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Subsequent Injury Risk After Return-to-Play From Lower-Extremity Muscle Injuries in Professional Male Football

Guangze Zhang^1,2, Michel S Brink², Dominik Szymski^3,4

¹Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany.

Orthopaedic Journal of Sports Medicine

|July 11, 2026

Summary

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This summary is machine-generated.

Subsequent injury risk after lower-extremity muscle injuries in football varies by muscle group and injury type (acute vs. overuse). Hamstring and adductor injuries pose higher initial risks, while calf injuries show a delayed risk peak post-return to play.

Area of Science:

Sports Medicine
Epidemiology
Biomechanics

Background:

Upper extremity injuries are prevalent in professional football, but lower extremity muscle injury risk post-return to play (RTP) is not well understood.
Subsequent injuries are common after RTP, particularly in the weeks following a player's return.
Characterizing these risk trajectories is crucial for injury prevention strategies.

Purpose of the Study:

To analyze the risk of noncontact subsequent injuries in professional football players after returning from major lower extremity muscle injuries.
To differentiate injury risk based on whether the initial injury was acute or overuse.
To investigate specific risk trajectories for hamstring, quadriceps, adductor, and calf injuries.

Main Methods:

A descriptive epidemiological study using prospectively collected injury data from German professional football leagues over three seasons.

Keywords:

football muscle injury return to play subsequent injury survival analysis

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Time-to-event analysis was employed, with noncontact time-loss subsequent injuries as the event of interest.

Kaplan-Meier survival function was used to estimate cumulative and continuous hazard functions for injury risk.

Main Results:

Over 600 acute and overuse lower extremity muscle injuries were analyzed.
Subsequent injury rates varied: acute hamstring (27.9%), quadriceps (26.2%), adductor (39.3%), calf (21.2%); overuse hamstring (28.1%), quadriceps (27.7%), adductor (27.2%), calf (27.4%).
Elevated risk was observed after acute hamstring and adductor injuries, diminishing within 12 and 4 weeks, respectively. Overuse calf injuries showed a delayed risk peak around 3 weeks post-RTP.

Conclusions:

Subsequent injury risk following lower extremity muscle injuries is time-varying and specific to the muscle group and injury type.
Distinct risk trajectories necessitate individualized return-to-play (RTP) protocols.
Understanding these patterns is vital for optimizing player recovery and preventing re-injury.