A multifactorial, criteria-based progressive algorithm for hamstring injury treatment

Abstract

Introduction: Given the prevalence of hamstring injuries in football, a rehabilitation program that effectively promotes muscle tissue repair and functional recovery is paramount to minimize re-injury risk and optimize player performance and availability. Purpose: To assess the concurrent effectiveness of administering an individualized and multifactorial criteria-based algorithm (RA) on hamstring injury rehabilitation in comparison to employing a general rehabilitation protocol (RP). Methods: Implementing a double-blind randomised controlled trial approach, two equal groups of 24 football players (48 total) completed either an RA group or a validated RP group five days following an acute hamstring injury. Results: Within 6 months after return to sport, 6 hamstring re-injuries occurred in RP versus 1 in RA [relative risk = 6 (90% confidence interval: 1-35); clinical inference: very likely beneficial effect]. The average duration of return to sport was possibly quicker (ES=0.34±0.42) in RP (23.2±11.7 days) than in RA (25.5±7.8 days) (-13.8%, 90%CI: -34.0 to 3.4%; clinical inference: possibly small effect). At the time to return to sport, RA players showed substantially better 10-m time, maximal sprinting speed as well as greater mechanical variables related to speed (i.e., maximum theoretical speed and maximal horizontal power) than the RP. Conclusions: Although return to sport was slower, male football players who underwent an individualized, multifactorial, criteria-based algorithm with a performance- and primary risk factor-oriented training program from the early stages of the process markedly decreased the risk of re-injury compared to a general protocol where long length strength training exercises were prioritized.