Return-to-play criteria for hamstring injuries in elite European football: a survey of current practice.

The study aimed to describe which criteria are used by medical and performance practitioners in elite European football to progress players through different stages of rehabilitation following a hamstring strain injury. Practitioners from European football clubs from five first-division leagues (Bundesliga, La Liga, Ligue 1, Premier League, Serie A) were invited to participate in an online survey developed in English using the online software QuestionPro. The survey was divided into two parts: part one (six questions) aimed to analyse demographic and job roles; part two (six questions) presented two clinical cases. In total, 25 surveys were completed. The participants were asked to rate on a Likert scale from "Not important" to "Very important" the following criteria for the Return-to-high-speed-running, Return-to-training and Return-to-performance phases: Time since injury, Absence of pain, Hamstring flexibility, Askling H-Test, Negative Magnetic Resonance Imaging (MRI) (injury fully healed), Psychological readiness, Isometric strength, Eccentric strength (Nordics test), Isokinetic test, Single leg bridge (maximal number of repetitions), Jump tests, Completion of progressive on-field exposure (internal and external training load), Ability to run at maximal speed, Repeated sprint ability test, Global Position System (GPS) metrics equivalent to match requirements. We found that practitioners used a variety of criteria across the different stages. This heterogeneity highlights the need for a multidisciplinary approach to return-to-play (RTP) decision-making across all the phases, especially when rehabilitating an intramuscular hamstring tendon injury. Overall, the practitioners felt the need for a greater number and higher specificity of tests during the rehabilitation progression for the intramuscular tendon than the myotendinous junction injury.