Managing Lower Limb Muscle Reinjuries in Athletes: From Risk Factors to Return-to-Play Strategies

Effectiveness of physical agent modalities for pain relief in injured athletes: A systematic review

IntroductionFrom a rehabilitation perspective, various approaches can be applied to help athletes overcome injury, including drugs, physical agent modalities (PAMs) with conventional physical therapy. This systematic review aimed to evaluate the impact of physical agent modalities (PAMs) for pain relief in injured athletes.MethodsPubMed, Scopus, and Web of Science were systematically searched from inception until May 8th, 2024. The papers were considered eligible for review in compliance with the conditions determined by the following PICO model: P) Participants: injured athletes; I) Intervention: magnetic therapy, TENS, lasertherapy, ultrasound therapy, diathermy, and extracorporeal shockwave therapy (ESWT); C) Comparator: NA; O) Outcome measure: any pain assessment. PROSPERO registration number: CRD42024532304ResultsStudy selection reported a total of 785 records, resulting in 484 articles after duplicate removal. After the title and abstract screening, 433 papers were excluded and 51 articles were evaluated for eligibility. Therefore, 21 studies were included, involving a total of 806 subjects: 10 ESWT, 1 Cryotherapy, 2 Cryo + ultrasound, 3 diathermy, 1 NMES, 1 TENS, 2 Laser therapy, 1 combined procedure.ConclusionsThe systematic review indicated potential effectiveness of PAMs in managing and reducing pain in sport-related injuries. Taken together, our findings suggested a positive role of ESWT in term of pain relief, also considering that these PAMs are the most used in these subjects. However, the high heterogeneity of the results could not consent to define the specific effect of the single PAMs.

The challenge of thigh tendon reinjuries: an expert opinion

This review critically examines the issue of thigh tendon reinjury in athletes, drawing on recent advancements and diverse perspectives in sports medicine. The findings underscore the paramount importance of an early and accurate diagnosis, which significantly influences treatment efficacy and rehabilitation outcomes. We explore the intricacies of tendon anatomy and the mechanisms underlying injuries, highlighting how these factors interplay with athlete-specific risk profiles to affect reinjury rates. A major finding from the review is the necessity for individualized rehabilitation approaches that integrate both traditional methods and emerging technologies. These technologies show promise in enhancing monitoring and facilitating precise adjustments to rehabilitation protocols, thus improving recovery trajectories. Additionally, the review identifies a common shortfall in current practices - premature to play (RTP) - which often results from inadequate adherence to tailored rehabilitation strategies or underestimation of the injury's severity. Such premature RTP significantly heightens the risk of further injury. Through this synthesis of contemporary research and expert opinion, the review advocates for a multidisciplinary approach in managing thigh tendon injuries, emphasizing the need for ongoing research to refine RTP criteria and optimize rehabilitation techniques. The ultimate goal is to support athletes in achieving safer and more effective recoveries, thereby reducing the likelihood of tendon reinjury.

The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial

INTRODUCTION

Groin injuries are common in soccer players and often involve adductor muscle strains. The Copenhagen Adduction Exercise (CAE) is a targeted intervention whose effectiveness in rehabilitation for these injuries warrants investigation.

OBJECTIVE

To investigate the impact of a rehabilitation program, which includes the CAE, on eccentric hip adduction (EHAD) strength, hip joint range of motion (ROM), self-reported disability, and pain among soccer players with adductor-related groin pain. It was hypothesized that the addition of CAE to the rehabilitation program would yield greater improvements.

METHODS

Employing a randomized controlled trial with a two-group parallel design, thirty male soccer players with a mean age of 26.4 ± 3.9 years were randomized into an intervention group (IG) including CAE (n = 15) and a control group (CG) without CAE (n = 15), based on a power analysis to ensure 80% power to detect significant differences. Both groups engaged in their respective rehabilitation programs twice a week for eight weeks. The primary outcome measured was EHAD strength, while secondary outcomes included hip joint ROM, self-reported disability measured by the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain levels.

RESULTS

Significant improvements within groups were observed across all measures (p < 0.001). The IG demonstrated a greater increase in EHAD strength (Mean Difference [MD] = 0.49 Nm/kg, 95% Confidence Interval [CI] [0.31, 0.66]), a more pronounced reduction in pain (MD = -1.60, 95% CI [-2.18, -1.02]), and betterment in all HAGOS subscale scores compared to the CG. There were no significant between-group differences in hip joint ROM.

CONCLUSION

Incorporating the CAE into rehabilitation programs significantly improves EHAD strength, decreases pain scores, and reduces self-reported disability in soccer players with adductor-related groin pain.

REGISTRATION

ClinicalTrials.gov identifier: NCT05589623.