At return to play following hamstring injury the majority of professional football players have residual isokinetic deficits

Abstract

Background There is an ongoing debate regarding the optimal criteria for return to sport after an acute hamstring injury. Less than 10% isokinetic strength deficit is generally recommended but this has never been documented in professional football players after rehabilitation. Our aim was to evaluate isokinetic measurements in MRI-positive hamstring injuries. Methods Isokinetic measurements of professional football players were obtained after completing a standardised rehabilitation programme. An isokinetic strength deficit of more than 10% compared with the contralateral site was considered abnormal. Reinjuries within 2 months were recorded. Results 52 players had a complete set of isokinetic testing before clinical discharge. There were 27 (52%) grade 1 and 25 (48%) grade 2 injuries. 35 of 52 players (67%) had at least one of the three hamstring-related isokinetic parameters that display a deficit of more than 10%. The percentage of players with 10% deficit for hamstring concentric 60°/s, 300°/s and hamstring eccentric was respectively 39%, 29% and 28%. There was no significant difference of mean isokinetic peak torques and 10% isokinetic deficits in players without reinjury (N=46) compared with players with reinjury (N=6). Conclusions When compared with the uninjured leg, 67% of the clinically recovered hamstring injuries showed at least one hamstring isokinetic testing deficit of more than 10%. Normalisation of isokinetic strength seems not to be a necessary result of the successful completion of a football-specific rehabilitation programme. The possible association between isokinetic strength deficit and increased reinjury risk remains unknown.

Evolution of isokinetic strength and return to sport after proximal hamstring rupture without surgical repair: a retrospective series of cases.

“…Especially since these measures are objective and validated to value strength recovery of the hamstrings after injury in a sportive population (17,26). We reported a more important deficit on eccentric mode than in concentric one (40 vs. 25%), which is usual in case of muscular lesions (35). Yet, the persistence of a dissociation between eccentric and concentric modes is arguable, it may be due to a neuromuscular inhibition because of the lack of healing, or/and because of patients' apprehension during isokinetic tests (36).…”

Return-to-Play Practices Following Hamstring Injury: A Worldwide Survey of 131 Premier League Football Teams

“…2 The frequency which teams reported achieving all the criteria they set across each phase of the return-to-play continuum hamstring muscle injury. Multifactorial and criteria-based rehabilitation programmes are advocated in research to support RTP decision-making [26][27][28]. Such a criteria-based decision approach provides practitioners with an individualized approach to RTP that integrates quantifiable assessment (objective and subjective) to systematically progress rehabilitation.…”

“…Unfortunately, our survey respondents did not provide sufficient information on the types of hamstring strength they tested as criteria. In 2014, Tol and colleagues [28] showed that normalisation of isokinetic strength was not necessary for successful hamstring RTP in professional footballers, while a 2017 systematic review [32] recommended the opposite: that hamstring strength could be a useful criterion during hamstring RTP. However, the systematic review was not specific to professional football only and specificity of population is arguably necessary.…”

Designing a Return to Training Model for Professional Athletes after Sport Injury

“…Main concepts and variables inherent in the injury that must be monitored and assessed at all times, and they are: the perception of pain [8,9], defined as asymptomatic, educating the athlete in its management as in the expression of perceiving it [10,11]; personal trust between the athlete and all the professionals involved; and setting specific, short term and achievable goals to prevent and challenge on the day by day motivation and concentration [4].…”

“…This periodisation design is a complex process that integrates conditioning adaptations, workout programing, the physical and cognitive complexity of exercises and the specificity of the drills [1,12,13]. Always following sport physician *Corresponding author: Toni Caparrós, Insititut Nacional d'Educació Física de Catalunya (INEFC), Barcelona, España, Tel: +34636789552; E-mail: info@tonicaparros.eu guidelines and timing, the design must to achieve the same competition patterns [9,11,14], which will define the thresholds, in terms of functional quantity (load) and quality (intensity) [1,12]. Prevention protocols, both general and specific, can't be avoided on the design.…”