Researchers Report on Return to Participation After Hamstring Strains Among College Soccer Athletes

Wednesday, July 22, 2015
Dallas, July 22, 2015 – World Cup soccer has made international headlines in recent weeks and with fall sports around the corner, a focus on the sport continues. Soccer players use hamstring muscles to provide speed, quickness and power to navigate field position and increase their intensity of activity. When strains occur, what determines a player’s return to participation (RTP) and what other considerations should be reviewed? A new study that compares RTP time among male and female collegiate soccer players suffering a hamstring strain shows little difference in time though each sex had unique factors that influenced return to play. “Days to Return to Participation after a Hamstrings Strain among Collegiate American Soccer Players” (pdf)appears in the July 2015 Journal of Athletic Training, the scientific publication of the National Athletic Trainers’ Association.
“This is the first study that examined gender differences as they pertain to hamstring strains and return to participation time in the collegiate setting,” said lead author Kevin M. Cross, PhD, ATC, PT, UVA-HealthSouth. “Prior studies have looked at professional soccer players. Our goal was not only to compare RTP time between men and women collegiate soccer players but to analyze the impact of other factors including time of season, practice or competition or the impact that player position had on injury time.”
Data were collected from collegiate teams that voluntarily participated in the National Collegiate Athletic Association Injury Surveillance System. Participants included collegiate soccer athletes who sustained 507 hamstring strains (306 men, 201 women) during the 2004 through 2009 fall seasons. Overall, for male players, 239 strains were first-time injuries and 67 were recurrent injuries; for females, 176 were first-time and 25 recurrent.
Researchers found no differences in the RTP time between the sexes for first-time strains (median for men, 7 days; women, 6 days). For male players with first-time strains, RTP time was increased when the strain occurred during competition rather than practice (9 days versus 6); during the in-season/post-season rather than the preseason (7 versus 5 days) and varied depending on the division of play (Division I athletes required 8 days for RTP versus Division II, 6 days or Division III, 5 days).
Among female players with first-time strains, researchers found no differences in RTP time when other factors were considered. For male players with recurrent hamstring strains, the RTP time was longer when the injury occurred during the in-season/post-season (11 days versus 7.5 days). Among female players with recurrent strains, RTP time was longer for forwards (11 days) than midfielders (2 days) or defenders (4 days).
“We used return to participation as a marker for the severity of the injury, while also noting there are other factors that may affect duration of time missed, such as the intrinsic motivation of the athletes, sociocultural influences and the values and beliefs of those involved in the decision making process,” added Cross.
Given heightened intensity of play during the in- and post-season, longer RTP times may be expected, especially among those who have had prior strains. Increased volume of high intensity activities and speed of activity may be other factors. Those individuals with recurrent injuries may have unresolved impairments that continue to influence RTP for an undetermined period of time.
“Athletic trainers must ensure that the athletes have been rehabilitated properly just before being released to play to be certain they are fully ready to participate in practices and competition and meet the requirement of both the sport and player position,” noted Cross.
The study findings offer insight into the clinical implications for preventive programs and rehab programs after hamstring strains. Most strains resulted from noncontact causes and most occurred during running activities. Training, for example, should emphasize repeated high-intensity and sprinting activities.
Additionally, the authors found that fatigue is a major factor for athletes susceptible to hamstring strains and especially during competition. Player position is also important. Male forwards have a longer RTP time than players at other positions. The specific player position was more pronounced among female athletes with recurrent injuries, and female forwards required a longer RTP than midfielders and defenders.
“Multiple factors may influence the RTP time after an injury,” Cross concluded. “Our findings may help to shape appropriate strategies to prevent injury in the first place or to rehab the injury for efficient and effective return to participation. Prevention programs to reduce the incidence and severity of hamstring strains should focus on sport-specific training and position-specific training to replicate the demands of participation.”
About NATA: National Athletic Trainers’ Association (NATA) – Health Care for Life & Sport
Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers' Association represents and supports 39,000 members of the athletic training profession.