BackgroundMore than half of the recurrent hamstring injuries occur within the first month after return-to-play (RTP). Although there are numerous studies on RTP, comparisons are hampered by the numerous definitions of RTP used. Moreover, there is no consensus on the criteria used to determine when a person can start playing again. These criteria need to be critically evaluated, in an attempt to reduce recurrence rates and optimize RTP.ObjectiveTo carry out a systematic review of the literature on (1) definitions of RTP used in hamstring research and (2) criteria for RTP after hamstring injuries.Study DesignSystematic review.MethodsSeven databases (PubMed, EMBASE/MEDLINE, CINAHL, PEDro, Cochrane, SPORTDiscus, Scopus) were searched for articles that provided a definition of, or criteria for, RTP after hamstring injury. There were no limitations on the methodological design or quality of articles. Content analysis was used to record and analyze definitions and criteria for RTP after hamstring injury.ResultsTwenty-five papers fulfilled inclusion criteria, of which 13 provided a definition of RTP and 23 described criteria to support the RTP decision. “Reaching the athlete’s pre-injury level” and “being able to perform full sport activities” were the primary content categories used to define RTP. “Absence of pain”, “similar strength”, “similar flexibility”, “medical staff clearance”, and “functional performance” were core themes to describe criteria to support the RTP decision after hamstring injury.ConclusionOnly half of the included studies provided some definition of RTP after hamstring injury, of which reaching the athlete’s pre-injury level and being able to perform full sport activities were the most important. A wide variety of criteria are used to support the RTP decision, none of which have been validated. More research is needed to reach a consensus on the definition of RTP and to provide validated RTP criteria to facilitate hamstring injury management and reduce hamstring injury recurrence.PROSPERO systematic review registration number: CRD42015016510.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-015-0468-7) contains supplementary material, which is available to authorized users.

Background: Plyometric training is a specific form of strength training that is used to improve the physical performance of athletes. An overview of the effects of plyometric training on soccer-specific outcomes in adult male soccer players is not available yet. Purpose: To systematically review and meta-analyze the effects of plyometric training on soccer-specific outcome measures in adult male soccer players and to identify which programs are most effective. Methods: PubMed, Embase/Medline, Cochrane, PEDro, and Scopus were searched. Extensive quality and risk of bias assessments were performed using the Cochrane ROBINS 2.0 for randomized trials. A random effects meta-analysis was performed using Cochrane Review Manager 5.3. Results: Seventeen randomized trials were included in the meta-analysis. The impact of plyometric training on strength, jump height, sprint speed, agility, and endurance was assessed. Only jump height, 20-m sprint speed, and endurance were significantly improved by plyometric training in soccer players. Results of the risk of bias assessment of the included studies resulted in overall scores of some concerns for risk of bias and high risk of bias. Conclusion: This review and meta-analysis showed that plyometric training improved jump height, 20-m sprint speed, and endurance, but not strength, sprint speed over other distances, or agility in male adult soccer players. However, the low quality of the included studies and substantial heterogeneity means that results need to be interpreted with caution. Future high-quality research should indicate whether or not plyometric training can be used to improve soccer-specific outcomes and thereby enhance performance.

BackgroundAlthough the Nordic Hamstring Exercise (NHE) prevents hamstring injury in soccer players effectively, the annual incidence of these injuries still increases. This may be because of poor long‐term compliance with the program. Furthermore, the timing and amplitude of gluteal and core muscle activation seem to play an important role in hamstring injury prevention, the NHE program was not designed to improve activation of these muscles. Therefore, we propose plyometric training as an alternative to reduce hamstring injuries in soccer players.PurposeTo determine the preventive effect of the Bounding Exercise Program (BEP) on hamstring injury incidence and severity in adult male amateur soccer players.Study designA cluster‐Randomized Controlled Trial.MethodsThirty‐two soccer teams competing in the first‐class amateur league were cluster‐randomized into the intervention or control group. Both groups were instructed to perform their regular training program, and the intervention group additionally performed BEP. Information about player characteristics was gathered at baseline and exposure, hamstring injuries and BEP compliance were weekly registered during one season (2016‐2017).ResultsThe data of 400 players were analyzed. In total, 57 players sustained 65 hamstring injuries. The injury incidence was 1.12/1000 hours in the intervention group and 1.39/1000 hours in the control group. There were no statistically significant differences in hamstring injury incidence (OR = 0.89, 95% CI 0.46‐1.75) or severity between the groups (P > 0.48).ConclusionIn this large cluster‐randomized controlled trial, no evidence was found for plyometric training in its current form to reduce hamstring injuries in amateur soccer players.

BackgroundHamstring injuries are the most common muscle injury in amateur and professional soccer. Most hamstring injuries occur in the late swing phase, when the hamstring undergoes a stretch-shortening cycle and the hamstring does a significant amount of eccentric work. The incidence of these injuries has not decreased despite there being effective injury prevention programmes focusing on improving eccentric hamstring strength. As this might be because of poor compliance, a more functional injury prevention exercise programme that focuses on the stretch-shortening cycle might facilitate compliance. In this study, a bounding exercise programme consisting of functional plyometric exercises is being evaluated.MethodsA cluster-randomized controlled trial (RCT). Male amateur soccer teams (players aged 18–45 years) have been randomly allocated to intervention and control groups. Both groups are continuing regular soccer training and the intervention group is additionally performing a 12-week bounding exercise programme (BEP), consisting of a gradual build up and maintenance programme for the entire soccer season. The primary outcome is hamstring injury incidence. Secondary outcome is compliance with the BEP during the soccer season and 3 months thereafter.DiscussionDespite effective hamstring injury prevention programmes, the incidence of these injuries remains high in soccer. As poor compliance with these programmes may be an issue, a new plyometric exercise programme may encourage long-term compliance and is expected to enhance sprinting and jumping performance besides preventing hamstring injuries.Trial registration NTR6129. Retrospectively registered on 1 November 2016.