title: A Multifactorial, Criteria-based Progressive Algorithm for Hamstring Injury Treatment.
abstract: Given the prevalence of hamstring injuries in football, a rehabilitation program that effectively promotes muscle tissue repair and functional recovery is paramount to minimize reinjury risk and optimize player performance and availability.
  
  
  
  This study aimed to assess the concurrent effectiveness of administering an individualized and multifactorial criteria-based algorithm (rehabilitation algorithm [RA]) on hamstring injury rehabilitation in comparison with using a general rehabilitation protocol (RP).
  
  
  
  Implementing a double-blind randomized controlled trial approach, two equal groups of 24 football players (48 total) completed either an RA group or a validated RP group 5 d after an acute hamstring injury.
  
  
  
  Within 6 months after return to sport, six hamstring reinjuries occurred in RP versus one injury in RA (relative risk = 6, 90% confidence interval = 1-35; clinical inference: very likely beneficial effect). The average duration of return to sport was possibly quicker (effect size = 0.34 ± 0.42) in RP (23.2 ± 11.7 d) compared with RA (25.5 ± 7.8 d) (-13.8%, 90% confidence interval = -34.0% to 3.4%; clinical inference: possibly small effect). At the time to return to sport, RA players showed substantially better 10-m time, maximal sprinting speed, and greater mechanical variables related to speed (i.e., maximum theoretical speed and maximal horizontal power) than the RP.
  
  
  
  Although return to sport was slower, male football players who underwent an individualized, multifactorial, criteria-based algorithm with a performance- and primary risk factor-oriented training program from the early stages of the process markedly decreased the risk of reinjury compared with a general protocol where long-length strength training exercises were prioritized.
authors.affiliation: 1Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, SPAIN; 2Chair of Sports Traumatology, Catholic University of San Antonio, Murcia, SPAIN; 3Inter-university Laboratory of Human Movement Biology (LIBM EA), University of Lyon, University Jean Monnet, Saint Etienne, FRANCE; 4Department of Clinical and Exercise Physiology, Sports Medicine Unity, University Hospital of Saint-Etienne, Faculty of medicine, Saint-Etienne, FRANCE; 5Medical Commission, French Athletics Federation (FFA), Paris, FRANCE; 6Université Côte d'Azur, LAMHESS, Nice, FRANCE; 7Virgin of Arrixaca University Hospital, Murcia, SPAIN; 8Radiology Department, San Miguel Clinic, Pamplona, SPAIN; and 9ASPIRE Academy for Sports Excellence, Doha, QATAR.
authors.forename: Jurdan
authors.initials: J
authors.lastname: Mendiguchia
authors.forename: Enrique
authors.initials: E
authors.lastname: Martinez-Ruiz
authors.forename: Pascal
authors.initials: P
authors.lastname: Edouard
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Morin
authors.forename: Francisco
authors.initials: F
authors.lastname: Martinez-Martinez
authors.forename: Fernando
authors.initials: F
authors.lastname: Idoate
authors.forename: Alberto
authors.initials: A
authors.lastname: Mendez-Villanueva
mesh_terms: D000465:Algorithms; D001265:Athletic Injuries / Q000534:rehabilitation; D054874:Athletic Performance / Q000502:physiology; D004311:Double-Blind Method; D000070633:Hamstring Muscles / Q000293:injuries*; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012008:Recurrence; D000068958:Return to Sport; D012307:Risk Factors; D012916:Soccer / Q000293:injuries*; D013997:Time Factors