Adam Paxton BSC (HONS), MSC, MCSP

Introduction

Hamstring injuries (HSI) are the most significant cause of time loss in professional football and their prevalence have significantly increased in training and matches over the last decade (Ekstrandet al 2023). The English Premier League (EPL) financial burden and team success estimates based on individual club injury rates were reported in 2016-17 by Eliakim et al (2020). It was estimated that the average overall cost per club was £45 million. Considering the estimated prevalence of hamstring time loss over a ten-year period in the elite football leagues was 19%, this is a huge cost for hamstring injuries alone.

Injuries to the medial hamstrings (semimembranosus (SMB) and semitendinosus (STD)) are reported to
be less common (20%) than injuries to Biceps Femoris (BF) (Ekstrand et al 2023). Injuries to the medial hamstrings also equate to lower overall time loss than those to BF in football. Most hamstring injuries are successfully managed conservatively. Different opinions and management strategies have been discussed for partial or indeed complete ruptures of distal medial hamstring tears. Schilders et al (2005) suggested that surgical tenotomy and resection of chronic STD injuries can provide a swift resolution to ongoing pain and return to full function. The timeframes of full return to performance (RTP) were not disclosed.

Recommended RTP timeframes for a distal medial hamstring rupture have not been widely documented in elite professional football, however it has been suggested that a 3.2-month RTP for distal tendon surgical cases is normal (Plastow et al 2023). Surgeons and Sports Medicine clinicians are still debating the best management for these injuries with the former swaying towards surgical intervention having a better outcome than conservative.

This article illustrates two successful examples of conservative rehabilitation in professional footballers in the EPL. Both returned to play within 50 days without recurrence over at least a six-month period. These examples aim to provide a rehabilitation framework for this type of injury and raise further discussion on the rehabilitation alone versus surgical or interventional (e.g. platelet rich plasma) treatment options. Written consent was gained from both players to share their rehabilitation journeys anonymously.