The focus on muscle injuries continues after the previous episode featuring Francesco Della Villa, Director of the Education and Research Department. In this new installment on Sky Sport, the spotlight shifts to Dr. Fabrizio Tencone, Managing Director of the Turin center.
How do you recover from a muscle injury?
The first thing to note is that these are not easy injuries to recover from, as evidenced by the fact that they have the highest risk of recurrence or reinjury.
If we are talking about injuries to the muscles at the back of the thigh, known as the “hamstrings” or more commonly referred to in the locker room as “flexors,” it’s crucial to understand one fundamental point:
The same type of injury has different recovery times for returning to sports depending on the sport and the position played within the same sport.
Different recovery times depending on the sport?
The medical staff at Barcelona are highly experienced in various sports, not just soccer, because Barça is a multi-sport club with teams competing at the highest international levels across many disciplines.
The Spanish colleagues have shown that a hamstring injury, involving the thigh flexors, of moderate severity has an expected return-to-play timeline:
of 2 weeks if you play basketball,
of 4 weeks if you play roller hockey,
of 6 weeks if you play soccer,
of 9 weeks if you are a sprinter in athletics.
Different recovery times depending on the position as well?
Correct! When we sports doctors estimate the return-to-play timeline, the so-called prognosis, we must consider several factors.
If we are talking about soccer, it is necessary to consider whether the player has previously injured the same muscle or if this is their first injury.
If the player is a midfielder, running at a more regular pace, or plays on the wing, making countless sprints and bursts.
If the player is essential to the team or not, and also the timing of the injury within the season —whether it is close to important events or not.
In the study conducted by the medical staff at Barcelona, it was observed that two different football players with the same injury, which “should heal in 4 weeks,” can have very different return-to-play times — one might return after 3 weeks, while the other takes 7 weeks!
What does rehabilitation after a muscle injury to the flexors involve?
Rehabilitation from a muscle injury to the flexors is a very delicate process, precisely because, as we have already mentioned, the risk of not healing properly and reinjuring is extremely high. It is crucial to monitor and track the progress of recovery through medical check-ups, ultrasound examinations, and, if necessary, MRI scans.
Regarding rehabilitation, the first thing to do, and this applies to all acute sports injuries, is to follow the POLICE protocol.
POLICE like “police” in English?
Exactly! It’s an acronym that helps us remember what to do in the first 24-48 hours after an injury.
The P stands for Protection of the injured area,
OL stands for Optimal Loading, meaning applying weight or bearing load as tolerated.
I stands for Ice.
C stands for Compression.
E stands for Elevation.
If we do this immediately after a sports injury, any injury — not just a muscle injury — we can never go wrong.
Rehabilitation progresses with highly effective pool exercises, ranging from simple walking to early simulations of sports movements.
Be careful! In the very early phase of a muscle injury, deep massages are strictly prohibited, as they can cause further bleeding in the injured muscle.
Once you can walk properly, can you start running?
That’s exactly right. Once the first goal is achieved — walking properly — you can start focusing on the next step: jogging.
Rehabilitation primarily takes place in the gym, and in addition to instrumental and manual therapies, running begins along with the first strengthening exercises for the injured muscle.
Once you can run properly, can you increase the speed and difficulty of running?
Correct, that’s exactly the right approach.
At this stage, the muscle has anatomically healed, and the focus of treatment must shift to the complete recovery of strength — this is the critical goal.
The use of the isokinetic dynamometer allows for training the muscle and, most importantly, measuring recovery and identifying any remaining differences between one thigh and the other.
In this phase, you sweat — a lot.
At this point, back with the team!
No, it’s not time to rejoin the team just yet. Running fast enough and having the muscle as strong as before isn’t sufficient to be considered ready. It’s essential to complete rehabilitation with the “testing” phase, the final step: field rehabilitation. Here, movements and game intensities are progressively tested at increasing levels while monitoring running with GPS to ensure high, or rather ultra-high, speeds are being achieved — these are crucial for recovering from a flexor injury.
It all seems quite complex and challenging, especially for the average athlete.
No, rehabilitation from a muscle injury isn’t complex. It’s delicate, yes, but it’s not difficult to heal the athlete and bring them back to performing their sport. The difficulty and complexity with flexor muscle injuries lie in the time — the limited time available because the player “needs to get back on the field as soon as possible”. This attitude, this “rush” is why muscle injuries have the highest rate of recurrence.
As for so-called regular athletes, the rules are the same: provide the best possible care, the best rehabilitation, and return to play not just when the ultrasound “looks fine”, but only after the strength of the flexors is fully recovered! If the muscle strength is completely restored, the return to play is safe.
For muscle injuries, my advice is: fewer massages and more exercises!
