Return to play after treating acute muscle injuries in elite football players with a multimodal therapy approach that includes a specific protocol of (almost) daily radial extracorporeal shock wave therapy
Authors: Morgan James P.M. , Hamm Mario , Schmitz Christoph , Brem Matthias H. 
Published: February 2020

AbstractAimTo compare lay-off times achieved by treating acute muscle injuries in elite football players with a multimodal therapy approach that includes a specific protocol of almost daily radial extracorporeal shock wave therapy (rESWT)) with corresponding data reported in the literature.MethodsWe performed a retrospective analysis of treatments and recovery times of muscle injuries suffered by the players of an elite football team competing in the first/second German Bundesliga during a previous season.ResultsA total of 20 acute muscle injuries were investigated in the aforementioned season, of which eight (40%) were diagnosed as type 1a/muscular tightness injuries, five (25%) as type 2b/muscle strain injuries, four (20%) as type 3a/partial muscle tear injuries and three (15%) as contusions. All injuries were treated with the previously mentioned multimodal therapy approach. Compared with data reported by Ekstrand et al. (Br J Sports Med 2013;47:769-774), lay-off times (median / mean) were shortened by 54% and 58% respectively in the case of type 1a injuries, by 50% and 55% respectively in the case of type 2b injuries as well as by 8% and 21% respectively in the case of type 3a injuries. No adverse reactions were observed.ConclusionsOverall, the multimodal therapy approach investigated in this study is a safe and effective treatment approach for treating type 1a and 2b acute muscle injuries amongst elite football players and may help to prevent more severe, structural muscle injuries.What are the findings?➢By treating acute muscle injuries suffered by the players of an elite football team competing in the first/second German Bundesliga during a previous season with a multimodal therapy approach (comprising cryotherapy, compression, manual therapy, resistance/weight-training, a progressive physiotherapy exercise programme and a specific protocol of (almost) daily radial extracorporeal shock wave therapy (rESWT)) we achieved median and mean lay-off times after type 1a (muscular tightness/hypertonicity) and 2b (muscular strain injury) muscle injuries that were 50% shorter than corresponding data reported in the literature (Ekstrand et al., Brit J Sports Med 2013;47:769-774).➢The percentage of structural muscle injuries, specifically type 3 (partial muscle tear according to the Müller-Wohlfahrt/Munich muscle injury classification) and type 4 (complete muscle tear and/or avulsion injury involving the tendon) amongst this sample group of players (including injury types 1-4 as classified by Müller-Wohlfahrt et al; and excluding contusions) that occurred during the entire season comprised 23.5% of all the muscle injuries suffered. In comparison, the percentage of structural muscle injuries amongst similar sample groups of elite football players has been found to be considerably higher - in the data set reported by Ekstrand et al. (2013) higher grade structural muscle injuries amongst elite European football teams typically make up 66.9% of all muscle injuries suffered during the course of one season.How might it impact on clinical practice in the future?Our findings emphasise the effective use of a multimodal therapy approach (comprising cryotherapy, compression, manual therapy, resistance/weight-training, a progressive physiotherapy exercise programme and a specific protocol of (almost) daily rESWT for substantially shortening lay-off times associated with functional/ultrastructural muscle injuries and possibly for preventing more severe structural muscle injuries amongst sportspeople.