Return to Play After Hamstring Injuries: A Qualitative Systematic Review of Definitions and Criteria

Abstract

BackgroundMore than half of the recurrent hamstring injuries occur within the first month after return-to-play (RTP). Although there are numerous studies on RTP, comparisons are hampered by the numerous definitions of RTP used. Moreover, there is no consensus on the criteria used to determine when a person can start playing again. These criteria need to be critically evaluated, in an attempt to reduce recurrence rates and optimize RTP.ObjectiveTo carry out a systematic review of the literature on (1) definitions of RTP used in hamstring research and (2) criteria for RTP after hamstring injuries.Study DesignSystematic review.MethodsSeven databases (PubMed, EMBASE/MEDLINE, CINAHL, PEDro, Cochrane, SPORTDiscus, Scopus) were searched for articles that provided a definition of, or criteria for, RTP after hamstring injury. There were no limitations on the methodological design or quality of articles. Content analysis was used to record and analyze definitions and criteria for RTP after hamstring injury.ResultsTwenty-five papers fulfilled inclusion criteria, of which 13 provided a definition of RTP and 23 described criteria to support the RTP decision. “Reaching the athlete’s pre-injury level” and “being able to perform full sport activities” were the primary content categories used to define RTP. “Absence of pain”, “similar strength”, “similar flexibility”, “medical staff clearance”, and “functional performance” were core themes to describe criteria to support the RTP decision after hamstring injury.ConclusionOnly half of the included studies provided some definition of RTP after hamstring injury, of which reaching the athlete’s pre-injury level and being able to perform full sport activities were the most important. A wide variety of criteria are used to support the RTP decision, none of which have been validated. More research is needed to reach a consensus on the definition of RTP and to provide validated RTP criteria to facilitate hamstring injury management and reduce hamstring injury recurrence.PROSPERO systematic review registration number: CRD42015016510.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-015-0468-7) contains supplementary material, which is available to authorized users.

Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making

“…The study was carried out by the Department of Rehabilitation, Physical Therapy Science, and Sport at the University Medical Centre of Utrecht, the Netherlands. Before the start of this project, a systematic review of the definition of, and criteria for, RTP after hamstring injury was performed 22. The results of the systematic review were used as a starting point for the Delphi procedure.…”

“…So far, no studies have specified how risk should be assessed when clinicians are faced with the RTP decision after hamstring injury, although this moment is vital if injury recurrence is to be prevented. A recent systematic review of the literature showed that there is great diversity in how RTP after hamstring injury is defined and which criteria are used to assess RTP readiness 22. Also, because multiple stakeholders have their own reasons why RTP should be accelerated or delayed, it is imperative to provide clarity on who is to be consulted and who is responsible for the RTP decision.…”

Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury

“…As recently outlined, there is no uniform RTP definition following hamstring injury 16. Our chosen definition is an MRI-independent measure of clinical recovery and very closely related to the RTP decision used in clinical practice.…”

Preventing hamstring injuries in football through enhanced exercise and RTP strategies

“…For the second study I performed another systematic review, focusing on the definition of and medical criteria for RTP after hamstring injuries 4. Then, a worldwide Delphi study with experts selected by the FIFA Medical Centres of Excellence network was conducted to discuss RTP after hamstring injuries in football 5…”