A Multifactorial, Criteria-based Progressive Algorithm for Hamstring Injury Treatment

Med Sci Sports Exerc. 2017 Jul;49(7):1482-1492. doi: 10.1249/MSS.0000000000001241.


Introduction: Given the prevalence of hamstring injuries in football, a rehabilitation program that effectively promotes muscle tissue repair and functional recovery is paramount to minimize reinjury risk and optimize player performance and availability.

Purpose: This study aimed to assess the concurrent effectiveness of administering an individualized and multifactorial criteria-based algorithm (rehabilitation algorithm [RA]) on hamstring injury rehabilitation in comparison with using a general rehabilitation protocol (RP).

Methods: Implementing a double-blind randomized controlled trial approach, two equal groups of 24 football players (48 total) completed either an RA group or a validated RP group 5 d after an acute hamstring injury.

Results: Within 6 months after return to sport, six hamstring reinjuries occurred in RP versus one injury in RA (relative risk = 6, 90% confidence interval = 1-35; clinical inference: very likely beneficial effect). The average duration of return to sport was possibly quicker (effect size = 0.34 ± 0.42) in RP (23.2 ± 11.7 d) compared with RA (25.5 ± 7.8 d) (-13.8%, 90% confidence interval = -34.0% to 3.4%; clinical inference: possibly small effect). At the time to return to sport, RA players showed substantially better 10-m time, maximal sprinting speed, and greater mechanical variables related to speed (i.e., maximum theoretical speed and maximal horizontal power) than the RP.

Conclusions: Although return to sport was slower, male football players who underwent an individualized, multifactorial, criteria-based algorithm with a performance- and primary risk factor-oriented training program from the early stages of the process markedly decreased the risk of reinjury compared with a general protocol where long-length strength training exercises were prioritized.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Algorithms*
  • Athletic Injuries / rehabilitation
  • Athletic Performance / physiology
  • Double-Blind Method
  • Hamstring Muscles / injuries*
  • Humans
  • Male
  • Recovery of Function
  • Recurrence
  • Return to Sport
  • Risk Factors
  • Soccer / injuries*
  • Time Factors