hamper the skeletal muscle repair process. Muscle regeneration phase can be aided by growth factors, including insulin-like growth factor-1 and nerve growth factor, but these factors are typically short-lived, and thus more effective methods of delivery are needed. Skeletal muscle damage caused by traumatic injury or genetic diseases can benefit from cell therapy; however, the majority of transplanted muscle cells (myoblasts) are unable to survive the immune response and hypoxic conditions. Our group has isolated neonatal skeletal muscle derived stem cells (MDSCs) that appear to repair muscle tissue in a more effective manner than myoblasts, most likely due to their better resistance to oxidative stress. Enhancing antioxidant levels of MDSCs led to improved regenerative potential. It is becoming increasingly clear that stem cells tissue repair by direct differentiation and paracrine effects leading to neovascularization of injured site and chemoattraction of host cells. The factors invoked in paracrine action are still under investigation. Our group has found that angiotensin II receptor blocker (losartan) significantly reduces fibrotic tissue formation and improves repair of murine injured muscle. Based on these data, we have conducted a case study on two hamstring injury patients and found that losartan treatment was well tolerated and possibly improved recovery time. We believe this medication holds great promise to optimize muscle repair in humans.
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Affiliation(s)
- Burhan Gharaibeh
- Stem Cell Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, USA
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Cloke D, Moore O, Shah T, Rushton S, Shirley MDF, Deehan DJ. Thigh muscle injuries in youth soccer: predictors of recovery. Am J Sports Med 2012; 40:433-9. [PMID: 22223714 DOI: 10.1177/0363546511428800] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Participation in soccer at younger ages with attendant risk of muscle injury is increasing. PURPOSE To delineate patterns of thigh muscle injury and predictors of recovery in male youth soccer academy players. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS Forty-one English Premiership soccer academy squads (all male, aged 8-16 years) over a 5-year period comprising 12 306 player seasons were studied prospectively for pattern, mechanism, and outcome after thigh muscle injury. Event analysis was used to identify independent predictors of slow recovery. RESULTS A total of 1288 injuries were recorded representing an incidence (mean [SD]) of 0.42 (0.24) per thousand hours of training with a mean annual incidence of 0.52. Midfield players received the most injuries, followed by defense and attack positions. The quadriceps muscle group was most likely to be injured. There were 345 reinjuries (27%). Median time off for a primary injury was 13 days (interquartile range, 7-22 days) and 12 days (7-21 days) following a reinjury. Risk of such injury increased as the game progressed toward the end of the first half period (P = .028), and this risk persisted throughout the entire second half. There were 2 peaks of incidence (January and September). The percentage of the total for hamstring, adductor, and quadriceps injuries did not significantly change with player age. However, the proportion of injuries that were severe increased with age of player (t = 3.72, P = .010). Poor prognostic factors for recovery were hamstring injuries (z = 2.182, P = .029), contact injury (z = -3.137, P = .002), and older age (z = -2.2298, P = .022). CONCLUSION The risk for prolonged recovery from thigh muscle injury was found to increase with age of the player and contact mechanism. The risk of injury increased toward the end of the first half, and this risk persisted throughout the second half. Delayed recovery was significantly associated with a hamstring muscle injury, first injury, and contact mechanism. This study, for the first time, allows identification of youth male soccer players at high-risk for prolonged symptoms after thigh muscle injury.
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Affiliation(s)
- David Cloke
- Newcastle University, Newcastle upon Tyne, United Kingdom
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