{"id":11392,"date":"2024-11-22T06:00:56","date_gmt":"2024-11-22T05:00:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11392"},"modified":"2024-11-21T12:25:06","modified_gmt":"2024-11-21T11:25:06","slug":"one-test-does-not-fit-all-tailoring-hamstring-return-to-play-assessment-in-football","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2024\/11\/22\/one-test-does-not-fit-all-tailoring-hamstring-return-to-play-assessment-in-football\/","title":{"rendered":"One test does not fit all: Tailoring hamstring Return-to-Play assessment in football"},"content":{"rendered":"

Authors<\/strong>: Paolo Perna and Marco Beato<\/span><\/em><\/p>\n

Hamstring injuries continue to be the most common muscle injury in professional football. Despite <\/span>the practitioners’ efforts, the high re-injury rate remains an issue (1). This makes the Return-to-Play <\/span>(RTP) decisions even more challenging and increases the pressure on the medical and performance <\/span>departments to clear players to return to training and play (faster but with limited risk). Frequently, <\/span>RTP protocols consider hamstring injuries as one, and the severity and individual characteristics of <\/span>the injuries are not taken into account. This blog aims to start thinking about RTP criteria based on <\/span>the specific characteristics of a hamstring injury. <\/span><\/p>\n

Specifically, we are going to look at three characteristics of hamstring injuries:<\/span><\/p>\n

    \n
  1. Tissues involved<\/span><\/li>\n
  2. Area of the injury<\/span><\/li>\n
  3. Mechanism of injury<\/span><\/li>\n<\/ol>\n

    Tissues involved<\/h4>\n

    Are all hamstring injuries equal? (2) The question started to be answered by the publication of the <\/span>British Athletics Muscle Injury Classification (BAMIC) (3) with the definition of three types of <\/span>injuries based on the tissue involved: myofascial, musculo-tendinous and intratendinous. Time is <\/span>the first criterion to consider, and it could change depending on the type of injury (4). Although <\/span>interesting to know, time is a small piece of the puzzle and is not enough to improve our decision-<\/span>making. Tendon injury rehabilitation has seen an increase in the use of isometric strength to target <\/span>tendon health and stiffness. Therefore, we could prefer isometric testing over concentric or <\/span>eccentric muscle strength tests when we look at ways to test hamstring tendon strength functionally. <\/span>This is only the first aspect of this individualised approach because the same tissue can be injured in <\/span>different areas of the muscles.<\/span><\/p>\n

    Area of the injury<\/span><\/h4>\n

    Several studies have highlighted how different exercises can target a specific muscle or area of the <\/span>muscle. Hamstring muscles are bi-articular, so they act on the movement of the hip and knee joints <\/span>as hip extensors and knee flexors. Bourne and colleagues showed that during eccentric contractions, <\/span>the lateral hamstring (biceps femoris) is more selectively activated by the hip-extension movement, <\/span>while the medial hamstrings (semitendinosus and semimembranosus) by the knee-flexion <\/span>movement (5). Furthermore, the hip-extension movements can target more the proximal area of the <\/span>hamstrings compared to the knee-flexion movements which showed a greater activation of the <\/span>middle and distal portions of the muscles (6). Therefore, depending on the injury that we are dealing <\/span>with, we can use more specific RTP strength criteria to target the area of the injured muscle. Some <\/span>tests could give as a better indication of the injured area\u2019s function and its ability to cope with the <\/span>high-intensity stimuli on the field of play.<\/span><\/p>\n

    Mechanism of injury<\/span><\/h4>\n

    The risk of a hamstring injury is higher when reaching very high speeds during sprinting (which is <\/span>the most common hamstring mechanism), but other movements can also cause the injury. The <\/span>stretching type mechanisms can be divided into: a) open-chain stretch type injuries caused by an <\/span>overstretch, likely in a combination of hip flexion and knee extension and b) closed-chain, likely <\/span>during a movement that involves high eccentric forces in a lengthened position (7). The most <\/span>appropriate criteria can also be defined based on the mechanism to reproduce and test the <\/span>movement that caused the injury and the ability of the muscle to produce high forces in those <\/span>specific and often lengthened positions.<\/span><\/p>\n

    Conclusion<\/span><\/h4>\n

    When deciding on the RTP criteria following a hamstring injury in professional football, we should <\/span>consider:<\/span><\/p>\n