Hans-Wilhelm Müller-Wohlfahrt’s research while affiliated with Cyberknife Center Munich and other places

Muscle injuries are very frequent in football. The primary goal of every rehabilitation is a safe RTP with a minimal risk of reinjury. The biology of tissue healing as a gradual process has to be respected during rehabilitation. Thus, different absence times are needed depending on injury type and the size of the tissue defect to restore the function and load-bearing capacity of the muscle. Exercises for neuromuscular function, core-strengthening and proprioception should be included into a rehabilitation programme.

Muscle injuries are frequent and represent one of the most substantial medical problems in professional football. They can have both traumatic and overuse causes with direct practical consequence due to differences in terms of the post-primary care regimen and prognosis. An accurate diagnosis is the first step towards a specific treatment and usually allows to predict return to play (RTP). Current treatment principles have no firm scientific basis; they are practiced largely as empirical medicine due to a lack of prospective randomised studies. Immediate treatment usually follows the PRICE-principle (protection, rest, ice, compression, elevation). Depending on the type of the muscle injury, specific physical and physiotherapeutical procedures as well as rehabilitative exercises and gradual training therapy are used to recondition the injured structure, to restore coordination and proprioception, and to normalise movement patterns. Injection therapy with various substances is frequently used, with positive results empirically, but evidence in form of prospective randomised studies is lacking. A precise rehabilitation plan should be developed for every muscle injury, including recommendations for sport-specific training with increasing intensity. Since there are no guidelines regarding safe RTP, regular follow-up examinations on the current muscle status are crucial to evaluate the progress made in terms of healing and to determine when the injured muscle can be exposed to the next step of load. This narrative review describes the various factors that a medical team should consider during assessment, treatment and rehabilitation of a muscle injury with particular focus on professional football.

To assess the outcome of nonoperative treatment after complete avulsion of the proximal adductor longus tendon in high-performance athletes. Six consecutive athletes were included. Treatment was conservative following a strict rehabilitation plan. Following parameters were analysed: basic data, mechanism of injury, classification, tendon retraction, size of defect in MRI and return to play (RTP). Mean age at injury was 28 ± 5 (range 20-32) years. Overstretch (83 %) and kicking (50 %) were the most frequent injury mechanisms, and the dominant leg was involved in 83 %. Average retraction of the avulsed tendon amounted 21 ± 5 mm. Follow-up MRIs demonstrated a gradual reattachment of the tendon in all cases. All athletes returned to full sportive activity on preinjury level within 88.7 ± 12.8 (range 75-110) days with no functional deficiencies. Manual muscle strength was equal to the contralateral side. Nonoperative treatment with a healing phase and a strict rehabilitation plan results in a functional, efficient reattachment of the tendon and allows unrestricted RTP. Since these injuries are rare, present study may help sports physicians when dealing with this type of injuries in professional athletes. Return to sports can be expected at approximately 13 weeks after injury, but can take even longer. Case series, Level IV.

Data regarding direct athletic muscle injuries (caused by a direct blunt or sharp external force) compared to indirect ones (without the influence of a direct external trauma) are missing in the current literature-this distinction has clinical implications. To compare incidence, duration of absence and characteristics of indirect and direct anterior (quadriceps) and posterior thigh (hamstring) muscle injuries. 30 football teams and 1981 players were followed prospectively from 2001 until 2013. The team medical staff recorded individual player exposure and time-loss injuries. Muscle injuries were defined as indirect or direct according to their injury mechanism. In total, 2287 thigh muscle injuries were found, representing 25% of all injuries. Two thousand and three were valid for further analysis, of which 88% were indirect and 12% direct. The incidence was eight times higher for indirect injuries (1.48/1000 h) compared to direct muscle injuries (0.19/1000 h) (p<0.01). Indirect muscle injuries caused 19% of total absence, and direct injuries 1%. The mean lay-off time for indirect injuries amounted to 18.5 days and differed significantly from direct injuries which accounted for 7 days (p<0.001). 60% of indirect injuries and 76% of direct injuries occurred in match situations. Foul play was involved in 7% of all thigh muscle injuries, as well as in 2% of indirect injuries and 42% of direct injuries. Muscle anterior and posterior thigh injuries in elite football are more frequent than have been previously described. Direct injuries causing time loss are less frequent than indirect ones, and players can usually return to full activity in under half the average time for an indirect injury. Foul play is involved in 7.5% of all thigh muscle injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.