Managing the return to sport of the elite footballer following semimembranosus reconstruction

Abstract

Hamstring strains are the most common injury in elite football and typically occur during high-speed running. Despite its important contribution to power production in the late swing phase, injury to the semimembranosus (SM) is less common than to the biceps femoris, but may involve the free tendon and depending on the degree of retraction, warrant surgical repair. Few case reports detail clinical reasoning, supported by objective data during rehabilitation in elite footballers, and none have described the return to sport (RTS) process following this type of hamstring injury. In this article, we outline the management and RTS of an English Premier League (EPL) footballer who suffered a high-grade SM proximal tendon tear during training. Due to the degree of retraction of the free tendon, the player underwent surgical reconstruction at the recommendation of an orthopaedic surgeon. Early physiotherapy care, nutritional support, on- and off-pitch injury-specific reconditioning and global athletic development are outlined, alongside strength and power diagnostic and global positioning systems data, assessment of pain, player feedback and MRI informed clinical reasoning and shared decision-making during the RTS process. 18 weeks post-surgery the player returned to team training, transferring to a new club 3 weeks later. 2.5 years post RTS, the player remains free of re-injury playing regularly in the EPL.

Complete Distal Rupture of the Rectus Femoris in an Elite Football Player: A Non-operative Treatment

“…First, we maintained contact avoidance to ensure safe player interaction, initially placing the athlete in controlled and closed situations, and then progressing to open-field situations. After five weeks of training with the team, the athlete reached >90% of his pre-injury-level GPS metrics, including total distance, maximum speed, accelerations, decelerations, high-speed running, and sprint distance [ 3 , 22 , 24 , 25 ].…”

“…We considered the athlete physically and psychologically ready for RTP, 21 weeks after his injury. To date, the criteria for RTT and RTP are not evidence-based, given the widespread lack of consensus on this specific topic, especially at the elite level [ 24 ]. Therefore, we involved the athlete in RTP decision-making, ensuring he was pivotal in the process (Figure 2 ).…”

On-field rehabilitation in football: Current knowledge, applications and future directions

“…Progressing sport-specific physical conditioning, technical skills and movement qualities, practitioners are encouraged to systematically manipulate volume and intensity whilst increasing uncertainty of action. This framework has been applied through a series of elite player case studies including a male tibia-fibula fracture ( 49 ), female ACL reconstruction ( 50 ), and male semimembranosus reconstruction ( 51 ). Whilst the stages remained the same for each case, durations were altered to reflect the specific needs of each injury.…”

Readaptación deportiva y retorno deportivo en el alto rendimiento. Del laboratorio al campo de juego: Una revisión de la literatura

“…Adicionalmente, se realiza el trabajo de entrenar el movimiento para ser eficiente ante movimientos funcionales del deporte que permitan al deportista realizar gestos específicos con mayor movilidad, fuerza, rango de movimiento trabajando la eficiencia del movimiento en patrones y planos específicos del movimiento donde se hace de vital importancia que todo movimiento que sea trabajado en la readaptación deportiva sea funcional, monitorizado, corregido y potencializado (34,65).La monitorización y periodización de la carga es un punto fundamental del proceso donde se controlan las variables del entrenamiento para prevenir la aparición de lesiones adyacentes, dolor, sobrentrenamiento donde por medio de dispositivos como los GPS se realiza control de variables tales como aceleraciones, desaceleraciones, sprint, distancia, carga, salto. velocidad controlada de forma real en campo donde se convierte en un indicativo para todo el cuerpo médico y de readaptación para seguir el proceso del jugador y llevarlo al éxito en el proceso de retorno deportivo (54,66).…”