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Return to Play in Muscle Injuries

  • Peter UeblackerEmail author
  • Hans-Wilhelm Mueller-Wohlfahrt
Chapter

Abstract

Muscle injuries are very frequent in football. The primary goal of every rehabilitation is a safe RTP with a minimal risk of reinjury. The biology of tissue healing as a gradual process has to be respected during rehabilitation. Thus, different absence times are needed depending on injury type and the size of the tissue defect to restore the function and load-bearing capacity of the muscle. Exercises for neuromuscular function, core-strengthening and proprioception should be included into a rehabilitation programme.

It has been shown that classification and sub-grouping into injury type and dimension of pathology can have a prognostic validity for RTP. However, there are no consensus guidelines or standardized criteria for safe return to sport following muscle injury. The value of strength testing and MR imaging as RTP criteria is controversially discussed and remains unknown.

This chapter describes the various factors that a medical team should consider during rehabilitation of an athletic muscle injury with particular focus on RTP and professional football.

Top Five Evidence Based References

  1. Bloch W (2013) Muscle healing: physiology and adverse factors. In: Mueller-Wohlfahrt HW, Ueblacker P, Haensel L, Garrett WE (eds) Muscle injuries in sports. Thieme, Stuttgart, NY, pp 105–126Google Scholar
  2. Ekstrand J, Hagglund M, Kristenson K et al (2013) Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 47:732–737CrossRefPubMedGoogle Scholar
  3. Ekstrand J, Askling C, Magnusson H et al (2013) Return to play after thigh muscle injury in elite football players: implementation and validation of the Munich muscle injury classification. Br J Sports Med 47:769–774CrossRefPubMedPubMedCentralGoogle Scholar
  4. Reurink G, Verhaar JA, Tol JL (2014) More on platelet-rich plasma injections in acute muscle injury. N Engl J Med 371:1264–1265CrossRefPubMedGoogle Scholar
  5. Tol JL, Hamilton B, Eirale C et al (2014) At return to play following hamstring injury the majority of professional football players have residual isokinetic deficits. Br J Sports Med 48:1364–1369CrossRefPubMedPubMedCentralGoogle Scholar

References

  1. 1.
    Ekstrand J, Hagglund M, Walden M (2011) Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 39:1226–1232CrossRefPubMedGoogle Scholar
  2. 2.
    Ekstrand J, Walden M, Hagglund M (2016) Hamstring injuries have increased by 4% annually in men’s professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med 50:731–737CrossRefPubMedGoogle Scholar
  3. 3.
    Ekstrand J (2017) Overview of football injuries. In: Encyclopaedia of football medicine, vol 2. Thieme, Stuttgart, NY, pp 1–13Google Scholar
  4. 4.
    Ekstrand J, Hagglund M, Kristenson K et al (2013) Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 47:732–737CrossRefPubMedGoogle Scholar
  5. 5.
    Ekstrand J (2013) Epidemiology of muscle injuries in soccer. In: Mueller-Wohlfahrt HW, Ueblacker P, Haensel L, Garrett WE (eds) Muscle injuries in sports. Thieme, Stuttgart, NY, pp 127–134Google Scholar
  6. 6.
    Ueblacker P, Müller-Wohlfahrt HW, Ekstrand J (2015) Epidemiological and clinical outcome comparison of indirect (‘strain’) versus direct (‘contusion’) anterior and posterior thigh muscle injuries in male elite football players: UEFA Elite League study of 2287 thigh injuries (2001-2013). Br J Sports Med 49:1461–1465CrossRefPubMedGoogle Scholar
  7. 7.
    Fuller CW, Ekstrand J, Junge A et al (2006) Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med 16:97–106CrossRefPubMedGoogle Scholar
  8. 8.
    Ueblacker P, Haensel L, Mueller-Wohlfahrt HW (2016) Treatment of muscle injuries in football. J Sports Sci 34:2329–2337CrossRefPubMedGoogle Scholar
  9. 9.
    Ekstrand J, Askling C, Magnusson H et al (2013) Return to play after thigh muscle injury in elite football players: implementation and validation of the Munich muscle injury classification. Br J Sports Med 47:769–774CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Mueller-Wohlfahrt HW, Ueblacker P, Binder A et al (2013) Terminology, classification, patient history, and clinical examination. In: Mueller-Wohlfahrt HW, Ueblacker P, Haensel L, Garrett WE (eds) Muscle injuries in sports. Thieme, Stuttgart, NY, pp 135–167Google Scholar
  11. 11.
    Askling CM, Tengvar M, Saartok T et al (2008) Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med 36:1799–1804CrossRefPubMedGoogle Scholar
  12. 12.
    Ekstrand J, Healy JC, Walden M et al (2012) Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med 46:112–117CrossRefPubMedGoogle Scholar
  13. 13.
    Kerkhoffs GM, Van Es N, Wieldraaijer T et al (2012) Diagnosis and prognosis of acute hamstring injuries in athletes. Knee Surg Sports Traumatol Arthrosc 21:500–509CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Noonan TJ, Garrett WE Jr (1999) Muscle strain injury: diagnosis and treatment. J Am Acad Orthop Surg 7:262–269CrossRefPubMedGoogle Scholar
  15. 15.
    Chan O, Del Buono A, Best TM et al (2012) Acute muscle strain injuries: a proposed new classification system. Knee Surg Sports Traumatol Arthrosc 20:2356–2362CrossRefPubMedGoogle Scholar
  16. 16.
    Mueller-Wohlfahrt HW, Haensel L, Mithoefer K et al (2013) Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med 47:342–350CrossRefPubMedGoogle Scholar
  17. 17.
    O’Donoghue DO (ed) (1962) Treatment of injuries to athletes. WB Saunders, Philadelphia, PAGoogle Scholar
  18. 18.
    Pollock N, James SL, Lee JC et al (2014) British athletics muscle injury classification: a new grading system. Br J Sports Med 48:1347–1351CrossRefPubMedGoogle Scholar
  19. 19.
    Ryan AJ (1969) Quadriceps strain, rupture and charlie horse. Med Sci Sports 1:106–111Google Scholar
  20. 20.
    Stoller DW (ed) (2007) MRI in orthopaedics and sports medicine. Wolters Kluwer/Lippincott, Philadelphia, PAGoogle Scholar
  21. 21.
    Takebayashi S, Takasawa H, Banzai Y et al (1995) Sonographic findings in muscle strain injury: clinical and MR imaging correlation. J Ultrasound Med 14:899–905CrossRefPubMedGoogle Scholar
  22. 22.
    Valle X, Alentorn-Geli E, Tol JL et al (2016) Muscle injuries in sports: a new evidence-informed and expert consensus-based classification with clinical application. Sports Med 47:1241.  https://doi.org/10.1007/s40279-016-0647-1 CrossRefGoogle Scholar
  23. 23.
    Hamilton B, Valle X, Rodas G et al (2015) Classification and grading of muscle injuries: a narrative review. Br J Sports Med 49:306CrossRefPubMedGoogle Scholar
  24. 24.
    Ueblacker P, Hänsel L, Müller-Wohlfahrt H (2017) Muscle injuries - examination and treatment. In: Encyclopaedia of football medicine, vol 2. Thieme, Stuttgart, NY, pp 32–49Google Scholar
  25. 25.
    Jarvinen TA, Jarvinen TL, Kaariainen M et al (2005) Muscle injuries: biology and treatment. Am J Sports Med 33:745–764CrossRefPubMedGoogle Scholar
  26. 26.
    Orchard JW, Best TM, Mueller-Wohlfahrt HW et al (2008) The early management of muscle strains in the elite athlete: best practice in a world with a limited evidence basis. Br J Sports Med 42:158–159CrossRefPubMedGoogle Scholar
  27. 27.
    Reurink G, Goudswaard GJ, Tol JL et al (2012) Therapeutic interventions for acute hamstring injuries: a systematic review. Br J Sports Med 46:103–109CrossRefPubMedGoogle Scholar
  28. 28.
    Bleakley CM, Glasgow P, Webb MJ (2012) Cooling an acute muscle injury: can basic scientific theory translate into the clinical setting? Br J Sports Med 46:296–298CrossRefPubMedGoogle Scholar
  29. 29.
    Brophy RH, Wright RW, Powell JW et al (2010) Injuries to kickers in American football: the National Football League experience. Am J Sports Med 38:1166–1173CrossRefPubMedGoogle Scholar
  30. 30.
    Ueblacker P, Müller-Wohlfahrt HW, Hinterwimmer S et al (2015) Suture anchor repair of proximal rectus femoris avulsions in elite football players. Knee Surg Sports Traumatol Arthrosc 23:2590–2594CrossRefPubMedGoogle Scholar
  31. 31.
    Garcia VV, Duhrkop DC, Seijas R et al (2012) Surgical treatment of proximal ruptures of the rectus femoris in professional soccer players. Arch Orthop Trauma Surg 132:329–333CrossRefPubMedGoogle Scholar
  32. 32.
    Cohen S, Bradley J (2007) Acute proximal hamstring rupture. J Am Acad Orthop Surg 15:350–355CrossRefPubMedGoogle Scholar
  33. 33.
    Harris JD, Griesser MJ, Best TM et al (2011) Treatment of proximal hamstring ruptures - a systematic review. Int J Sports Med 32:490–495CrossRefPubMedGoogle Scholar
  34. 34.
    Ueblacker P, English B, Mueller-Wohlfahrt HW (2016) Nonoperative treatment and return to play after complete proximal adductor avulsion in high-performance athletes. Knee Surg Sports Traumatol Arthrosc 24:3927–3933CrossRefPubMedGoogle Scholar
  35. 35.
    Obremsky WT, Seaber AV, Ribbeck BM et al (1994) Biomechanical and histologic assessment of a controlled muscle strain injury treated with piroxicam. Am J Sports Med 22:558–561CrossRefPubMedGoogle Scholar
  36. 36.
    Paoloni JA, Milne C, Orchard J et al (2009) Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. Br J Sports Med 43:863–865CrossRefPubMedGoogle Scholar
  37. 37.
    Shen W, Li Y, Tang Y et al (2005) NS-398, a cyclooxygenase-2-specific inhibitor, delays skeletal muscle healing by decreasing regeneration and promoting fibrosis. Am J Pathol 167:1105–1117CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Ziltener JL, Leal S, Fournier PE (2010) Non-steroidal anti-inflammatory drugs for athletes: an update. Ann Phys Rehabil Med 53(278-282):282–278Google Scholar
  39. 39.
    Lee P, Rattenberry A, Connelly S et al (2011) Our experience on Actovegin, is it cutting edge? Int J Sports Med 32:237–241CrossRefPubMedGoogle Scholar
  40. 40.
    Pfister A, Koller W (1990) Treatment of fresh muscle injury. Sportverletz Sportschaden 4:41–44CrossRefPubMedGoogle Scholar
  41. 41.
    Reichl FX, Holdt LM, Teupser D, Schütze G, Metcalfe AJ, Hickel R, Högg C, Bloch W (2017) Comprehensive analytics of actovegin® and its effect on muscle cells. Int J Sports Med 38(11):809–818. doi: 10.1055/s-0043-115738. Epub 2017 Sep 11
  42. 42.
    A Hamid MS, Mohamed Ali MR, Yusof A et al (2014) Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med 42:2410–2418CrossRefPubMedGoogle Scholar
  43. 43.
    Reurink G, Verhaar JA, Tol JL (2014) More on platelet-rich plasma injections in acute muscle injury. N Engl J Med 371:1264–1265CrossRefPubMedGoogle Scholar
  44. 44.
    Harmon KG (2010) Muscle injuries and PRP: what does the science say? Br J Sports Med 44:616–617CrossRefPubMedGoogle Scholar
  45. 45.
    Andia I, Abate M (2015) Platelet-rich plasma in the treatment of skeletal muscle injuries. Expert Opin Biol Ther 15:987–999CrossRefPubMedGoogle Scholar
  46. 46.
    Li H, Hicks JJ, Wang L et al (2016) Customized platelet-rich plasma with transforming growth factor beta1 neutralization antibody to reduce fibrosis in skeletal muscle. Biomaterials 87:147–156CrossRefPubMedGoogle Scholar
  47. 47.
    Ota S, Uehara K, Nozaki M et al (2011) Intramuscular transplantation of muscle-derived stem cells accelerates skeletal muscle healing after contusion injury via enhancement of angiogenesis. Am J Sports Med 39:1912–1922CrossRefPubMedGoogle Scholar
  48. 48.
    Quintero AJ, Wright VJ, FH F et al (2009) Stem cells for the treatment of skeletal muscle injury. Clin Sports Med 28:1–11CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Wong S, Ning A, Lee C et al (2015) Return to sport after muscle injury. Curr Rev Musculoskelet Med 8:168–175CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Beiner JM, Jokl P, Cholewicki J et al (1999) The effect of anabolic steroids and corticosteroids on healing of muscle contusion injury. Am J Sports Med 27:2–9CrossRefPubMedGoogle Scholar
  51. 51.
    Kary JM (2010) Diagnosis and management of quadriceps strains and contusions. Curr Rev Musculoskelet Med 3:26–31CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Levine WN, Bergfeld JA, Tessendorf W et al (2000) Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League. Am J Sports Med 28:297–300CrossRefPubMedGoogle Scholar
  53. 53.
    Bloch W (2013) Muscle healing: physiology and adverse factors. In: Mueller-Wohlfahrt HW, Ueblacker P, Haensel L, Garrett WE (eds) Muscle Injuries in Sports. Thieme, Stuttgart, NY, pp 105–126Google Scholar
  54. 54.
    Orchard JW, Best TM (2002) The management of muscle strain injuries: an early return versus the risk of recurrence. Clin J Sport Med 12:3–5CrossRefPubMedGoogle Scholar
  55. 55.
    Hurme T, Kalimo H, Lehto M et al (1991) Healing of skeletal muscle injury: an ultrastructural and immunohistochemical study. Med Sci Sports Exerc 23:801–810CrossRefPubMedGoogle Scholar
  56. 56.
    Lieber RL, Ward SR (2013) Cellular mechanisms of tissue fibrosis. 4. Structural and functional consequences of skeletal muscle fibrosis. Am J Physiol Cell Physiol 305:C241–C252CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Diaz JA, Fischer DA, Rettig AC et al (2003) Severe quadriceps muscle contusions in athletes. A report of three cases. Am J Sports Med 31:289–293CrossRefPubMedGoogle Scholar
  58. 58.
    Trojian TH (2013) Muscle contusion (thigh). Clin Sports Med 32:317–324CrossRefPubMedGoogle Scholar
  59. 59.
    Ong A, Anderson J, Roche J (2003) A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Br J Sports Med 37:263–266CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Ozturk A, Ozkan Y, Ozdemir RM et al (2008) Radiographic changes in the lumbar spine in former professional football players: a comparative and matched controlled study. Eur Spine J 17:136–141CrossRefPubMedGoogle Scholar
  61. 61.
    Orchard JW, Farhart P, Leopold C (2004) Lumbar spine region pathology and hamstring and calf injuries in athletes: is there a connection? Br J Sports Med 38:502–504. discussion 502-504CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Arnason A, Andersen TE, Holme I et al (2008) Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports 18:40–48CrossRefPubMedGoogle Scholar
  63. 63.
    Askling C, Karlsson J, Thorstensson A (2003) Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scand J Med Sci Sports 13:244–250CrossRefPubMedGoogle Scholar
  64. 64.
    Brukner P (2015) Hamstring injuries: prevention and treatment-an update. Br J Sports Med 49:1241–1244CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Hrysomallis C (2013) Injury incidence, risk factors and prevention in Australian rules football. Sports Med 43:339–354CrossRefPubMedGoogle Scholar
  66. 66.
    Orchard J, Best TM, Verrall GM (2005) Return to play following muscle strains. Clin J Sport Med 15:436–441CrossRefPubMedGoogle Scholar
  67. 67.
    Schlumberger A (2013) Prevention of muscle injuries. In: Mueller-Wohlfahrt HW, Ueblacker P, Haensel L, Garrett WE (eds) Muscle injuries in sports. Thieme, Stuttgart, NY, pp 365–380Google Scholar
  68. 68.
    Sherry MA, Best TM (2004) A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther 34:116–125CrossRefPubMedGoogle Scholar
  69. 69.
    Reurink G, Brilman EG, De Vos RJ et al (2015) Magnetic resonance imaging in acute hamstring injury: can we provide a return to play prognosis? Sports Med 45:133–146CrossRefPubMedGoogle Scholar
  70. 70.
    Creighton DW, Shrier I, Shultz R et al (2010) Return-to-play in sport: a decision-based model. Clin J Sport Med 20:379–385CrossRefPubMedGoogle Scholar
  71. 71.
    Delvaux F, Rochcongar P, Bruyere O et al (2014) Return-to-play criteria after hamstring injury: actual medicine practice in professional soccer teams. J Sports Sci Med 13:721–723PubMedPubMedCentralGoogle Scholar
  72. 72.
    Schut L, Wangensteen A, Maaskant J et al (2016) Can clinical evaluation predict return to sport after acute hamstring injuries? A systematic review. Sports Med 47:1123.  https://doi.org/10.1007/s40279-016-0639-1 CrossRefGoogle Scholar
  73. 73.
    Mendiguchia J, Brughelli M (2011) A return-to-sport algorithm for acute hamstring injuries. Phys Ther Sport 12:2–14CrossRefPubMedGoogle Scholar
  74. 74.
    Croisier JL, Forthomme B, Namurois MH et al (2002) Hamstring muscle strain recurrence and strength performance disorders. Am J Sports Med 30:199–203CrossRefPubMedGoogle Scholar
  75. 75.
    Tol JL, Hamilton B, Eirale C et al (2014) At return to play following hamstring injury the majority of professional football players have residual isokinetic deficits. Br J Sports Med 48:1364–1369CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Mendiguchia J, Samozino P, Martinez-Ruiz E et al (2014) Progression of mechanical properties during on-field sprint running after returning to sports from a hamstring muscle injury in soccer players. Int J Sports Med 35:690–695CrossRefPubMedGoogle Scholar
  77. 77.
    Hallen A, Ekstrand J (2014) Return to play following muscle injuries in professional footballers. J Sports Sci 32:1229–1236CrossRefPubMedGoogle Scholar
  78. 78.
    Koulouris G, Connell DA, Brukner P et al (2007) Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med 35:1500–1506CrossRefPubMedGoogle Scholar
  79. 79.
    Schneider-Kolsky ME, Hoving JL, Warren P et al (2006) A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries. Am J Sports Med 34:1008–1015CrossRefPubMedGoogle Scholar
  80. 80.
    Slavotinek JP (2010) Muscle injury: the role of imaging in prognostic assignment and monitoring of muscle repair. Semin Musculoskelet Radiol 14:194–200CrossRefPubMedGoogle Scholar
  81. 81.
    Moen MH, Reurink G, Weir A et al (2014) Predicting return to play after hamstring injuries. Br J Sports Med 48:1358–1363CrossRefPubMedGoogle Scholar
  82. 82.
    Reurink G, Whiteley R, Tol JL (2015) Hamstring injuries and predicting return to play: ‘bye-bye MRI? Br J Sports Med 49:1162–1163CrossRefPubMedGoogle Scholar
  83. 83.
    Boeck J, Mundinger P, Luttke G (2013) Magnetic resonance imaging. In: Mueller-Wohlfahrt HW, Ueblacker P, Haensel L, Garrett WE (eds) Muscle injuries in sports. Thieme, Stuttgart, NY, pp 203–225Google Scholar
  84. 84.
    Reurink G, Goudswaard GJ, Tol JL et al (2014) MRI observations at return to play of clinically recovered hamstring injuries. Br J Sports Med 48:1370–1376CrossRefPubMedGoogle Scholar
  85. 85.
    Sanfilippo JL, Silder A, Sherry MA et al (2013) Hamstring strength and morphology progression after return to sport from injury. Med Sci Sports Exerc 45:448–454CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Araujo PH, Rabuck SJ, Fu FH (2012) Are we allowing patients to return to participation too soon? Am J Sports Med 40:NP5. author reply NP5-6CrossRefPubMedGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  • Peter Ueblacker
    • 1
    Email author
  • Hans-Wilhelm Mueller-Wohlfahrt
    • 1
  1. 1.MW Center of Orthopedics and Sports MedicineMunichGermany

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