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Clinical Practice Guidelines for Muscle Injury
FC Barcelona and Aspetar Experience
http://muscletechnetwork.org/proyectos-id/publicaciones/
Clinical Practice Guidelines

for Muscle Injury
(2009)

for Muscle Injury
(2015)

for Muscle Injury
(2018)
Previous consensus
(2017)
XXIV International Conference on Sports Rehabilitation and Traumatology

Clinical Practice Guidelines for Muscle Injury, FC Barcelona Aspetar
11th-12th April, 2015 - London
(UCL Elite Club Injury Study. 2013/2014 Season Report)

70%
FCB 1st Team

FCB Academy
60%
61%
50%
43%
40%
32%
28%
30%
25%
20%
11%
10%
0%
Quadriceps
Adductor
Hamstrings

CONTENTS
1. Muscle injuries classification
2. Diagnosis and management of muscular injuries
3. Algorithm of rehabilitation
4. Return to play criteria

5. Primary and secondary prevention


Introduction
Several grading and classification systems for muscle
injuries have been published; indeed, no validated
classification system exists.
To classify is necessary to have good epidemiological
data, which are basic to find the best therapeutic
option for an injury/disease.

The Proposal
In our opinion the evaluation of the amount of extracellular matrix
(ECM) damaged and its impact in force generation and transmission is
a key factor in muscle injuries clinics and prognosis; therefore the
classification is based on this concept.
We reviewed the literature to select and organize the knowledge
about muscle injuries:
Mechanism.
Clinic and imaging prognosis factors.
Injury relation with MTJ and amount of connective tissue damage (indeed of
function).
Evolution in time.
We organize and resume this concept in a 4 letters acronym structure.

Muscle Injury Mechanism

1. Direct injuries:
Located in the place of the trauma.
Size is not well correlated with the functional
impairment.
Different clinical evolution than indirect injuries
(shorter time loss).
2. Indirect muscle injuries are located close

to a myotendinous junction (MTJ).
Lee J, Mitchell A, and Healy J. Imaging of muscle injury in the elite athlete. British Journal of Radiology 85: 1173-1185, 2012.
Thorsson O, Lilja B, Nilsson P, and Westlin N. Immediate external compression in the management of an acute muscle injury. Scandinavian journal of medicine & science in sports 7: 182-190,
1997.
Garrett WE, Nikolaou PK, Ribbeck BM, Glisson RR, and Seaber AV. The effect of muscle architecture on the biomechanical failure properties of skeletal muscle under passive extension. The
American journal of sports medicine 16: 7-12, 1988.

Extracellular matrix (ECM) damage

The evaluation of the amount/severity of ECM damaged is
done trough:
Muscle injury relation with the MTJ (proximal or distal).
% CSA as reflection of the amount of ECM damaged.
If there is tendon gap/retraction/loss of tension.
Structure and function of the skeletal muscle extracellular matrix Gillies 2011
Mechanism
Location
Grade
Re-injury

Mechanism
It describes the mechanism of injury, which could be a
direct blow or an indirect strain:
Direct injuries
Indirect injuries

Location for direct injuries

Is a lowercase regarding the anatomical location:
p
injuries located at the proximal third.
injuries located at the middle third.
injuries located at the distal third.

Location for indirect injuries

Is a capital letter followed or not by a lowercase regarding the
Location.
It describes the connective tissue damage location, tendon or MTJ.

J
for the injuries at the MTJ.
for injuries affecting the tendon: gap/retraction/loss of tension.
After the T and J, as a sub-index, the proximal and distal location must be
specified (p for proximal and d for the distal).
Grade
Is a number from 0 to 4 regarding the Grade. MRI based, is referred to the
percentage of the cross sectional area (% CSA) of the affected muscle to total
muscle belly, in the axial plane where the injury is greater.
The affected area is considered where there is a hyper-signal change on fat
suppressed/STIR images.
If more than one muscle is injured, the muscle with the greater area of signal
abnormality or architectural distortion will be considered the primary site of
injury and the grading criteria will be taken for that particular muscle.

Grade
0 Grade 0:
1 Grade 1:
2 Grade 2:
3 Grade 3:
4 Grade 4:
clinical suspicion of muscle injury with negative MRI.

10% of CSA.
11-25% of CSA.
26-49% of CSA.
50% of CSA.
In the future, the architectural distortion, more than the oedema, should
be the key in the imaging evaluation to grade the muscle injuries.

Re-injury
Describes the injury chronology (first episode or a re-injury):
R0: First episode,
R1: First re-injury, R2: Second re-injury and so on.
A re-injury is defined as injury of the same type and at the same site as an index
injury occurring no more than 2 months after a players return to full
participation from the index injury (Ekstrand 2011).
If during the two months period after the RTP a new injury occur in the same
muscle but in a different location, it will also considered a re-injury.

Proposal
Mechanism
Location
Grade
Reinjury
D p proximal third direct injury
D (direct)
D m medial third direct injury

D d distal third direct injury
I T p proximal tendon injury
I T d distal tendon injury
0
1
2
3
4
negative MRI
< 10 % CSA
11 25 % CSA
26 49 % CSA
>50 % CSA
R0 1st episode
R1 1st reinjury
R2 2nd reinjury
..and so on.
I (indirect)
I J p proximal MTJ injury
I J d distal MTJ injury

Direct Injuries Codification

A
Direct injury located in A:

D-p-G-R0
Direct injury located in B:

D-m-G-R0
C
Direct injury located in C:

D-d-G-R0

Indirect Injuries Codification

Indirect injury located in A:
A
B
I-Jp-G-R
Indirect injury located in B:

I-Jd-G-R

Indirect Injuries
Codification
I-Tp-G-R

Take home messages

1. With an acronym we can describe the injury.
2. Allows communication among medical staff.
3. Flexible structure allowing to incorporate

knowledge in the future.
4. Easy to use.


Background
Most of them are treated non-surgically.
The clinical appearance is not always clear.
Determining the optimal treatment for any injury can be difficult.
NEEDS
Detailed history of the patient and about the injury mechanism.
Careful examination.
Imaging diagnosis:
Magnetic Resonance Imaging (MRI)
Ultrasound (US)
Critical goal is to differentiate between those patients with injuries possibly
requiring surgical treatment from patients with non-surgical injuries

1. Appropriate history
About the player:
Similar injuries before?
Medications?
Susceptibility
About the mechanism of injury:
Direct blow or indirect strain?
During training or competition?
When and how did it start?
About the initial progress:
Stop or continue playing?
Normal walk without pain?

2. Physical exam
Looking for asymmetries.
Pain.
Colour.
Muscle belly shape.
Strength.
ROM without pain.
The athlete is unable to walk at a normal pain-free pace.
BF injury is more painful during stretching than contraction while a injury in
SM or ST will have more pain during contraction than during stretching.

3. Imaging of muscle injury
RX: limited value unless an avulsion fracture with bony fragment or apophyseal
fracture in a skeletally immature individual.
US and MRI:
Describe the location (which muscle and tissue).
The lesion size.
The lesion nature (oedema/haemorrhage) by echotexture (US) and signal
intensity (MRI)
3.1 Ultrasound
Cost effective.
Radiologist experience dependent.
Dynamic and interactive process
allowing echopalpation of painful
areas.
It enables progress monitoring.
Guide the evacuation of fluid
collections.
Useful in distal hamstring injuries
(superficial anatomy).

3.2 Magnetic resonance imaging

To evaluate the involvement of tendons, fascia
and contractile tissue.
Routine MRI protocol:
At least two orthogonal planes (axial,
coronal or sagital) and one of two pulse
sequences (STIR or T2 fat sat).
Restricted in routine assessment of injuries
(limited availability and high costs).
Its utilization in prognosis of return to play is
controversial.

MRI advantages
To measure the size of injury (length

and cross-sectional area).
Proximal hamstring injuries.
Groin area injuries.
In assessing the tendon retraction
(preoperative planning).
In highlighting subtle edema.
In evaluating injuries to deep injuries
of muscles.
In evaluating injuries when a previous
injury is present (residual scarring).
Discovering concomitant image.

Management of a muscle injury

Immediate
Initial
acute
phase
Subacute
and
functional
phase
Clinical
history
Physical
exam
US
12 hours
24 hours
48 hours
1st week
Weekly
Return to
play
Monitorize
players
feelings
MRI
Treatment
Could be
made
anytime
Rest
Ice
Compression
Elevation
Analgesia
Functional
tests
To evaluate
how the
progression of
loads are
assumed
Rehabilitatio
n
progressive
protocol
For follow-up the functional recovery and sometimes to help to decide return to play:
Muscle: Tensiomyography, electromyography and strength tests.
Player: GPS, HR and self administered scales during and after the rehabilitation sessions on field.
Surgical treatment
Muscle injuries heal conservatively.
Indications of surgical treatment:
Total or subtotal (>50%) rupture with few or no agonist muscles.
Large intramuscular hematoma.
Complains of chronic pain (>4-6 months) in a previously injured muscle,
specially with ROM deficit.
Surgical procedure:
Anatomic restoration when is possible.
Surgical release of adhesions from the nerve and scar debridement in
chronic cases.

Bony avulsions
Muscle
Part of muscle
Tendon
Treatment
Proximal
ASIS
AIIS
Conservative; unless > 2cm
Distal
Patellar avulsion
Surgical; (except non

displaced)
Proximal
Ischial tuberosity
Gap < 2cm conservative

Bigger gaps: surgical
Distal
All (rare)
( BF SM )
Surgical reattachment must

be considered
Quadriceps
Hamstrings

Proximal
Rectus femoris
Distal

Tendon-bone disinsertions
Muscle
Quadriceps
Localization
Rectus Femoris
Proximal
Tendon
Treatment
Direct head
Surgical reattachment
Indirect head
Little gap: Conservative

Big gap: Surgical
Direct + Indirect head
Surgical
Biceps Femoris Long Head

and/or Semitendinosus
Surgical
Semimembranosus
Conservative.
If there were symptoms after 4
months: surgical reattachment
must be considered
All (rare)
Surgical reattachment must be

considered
Proximal
Hamstrings
Distal

Ischion
Central
Tendon

Reattached

New surgical indication for hamstring?
Long recovery times.

Worse results.
Biceps femoris 45%
Recurrent injury.
Comin J, Malliaras P, Baquie P, Barbour T, Connell D.
Return to competitive play after hamstring injuries
involving disruption of the central tendon. Am J Sports
Med. 2013;41(1):111-115.

Proximal end
of Central
Tendon
PROXIMAL
DISTAL
Distal end
of Central
Tendon

Central Tendon injuries

MTJ injuries, when the Central Rectus Femoris Tendon or Common
Hamstring Tendon is involved with loss of tension
Muscle
Part of muscle-tendon
Treatment
< 2 cm from bone insertion
Reattachment to the
bone and reduce
tension at MTJ
More than 2 cm to bone

insertion
Surgical treatment:
Anatomical repair
with minimally
invasive approach
Quadriceps
and
Hamstrings

Take home messages

1. Clinical expertise in muscle injuries.
2. US and MRI to confirm diagnosis.
3. Surgical treatment when tendon is
affected.

Rehabilitation Program
LITERATURE
SEARCH
SCIENTIFIC
EVIDENCE
CONSENSUS
THERAPEUTIC
EXPERIENCE

Proposal of Algorithm
ALL PARAMETERS
DIAGNOSTIC PHASE
AND CONTROL TEST
ACUTE PHASE
SUBACUTE PHASE
FUNCTIONAL PHASE
DESTRUCTION
REPAIR
REMODELLING
PHASE TO RTP
PHISICAL THERAPY
MANUAL THERAPY
FLEXIBILITY AND ROM
PROPIOCEPTION
CORE
NEUROM-CONTROL
POWER
FITNESS
STRENGTH
PAIN/FATIGUE
BIOMECANICHS
IMAGE

Progression of exercises

Algorithm of Rhb
Goals
Criteria
Validation Test
Goals
Criteria
Validation Test
RTP
Goals
Criteria
Validation Test
DIAGNOSTIC PHASE
INJURY
Diagnostic Phase
ANAMNESIS (Injury analysis, antecedents,...)

COMPLEMENTARY PROOFS (RN, ECO, ...)
GENERAL TESTS (Assessment muscular, articular,...)
SPECIFIC TESTS (types of pain, localisation, function)
PSICOLOGIC SUPPORT OF PLAYER
DIFFERENTIAL DIAGNOSTIC
FINAL DIAGNOSTIC
INJURY !!!
PRESSION (together with Cryotherapy 3 times/day, every 3h, 20-30)

REST (sporting, not total)
ICE (Cryotherapy 3 times/day, every 3h., 20-30)
IMMOBILISATION (3-4 days, every 3-4h, between 15-20)
ELEVATION (upper the heart level and different positions)
Kerkhoffs, G., et al. "Diagnosis and prognosis of acute hamstring injuries in athletes, 2013
Algorithm of Rhb
Goals
Criteria
Validation Test
Goals
Criteria
Validation Test
RTP
Goals
Criteria
Validation Test
DIAGNOSTIC PHASE
INJURY
Acute Phase

Goals and Criteria

Acute Phase
- NO PAIN or discomfort during exercises
- During exercises to maintain neutral spine in static position to Bosu or Board
- To work from Low to Moderate Intensity
- Isometric knee flexion 15, decubitus prono (ISOM)/(CONC)/(ECC)
- Work with flexion knee to 45 and hip 0>50% (CKC) / (OKC)
- Uninjured leg (dynamometer or similar 50%.)
- (SBET) with 30 Flexion Knee +(SLS) +(ESH) <70 avoiding pain
- Walk/Run to treadmill until 70% -3% (ESH) decrease
CKC: Close Kinetic Chain, OKC: Open Kinetic Chain, ISOM: Isometric, CONC: Concentric, ECC: Eccentric, ROM: Range of Motion; ESH
(Elongation Stress on Hamstrings.). DST: (Deep squat test). SLS: Single leg squat. RPT: Runner post test. AKET: Active Knee Ext Test:

Algorithm of Rhb
Goals
Criteria
Validation Test
Goals
Criteria
Validation Test
RTP
Goals
Criteria
Validation Test
DIAGNOSTIC PHASE
INJURY
Subacute Phase

Goals and Criteria

Subacute Phase
- NO PAIN or discomfort during exercises.
- Not tilting the pelvis or flattening the spine during dynamic exercises
- To work from Moderate to High Intensity
- Isometric knee flexion strength decubitus supine knee flexion 25
- hip flexion 45, less than 10% asymmetry (OKC)/(CKC)
- Work uninjured leg (dynamometer or similar 70%.)
- Isometric hip extension strength, knee 0, Hip 70 less than 10%
- (ESH) Stretch < 70 +(SLS) +(DST) painless
- Start Walking on the treadmill to <8 km/h 5% (ESH)

Algorithm of Rhb
Goals
Criteria
Validation Test
Goals
Criteria
Validation Test
RTP
Goals
Criteria
Validation Test
DIAGNOSTIC PHASE
INJURY
Functional Phase

Goals and Criteria

Functional Phase
- No PAIN or discomfort during exercises.
- Correct spine control and strength transfer during exercises
- To work from High to Explosive Intensity
- Integrate strength, neuromuscular and proprioceptive work
- Achieved in contralateral leg no asymmetry (dynamometer/encoder 100%)
- Uninjured leg (Encoder or isokinetic 100%.)
- Isokinetic criteria: We should avoid differences higher than 20%
- (RPT)+(AHFT)+(AKET) No asymmetry
- Test of the feed and games

Algorithm of Rhb
Goals
Criteria
Validation Test
Goals
Criteria
Validation Test
RTP
Goals
Criteria
Validation Test
DIAGNOSTIC PHASE
INJURY
Criteria-based progression
Development of an approach

0%
On-field
Physio
100%

Physio
Stage 1
Stage 2
On-field
Stage 3
Painless single leg squat

Painless bike 150W, 5 mins
Full knee Ext supine
Run > 70%

ROM SLR & HS > 75%
100% running
Painless direction change
Stage 4
Stage 5
Stage 6
Light Football Training

Session
In-between Football
Training Session
Heavy Football Training

Session

Passive
movement
Massage no
pain
Massage discomfort
Active range of
motion
Eccentric outer
range
Slow run
Concentric
through range
Fast run
Eccentric inner
range
Outer range
ballistic

Painless bike 1.5*BW, 5 mins
Direction change
Isometric inner
range
Run > 70%

ROM SLR & HS > 75%
Stretching
Trunk control
Cardio (bike)
100% running
Isometric outer
range

Gait
Walk
Jog
Run
Triple extension
Late swing (A drill)
Direction change
4 laps =8 sprints X 3 sets

~ 700m
11s 3.1 s
10% 100%
3 reps
12s 9s
60% 100%

Physio
Stage 1
Stage 2
On-field
Stage 3

Painless bike 150W, 5 mins
Run > 70%

ROM SLR & HS > 75%
100% running
Stage 4
Stage 5
Stage 6
Light Football Training

Session
In-between Football
Training Session
Heavy Football Training

Session

140
Inner range
Mid range
Outer range
Percent of uninjured side
120
100
80
60
40
20

Take home messages

1. Sequential and progressive.
2. Dynamic and open.
3. Adaptable to each player.
4. Criteria-based progression
5. Based on knowledge and experience.

The decision-making process of returning an injured or ill player to competition

All clear to play

Huge reinjury risk (14-16%)
Criteria
WHEN?
1. Clinical/ Anatomical
2. Imaging (US)
3. Functional
Specific Physical Test
HEALTHY INDIVIDUALS
High workloads
Highest competition level
No reinjury

Return to play
Anatomical, imaging and functional CRITERIA have to be taken into
consideration in order to provide:
Personalized return to play:
1. Injury location/connective tissue involved
2. Anatomical variability
3. Imaging
4. Player position/GPS

1. Injury location/connective tissue

Return to play
3. Imaging


Semimembranosus injuries
A
B
C

Return to play
3. Imaging

3. Imaging


Return to play
3. Imaging

4. Player position / GPS

COMPARISON THE PLAYERS SAME POSITION WITH THE PLAYER INJURED

Comparision with the same players injured player position return to train with the group
PLAYER INJURY
AVE VEL.MAX SET6
PLAYER INJURY
AVE VEL.MAX SET5
DATA WEEKS 5/6
PLAYER INJURY
AVE DEC SET 6
PLAYER INJURY
AVE DEC SET5
PLAYER INJURY
AVE ACEL SET 6
PLAYER INJURY
AVE ACEL SET 5
PLAYER INJURY
AVE SPRINTS SET 6
PLAYER INJURY
AVE SPRINT SET 5
PLAYER INJURY
AVE HSR SET 6
PLAYER INJURY
AVE HSR SET 5
0
50
100
150
200
250
300
SUMMARY
COMPARED TO OTHER DEFENDER SAME POSITION DURING 60 MINUTS THE FRIENDLY MATCH
HSR DISTANCE <21K/h

600
500
400
300
200
100
0
HIGH ACEL/DESA <3mts/s

542,61
290,59
202,91
303,53
292,24
211,5
DEFENDER 1DEFENDER 2DEFENDER 3DEFENDER 4DEFENDER 5
120
100
80
60
40
20
0
49
45
43
51
45
44
42
32
37
38
55
DESA.MAXIMES
ACEL.MAXIMES
PLAYER
INJURED
TOTAL SPRINTS
PEAK SPEED MAX
30
36
25
25
20
15
59
20
15
21
19
34,31
34
32,73
32
15
30
10
31,68
29,88
30,38
29,12
28
5
0
26
DEFENDER 1 DEFENDER 2 DEFENDER 3 DEFENDER 4 DEFENDER 5
PLAYER
INJURED
DEFENDER 1 DEFENDER 2 DEFENDER 3 DEFENDER 4 DEFENDER 5
PLAYER
INJURED

Take home messages

1. Personalized.
2. Technology and experience.
3. Six training sessions.
4. Friendly matches.

PRIMARY PREVENTION
Prevent the onset of muscle injury
Addressing risk factors
Enhancing resistance to exposure
Part of the general football training

(all players)
SECONDARY PREVENTION
Avoidance of a new muscle injury when the
player has suffered a previous injury
Individual, personalized, specific program

PREVENTION SNAPSHOT
PITCH
SMALL GROUPS CIRCUITS
GYM
PITCH
FOOTBALL CIRCUITS
STRENGTH CIRCUITS
GYM
WARM UPS PREVENTION OBJECTIVES DAILY

PLAYER INDIVIDUAL STRENGTH PROGRAMME
SQUAD PREVENTION PROGRAMME (SPECIFIC EXERCISES)

PRIMARY PREVENTION
Primary Prevention
Strength Training
minimum stimulus
strength training
of the hamstrings
Image
Code
Description
weight
maximum stimulus
Ser/Repet
weight
Ser/Repet
3x4
body weight or body

weight with 3kg
3x8
frequency
When
Eccentric working with variants in dop:

body weight or body
STh1 drop with rotation, different angles of
weight with 3kg
flexion..
Splits with body

flexion
STh2
Work hamstring
body weight
4 repetitions
body weight
8 repetitions once or twice a week
Alternate days ,
never before or
afther to match
Angel
STh3
Work hamstring
body weight
4 repetitions
body weight
8 repetitions once or twice a week
Alternate days ,
never before or
afther to match
GYM
Musculador belt
1x7 (1 competition)/10 Before or afther 48

days( 2 competitions)
hours to match

PITCH
PRIMARY PREVENTION
DAY -4.
ECCENTRIC
STRENGHT.
TIRANTE
MUSCULADOR
DAY -3.
RUNNING
TECHNIQUE &
PROPIOCEPTION
EXERCISES.
DAY -2.
AGILITY AND
COORDINATION
SKILLS.
DAY -1.
SPEED REACTION
AND FEET
WORK
GYM

PRIMARY PREVENTION
DAY -4.
ECCENTRIC
STRENGHT.
TIRANTE
MUSCULADOR

PRIMARY PREVENTION
DAY -2.
AGILITY AND
COORDINATION
SKILLS.

PRIMARY PREVENTION
HAMSTRINGS
QUADRICEPS
PITCH
ADDUCTOR MUSCLES
CORE STABILITY
COORDINATION / AGILITY
PROPIOCEPTION
UPPER BODY
W/O BALL
BOXES
PASSING DRILLS
POSSESSION GAMES
STRENGTH CIRCUITS
GYM

PRIMARY PREVENTION
HAMSTRINGS
QUADRICEPS
STRENGTH CIRCUITS ON THE FIELD
ADDUCTOR MUSCLES
CORE STABILITY
PROPIOCEPTION
UPPER BODY
MULTISTATIONS
WITHOUT BALL
MULTISTATIONS
WITH BOXES
MULTISTATIONS
WITH PASSING
DRILLS
MULTISTATIONS
WITH POSSESSION
GAMES

PRIMARY PREVENTION
HAMSTRINGS
QUADRICEPS
ADDUCTOR MUSCLES
CORE STABILITY
PROPIOCEPTION
UPPER BODY
MULTISTATIONS
WITHOUT BALL
MULTISTATIONS
WITH BOXES
MULTISTATIONS
WITH PASSING
DRILLS
MULTISTATIONS
WITH POSSESSION
GAMES

PRIMARY PREVENTION
HAMSTRINGS
QUADRICEPS
ADDUCTOR MUSCLES
CORE STABILITY
PROPIOCEPTION
UPPER BODY
MULTISTATIONS
WITHOUT BALL
MULTISTATIONS
WITH BOXES
MULTISTATIONS
WITH PASSING
DRILLS
MULTISTATIONS
WITH POSSESSION
GAMES

PRIMARY PREVENTION
HAMSTRINGS
QUADRICEPS
ADDUCTOR MUSCLES
CORE STABILITY
PROPIOCEPTION
UPPER BODY
MULTISTATIONS
WITHOUT BALL
MULTISTATIONS
WITH BOXES
MULTISTATIONS
WITH PASSING
DRILLS
MULTISTATIONS
WITH POSSESSION
GAMES

PRIMARY PREVENTION
PITCH
FOOTBALL CIRCUITS
STRENGTH CIRCUITS
GYM

PRIMARY PREVENTION
RELATIONSHIP BETWEEN
TECHNICAL, TACTICAL AND
CONDITIONING CIRCUITS.
CONDITIONING OR PREVENTION
STATION PREVIOUS TO THE
FOOTBALL ACTION.
DECISSION MAKING +
MULTIPLE OPTIONS
CLOSER TO OUR
STYLE OF PLAY/
GAME PLAN

PRIMARY PREVENTION
LEVEL
1. Indoor Prevention
2. Daily Prevention
Warm Ups
3. Multi Stations
Prevention Circuits
CATEGORIES
OBJECTIVE
EXERCISES
Stretching
STrength
St 1
STq1, STq2
Stretching
STrength
PRoprioception
CoreStability
AGility
St2, St3, St4

STh1, STh3
PR2
CS1, CS2, CS3
AG 2
1-2 p week
Stretching
STrength
PRoprioception
CoreStability
AGility
MultiInterv
St2,
STh1, STh2,ST
q3
PR2, PR3
CS1,CS2,CS3
AG 1
MI 1, MI 2, MI 3
1-2 p week
STrength
PRoprioception
AGility
STh1, STq3
PR 3
AG 1
PROGRAMME
FREQUENCY
Squad Prevention Programme

Player Individual Strength Programme
Eccentric Training
Proprioception
Agility & Coordination
1 p week
2 p week
1 p week
1 p week
1 p week
Speed Reaction
1 p week
Multi Station Circuit Not Ball

Multi Station Circuit with Boxes
Multi Station Circuit with Passing Drills
Multi Station Circuit with Pos Games
4. Football Circuit
Drills
Football Specific Strength Circuits

SECONDARY PREVENTION
PITCH 2
GYM 2
PITCH
FOOTBALL CIRCUITS
STRENGTH CIRCUITS
GYM


Hamstrings injury prevention

Seated eccentric knee flexor stretch (Seated Straight-Leg Raise)


Eccentric hip extensor stretch with inertial technology (VersaPulley)


Eccentric knee flexor extension with inertial technology (Yo-Yo Knee Extension)

Take home messages

1. Evolving knowledge.
2. Primary prevention linked with

training.
3. Secondary prevention: personalized.
It has been demonstrated that hamstring injuries

typically occur at this musculotendinous junction: either at
the proximal or distal free ends or, more commonly, at
the central intramuscular tendon...
Comin et al. Am J Sports Med. 2013;41(1):111-115


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Clinical Practice Guidelines for Muscle Injury

FC Barcelona and Aspetar Experience

Clinical Practice Guidelines

Clinical Practice Guidelines

Clinical Practice Guidelines

XXIV International Conference on Sports Rehabilitation and Traumatology

(UCL Elite Club Injury Study. 2013/2014 Season Report)

XXIV International Conference on Sports Rehabilitation and Traumatology

FCB 1st Team

XXIV International Conference on Sports Rehabilitation and Traumatology

4. Return to play criteria

XXIV International Conference on Sports Rehabilitation and Traumatology

1. Muscle injuries classification

2. Diagnosis and management of muscular injuries

XXIV International Conference on Sports Rehabilitation and Traumatology

We organize and resume this concept in a 4 letters acronym structure.

XXIV International Conference on Sports Rehabilitation and Traumatology

Muscle Injury Mechanism

2. Indirect muscle injuries are located close

XXIV International Conference on Sports Rehabilitation and Traumatology

Extracellular matrix (ECM) damage

XXIV International Conference on Sports Rehabilitation and Traumatology

XXIV International Conference on Sports Rehabilitation and Traumatology

Location for direct injuries

injuries located at the proximal third.

injuries located at the middle third.

injuries located at the distal third.

XXIV International Conference on Sports Rehabilitation and Traumatology

Location for indirect injuries

It describes the connective tissue damage location, tendon or MTJ.

for the injuries at the MTJ.

for injuries affecting the tendon: gap/retraction/loss of tension.

XXIV International Conference on Sports Rehabilitation and Traumatology

clinical suspicion of muscle injury with negative MRI.

XXIV International Conference on Sports Rehabilitation and Traumatology

XXIV International Conference on Sports Rehabilitation and Traumatology

D p proximal third direct injury

D m medial third direct injury

XXIV International Conference on Sports Rehabilitation and Traumatology

Direct Injuries Codification

Direct injury located in A:

Direct injury located in B:

Direct injury located in C:

XXIV International Conference on Sports Rehabilitation and Traumatology

Indirect Injuries Codification

Indirect injury located in B:

XXIV International Conference on Sports Rehabilitation and Traumatology

XXIV International Conference on Sports Rehabilitation and Traumatology

Take home messages

3. Flexible structure allowing to incorporate

XXIV International Conference on Sports Rehabilitation and Traumatology

1. Muscle injuries classification

2. Diagnosis and management of muscular injuries

XXIV International Conference on Sports Rehabilitation and Traumatology

Similar injuries before?

About the mechanism of injury:

Direct blow or indirect strain?

During training or competition?

When and how did it start?

About the initial progress:

Stop or continue playing?

Normal walk without pain?

XXIV International Conference on Sports Rehabilitation and Traumatology

XXIV International Conference on Sports Rehabilitation and Traumatology