Return-to-Play Criteria Following Lower Limb Muscle Injuries in Soccer: A Systematic Review with Evidence Synthesis

Area of Science:

• Sports Medicine
• Musculoskeletal Injuries
• Soccer Performance

Background:

• Muscle injuries are common in male soccer players, impacting return-to-play (RTP) timelines.
• Standardized RTP criteria are crucial for safe and effective athlete rehabilitation.

Purpose of the Study:

• To systematically identify and categorize RTP domains and criteria for muscle injuries in male soccer players.
• To assess the certainty of evidence for various RTP criteria based on study design and quality.

Main Methods:

• A comprehensive literature search was conducted across six databases up to March 2024.
• Studies reporting RTP criteria for hamstring, adductor, quadriceps, calf, and general lower limb muscle injuries were included.
• Certainty of evidence for each RTP criterion was evaluated based on the number, design, and methodological quality of supporting studies.

Main Results:

• 135 studies met inclusion criteria, analyzing 58,057 records.
• For hamstring injuries, strength symmetry and pain-free soccer-specific actions were most cited, with high evidence for range of motion and subjective readiness.
• Evidence for adductor, quadriceps, and calf injuries was generally moderate-to-very-low, with limited high-quality research.

Conclusions:

• Strength symmetry and pain assessment are key for hamstring injury RTP, supported by range of motion and subjective readiness.
• RTP criteria for adductor injuries rely on pain assessment and training participation, with moderate evidence.
• Further high-quality research is needed for quadriceps, calf, and general lower limb muscle injuries to establish robust RTP guidelines.