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      Match High-Speed Running Distances Are Often Suppressed After Return From Hamstring Strain Injury in Professional Footballers

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          Abstract

          Background:

          High-speed running is commonly implicated in the genesis of hamstring injury. The success of hamstring injury management is typically quantified by the duration of time loss or reinjury rate. These metrics do not consider any loss in performance after returning to play from hamstring injury. It is not known to what extent high-speed running is altered on return to play after such injury.

          Hypothesis:

          Match high-speed running distance will change after returning from hamstring injury.

          Study Design:

          Non-randomized cohort.

          Level of Evidence:

          Level 3.

          Methods:

          Match high-speed running distance in highest level professional football (soccer, Rugby League, Rugby Union, and Australian Rules) were examined for a minimum of 5 games prior and subsequent to hamstring strain injury for individual differences using a linear regression models approach. A total of 22 injuries in 15 players were available for analysis.

          Results:

          Preinjury cumulative high-speed running distances were strongly correlated for each individual ( r 2 = 0.92-1.0; P < 0.0001). Pre- and postinjury high-speed running data were available for a median of 15 matches (range, 6-15). Variance from the preinjury high-speed running distance was significantly less ( P = 0.0005) than the post injury values suggesting a suppression of high-speed running distance after returning from injury. On return to play, 7 of the 15 players showed a sustained absolute reduction in preinjury high-speed running distance, 7 showed no change, and 1 player (only) showed an increase. Analysis of subsequent (second and third injury) return to play showed no differences to return from the index injury.

          Conclusion:

          Return to play was not associated with return to high-speed running performance for nearly half of the players examined, although the same number showed no difference. Persisting deficits in match high-speed running may exist for many players after hamstring strain injury.

          Clinical Relevance:

          Returning to play does not mean returning to (high-speed running) performance for nearly half of the high-level professional football players examined in this study. This suggests that successful return to play metrics should be expanded from simple time taken and recurrence to include performance.

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          Most cited references32

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          Match performance of high-standard soccer players with special reference to development of fatigue.

          The aim of this study was to assess physical fitness, match performance and development of fatigue during competitive matches at two high standards of professional soccer. Computerized time-motion analyses were performed 2-7 times during the competitive season on 18 top-class and 24 moderate professional soccer players. In addition, the players performed the Yo-Yo intermittent recovery test. The top-class players performed 28 and 58% more (P < 0.05) high-intensity running and sprinting, respectively, than the moderate players (2.43 +/- 0.14 vs 1.90 +/- 0.12 km and 0.65 +/- 0.06 vs 0.41 +/- 0.03 km, respectively). The top-class players were better (11%; P < 0.05) on the Yo-Yo intermittent recovery test than the moderate players (2.26 +/- 0.08 vs 2.04 +/- 0.06 km, respectively). The amount of high-intensity running, independent of competitive standard and playing position, was lower (35-45%; P < 0.05) in the last than in the first 15 min of the game. After the 5-min period during which the amount of high-intensity running peaked, performance was reduced (P < 0.05) by 12% in the following 5 min compared with the game average. Substitute players (n = 13) covered 25% more (P < 0.05) ground during the final 15 min of high-intensity running than the other players. The coefficient of variation in high-intensity running was 9.2% between successive matches, whereas it was 24.8% between different stages of the season. Total distance covered and the distance covered in high-intensity running were higher (P < 0.05) for midfield players, full-backs and attackers than for defenders. Attackers and full-backs covered a greater (P < 0.05) distance in sprinting than midfield players and defenders. The midfield players and full-backs covered a greater (P < 0.05) distance than attackers and defenders in the Yo-Yo intermittent recovery test (2.23 +/- 0.10 and 2.21 +/- 0.04 vs 1.99 +/- 0.11 and 1.91 +/- 0.12 km, respectively). The results show that: (1) top-class soccer players performed more high-intensity running during a game and were better at the Yo-Yo test than moderate professional players; (2) fatigue occurred towards the end of matches as well as temporarily during the game, independently of competitive standard and of team position; (3) defenders covered a shorter distance in high-intensity running than players in other playing positions; (4) defenders and attackers had a poorer Yo-Yo intermittent recovery test performance than midfielders and full-backs; and (5) large seasonal changes were observed in physical performance during matches.
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            World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects.

            (2001)
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              Physical and metabolic demands of training and match-play in the elite football player.

              In soccer, the players perform intermittent work. Despite the players performing low-intensity activities for more than 70% of the game, heart rate and body temperature measurements suggest that the average oxygen uptake for elite soccer players is around 70% of maximum (VO(2max). This may be partly explained by the 150 - 250 brief intense actions a top-class player performs during a game, which also indicates that the rates of creatine phosphate (CP) utilization and glycolysis are frequently high during a game. Muscle glycogen is probably the most important substrate for energy production, and fatigue towards the end of a game may be related to depletion of glycogen in some muscle fibres. Blood free-fatty acids (FFAs) increase progressively during a game, partly compensating for the progressive lowering of muscle glycogen. Fatigue also occurs temporarily during matches, but it is still unclear what causes the reduced ability to perform maximally. There are major individual differences in the physical demands of players during a game related to physical capacity and tactical role in the team. These differences should be taken into account when planning the training and nutritional strategies of top-class players, who require a significant energy intake during a week.
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                Author and article information

                Journal
                Sports Health
                Sports Health
                SPH
                spsph
                Sports Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                1941-7381
                1941-0921
                5 November 2020
                May-Jun 2021
                5 November 2020
                : 13
                : 3
                : 290-295
                Affiliations
                []Aspetar Sports Medicine Hospital Sports City Street, Doha, Qatar
                []Liverpool Football Club, Liverpool, UK
                [§ ]Gabbett Performance Solutions, Centre for Health Research, University of Southern Queensland, Ipswich, Queensland, Australia
                []Brisbane Lions Australian Rules Football Club, Brisbane, Queensland, Australia
                []Sydney Swans Australian Rules Football Club, Sydney, New South Wales, Australia
                [# ]Australian Catholic University, Sydney, New South Wales, Australia
                [** ]Canberra Raiders Rugby League Football Club, Canberra, Australian Capital Territory, Australia
                [†† ]University of South Wales, Treforest, South Wales, UK
                Author notes
                [*] [* ]Rodney Whiteley, PhD, Aspetar Sports Medicine Hospital Sports City Street, PO Box 29222, Doha, Qatar (email: rodney.whiteley@ 123456aspetar.com ) (Twitter: @RodWhiteley).
                Article
                10.1177_1941738120964456
                10.1177/1941738120964456
                8079800
                33151808
                230beea1-df85-44de-a7c6-598aa8ecf5d6
                © 2020 The Author(s)

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
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                Current Research
                Custom metadata
                ts1
                May/June 2021

                Sports medicine
                hamstring,performance,shared decision making,return to sport,professional,football
                Sports medicine
                hamstring, performance, shared decision making, return to sport, professional, football

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