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Return to play after injury in professional football

Is there an optimal number of training sessions before return to play?

  • Extra training sessions before return to play protects against muscle injuries
  • Injury chance in first match after injury almost five percent
  • Advice: increase training load during rehabilitation

Every training session a professional football player completes after he is declared fit to play after an injury, reduces the risk of injury during the first game with seven percent. The risk of muscle injury even decreases by thirteen percent for every completed training session before returning to the highest level. This was the conclusion of a very extensive cohort study of a Swedish research group with data of 50 professional football clubs covering sixteen seasons.

UEFA Elite Club Injury Study

The researchers used data of the UEFA Elite Club Injury Study with figures of over 16,000 injuries. In 4,805 of the cases, the football player was 1) absent for a minimum of eight days and 2) returned to the highest level on the pitch after he was 3) declared fit by the medical staff and 4) completed a maximum of ten training sessions before he played a game. 219 of them sustained a reinjury in this first game. All training sessions prior to the ‘fit to play’-statement were labelled as part of the rehabilitation and were excluded in the calculations.

Injury risk

The average risk to sustain an injury in a game was three percent, while in the first game after injury this was on average 4.6 percent. The researchers suspect that football players are less fit after injury and the sudden increase in training load and a game leads to a higher injury risk. According to the authors, this could possibly be prevented by already increasing the training load during rehabilitation. They refer to a study among Australian football players, in which an increase of the training load during rehabilitation led to less secondary muscle injuries. 

> From: Bengtsson, Br J Sports Med 54 (2020) 427-432 . All rights reserved to The Author(s). Click here for the online summary. Translation by Casper Martens

Expert opinion by Maarten Barendrecht

Even though the relationship is presented by the authors as completely linear, it appears from the separate figures per number of training sessions that the risk of injury, particularly in muscle injuries, only diminishes after four complete group training sessions. Consider also that these football players have on average five training sessions between two games. When transferring these results to lower levels of play, it is the question whether this means that after rehabilitation participating in all training sessions between two games is the minimum requirement, or that only four completed training sessions are needed. 

The assumption seems justified, that the level and intensity of the rehabilitation in these professional football clubs is high before the player is declared competition ready (return to play decision). If this process has been less due to facilities, motivation, available time and attention for optimal rehabilitation, it is likely that more training sessions are needed. On the other hand, training without complaints can create a selection bias; this study does not show how many football players sustained a reinjury during the training sessions prior to the first match. Lastly, the average duration of the first game load is less than an hour. This indicates that the reduction in load capacity has been and should be considered. 

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