Thursday, 2 April 2015

Return to Play Predictors for Hamstring Strains

Not sure where I found this, but it adds another dimension to the return to play discussion.

The following have been found to be significant predictors of length of recovery:

 Higher V.A.S at the Time of Injury: high correlation (r=0.77) between pain, measured by visual analog scale, and days lost from competition. Interestingly, in this study pain was a more accurate prognostic indicator than clinician’s assessment.

Recent Past History of Hamstring Injury (Within 12 Months): within the last 12 months were 4.2 times more likely to take greater than 3 weeks to return to play.

Time to Walk Pain Free: athletes that took longer than 24 hours to walk pain-free with a normal gait pattern where 4 times more likely to take longer than 3 weeks to return to play than those who did not.

Location of Strain (Medial vs. Lateral): site of injury i.e. biceps femoris, was a significant predictor of longer recovery time. Biceps femoris strains being 2.3 times more likely to take longer than 3 weeks to recovery.

Wednesday, 1 April 2015

Return to play strategies for sports injuries

I was doing a bit of research about assessing players for return to play after injury and came across an article from the Clinical Journal of Sports Medicine in 2005 looking at return to play after muscles strains. In my first year as a therapist with a local rugby club I've found myself having to deal with muscle injuries and helping a player decide when they are ready to return to play.

Every player and every injury is subtly different, but there are of course some general principles that apply. Normally I assess muscle strength and pain-free ROM as the basic tools for the decision. Of course some players make their own decisions, as do many athletes!

The approach you take to return to play strategies will broadly speaking be either a conservative approach, i.e. erring on the side of caution to avoid recurrence of the injury, or looking for an earlier return without being reckless. The paper I was reading provided a table looking at the factors that could affect early return or a more cautious approach.

Factors Indicating a More Conservative Approach
Factors That May Allow More Rapid Return to Play
Persisting strength deficit
Strength equal to uninjured side
Persisting flexibility deficit
Flexibility equal to uninjured side
Inability to complete full training without pain or limping
Ability to do all functional activities at training
Large area of abnormal signal on imaging
Normal ultrasound and/or MRI scan
100-m sprinter or team player in high-risk position (Australian footballer, rugby outside back, wide receiver, outfield soccer player)
Team sport player in low-risk position (e.g., offensive lineman, goalkeeper, rugby forward, basketball player)
Older player
Younger player (but with experience of playing with injury)
Early stage of season
Playoff or must-win game with no adequate replacement player
Strain in high-risk location (biceps femoris, central tendon of rectus femoris, medial head of gastrocnemius, adductor longus or magnus)
Strain in low-risk location (semimembranosus, vastus muscles, lateral head of gastrocnemius, gluteal muscles)

Some of the points are quite interesting. For example, the difference of approach depending on the position in a team setting, or the location of the strain.

The table suggests that simply taking into account strength, flexibility and functional activity should not be the only things to consider. 

As a therapist I'm often under pressure from both the player and coach to pass them fit as soon as possible, but this table gives some weight to choosing to be more conservative when other criteria are applied.

I found the original article here: Return to play following muscles strain