Italian consensus statement (2020) on return to play after lower limb muscle injury in football (soccer)

Abstract

Return to play (RTP) decisions in football are currently based on expert opinion. No consensus guideline has been published to demonstrate an evidence-based decision-making process in football (soccer). Our aim was to provide a framework for evidence-based decision-making in RTP following lower limb muscle injuries sustained in football. A 1-day consensus meeting was held in Milan, on 31 August 2018, involving 66 national and international experts from various academic backgrounds. A narrative review of the current evidence for RTP decision-making in football was provided to delegates. Assembled experts came to a consensus on the best practice for managing RTP following lower limb muscle injuries via the Delphi process. Consensus was reached on (1) the definitions of ‘return to training’ and ‘return to play’ in football. We agreed on ‘return to training’ and RTP in football, the appropriate use of clinical and imaging assessments, and laboratory and field tests for return to training following lower limb muscle injury, and identified objective criteria for RTP based on global positioning system technology. Level of evidence IV, grade of recommendation D.

Indirect Structural Muscle Injuries of Lower Limb: Rehabilitation and Therapeutic Exercise

“…There are no validated imaging criteria to guide the decision of a safe RTP. To date, no study has suggested US to guide the RTP decision, but a few studies have focused on MRI following hamstring injury [ 101 , 102 , 103 , 104 ]. Normalization of increased signal intensities on MRI is therefore not required for a successful RTP, since the signal alterations also persist at different weeks after the clinical healing of the injury, suggesting that functional recovery advances structural recovery at imaging [ 9 ].…”

“…The RTT process should be as individualized as possible, to allow a safe and fast return after a muscle injury. Regarding this point, the Italian consensus conference gave useful advice [ 101 ]. General assessment about this process is made up of some key points: absence of clinical symptoms [ 105 , 106 , 107 ]; absence of pain or tenderness during muscle palpation [ 10 , 107 , 108 , 109 ]; absence of pain on passive and active stretching [ 110 ]; absence of pain on isometric, concentric and eccentric contraction [ 10 ]; completion of the prescribed rehabilitation program [ 108 ]; MRI and US imaging [ 111 , 112 ]; subjective feelings of the player taken into account [ 113 , 114 , 115 ].…”

“…Furthermore, an evaluation of aerobic capacity is recommended. A VO2 max equal to at least 90% of their preinjury level seems to offer more guarantees for a safer RTP [ 101 ].…”

Ultrasound Imaging in Sport-Related Muscle Injuries: Pitfalls and Opportunities

“…The risk of occurrence of this lesion is mostly observed in sports requiring maximal contractions, such as soccer and track and field. In these sports, muscle injury mainly affects biarticular muscles, in particular those with high percentage of fast-twitch fibers [2,4]. Soleus-gastrocnemius lesions are the most common muscle injuries in high-speed running, although in other sports (i.e., soccer) hamstrings and the rectus femoris are most involved [4].…”

Role of ultrasound and magnetic resonance imaging in the prognosis and classification of muscle injuries in professional football players: correlation between imaging and return to sport time

“…At the present time, there are several studies in the literature which try to identify if any radiological parameter can correlate with the recovery time [9][10][11][12][13][14].…”