MUSCLE INJURY GUIDE: Prevention of and Return to Play from Muscle Injuries - Lasse Lempainen
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES
MUSCLE
INJURY
GUIDE: 1
Prevention of
and Return to
Play from
Muscle Injuries
Editors: Senior Editorial
Ricard Pruna Assistant:
Thor Einar Andersen Steffan Griffin
Ben Clarsen
Alan McCall Editorial Assistant:
Johann Windt
CHAPTER 1
SECTION
LEADERS
FC BARCELONA
CONTRIBUTORS
Muscle Injury
Guide:
Clare Ardern Juanjo Brau
Roald Bahr Xavi Linde
Aaron Coutts Antonia Lizárraga
Maurizio Fanchini Sandra Mecho
Prevention of
Phil Glasgow Edu Pons
Tero Jarvinen Jordi Puigdellivol
Lasse Lempainen Xavi Valle
Andrea Mosler Xavi Yanguas
James O’Brien
and Return to
Tania Pizzari
Nicol van Dyk
Markus Waldén
Arnlaug Wangensteen EXERCISE-BASED
Play from
MUSCLE INJURY
PREVENTION (EBMIP)
GROUP (see section
1.4.4a)
Muscle Injuries
INTERNATIONAL
CONTRIBUTORS Andrea Azzalin
Andreas Beck
Abd-elbasset Abaidia Andrea Belli
Khatija Badhur Martin Buchheit
Natalia Bittencourt Gregory Dupont
Mario Bizzini Maurizio Fanchini
Ida Bo Steenhal Duccio Ferrari Bravo
Martin Buchheit Shad Forsythe
Phil Coles Marcello Iaia
Aaron Coutts Yann-Benjamin Kugel
Michael Davison Imanol Martin
Gregory Dupont Samuele Melotto
Caroline Finch Jordan Milsom
Brady Green Darcy Norman
Martin Hägglund Edu Pons
Shona Halson Stefano Rapetti
Joar Harøy Bernardo Requena
Per Hölmich Roberto Sassi
Franco Impellizzeri Andreas Schlumberger
Gino Kerkhoffs Tony Strudwick
Ozgur Kilic Agostino Tibaudi
Justin Lee
Matilda Lundblad
Nicolas Mayer
Bob McCunn
Tim Meyer DESIGNER AND
Haiko Pas PUBLISHER
Noel Pollock
Janne Sarimo FCB Marketing
Anthony Schache Department
Andreas Serner
Karin Silbernagel
Adam Weir
Jonas Werner Editors: Senior Editorial
Nick van der Horst Ricard Pruna Assistant:
Anne D van der Made Thor Einar Andersen Steffan Griffin
Ben Clarsen
Alan McCall Editorial Assistant:
Johann Windt
MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES
6 Summary E. Editor’s biographies
P8
1.3.4 BARRIERS AND FACILITATORS TO DELIVERING
INJURY PREVENTION STRATEGIES
P 37
2.3.1 EXERCISE PRESCRIPTION FOR MUSCLE INJURY
P 96
7
2.3.2 RESTORING PLAYERS’ SPECIFIC FITNESS AND
1.4.1 STRATEGIES TO PREVENT MUSCLE INJURY PERFORMANCE CAPACITY IN RELATION TO MATCH
0. Introduction to P 38
1.4.2 CONTROLLING TRAINING LOAD
PHYSICAL AND TECHNICAL DEMANDS
P 101
the Guide P 40 2.4.1 REGENERATIVE AND BIOLOGICAL TREATMENTS
FOR MUSCLE INJURY
P 12
1.4.3 RECOVERY STRATEGIES
P 110
P 44
2.4.2 SURGERY FOR MUSCLE INJURIES
0.1 PREVENTING AND TREATING MUSCLE INJURIES 1.4.4A EXERCISE-BASED STRATEGIES TO PREVENT
P 114
IN FOOTBALL MUSCLE INJURIES
P 13 P 46
0.2 PARTNERSHIP WITH OSLO SPORTS TRAUMA
RESEARCH CENTRE
1.4.4B EXERCISE SELECTION FOR THE MUSCLE INJURY
PREVENTION PROGRAM 3. RTP from Specific
P 14
0.3 SCIENCE AND MEDICINE IN FOOTBALL JOURNAL’S
P 54
1.4.4C EXERCISE SELECTION: HAMSTRING INJURY
Muscle Injury
SUPPORT
P 15
PREVENTION
P 55
P 120
0.4 A LETTER OF SUPPORT FROM 1.4.4D EXERCISE SELECTION: QUADRICEPS INJURY 3.1 RETURN TO PLAY FOLLOWING HAMSTRING
DR MICHEL D’HOOGE PREVENTION MUSCLE INJURY
P 16 P 58 P 121
0.5 INTERNATIONAL COLLABORATORS 1.4.4E EXERCISE SELECTION: ADDUCTOR MUSCLE 3.2 RETURN TO PLAY FOLLOWING QUADRICEPS
P 17 INJURY MUSCLE INJURY
P 61 P 140
1.4.4F EXERCISE SELECTION:CALF INJURY 3.3 RETURN TO PLAY FOLLOWING GROIN MUSCLE
1. General Principles of PREVENTION INJURY
P 63 P 156
Preventing Muscle Injury 1.4.5 COMMUNICATION 3.4 RETURN TO PLAY FOLLOWING CALF MUSCLE
P 18 P 66
1.5 CONTINUOUS (RE)EVALUATION AND MODIFICATION
INJURY
P 170
OF PREVENTION STRATEGIES
1.1.1. AN INTRODUCTION TO PREVENTING MUSCLE
P 68
INJURIES.DOCX
P 19
1.1.2 A NEW MODEL FOR INJURY PREVENTION IN TEAM
SPORTS: THE TEAM-SPORT INJURY PREVENTION (TIP) 2. General Principles
CYCLE
P 20 of Return to Play from
1.2.1 EVALUATING THE MUSCLE INJURY SITUATION
P 22
Muscle Injury
1.2.2 EVALUATING THE MUSCLE INJURY SITUATION IN P 78
YOUR OWN TEAM
P 25 2.1.1 RETURN TO PLAY FROM MUSCLE INJURY: AN
INTRODUCTION
1.3.1 RISK FACTORS AND MECHANISMS FOR MUSCLE
P 79
INJURY IN FOOTBALL
P 26 2.1.2 RETURN TO PLAY IN FOOTBALL: A DYNAMIC MODEL
P 80
1.3.2 THE COMPLEX, MULTIFACTORIAL AND DYNAMIC
NATURE OF MUSCLE INJURY 2.1.3 ESTIMATING RETURN TO PLAY TIME
P 31 P 82
1.3.3 MUSCULOSKELETAL SCREENING IN FOOTBALL 2.2.1 MAKING AN ACCURATE DIAGNOSIS
P 34 P 85
SUMMARY
MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES
EDITOR’S
BIOGRAPHIES
8 Editor’s DR. RICARD PRUNA PROF. THOR EINAR ANDERSEN DR. BEN CLARSEN DR ALAN MCCALL 9
biographies
MD, PhD MD, PT, PhD,PM&R PT, PhD Msc, PhD
Ricard Pruna is a specialist Thor Einar Andersen is a Ben Clarsen is a specialist Alan is Head of Research
in Sport & Exercise Medicine Professor and Head of football sports physiotherapist at & Development for Arsenal
with a Masters in both medicine research at the Oslo the Norwegian Olympic Football Club and Co-head of
‘Traumatology and Sports’ Sports Trauma Research Centre Training Center and a Research & Innovation (with
and ‘Biology and Sports’ and in the Department of Sports Me- postdoctoral research fellow Assoc Prof Rob Duffield) at
additionally holds a PhD dicine at the Norwegian School at the Oslo Sports Trauma Football Federation Australia.
in ‘Genetics and Injury in of Sport Sciences, Norway. He Research Center (OSTRC). Alan’s background is as a fit-
Football’. Ricard has a rich and has a master degree in health He has a bachelor degree ness coach and sport scientist
vast experience in top-level administration from the Uni- in physiotherapy from the with over ten years experience
football having been the first versity of Oslo. He is a trained University of Sydney and working in professional club
team doctor of FC Barcelona physiotherapist, consultant phy- a master degree in sports teams competing in Ligue
for over 20 years. He is also sician, and specialist in Physical physiotherapy and PhD 1, English Premier League,
the Head of Medical Services and Rehabilitation Medicine. His from the Norwegian School A-League, Scottish League
at FC Barcelona, overseeing main research areas are football of Sport Sciences. He is a and European competitions.
the medical strategy and staff injury epidemiology, injury me- director of the IOC Diploma He was Head of Sport Science
of all medical aspects in the chanisms and causes, as well as in Sports Physical Therapies and fitness coach of the Aus-
club, including professional injury prevention. and a lecturer on the sports tralian Socceroos at the 2014
sports in addition to his first physiotherapy master FIFA World Cup and the U20
team football duties. Thor Einar is the Chief medical program at the Norwegian Young Socceroos at the 2013
officer of the Medical Commit- School of Sport Sciences. Ben World Cup.
Ricard’s clinical interests lie tee in The Football Association of has been physiotherapist
in football medicine, muscle Norway. He has served as team for a number of professional Alan’s research interests include
injuries, genetics, return to physician for the senior male road cycling teams, and the injury prevention, recovery
play, anatomy and injury national team from 2002-2014. Norwegian and Australian and performance in football.
diagnosis. He has many He is medical director at the national programmes. He He holds a PhD in ‘Injury
scientific publications in Norwegian FA Medical Centre is a senior associate editor Prevention in Elite Footballers’
the football medicine areas and is a member of the board of BJSM and was the senior from Université de Lille 2 and a
and has received various and director of elite sports in editor of the 5th edition of Msc in Strength & Conditioning
awards for his scientific work, the football department at Brukner and Khan’s Clinical from Edith Cowan University,
including, the Award for Nordstrand IF. Sports Medicine textbook. Australia.
Medical Excellence from the
Medical College University Thor Einar has a strong con- Alan is a member of the
of Barcelona, a National and nection with high-level football Football Research Group, Senior
UEFA Award for research in having played professionally Associate Editor at British
sports medicine. winning two Norwegian cham- Journal of Sports Medicine,
pionships with IK Start, and Associate Editor at Science and
represented Norwegian interna- Medicine in Football and on the
tional youth teams (U15-U23). editorial board of Apunts which
is a joint publication by the
Conseil Catala de l’Esport and
Barca Innovation Hub.
EDITOR’S BIOGRAPHIES
MUSCLE INJURY GUIDE: MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES PLAY FROM MUSCLE INJURIES
EDITORIAL ASSISTANTS
BIOGRAPHIES
10 JOHANN WINDT DR. STEFFAN GRIFFIN WHAT WE DO? OUR FOCUS 11
PhD Candidate, MSc, CSCS MBChB BSc (Hons)
KNOWLEDGE FC Barcelona aims to help change the
Johann Windt is a Sports Steffan is a junior doctor at world through sporting excellence via
Medicine Data Analyst at Chelsea and Westminster Exchanging ideas with the greatest knowledge and innovation
the United States Olympic Hospital in London, and is minds around the world to develop
Committee. Before his passionate about pursuing a cutting edge applied research projects. We are looking to form an ecosystem to
current role at the USOC, career in Sport and Exercise We have the commitment to share this foster knowledge and innovation. This
he spent two years with Medicine. He sits on the British knowledge to the new generation of ecosystem is based on a model that
the Vancouver Whitecaps Journal of Sports Medicine’s sports industry professionals. promotes a culture of excellence and
Football Club (competing in editorial board as senior collaboration with prestigious brands,
the Major League Soccer) associate editor and helps universities, research centres, start-
as a sport science data lead the journal’s social media ups, entrepreneurs, students, athletes,
NEW PRODUCTS AND SERVICES
analyst. He is currently a PhD channels. Steffan is also a investors, and visionaries around the
candidate at the University board member of the Institute world.
Leveraging our know how to partner
of British Columbia Canada. of Sport and Exercise Medicine,
with key stakeholders and create game
Co-supervised by Professors and has active research By doing so, we aim to generate new
changing technologies, processes and
Karim Khan and Tim Gabbett, interests in concussion, return- knowledge and create new products
experiences which create value not
his doctoral work focuses to-play, and medical education. and services that will be of benefit to
only for the Club but for the whole
on athlete monitoring and our own athletes, members and fans,
society.
injury aetiology. Johann is and society in general.
also a member of the Football
Research Group, which is an A RELEVANT ECOSYSTEM
international research group
collaborating closely with the Encouraging and connecting the sports HOW?
Union of European Football business ecosystem: industry leaders,
Associations (UEFA) on various sport organizations, research centers, Our knowledge and innovation
research projects related to universities, entrepreneurs and start-ups. activities are structured into 5 areas:
football player health and
performance. 1. Medical services and nutrition
2. Sports performance
3. Team sports
4. Technology
5. Social science
EDITOR’S BIOGRAPHIES
MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES
0.1
PREVENTING AND TREATING
MUSCLE INJURIES IN FOOTBALL
There are many physical and mental health benefits to training and playing
football, however, there is also, unfortunately, one key adverse effect; an increased
risk of injury, with muscle injuries being one of the most common that we see in
elite football.
— With Ricard Pruna
12 Introduction Due to the negative effects that we know injuries have on performance, club finances and
13
to the Guide
long-term player health, their prevention and optimal treatment (when they do occur) is
an essential part of the football medicine and performance department. In particular, at FC
Barcelona (and I am sure in many of the football clubs around the world) we see the role
of the football medicine and performance department and staff as three-fold;
1. Protect our players’ health
2. Maximise player and team performance
3. Ensure the scientific integrity of medical and performance programs delivered
in FC Barcelona
At FC Barcelona we believe that the creation, integration and delivery of an effective and
efficient medical and performance program requires an evidence led approach, using the
best of research knowledge combined with our many years of practical experience. We
also believe strongly in sharing our knowledge and experiences among the football and
sports community globally.
In 2009, we published the first FC Barcelona Muscle Injury Guide with the aim of providing
an insight into our philosophy and methods of preventing and treating muscle injuries.
Then in 2015 we released our second Muscle Injury Guide. With each Guide we strive to
progress on the last. We now have the great pleasure of launching our 2018 FC Barcelona
Muscle Injury Guide: ‘Prevention of and Return to Play from Muscle Injuries’. We see this
Guide not as a progression on the previous two, but rather as a new concept and with a
new direction. In the true spirit of FC Barcelona, we are ‘mes que un club’ (more than a
club) and have welcomed into our football family, a number of internationally renowned
sports medicine and performance practitioners and researchers to contribute with us on
the practical recommendations that follow. We are truly grateful for the partnerships we
have formed in the production of this Guide including; the Oslo Sports Trauma Research
Centre and the Science and Medicine in Football Journal. Our aim is to provide you, the
reader/practitioner with the most up to date knowledge and experiences from 60+
worldwide experts combined with the ‘Barça Way’.
Our Muscle Injury Guide is not intended to be a ‘must follow recipe’, but rather to provide
some key ingredients that you can adapt and integrate appropriately into your own
practice. We hope you enjoy reading the combined knowledge and experiences of the
many valued contributors included throughout.
Dr Ricard Pruna
Head of Medical Services, FC Barcelona
CHAPTER 0
MUSCLE INJURY GUIDE: MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES PLAY FROM MUSCLE INJURIES
0.2 0.3
PARTNERSHIP WITH OSLO SPORTS SCIENCE AND MEDICINE IN
TRAUMA RESEARCH CENTRE FOOTBALL JOURNAL’S SUPPORT
The Oslo Sports Trauma Research Centre was established at the Norwegian School At Science and Medicine in Football, our mission is to advance the theoretical
of Sport Sciences in 2000 as a research collaboration between the Department knowledge, methodological approaches and professional practice associated
of Orthopaedic Surgery, Oslo University Hospital, Ullevaal, the Department of with the sport of football. In other words, we want to help bridge the gap between
Sports Medicine, Norwegian School of Sport Sciences, and The Norwegian Football science/research and the practical setting. Essentially, we are an international,
Association Medical Clinic (2015). Since 2009, the OSTRC has been recognised as a peer-reviewed journal interested in promoting evidence-based practice i.e. use of
FIFA Medical Centre of Excellence and selected as one of four IOC Research Centres quality research knowledge with current best practice.
for Prevention of Injury and Protection of Athlete Health. — With Tim Meyer and Franco Impellizzeri
— With Thor Einar Andersen and Roald Bahr
14 The main objective of the Oslo Sports Trauma Research Centre has been to develop a long- 1. Arnason A, Andersen TE, We focus on many areas of football including, physiology, biomechanics, nutrition, training, 15
term research program on sports injury prevention (including studies on epidemiology, Holme I, Engebretsen L, testing, performance analysis, psychology and coaching. Additionally, sports science and
Bahr R. (2008) Prevention
risk factors, injury mechanisms, and interventions). The program focuses mainly on three of hamstring strains in eli- medicine in football is key for us and our readership, with injury prevention and return to
sports (football, handball, and alpine skiing/snowboarding). We have addressed the most te soccer: an intervention play current hot topics.
study. Scand J Med Sci
common (e.g. ankle, hamstrings) and the most serious (e.g. ACL, concussions) injuries seen Sports;18(1):40-8
in these sports. The FC Barcelona Muscle Injury Guide corresponds to our vision of bringing research and
2. Soligard T, Myklebust
G, Steffen K, Holme I, practice together. In this resource, FC Barcelona have brought together over 60 of some
In football, one focus has been on the preventive effect of eccentric hamstring training Silvers H, Bizzini M et al. of the world’s leading applied researchers and practitioners to share and perhaps most
(2008) Comprehensive
using the Nordic Hamstring exercise.1 We have, in partnership with FIFA, also developed warm-up programme to
importantly, work together to combine their knowledge and experience into one voice.
“The 11+”, a warm-up program with exercises focusing on core stability, neuromuscular prevent injuries in young
control, strength, balance, hip control and knee alignment in football.2 In 2011, we female footballers: cluster Not only will this Guide provide a great practical recommendations’ resource for football
randomised controlled
conducted an intervention study in the Norwegian male professional league involving trial. BMJ;337:a2469 science and medicine practitioners worldwide, but should also help to drive forward
sanctioning of two-footed tackles as well as tackles with excessive force and intentional 3. Bjørneboe J, Bahr R,
meaningful applied research to further improve our field.
high elbow with an automatic red card to enforce the Rules of the Game.3 Dvorak J, Andersen TE.
(2013) Lower incidence It is with great pleasure that we support this initiative by FC Barcelona. One aspect that
of arm-to-head contact
We have through several conferences, workshops, visits and meetings with FC Barcelona incidents with stricter we are particularly excited about is that various contributors involved in the Guide will
(FCB) and its medical staff, been inspired by the clubs’ constant strive to implement best interpretation of the progress on some of the chapters written within, by preparing scientific articles and
medical practice and scientific knowledge into their daily practice. In particular, we have Laws of the Game in submitting these to enter the Science and Medicine in Football peer review process. So,
Norwegian male profes-
been impressed by the FCB philosophy on training principles, diagnostic procedures and sional football. Br J Sports watch this space…
management of return to play after injury. Med;47(8):508-14
Both the Oslo Sports Trauma Research Centre and the FC Barcelona share a common
understanding that scientists and practitioners should collaborate closely to bridge the gap
between science and practice. We certainly believe developments in the area of football
medicine will benefit from improved on- and off-field teamwork to answer the key
research questions of the future.
Therefore, it is a great honour and pleasure for the Oslo Sports Trauma Research Centre to
contribute in an exciting partnership with FCB to produce the FC Barcelona Muscle Injury
Guide: Prevention of and Return to Play from Muscle Injuries. We are very much looking
forward to this mutual collaborative effort and to continued projects in the near future.
CHAPTER 0 CHAPTER 0
MUSCLE INJURY GUIDE: MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES PLAY FROM MUSCLE INJURIES
0.4 0.5
A LETTER OF SUPPORT FROM INTERNATIONAL
DR MICHEL D’HOOGE COLLABORATORS
In the medical world around football, great interest is given to articular and
ligament lesions. At each medical congress, new techniques are presented in
relation with important topics as anterior cruciate ligament tears of the knee, or
posttraumatic ankle instability and others. One should, however, never forget that
the most important injury in the world of football remains a muscle injury.
— With Michel Baron D’Hooghe, Chairman Medical Commission FIFA and UEFA
16 A lot remains to be studied, in the sphere of prevention, diagnosis and treatment 17
of these injuries. Although the scientific world around our sport has spectacularly
improved our medical assistance to the players, the impressive epidemiological
studies of Prof Ekstrand and his team indicate that the number of muscular injuries
did not decrease over the last years.
I remain convinced that, in different aspects, our approach of muscular injuries
can be improved, and this as well in the preventive, pharmacological, surgical and
conservative sphere.
We must work together to improve our criteria for return to play, as the high number
of re-injuries confronts us sometimes with our own deficiencies.
That is why this scientific work, the great medical guide of muscle injuries, is a gift to
all practitioners, active in the field of football.
Many thanks to all the collaborators of this important book, which will greatly
improve our care of the injured player.
Countries represented
in the guide
Australia Norway
Brazil Northern Ireland
Canada Qatar
Denmark South Africa
Finland Spain
France Sweden
Germany Switzerland
Holland UK
Italy USA
CHAPTER 0 CHAPTER 0
MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES
1.1.1
AN INTRODUCTION TO
PREVENTING MUSCLE INJURIES
The objective of football is to win games and there are many factors (i.e. tactical,
technical, physical and mental) interacting to achieve this objective. However,
one key, contributing factor that the medical and performance team can influence is
player availability i.e. through a lower impact of injuries (incidence and severity).
— With Alan McCall and Ricard Pruna
18 General This makes sense, given that one would benefits of preventative strategies to key 19
Principles of
logically agree that having the best stakeholders (players, coaches, board
players available to play, enhances the level administrators etc) is essential if we
likelihood of winning. A higher player are to succeed in at least reducing the risk
availability means that the coach will and minimising the occurrence of injuries,
Muscle Injury
have more players available to train and in particular muscle injuries which
and in turn more opportunity and time are one of the most common types of
to work on tactics, technical aspects injuries that we are faced with.
and team dynamics. There is also
Prevention
strongs cientific evidence to support The purpose of this opening chapter of
this notion; less injuries have been the FC Barcelona Muscle Injury Guide:
associated with increased success in ‘General Principles of Muscle Injury
domestic league competition1, 2 and Prevention in Football’ is to highlight,
in Football
UEFA Champions / Europa League.3 In explain and delve into some of the key
addition to performance and success, general principles to consider when
injuries also carry with them a significant the goal is to prevent muscle injury in
financial cost. It has been estimated that footballers. Specifically, we will provide
the financial cost of one player missing a new injury prevention model specific
one month due to injury equates to an to team sports, followed by taking
average of ~€500,000.4 Remember that you through a journey of this model,
this is an average, imagine the costif providing practical guidelines along
this was a star player. A third important the way.
potential consequence of injury is an
adverse effect on players’ long term
physical and mental health.5
While in an ideal world, we would be
able to prevent all injuries from ever
occurring, this is, in reality, impossible
and our aim is really to minimise the
risk of players suffering an injury. Life
is full of risky decisions, from mundane
ones to matters of life and death.6 Risk
is something that we must accept
exists; even walking down the street
has a meaningful (albeit small) risk for
our safety.7 The fact is,that injury is so
complex, multifactorial and dynamic8
that prevention must also be complex,
multifactorial and dynamic. We should
aim to identify and minimise known risk
factors for injury while simultaneously
identifying and maximising protective
factors. Communicating the risks and the
CHAPTER 1MUSCLE INJURY GUIDE: MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES PLAY FROM MUSCLE INJURIES
1.1.2
PHASE 1: EVALUATE This second phase also involves
ONGOING RE-
A NEW MODEL FOR INJURY
identifying barriers and facilitators to
This phase involves evaluating the current implementing injury prevention strategies, EVALUATION AND
PREVENTION IN TEAM SPORTS: MODIFICATION
“state-of-play” in your team. Addressing which will strongly impact on the
the question, “What is the current injury ultimate success of a preventive strategy.
THE TEAM-SPORT INJURY
situation?” involves evaluating the type, These factors will be context-specific, Injury prevention is a dynamic,
incidence and severity/burden of injuries but recent research has highlighted a cyclical process. Having introduced
PREVENTION (TIP) CYCLE
in the team. The second question, “What is number of potential barriers/facilitators to or modified a preventive measure,
the injury prevention situation?” involves implementing injury prevention exercise ongoing evaluation is required. In
analysing which injury prevention programs.15,16 These relate either to the the re-evaluation phase, successful
Recently there has been growing interest in injury prevention for football and other strategies are currently being used (or not content and nature of the prevention implementation can be judged against
team sports, including the development of models and frameworks to guide injury used) and the reasons why. For example: program itself, or to how it is delivered metrics such as injury and physical
prevention efforts1,2 , and improve understanding of injury aetiology3,5. and supported by players, coaches and performance data, team members’
— With James O’Brien, Caroline Finch, Ricard Pruna and Alan McCall team staff members. In large, multi- perceptions and the degree of fidelity
1. Is the team implementing
disciplinary sports medicine/performance to the injury prevention strategy (e.g.
evidence-based exercises
teams there is potential for conflict among the number and quality of completed
(e.g. Nordic Hamstring13 and
staff,17,18 which can jeopardise the success injury prevention exercise sessions).
the Copenhagen Adduction
of injury prevention efforts. Identifying With continual progression through the
exercise14)?
these staff-related factors will inform the model’s three phases, the team’s injury
2. What is the team’s current subsequent intervention phase. prevention strategy can dynamically
strategy for managing high- evolve, responding to various changes
20 The most widely cited injury prevention speed running load? in the team’s environment (e.g. new 21
model, called the ‘sequence of prevention’, players, new staff members and
3. What recovery strategies are in
was introduced by van Mechelen and varying game schedules). While
WHAT IS THE CURRENT place following match-play?
colleagues in 1992.2 This model builds on
previous public health approaches6 and
WHAT IS THE CURRENT
INJURY SITUATION?
INJURY PREVENTION
SITUATION?
4. Is squad rotation being used?
PHASE 3: INTERVENE evaluation of certain metrics will
occur on a daily basis in professional
The next phase involves planning both the
consists of four key steps: teams (e.g. wellness scores, workload
5. Which other preventive strategies content (what to do) and delivery (how to
data), it is recommended that teams
E) E
VALUA
TE are currently in place, and with do it) of injury prevention strategies. This
(R also undertake more formal injury
WHAT ARE THE what rationale? process will be influenced by the team’s
1. Establishing the extent of the INTRODUCE prevention evaluation, involving all key
INJURY INJURY RISK
current situation, the identified injury
injury problem PREVENTION FACTORS AND individuals, at least two or three times
INTER
MECHANISMS? risk factors and implementation barriers/
TIF Y
STRATEGIES
A detailed understanding of all team per season.
2. Identifying the key risk factors facilitators, published injury prevention
EN
NE members’ perceptions towards injury
VE
ID
and mechanisms of injury research and the team staff members’
risk and injury prevention is important to In the following chapters of this
previous experiences from working in the
3. Introducing preventive strategies inform subsequent phases in the cycle. opening section on preventing muscle
field. Implementation research highlights
to mitigate the risk of injury PLAN THE CONTENT WHAT ARE THE BARRIERS injuries we will take you through each
AND DELIVERY OF & FACILITATORS TO the importance of securing administrative
INJURY PREVENTION DELIVERING INJURY In addition to establishing what is being of the 3 key phases in more detail.
4. Evaluating the effectiveness support for preventive strategies10 and
STRATEGIES PREVENTION?
done, it is essential to determine precisely
of preventive strategies by engaging all key partners in the design
how these strategies are being carried
repeating Step 1. process.19 In the professional football
out. For example, in the case of exercises,
setting, this means involving club officials
^ key considerations are the number
(who decide on club policy), coaches and
In 2006, Finch1 introduced an extension of risk management approaches.11,12 Figure 1: The Team-sport Injury and frequency of sessions, the exercise
Prevention (TIP) Cycle team staff members (who deliver injury
of the van Mechelen model called Such a model should be simple, directly dose within these sessions (e.g. sets,
prevention) and key players (the targeted
the ‘Translating Research into Injury applicable to the team’s specific context Phase 1: (Re) evaluate repetitions, intensity) and also the quality
Phase 2: Identify health beneficiaries) from the onset.
Prevention Practice (TRIPP)’ framework, and also acknowledge real-world Phase 3: Intervene of exercise execution.
Through involvement of all key partners
which emphasises the key role of implementation challenges. Furthermore, These phases incorporate key in the design phase, context-specific
implementation aspects in achieving the model should reflect the cyclical aspects of previous models,1,2 along
strategies can be developed which
real-world injury prevention success. nature of injury prevention, involving with important implementation
aspects applicable to team sports have adequate support and account for
Subsequently, several further models ongoing evaluation and adaptation of such as football.
have been proposed, each aiming preventive strategies as opposed to a PHASE 2: IDENTIFY barriers/facilitators in the team’s specific
context. The multi-factorial epidemiology
to address potential limitations of linear step-by-step process.
The next phase in the cycle involves of muscle injuries in football implies the
previous models. These limitations
In the process of developing this Muscle exploring the risk factors and need for multiple preventive strategies
include linear,5,7 reductionist8 or generic
Injury Guide, it became apparent that no mechanisms of the injuries identified (e.g. load management, recovery
approaches,9 a lack of operational
existing model adequately reflects the during the evaluation. This process will strategies and specific exercise-based
steps9,10 and the failure to incorporate
everyday injury prevention approach of be primarily driven by the team’s internal interventions).
player workloads.4
sports medicine and performance staff data (e.g. injury, tracking and monitoring
The applicability of each of these working in professional football teams. data), along with consideration of
models will be context-dependent, with To remedy this, we developed a new established risk factors and mechanisms
the majority being geared towards the model, the Team-sport Injury Prevention from the published literature. It is
conduct of injury prevention research,1,2 (TIP) cycle, specifically aimed at the important to appreciate the multi-factorial
and developing etiological theory.5,8 sports team medicine/performance nature of injury epidemiology,4,8 assess
However, practitioners working at the practitioner. It involves a simple injury risk at an individual player level9
injury prevention “coalface” will be continual cycle with three key phases and consider the degree to which
better served by a model more reflective (figure 1): identified risk factors can be modified.
CHAPTER 1 CHAPTER 1MUSCLE INJURY GUIDE: MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES PLAY FROM MUSCLE INJURIES
1.2.1 40
QUADRICEPS MUSCLE INJURIES
EVALUATING THE MUSCLE 35
Quadriceps injury represent 5% of
all time-loss injuries and 19% of all
INJURY SITUATION 30
muscle injuries in men’s professional
football (figure 1), which means that
(EPIDEMIOLOGY) a 25-player squad can expect about
% OF MUSCLE INJURIES
25
three quadriceps injuries each season.
Similar to the findings for hamstring
Muscle injuries are one of the biggest medical problems in modern football, 20 injuries, the injury rate during match
regardless of the playing level.1 2 Specifically, muscle injuries represent almost one
play is higher, approximately four
third of time-loss injuries and account for more than one-quarter of the overall
15 times, than during training (table 2).
injury burden as it was shown in the largest available study involving more than
Studies involving imaging modalities
9,000 injuries in men’s professional football players in Europe.2 Numbers from this
10 have shown that rectus femoris is the
investigation also reveal that on average, an individual player will sustain a muscle
most common injury location in the
injury every other season.2
quadriceps.2 10
— With Markus Waldén, Tim Meyer, Matilda Lundblad, Martin Hägglund 5
<
Figure 1 Muscle injury location in men’s
0
HAMSTRING ADDUCTOR QUADRICEPS CALF OTHER professional football players
(adapted from Ekstrand et al.2)
22 MUSCLE INJURY HAMSTRING MUSCLE INJURIES ADDUCTOR-RELATED MUSCLE INJURIES 23
LOCATIONS AND RATES Hamstring injury is the single most common time-loss injury Each season a typical 25-player squad
type representing 12% of all injuries in men’s professional in men’s professional football can expect
Most of the muscle injuries (92%) are
football.2 In that study, 37% of all muscle injuries were in the four to five muscle injuries to the hip
located within the four big muscle
hamstrings (figure 1). The injury rate during match play is and groin.2 The most relevant muscle
groups of the lower limbs (hamstrings,
almost nine times higher than during training (table 2). This groups from an injury perspective
quadriceps, adductors and calves).2
means that a typical 25-player squad in men’s professional are the adductors and the hip flexors,
A men’s professional football team,
football can expect about six hamstring injuries each season. whereas injuries in other muscles such
typically consisting of a squad of around
Studies incorporating imaging modalities have shown that a as the abdominal, sartorius and tensor
25 players eligible for first team match
clear majority of these injuries involve the long head of the fascia latae muscles are less frequent,or
play, can expect about 16 muscle injuries
biceps femoris, i.e. the typical ‘sprinting injury’.4 5 even rare.11-12 Adductor-related injuries
leading to time-loss each season (table 1).
are the second most common muscle
Other studies on high-level male players have reported injury among men’s professional
MUSCLE GROUP N. OF INJURIES
similar findings as those outlined above.6 7 However, two players representing 23% of all muscle
Hamstring 6 studies on US collegiate players found a lower rate of injuries (figure 1) and 7% of all time-loss
hamstring injuries in female players,8 9 whereas one study on injuries.2 A typical 25-player squad in
Quadriceps 3
Swedish elite players observed no sex-related difference in men’s professional football can therefore
Adductors 3 the rate of hamstring injuries.3 expect about three adductor-related
muscle injuries each season (table 1).
Calf 1-2 CALF MUSCLE INJURIES
MUSCLE GROUP INJURY INCIDENCE MATCH INJURY INCIDENCE < The injury rate during match play is
Table 2
Other Locations 2-3 Muscle injury rate in
more than six times higher than during There is a lack of studies on lower leg
Hamstring 0.4 per 1000 hours 3.7 per 1000 hours
men’s professional training (table 2). Studies involving muscle injuries in football, especially
^ Quadriceps 0.3 per 1000 hours 1.2 per 1000 hours football players imaging modalities have documented in females and in males from non-
Table 1 Average number of muscle injuries in (adapted from
Ekstrand et al.2)
that most of the adductor-related professional settings. However, one
a men’s professional team per season Adductors 0.3 per 1000 hours 2.0 per 1000 hours
(adapted from Ekstrand et al.2) injuries involve the adductor longus.12 13 or two of all muscle injuries incurred
Calf 0.2 per 1000 hours 1.0 per 1000 hours Although less detailed, publications on by a typical 25-player squad in men’s
Muscle injuries also occur at a high rate male sub-elite or amateur players have professional football will be located
among, for example, female elite players reported similar findings on the location to the calf (table 1). In this sample, calf
and male youth academy players.1 3 The and rate of muscle injuries to the hip muscle injuries represented 13% of all
muscle injury spectrum in those cohorts and groin.14 15 muscle injuries (figure 1),and 4% of
is essentially similar to high-level male all time-loss injuries.2 The calf muscle
players, whilst quadriceps injuries may be Finally, substantially less is known about injury rate during match play is almost
more frequent in early adolescence than hip and groin muscle injuries in youths six times higher than during training
in adulthood.1 and in female players, but a recent (table 2). The classical injury involves the
review on 34 epidemiological studies medial gastrocnemius, but less is known
on football players concluded that hip about soleus injuries even though these
and groin injury in general was twice as injuries probably are more frequent than
common in males as in females..16 once thought.17
CHAPTER 1 CHAPTER 1MUSCLE INJURY GUIDE: MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES PLAY FROM MUSCLE INJURIES
1.2.2
EVALUATING THE MUSCLE
INJURY SITUATION IN YOUR
OWN TEAM
— With Alan McCall, Markus Waldén, Martin Hägglund and Ricard Pruna
24 MUSCLE INJURY BURDEN MUSCLE GROUP 1-3 DAYS(%) 4-7 DAYS(%) 8-28 DAYS(%) >28 DAYS(%) < HAMSTRING
HAMSTRING BURDEN < 25
Figure 1
AND SEVERITY
Table 3 QUADRICEPS
QUAD BURDEN
Muscle injury severity Muscle injury burden
Hamstring 13 25 51 11 90,0
ADDUCTOR
ADDUCTER BURDEN in FC Barcelona during
according to lay-off
Injury severity is commonly based on Quadriceps 12 25 48 15 in men’s professional 80,0 CALFBURDEN
CALF nine seasons: (2008/09
football players to 2016/17).
INJURY BURDEN (DAYS LOST PER 1000 HOURS)
the number of days that the player is
(adapted from Ekstrand
unable to train and compete due to Adductors 18 31 41 10 et al.2)
70,0
injury. The average lay-off time due to
Calf 14 25 48 13 60,0
a muscle injury is approximately two
weeks with little variation between 50,0
muscle groups.2 About 10-15% of all 40,0
injuries in the big four muscle groups MUSCLE GROUP INJURY BURDEN (days lost per 1000 h) <
are severe with a lay-off time longer Table 4 30,0
Hamstring 18.2 per 1000 hours Muscle injury burden
than four weeks (table 3). There is a in men’s professional
20,0
tendency that thigh and calf injuries are Quadriceps 10.3 per 1000 hours football players
(adapted from Ekstrand
more severe than hip and groin injuries. et al.19) 10,0
Adductors 8.1 per 1000 hours
Higher grade hamstring injuries, as Calf 6.5 per 1000 hours
0,0
SEASON 1 SEASON 2 SEASON 3 SEASON 4 SEASON 5 SEASON 6 SEASON 7 SEASON 8 SEASON 9
classified on MRI, are associated with
longer lay-off, but there seems to
be no differences in average lay-off
between the three hamstring muscles
MUSCLE INJURY TRENDS
(semimembranosus, semitendinosus
and biceps femoris).18 Two recent studies from the UEFA Elite
EVALUATING YOUR
Club Injury Study have delineated OWN TEAM’S INJURY
The term injury burden is increasingly
used in sports injury surveillance. It is
muscle injury rates over time in men’s
professional football.20 21 In the first
SITUATION
a combined measure of frequency and report on 1614 hamstring injuries in The previous section has evaluated the As an example on why this is
severity and is usually expressed as the 36 clubs between 2001 and 2014, muscle injury situation of professional important, we illustrate in figure 1
number of days lost per 1000 hours. there was an average annual increase football in general, i.e. studies using data the injury burden at FC Barcelona
Since the percentage of injuries in the of 2%,20 and in the second report on from multiple teams and over various over 9 consecutive seasons (2008/09
severity categories and the average 1812 hip and groin injuries in 47 clubs leagues, to highlight specific average to 2016/17). You will see that in line
number of lay-off days are similar between 2001 and 2016, there was, characteristics and trends in injury with the research literature, the
for the big muscle groups, the same in some contrast, an average annual epidemiology. While this information is hamstring injury burden is generally
pattern is seen as for the rates, with decrease of 3% for adductor-related essential to help guide our knowledge the main muscle injury we are faced
hamstring injuries having the highest injuries.21 Up to now, little is known of injury in football and possible with, however, you will also see that
and calf injuries the lowest burden about the injury trends in other cohorts preventative strategies, it is essential that there are differences in the injury
(table 4). or for other muscle groups. you evaluate the injury trends within your burdens of other muscle types. So,
own team, as these can differ between with continual (re) evaluation, it is
and even within seasons. This is a key possible to follow how the burden of
focus to ensure that your evaluation of muscle injuries varies. These insights
the injury problem in your own team then allow us to continually adapt our
is accurate and that the subsequent own preventative strategies to match
strategies implemented in the Team- the most current and relevant injury
Sport Injury Prevention cycle are relevant. situation to our team.
CHAPTER 1 CHAPTER 1MUSCLE INJURY GUIDE: MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES PLAY FROM MUSCLE INJURIES
1.3.1
NON-MODIFIABLE RISK In addition to the literature on senior LEG DOMINANCE
RISK FACTORS AND FACTORS players, recent data from FC Barcelona
Leg dominance in football is usually
indicate that academy players have an
defined as the preferred kicking leg.
MECHANISMS FOR MUSCLE
SEX increased frequency of rectus femoris
Interestingly, both adductor and quadriceps
injuries compared with professional
One study on elite players showed injury rates are higher in the kicking
INJURY IN FOOTBALL
players, whereas the reverse is seen for
a significantly higher rate of muscle leg,18 which probably is due to increased
hamstring injuries.23 No effect of age was,
strains in males compared with exposure of high-risk player actions
however, seen for groin muscle injuries in
females, but no sex-related difference (shooting, passing, crossing, blocking, etc).
— With Markus Waldén, Khatija Bahdur, Matilda Lundblad, Martin Hägglund that study.
for hamstring injuries.12 Similarly, a Conversely, leg dominance has not been
study on collegiate players also found identified as a risk factor for hamstring
a higher rate of muscle strains in injuries18 28 and calf injuries,18 probably due
PREVIOUS INJURY
males, but only during match play.13 to other injury mechanisms involved.
Moreover, studies on collegiate players Previous injury is one of the most
report a lower hamstring injury rate consistent and scientifically best
in female players compared with validated risk factor for muscle injury.1 5 6 PLAYING LEVEL
their male counterparts.14-16 In one of In a large study on male professional
The influence of playing level on the muscle
these studies, male players also had players, previous injury was a significant
injury risk is currently under-studied, but it
a lower recurrence rate than their risk factor (1.4 to 3.1 times higher rate)
has been shown for hamstring injuries that
female counterparts.14 Finally, a recent for all the big four muscle groups
the injury rate is highest and the recurrence
systematic review identified that male of the lower extremities (adductors,
rate is lowest at the highest professional
26 WHY AND HOW DO injuries such as concussions, lateral
players had a more than doubled
aggregated groin injury rate compared
hamstrings, quadriceps and calf
muscles).18 Interestingly, a previous
level.29 The same pattern with higher injury 27
MUSCLE INJURIES ankle sprains and anterior cruciate
ligament injuries. Little is, however,
with female players, although this adductor and calf muscle injury also
rates and lower recurrence rates at the
professional level compared with amateur
OCCUR? known about football-relevant injury
comparison was not done for muscle
injuries exclusively.4 However, this is in
increased the quadriceps injury rate, and
a previous adductor and hamstring injury
level is seen for injuries in general,30 and
mechanisms or playing situations there are therefore good reasons to assume
Most studies on potential risk factors line with recent data showing that both increased the calf muscle injury rate in
leading up to muscle injuries, and that this would be similar also for other
for injury in football have addressed all hip flexor,17 and adductor strain rates that study. Moreover, male elite players
studies in this field are therefore muscle injuries than hamstring injuries.
injuries or injuries to the lower limbs were significantly higher in male players with previous groin and hamstring
urgently needed.
in general and not muscle injuries at the collegiate level.16 17 In summary, strains had seven and twelve times
specifically. There are, however, a the literature on sex as a risk factor for higher odds of sustaining new groin
PLAYING POSITION
number of risk factor studies on football muscle injury in football is somewhat and hamstring strains, respectively.21
players that have targeted hamstring inconclusive, but it appears that male Similarly, previous hamstring injury was Goalkeepers carry a lower injury risk in
injuries,1 whereas risk factor data on RISK FACTORS FOR players have similar or higher groin and associated with a significantly higher general compared with outfield players
quadriceps and calf muscle injuries
in football are scarce.2 3 Also, although
MUSCLE INJURY hamstring muscle injury rates compared
with female players.
hamstring muscle injury rate in another
study on male elite players,22 and in male
and this seems to be the case also for
adductor, hamstring, quadriceps and
there are many studies reporting on Risk factors in football have traditionally amateur players.20 Although not specified calf muscle injuries in male professional
groin injuries among football players,4 been divided into intrinsic (player- for muscle injuries, male amateur players football players.18 28 29 In one of these
the majority of these report on hip related), such as age and sex, and AGE with previous acute groin injury in the studies, it was also shown that forwards
and groin injuries combined and few extrinsic (environmental-related) ones.1 latter cohort had more than doubled had the highest hamstring injury rate of
Age is a frequently studied risk factor
studies on risk factors for groin injury They can, however, also be categorized odds of sustaining future groin injury.24 all player positions.29 Finally, goalkeepers
for injury per se but is also important
in sports have reported data on groin into non-modifiable (unalterable) and also had fewest muscle injuries in a study
to adjust for when analysing other
muscles separately.5 6 potentially modifiable (alterable) factors There are, however, also a few studies on male academy players aged 8-16 years
potential risk factors due to the apparent
which might be more relevant from a showing no association with previous where the highest thigh injury rate was
risk of confounding. The calf muscle
The majority of the studies with risk prevention perspective (table 1). muscle injury. One study on male seen among midfielders.31
injury rate was approximately doubled
factor data on muscle injuries in professional players showed in fact a
in male professional players older
football have been carried out on significantly increased hamstring injury
INJURED TISSUES NON-MODIFIABLE MODIFIABLE < than the average age (>26 years), but
professional or elite male senior players Table 1 rate with no previous injury,25 and two PLAYING ACTIVITY
there was no such age effect with
with considerably less literature on Intrinsic Sex Strength Examples of studies on female players showed no
modifiable and non- adductor, hamstring and quadriceps It is well-known that the injury rate in
female and youth players. The findings association between previous injury
Age Flexibility modifiable risk factors injuries.18 Similar findings were found general is several-fold higher in matches
on suggested risk factors are often for muscle injury and future muscle injury; for thigh
in male elite players where older than during training regardless of the
identical or similar between studies Previous injury Fitness level muscle injuries in youth players,26 and
age (>23 years) was associated with setting and playing level. Muscle injury
but could occasionally be muscle- for hamstring injuries in elite players.27
Leg dominance Psychological factors a significantly higher percentage of rates are also higher, of approximately the
specific or even contradictory. Muscle In summary, a majority of studies have
calf muscle injuries, but again no same magnitude, during match play; the
injuries are, however, unlikely to result Extrinsic Playing level Workload and congestion found previous injury to be a risk factor
association with adductor, hamstring adductor, hamstring, quadriceps and calf
from a single risk factor, but rather as for future muscle injuries even if there
and quadriceps injuries.19 Similarly, muscle injury rates were, for example, 4-9
a consequence of several risk factors Playing position Rules and regulations are a few exceptions.
increasing age was not associated with times higher during match play in male
interacting at the time of the inciting
Playing activity Equipment higher odds of sustaining hamstring professional players.32 A higher match
event.7
injury in male amateur players,20 but injury rate has also been shown in other
Time of season Playing time
was so in two studies on male elite studies on male elite/professional players
In addition to traditional risk factor
Weather conditions Playing surface players.21 22 The literature is also here for groin muscle injuries,21 hamstring
research, there are an emerging
somewhat inconclusive, but it appears muscle injuries,21 28 33-36 and quadriceps
number of studies, mainly using
that increasing age is associated with muscle injuries,34 35 as well as in studies
systematic video analysis, describing
similar or higher muscle injury rates in on male and female players at the
injury mechanisms for typical football
male players. collegiate level.14 15
CHAPTER 1 CHAPTER 1MUSCLE INJURY GUIDE: MUSCLE INJURY GUIDE:
PREVENTION OF AND RETURN TO PREVENTION OF AND RETURN TO
PLAY FROM MUSCLE INJURIES PLAY FROM MUSCLE INJURIES
<
Figure 1 FLEXIBILITY increased the odds for sustaining The influence of congested match
1,6
Seasonal distribution hamstring muscle injury,47 and the total periods on injury rates is another area
of muscle injury in Poor flexibility, sometimes also
hip rotation (internal plus external) of interest. It was recently shown that
1,4 men’s professional described as muscle tightness or
football players was lower in players who sustained high match load in male professional
reduced muscle length, has for long
(adapted from adductor strains compared with players was significantly associated
1,2 Hägglund et al.18) been suggested as a risk factor for
uninjured players.48 Finally, decreased with an increased muscle injury rate
muscle injury, but one of the first
INJURIES PER 1000 HOURS
hip abduction was a risk factor for during match play.56 In that study,
1,0 studies in the field showed that there
sustaining new groin strain in male elite the overall muscle injury rate was
was no difference in range of motion
players.21 In summary, there is some significantly higher in league matches
0,8 between male amateur players with
conflicting evidence on poor flexibility with ≤ 4 recovery days compared with
or without hamstring strains.44 In one
as a risk factor for muscle injuries in ≥ 6 recovery days; significantly higher
0,6 subsequent study on male elite players,
football and further well-designed rates were also identified for hamstring
there was no difference in muscle
studies appears to be needed. and quadriceps injuries, but not for
0,4 tightness between players with and
adductor and calf muscle injuries. This
without muscle strains, but players
tallies with previous findings where
0,2 with previous quadriceps strain had
FITNESS LEVEL the muscle injury rate in a men’s
significantly shorter rectus femoris than
professional team was more than five-
0 those without strains.33 In professional There is emerging evidence that poor
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY fold higher in congested match periods
football, one study showed that male intermittent aerobic fitness is associated
ADDUCTORS HAMSTRINGS QUADRICEPS CALF with two matches per week compared
players with hamstring and quadriceps with an increased odds to sustain
with periods one match per week.57
muscle injuries had lower flexibility in lower limb injuries, especially muscle
Looking at individual player match
28 TIME OF SEASON MODIFIABLE RISK Male amateur players with weak
these muscles than uninjured players,
whereas no difference was seen for
injuries, in male professional players.49
50
Specifically, players with lower
loads, it seems that six days or more 29
For male professional players in teams FACTORS adductor muscles had four-fold
increased odds to sustain a future groin
adductor and gastrocnemius muscle fitness level were unable to tolerate
are needed between match exposures
to reach a baseline level of the muscle
with an autumn spring season, the rates injuries.45 Similarly, male professional acute:chronic workloads of at least
STRENGTH injury.24 In addition, male elite and sub- injury rate.58
of adductor, hamstrings and calf muscle players with hip and knee flexor muscle 1.25 and had a five-fold higher odds to
elite players with ongoing adductor-
injuries are significantly higher during the Muscle weakness and strength strains had significantly lower range sustain a lower limb injury compared
related pain had lower hip adduction
competitive season, whereas the reverse imbalances are frequently suggested of motion in these muscle groups with players on a higher fitness level in
strength compared with asymptomatic RULES AND REGULATIONS
finding for is seen quadriceps muscle risk factors in the sports injury compared with uninjured players.46 one of these studies.49 Future studies in
control players,42 a finding that was
injuries with a higher injury rate during literature. A pioneer study carried out There is also more indirect evidence of this field and on other fitness variables The majority of all muscle injuries (>90%
also seen in male amateur players
the pre-season period (figure 1).18 Another on a mixed cohort of athletes, mainly muscle tightness as a risk factor in a are, however, needed. regardless of muscle group) in male
with current groin pain.43 In the latter
study on male elite players showed that consisting of high-level male football study where hamstring-injured male professional players occurred in non-
study, previous long-standing groin
there was an accumulation of hamstring players, with previous hamstring injury professional players had significantly contact situations with few match-related
pain (>6 weeks) during the preceding PSYCHOLOGICAL FACTORS
injuries in the spring season after the and recurrent strains and discomfort shorter fascicles of the long head of the injuries being the result of foul play in
season was associated with lower hip
winter break.36 Similarly, most thigh muscle showed that muscle strength deficits biceps femoris than uninjured players.40 The literature in this field is still scarce the view of the referee.32 Consequently,
adduction strength.43
injuries in male youth players occurred in were common and that a rehabilitation Moreover, two studies on male compared with studies on physical re-enforcements of the existing rules will
September (after the summer break) and programme with normalisation of professional players have found that factors. A recent cross-sectional study probably have negligible impact on the
There is no published data yet on the
in January (after the winter break).31 the muscle strength reduced the risk found that decreased range of motion of male professional players, however, panorama and burden of muscle injuries.
potential association between muscle
of re-injury.38 Moreover, in a separate in the hip was significantly associated showed that players who had suffered However, as discussed further below,
strength deficits and/or imbalances and
study on male professional players, with muscle injury; lower hip flexion at least three severe (>28 lay-off days) muscle injuries might be associated
future calf muscle injury risk.3
WEATHER CONDITIONS the hamstring muscle injury rate was muscle injuries during their career with fatigue and regulations on reducing
increased four-fold in players with had 2.6 times higher odds of reporting individual playing time and/or increasing
Although insufficiently investigated,
thigh muscle strength imbalances distress than players without previous the recovery window between matches
there are currently no studies indicating
compared with players without any severe muscle injuries.51 might therefore be of value.
that weather conditions, such as air
muscle imbalances.39 Similarly, male
temperature and evaporation, are
professional players with eccentric
associated with increased or decreased WORKLOAD AND CONGESTION EQUIPMENT
hamstring strength asymmetries
muscle injury rates in football. However,
at pre-season had four-fold higher The influence of workload on sports Currently, there are no studies
one study on male professional players
odds of sustaining hamstring strain injury risk has received a lot of interest indicating that any particular
showed no regional differences in
during the following season.25 More in recent years with both high absolute equipment, such as taping or type of
adductor, hamstring, quadriceps and calf
recent research has shown that male and relative loads being associated footwear, are associated with increased
muscle injury rates between teams from
professional players with hamstring with increased injury risk as shown in or decreased muscle injury rates in
northern Europe compared with teams
injury were weaker during eccentric a recent review by the International football.
from southern Europe, indicating that
contractions than uninjured players, Olympic Committee.52 At the time of
weather (and pitch) conditions are not
but between-limb imbalances did the publication of that paper, there
equally important for muscle injuries as
not infer a higher rate of hamstring were only a few studies on workload
perhaps for other injuries such as ligament
injury.40 Conversely, only one of 24 and injuries in football, but thereafter a
sprains and tendinopathies.37
studied muscle strength variables was number of studies on male professional
associated with increased hamstring players have been added; these studies
muscle injury rate in a recent study on show essentially the same findings by
male professional players.41 Similarly, mainly including muscle injuries in their
hamstring strength had no association analyses.49 50 53-55
with future occurrence of hamstring
muscle injury in female elite players.27
CHAPTER 1 CHAPTER 1You can also read
