The Criteria and Design for Return-to-Play Following Muscle Injury in Football are Not Standardized: A Systematic...

Area of Science:

• Sports Medicine
• Orthopedics
• Rehabilitation Science

Background:

• Return-to-play (RTP) decisions post-muscle injury in professional football are multifaceted, involving biological healing, functional capacity, and sport-specific demands.
• Existing RTP models are evolving towards multifactorial and individualized approaches, yet are primarily based on expert consensus rather than robust empirical evidence.
• Heterogeneity in study designs and RTP criteria complicates objective assessment and validation of current frameworks.

Purpose of the Study:

• To systematically review and describe the criteria used for return-to-play decisions following muscle injuries in football.
• To analyze the heterogeneity in study designs and the integration of criteria within different RTP frameworks.
• To evaluate the evidence base supporting current RTP decision-making processes in football.

Main Methods:

• A systematic review was conducted, including studies on RTP criteria, decision-making, or rehabilitation frameworks for football players with muscle injuries.
• Searches were performed across five databases, with study selection and risk of bias assessment performed by two independent reviewers using Joanna Briggs Institute tools.
• Included studies were categorized into Classical-Physical, Consensus-Multifactorial, or Individualized RTP models.

Main Results:

• A median of six RTP criteria were reported per study, commonly including absence of pain, ≥90% strength symmetry, and successful functional testing.
• Psychological readiness and advanced monitoring (GPS/on-field) gained prominence post-2020, particularly within multifactorial and individualized frameworks.
• A discernible shift towards multifactorial and individualized RTP models was observed, though no significant association was found between model type and specific criteria; reinjury data was scarce.

Conclusions:

• The current literature exhibits considerable heterogeneity in RTP criteria and study designs, with a predominance of consensus-based evidence and low-level support.
• RTP decision-making in football appears largely driven by expert opinion rather than validated outcomes, indicating a need for improved evidence.
• RTP is recognized as a dynamic, context-dependent process integrating biological, functional, psychological, and load tolerance factors; prospective validation of integrated frameworks and standardized reporting are crucial for future research.