Return to play criteria after hamstring muscle injury in professional football: a Delphi consensus study

Mattia Zambaldi, Ian Beasley, Alison Rushton

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22 Citations (Scopus)
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Background: Hamstring muscle injury (HMI) is the most common injury in professional football and has a high re-injury rate. Despite this, there are no validated criteria to support return to play (RTP) decisions.

Aim: To use the Delphi method to reach expert consensus on RTP criteria after HMI in professional football.
Methods: All professional football clubs in England (n=92) were invited to participate in a 3-round Delphi study. Round 1 requested a list of criteria used for RTP decisions after HMI. Responses were independently collated by 2 researchers under univocal definitions of RTP criteria. In round 2 participants rated their agreement for each RTP criterion on a 1–5 Likert Scale. In round 3 participants again rated the criteria that had reached consensus in round 2. Descriptive statistics and Kendall's coefficient of concordance enabled interpretation of consensus.

Results: Participation rate was limited at 21.7% (n=20), while retention rate was high throughout the 3 rounds (90.0%, 85.0%, 90.0%). Round 1 identified 108 entries with varying definitions that were collated into a list of 14 RTP criteria. Rounds 2 and 3 identified 13 and 12 criteria reaching consensus, respectively. Five domains of RTP assessment were identified: functional performance, strength, flexibility, pain and player's confidence. The highest-rated criteria were in the functional performance domain, with particular importance given to sprint ability.

Conclusion: This study defined a list of consensually agreed RTP criteria for HMI in professional football. Further work is now required to determine the validity of the identified criteria.
Original languageEnglish
Pages (from-to)1221-1226
Number of pages6
JournalBritish Journal of Sports Medicine
Issue number16
Early online date28 Feb 2017
Publication statusPublished - 1 Aug 2017


  • Hamstring
  • Muscle injury
  • Assessment
  • Consensus
  • Football


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