What factors are involved in hamstrings injury?
Hamstrings injury is the most frequent muscle injury in sports that require high speeds, such as football, rugby or American football.
The SARS-CoV-2 (COVID-19) health crisis has made our society take extraordinary measures affecting all aspects of our lives, and sport could not be less. World-renowned international competitions such as the Olympic Games or the UEFA Euro that were going to be held this coming summer, have been cancelled due to the confinement to which a large part of the world population has been subjected. The suspension of national leagues and championships has also taken place, something that hasn’t happened since World War II and has meant the loss of millions of Euros for sports entities. Therefore, once the first outbreak of the disease has passed, and in order to minimise economic losses, major sports leagues such as football and basketball have resumed the competition.
During this period of isolation, the medical staff has been in charge of the epidemiological monitoring and control of the usual COVID-19 symptoms among the athletes and their families, ensuring at all times that they follow the safety recommendations (hygiene and social distancing measures) established by the experts in the field. In those cases that there has been a positive test, the protocol followed the same procedure as for the rest of the population1, 2. Regarding football, according to the data that is in possession of LaLiga, after the first wave of tests performed on First and Second Division team squads, 16% of the players have developed antibodies, which contrasts the average for the Spanish population which is 5.2%, according to the ENE-COVID-19 Study. Despite the fact that athletes are generally young and have a lower risk to develop serious symptoms due to COVID-19, as well as not having any associated comorbidities such as hypertension or obesity, they too can transmit the virus or suffer complications. That’s the reason why sports entities have followed the same prevention strategies as the rest of the population in order to help prevent the spread of the virus and the collapse of the health system3.
During this confinement, players have been forced to train at home “following training plans and recommendations on physical work that they received from the strength and conditioning coaches” as indicated by Drs. Javier Yanguas and Eva Ferrer, who both belong to FC Barcelona’s Medical Department. As Dr. Ferrer mentions, “it is not the same to train every day on a football pitch or in the gym compared to at home, so the players have undergone a process called detraining, in which the body reduces its functional response capacity, in addition to having less lean mass and more fat mass”. This has caused an increase in the risk of a player getting injured once back to the normal training routine. An example which showcases this risk is the number of injuries that took place in the National Football League or NFL in the comeback of its players after the three month strike4 that took place. After the lockout, many suffered from an Achilles tendon injury in the first month.
Having in mind all these situations, mini pre-seasons have been designed for players to be able to adapt to a gradual increase in training loads, in order to return to compete at the highest level, guaranteeing their safety under strict conditions5-7. The technical staff also followed an interdisciplinary approach which included doctors, physical trainers, physical therapists, and nutritionists, to undertake different measures to reduce the risk of injury after the resumption of training. Dr Daniel Florit, from FC Barcelona’s Medical Department, lists the main measures which are: “evaluation of body composition to know which is our starting point; scheduling training loads progressively; maximising communication with players to anticipate any risky situation and to be able to act sooner than later, and establishing an adaptive nutritional plan together with ergogenic aids”.
FC Barcelona’s Medical Department has developed a protocol following LaLiga’s guidelines, with a special emphasis on controlling the transmission of COVID-19, to guarantee optimal health and physical performance among players before returning to competition8. Specifically, the protocol consisted of a Pre-Participation Medical Examination, similar to that carried out during a conventional preseason9, followed by a PCR and ELISA test, to detect the virus and any potential contagious case, as well as knowing the seroprevalence of FC Barcelona’s players. In the case of a positive test, the protocol included an analysis to measure the impact on other organs and the respiratory, cardiovascular, musculoskeletal, or immune systems, which could also have a negative effect on the player’s performance. Also, it was essential to rule out myocardial symptoms among those affected before resuming training, as myocarditis or pericarditis are clinical manifestations of COVID-1910.
Due to this increased risk of injury after resuming sports activity, it is key to control the workload, the use of wellness questionnaires, and an effective rotation of players throughout the competition. That’s the main reason why now teams can substitute 5 players. In these running times, team doctors have a relevant role in the return to sports practice, monitoring and controlling symptoms and possible signs related to COVID-19. In addition to the evaluation of injury risk factors that under normal conditions do not appear among elite athletes. That’s why doctors now also have to promote “the protection and safety measures implemented by the health authorities and by the competitions themselves, which consist of maintaining the physical safety distance, the use of the mask, frequent cleaning of the hands, avoid coughing or sneezing directly into the air, touching the face, mouth or eyes, and minimising daily social contacts”, as Dr David Domínguez mentions who is also part of the Medical Department at FC Barcelona.
As the days pass by and the competition follows its course, it will allow us to know whether these measures which have been implemented, are effective in terms of performance and safety for the players. If from now, until the end of the competition there’s no positive test for COVID-19 among players and members of the different staffs, and the injury rate remains with a similar rate to that from past years, we will be able to say that the protocols followed have been successful thanks to the well-doing of the doctors. Also, if this is the case, these protocols could be useful for other athletes, disciplines and amateurs.
Javier Salvador Morales
An article published in The Orthopaedic Journal of Sports Medicine —in which members of the club’s medical services participated— now suggests to consider the detailed structure of the area affected, and treating the extracellular matrix as an essential player in the prognosis of the injury.