Return to play after treating acute muscle injuries in elite football players with radial extracorporeal shock wave therapy

Abstract

Background: To 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.

Methods: We 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 one of the previous seasons.

Results: A total of 20 acute muscle injuries were diagnosed and treated 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 47:769-774, 2013), 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.

Conclusions: Overall, 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.

Keywords: Acute muscle injury; Athletes; Extracorporeal shock wave therapy; Rehabilitation; Return-to-play.

Fig. 1

Protocols of radial extracorporeal shock wave therapy (rESWT) (A–S) or focused extracorporeal shock wave therapy (fESWT) (T) of all acute muscle injuries type 1a (A–H), 2b (I-M), 3a (N–Q) and contusions (R–T) suffered by the players of an elite football team during one of the previous seasons (first/second German Bundesliga), arranged in order of increasing lay-off times. All rESWT treatments were performed with a Swiss DolorClast device (Electro Medical Systems, Nyon, Switzerland) equipped with EvoBlue handpiece and 36-mm applicator; radial extracorporeal shock waves (rESWs) were applied at 20 Hz. Air pressure data are marked by red dots (between 2 and 3.5 bar) and the number of rESWs per treatment session by blue dots (between 6.000 and 12,000 per treatment session). The fESWT treatment shown in T was performed with a Swiss PiezoClast (Electro Medical Systems) and 15-mm gel pad; focused extracorporeal shock waves (fESWs) were applied at 8 Hz. Energy level data are marked by red dots (Level 10) and the number of fESWs per treatment session by blue dots (between 2.500 and 3.000 per treatment). In each case, Day 0 was the day of injury. Every pair of red and blue dots indicates a single treatment session. When the player’s status was 4 on the day of the last treatment (explained in Fig. 2), return to play was achieved on this day. In contrast, when the player’s status was 3 on the day of the last treatment (explained in Fig. 2), return to play was achieved on the following day. Delays in starting with rESWT were due to away games and traveling

Fig. 2

Time course of treatments of acute muscle injuries Type 1a (A–H), 2b (I–M), 3a (N–Q) and contusions (R–T) suffered by the players of an elite football team during one of the previous seasons (first/second German Bundesliga), arranged in order of increasing lay-off times. VAS scores are marked by red dots (0 = no pain; 10 = maximal pain) and the player’s status by blue dots (1 = injured; 2 = rehabilitation; 3 = training; 4 = fully fit/return to play). Diagrams A–S represent treatments with radial extracorporeal shock wave therapy (rESWT), whereas Diagram T represents treatments with focused extracorporeal shock wave therapy (fESWT). In every case Day 0 was the day of injury, and a pair of red and blue dots indicates a single treatment session. When the player’s status was 4 on the day of the last treatment, return to play was achieved on this day. In contrast, when the player’s status was 3 on the day of the last treatment, return to play was achieved on the following day. Delays in commencing rESWT/fESWT were due to away games and traveling

Fig. 3

MRI images of the lower leg of an elite football player who was diagnosed with a minor partial muscle tear (Type 3a) of the right soleus muscle (yellow arrows). The time course of the rehabilitation of this player is shown in Fig. 1Q; the detailed treatment protocol is summarized in Table 2. Return to play was achieved on Day 22 post-injury