Jan Ekstrand. Professor of Sports Medicine, Football Research Group, Linköping University, Sweden and 1st vice Chairman of the UEFA Medical Committee. - Epidemiology of hamstring injuries in football (13th October, Barcelona) 6th MuscleTech Network Workshop

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Professor Jan Ekstrand, MD, PhD
Football Research Group
Linköping University, Sweden
1st vice chairman UEFA Medical Committee
Epidemiology of hamstring injuries
in football
6th Muscle Tech Network Workshop,Barcelona, Oct 2014
Ekstrand et al. 2014
Important factors for injury prevention: the future
www.footballresearchgroup.eu
Elite Club Injury Study programme 2014/15
Manchester City FC
Chelsea FC
Liverpool FC
Arsenal FC
Manchester United FC
TottenhamHotspur FC
Newcastle
FC Porto
SL Benfica
Sporting Lisbon
Paris St.Germain
AS Monaco
Olympique Marseille
Olympique Lyonnais
FC Shakhtar Donetsk
BV Borussia
Dortmund
FC Bayern München
Schalke 04
Bayer Leverkusen
Juventus FC
AS Roma
AC Milan
Inter
RSV Anderlecht
Club Brugge KV
AFC AJAX
PSV Eindhoven
Olympiacos
Panathinaikos
CSKA Moscow
Zenit St.Petersgburg
GalatasarayFC Basel
Malmö FFMaribor Corinthians
Brazil
Boca Juniors
Argentina
Real Madrid
FC Barcelona
Athletico Madrid
Athletico Bilbao
UEFA Champions League (2001- )
English Premiere League (2011- )
Scandinavian Top Divisions (2001- )
Database:
> 100 teams
18 countries
18.000 injuries
1.2 million trainings & matches
14 seasons
6000
Muscle injuries
Muscle Injury – Definitions The Munich consensus statement
A traumatic distraction or overuse injury to the muscle leading to a player being unable to fully
participate in training or match play
Muscle injuries account for 1/3 of all football injuries
 Structural muscular disorders
• Total or partial muscle tears
Hans Wilhelm Mueller-Wohlfahrt, Lutz Hansel, Kai Mithoefer, Jan Ekstrand, Bryan English, Steven McNally, John Orchard, C. Niek Van Dijk,
Gino M. Kerkhoffs, Patrick Schmasch, Dieter Blottner, Leif Swaerd, Edwin Goedhart, Peter Ueblacker.
Terminology and classification of muscle injuries in sport: The Munich consensus statement
Br J Sports Med 2013;47:342-350.
 Functional muscular disorders
Incidence of muscle injuries in Champions League teams across eleven seasons
95% of injuries
affect 4 muscle
groups
Quadriceps 17%
Hamstrings 37%
Calf 13%
Hip/groin 28%
When can
he play?
In 15 +/-3
days

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Peetrons, P. Eur Radiology (2002) 12: 35-43 Ekstrand et al. 2012. Hamstring muscle injuries in professional football –association of injury by MRI. Br J Sp Med
70%
No rupture
Cause > 50%
of absence
in a club
Severity of injury (Hamstrings)
0
10
20
30
40
50
60
Normal MRI Grade 1 Grade 2 Grade 3
Daysofabsence
Absence (days)
Ekstrand et al. 2011
Ekstrand et al. 2012. Hamstring muscle injuries in professional football –association of injury by
MRI. Br J Sp Med
Lay-off days by hamstring muscle injuries
and MRI grading according to Peetrons
(Hallén & Ekstrand: RTP following muscle injuries…)
Muscle Grade Mean ± SD Median % re-injuries
Hamstring muscle
injuries
Grade 1 18 ± 15 15 16
Grade 2 24 ± 13 21 16
Grade 3 60 ± 57 37 13
Biceps femoris Grade 1 19 ± 16 15 18
Grade 2 24 ± 13 21 19
Grade 3 71 ± 63 55 17
Semimembranosus Grade 1 17 ± 7 14 5
Grade 2 23 ± 15 20 <5
Grade 3
Semitendinosus Grade 1 18 ± 18 13 <5
Grade 2 25 ± 12 23 <5
Grade 3

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Lay-off days by hamstring muscle injuries
and MRI grading according to Peetrons
(Hallén& Ekstrand: RTP following muscle injuries…)
Muscle Grade Mean ± SD Median % re-injuries
Hamstring muscle
injuries
Grade 1 18 ± 15 15 16
Grade 2 24 ± 13 21 16
Grade 3 60 ± 57 37 13
Biceps femoris Grade 1 19 ± 16 15 18
Grade 2 24 ± 13 21 19
Grade 3 71 ± 63 55 17
Semimembranosus Grade 1 17 ± 7 14 5
Grade 2 23 ± 15 20 <5
Grade 3
Semitendinosus Grade 1 18 ± 18 13 <5
Grade 2 25 ± 12 23 <5
Grade 3
Lay-off days by hamstring muscle injuries
and MRI grading according to Peetrons
(Hallén& Ekstrand: RTP following muscle injuries…)
Muscle Grade Mean ± SD Median % re-injuries
Hamstring muscle
injuries
Grade 1 18 ± 15 15 16
Grade 2 24 ± 13 21 16
Grade 3 60 ± 57 37 13
Biceps femoris Grade 1 19 ± 16 15 18
Grade 2 24 ± 13 21 19
Grade 3 71 ± 63 55 17
Semimembranosus Grade 1 17 ± 7 14 5
Grade 2 23 ± 15 20 <5
Grade 3
Semitendinosus Grade 1 18 ± 18 13 <5
Grade 2 25 ± 12 23 <5
Grade 3
83%
12%
5%
Lay-off days by hamstring muscle injuries
and MRI grading according to Peetrons
(Hallén& Ekstrand: RTP following muscle injuries…)
Muscle Grade Mean ± SD Median % re-injuries
Hamstring muscle
injuries
Grade 1 18 ± 15 15 16
Grade 2 24 ± 13 21 16
Grade 3 60 ± 57 37 13
Biceps femoris Grade 1 19 ± 16 15 18
Grade 2 24 ± 13 21 19
Grade 3 71 ± 63 55 17
Semimembranosus Grade 1 17 ± 7 14 5
Grade 2 23 ± 15 20 <5
Grade 3
Semitendinosus Grade 1 18 ± 18 13 <5
Grade 2 25 ± 12 23 <5
Grade 3
Type of injury
Is size of pathology (oedema) correlated to
absence?
R Square= 0.14R Square= 0.04
Weak correlation
Proximal
Middle
Distal
Muscular location (Hamstrings)
No difference
0
5
10
15
20
25
30
Proximal Middle Distal
Absence (days)
0
5
10
15
20
25
Proximal Middle Distal
Absence (days)

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p=0.9
p=0.6
0
2
4
6
8
10
12
14
16
18
20
MT junction Muscle Fascial Myofascial
Absence (days)
0
5
10
15
20
25
30
MT junction Muscle Myofascial
Absence (days)
Injury types and absence (hamstring injuries)
Differentiation into
Injury types not meaningful
MRI and Ultrasound are
valuable for prognosticating RTP
Radiological grading associated
with lay-off times after injury.
Take home message:
Information on injury study found on UEFA.com:
http://www.uefa.com/trainingground/medical/index.htm
Twitter !
Follow us on twitter: @frgsweden
Football Research Group
 Jan Ekstrand (MD, PhD)
 Martin Hägglund (PT, PhD)
 Markus Waldén (MD, PhD)
 Jon Karlsson (MD, PhD)
 Anna Nordström (MD, PhD)
 Karolina Kristenson (MD, PhD student)
 Matilda Lundblad (MD, PhD student)
Henrik Magnusson (MSc, statistician)
Håkan Bengtsson (PT)
Mariann Knudsen (PT)
Christoffer Thomée (Data analyst)
Anna Hallén (PTI)
Funding resources:

5. 5
Hamstring injuries in elite football-
when can he/she play again?
Jan Ekstrand
Football Research Group
Linköping
5th Arthroscopy Conference, Stockholm, October 2014