Return to play after treating acute muscle injuries in elite football players.

Return to play after treating acute muscle injuries in elite football players.


Return to play after treating acute muscle injuries in elite football players. 2021-06-15 Morgan JPM, Hamm M, Schmitz C, Brem MH. Return to play after treating acute muscle injuries in elite football players with radial extracorporeal shock wave therapy. J Orthop Surg Res. 2021 Dec 7;16(1):708. doi: 10.1186/s13018-021-02853-0. PMID: 34876172; PMCID: PMC8650394.

Full abstract

Study background

Main goal of this study was to assess and compare recovery time after acute muscle injuries in elite football players subjected to different treatment approaches. Reviewing available studies of ESWT highlighted its strong beneficial impact on treating various musculoskeletal disorders. Therefore, researchers hypothesized whether implementing rESWT in the multimodal therapy approach will shorten the lay-off times and reduce re-injury rate.

How does the multimodal approach with the use of rESWT influences recovery time?


To explore it, the authors performed an extensive, retrospective analysis of 20 acute muscle injuries diagnosed with international guidelines. They were classified according to Müller-Wohlfahrt et al. as follows:

  • 8 (40%) were diagnosed as type 1a,
  • 5 (25%) as type 2b,
  • 4 (20%) as type 3a,
  • 3 (15%) as contusions.

There were no registered type 3b or 4 muscle injuries during the season.


Multimodal therapy approach

Taking advantage of novel treatment solutions, all patients underwent customised, multimodal therapy which combined cryotherapy, compression, manual therapy, resistance or weight-training, progressive physiotherapy exercise programme and extracorporeal shock wave therapy. An experienced therapist decided whether applying radial or focused ESWT protocol will be more appropriate and effective for the patient. The majority of cases (19/20) were qualified for rESWT and only 1 case (contusion of the gluteus maximus muscle) was treated with the use of fESWT.

  • rESWT was performed using a Swiss DolorClast device with an EvoBlue handpiece
  • fESWT Swiss PiezoClast device and 15-mm gel pad.

Proposed study outcome, defined as return-to-sport, was characterized by being able to fully participate in team exercises, including contact training, and being ready for the return to play during the championship.


Return-to-sport was achieved after (median / mean / range):

  • type 1a injuries - 3 / 3.3 / 2-6 days
  • type 2b injuries - 4 / 6.2 / 3-14 days
  • type 3a injuries - 4 / 4 / 4 days

Corresponding to a data set obtained from 31 European male football teams published by Ekstrand et al., multimodal therapy comprising ESWT has significantly reduced median lay-off times:

  • type 1a injuries - by 54%,
  • type 2b injuries - by 50%,
  • type 3a injuries - by 8% (or 23% when classified as more severe 3b type)

The authors also retrospectively analysed re-injury rate during the football season. Only 1 case of reinjury (previously classified as type 1a) occurred after the full recovery. The study clearly presented satisfactory results demonstrating that pain (measured with Visual Analog Scale, VAS) was constantly decreasing during the course of the multimodal treatment. This is an extremely important success factor both for the patient and for the therapist, as it allows to intensify the treatment to achieve even better results.


Findings of this study

  • incorporating rESWT/fESWT into a multimodal therapy approach is safe, effective and beneficial for the athletes suffering from various muscle injuries;
  • specifically, median and mean lay-off times after type 1a (muscular tightness/hypertonicity) and 2b (muscular strain injury) muscle injuries were 50% shorter than comparable cases reported in literature;
  • radial and focused ESWT can have an influence in re-injury prevention.

The therapy was well tolerated by the players and there were no adverse effects registered during the treatment sessions.

How Physiotherapy Helps with Knee Pain

The knee joint is one of the most active joints in the human body, which implies that knee discomfort is a typical occurrence. It has the power to sabotage even the most mundane aspects of everyday existence. It only has the ability to do two things: flex and extend. Bones, cartilage, tendons, and ligaments make up the intricate structure, all of which are prone to damage, injury, and degeneration. Physiotherapy is one of the quickest and safest methods to regain your strength and get back on the road to recovery if you are suffering from knee discomfort.

Spinal Osteoarthritis

Low back discomfort affects up to 80% of the population. In osteoarthritis, cartilage degeneration is a frequent source of low back discomfort (tissue covering the joint surfaces at the ends of bones).

Guide To Golfer's Elbow

Medial epicondylitis is commonly called golfer's elbow or thrower's elbow. Inflammation, discomfort, and irritability occur in the tendons on the inside of the forearm, resulting in this condition. Golfer's elbow is caused by overuse of the hand, wrist, forearm, and elbow. People with this problem are often seen to be swinging a golf club or other things repeatedly. In addition to using a computer or doing yard labour, this might lead to the condition. It's especially dangerous for athletes who do a lot of overhead work, as well as for carpenters and plumbers. In males, golfer's elbow is more frequent beyond the age of 35 than it is in younger ones. Unlike tennis elbow, it is not as frequent (lateral epicondylitis). For those suffering from medial epicondylitis, a physiotherapist at Phoenix Physio Clinic can assist alleviate discomfort and increase the elbow's range of motion and strength.

All You Need to Know About Tennis Elbow

Inflammation of the tendons that connect the forearm muscles to the outside of the elbow is known as tennis elbow. Overuse of the forearm muscles and tendons, as well as those surrounding the elbow joint, is a common cause of this condition. Lateral elbow discomfort or lateral epicondylitis, which is not necessarily connected to tennis, is sometimes known as "tennis elbow." Repetitive muscular usage is a common cause of tendonitis in tennis players. Tennis elbow affects half of all tennis players at some point in their careers. Approximately 1 to 3 percent of the population in Canada is estimated to suffer from tennis elbow (Canada). Between the ages of 30 and 50, it is most common. A source that you can trust.

Dose-related effects of radial extracorporeal shock wave therapy for knee osteoarthritis: a randomized controlled trial

Over 13.000 DolorClast® shock-wave devices are installed worldwide and are continuously employed in conducting scientific research. In fact, with 34 out of 62 randomized Controlled Trials listed in the PEDro database, the DolorClast® devices are used in more studies than any other ESWT device. In this list of clinical evidence, the following study triumphs, due to the fact that it demonstrates the extent to which treatment outcomes are dose-dependent.