Thigh muscle injuries occur frequently as a result of contusions, and as muscle strains due to repeated maximal sprints and acceleration. Because football combines maximal sprints with frequent player-to-player contact, it is not surprising that up to 30% of all football injuries are thigh muscle injuries. In fact, results from the elite leagues in England, Iceland and Norway show that hamstring strains are the most common type of injury in men’s football, accounting for between 13% and 17% of all acute injuries. Other studies have shown that muscle contusion injuries to the thigh account for up to 16% of all acute football injuries at the elite level. F-MARC studies have revealed similar results. On average, a male elite-level football team with a squad of 25 players can expect around 18 muscle injuries per season. Of these, seven will affect hamstrings and three will affect quadriceps.1
According to our observations (FC Barcelona, unpublished data) in young players, the most common muscle injury is a tear of the rectus femoris, whereas in professional football players it is the hamstring.
Due to the magnitude of the problem, a need for a better understanding of muscle injuries and their prevention has become an emerging challenge for football clubs.
Hamstring strains occur most often during maximal sprints. This injury mechanism has been called the “high-speed running” mechanism. A second injury type has also been described. This is referred to as a “stretch” injury. This occurs during movements leading to extensive lengthening of the hamstrings, such as high kicking, sliding tackles and sagittal splits. The distinction is important to make as the “stretch” injury may have a more prolonged recovery.2
Strain injuries to the rectus femoris have been less studied but most of them result from kicking the ball. In both situations, athletes will describe a sudden onset of localised, significant pain. The quadriceps is also a common site for a contusion/direct blow injury.
Several risk factors have been proposed for muscle injury. The most compelling risk factor is a past history of injury. Football players with a previous hamstring injury have a seven-times higher risk of injury than players with no injury history. On average, repeat injuries also result in a 30% longer absence from football.3
Age is also an important risk factor for injury. Players under the age of 22 had a significantly lower incidence than players between the ages of 22 and 30 and those over the age of 30.4
Poor strength, hamstring/quadriceps strength-ratio imbalance, poor flexibility, poor warm-up before practice/competition, fatigue, intense periods of training, imperfect core stability, mechanical and anthropometric aspects, and competition against opponents of a higher level have all been identified as possible risk factors for injury.
The main objective in this phase is to restore pain-free motion.
The goal is to remove haematoma and avoid scar tissue formation in the injured area.
Developing strength, improving core stability and adding specific football tasks are key in this third phase.
A very comprehensive revue of the scientific literature ob hamstring Rehab
Exercises in this phase may be useful in removing bleeding residue and avoiding scar tissue formation in the injured area. Massage and various types of electrotherapy may be indicated. The exercise programme should include various stretching, strength, core stability, neuromuscular and functional exercises. The progression is individualised – and guided by pain and function. In general, numerous repetitions and low loads are emphasised early in this phase. Load is gradually increased and the numbers of repetitions decreased. The use of a stationary bicycle or exercise in a pool is a gentle and effective method of increasing mobility.