Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making.

There are three major questions about return to play (RTP) after hamstring injuries: How should RTP be defined? Which medical criteria should support the RTP decision? And who should make the RTP decision? The study aimed to provide a clear RTP definition and medical criteria for RTP and to clarify RTP consultation and responsibilities after hamstring injury. The study used the Delphi procedure. The results of a systematic review were used as a starting point for the Delphi procedure. Fifty-eight experts in the field of hamstring injury management selected by 28 FIFA Medical Centres of Excellence worldwide participated. Each Delphi round consisted of a questionnaire, an analysis and an anonymised feedback report. After four Delphi rounds, with more than 83% response for each round, consensus was achieved that RTP should be defined as 'the moment a player has received criteria-based medical clearance and is mentally ready for full availability for match selection and/or full training'. The experts reached consensus on the following criteria to support the RTP decision: medical staff clearance, absence of pain on palpation, absence of pain during strength and flexibility testing, absence of pain during/after functional testing, similar hamstring flexibility, performance on field testing, and psychological readiness. It was also agreed that RTP decisions should be based on shared decision-making, primarily via consultation with the athlete, sports physician, physiotherapist, fitness trainer and team coach. The consensus regarding aspects of RTP should provide clarity and facilitate the assessment of when RTP is appropriate after hamstring injury, so as to avoid or reduce the risk of injury recurrence because of a premature RTP.

Association of Arm Position and Playing Time with Prevalence of Complaints of the Arm, Neck, and/or Shoulder (CANS) in Amateur Musicians: A Cross-Sectional Pilot Study Among University Students.

OBJECTIVE: In addition to known risk factors for musculoskeletal complaints in the general population, playing a musical instrument is an additional risk factor. In this pilot study, the prevalence of musculoskeletal complaints in student amateur musicians and their relation with playing posture and playing time were evaluated. METHODS: A cross-sectional web-based survey among amateur musicians studying at a Dutch university. RESULTS: 162 amateur musicians were included in this pilot study (response rate 17.6%). 46.9% of these amateur musicians played with an elevated arm position. Presence of complaints of the arm, neck and/or shoulder (CANS) was not statistically significantly related to arm position, except for complaints in the left shoulder with an elevated left arm position compared to neutral left arm position (OR 6.7, CI 95% 2.2-20.8) The number of hours playing per week did not significantly contribute to CANS (OR 1.0, CI 95% 0.95-1.17). CONCLUSIONS: In this pilot study among student amateur musicians, the occurrence of CANS was not significantly related to arm position, except for musicians playing with an elevated left arm position, which was associated with complaints of the left shoulder (OR 6.7). The number of hours playing per week did not significantly contribute to CANS in this group of musicians.

Associations between work-related factors and specific disorders of the shoulder--a systematic review of the literature.

OBJECTIVE: Our aim was to provide a quantitative assessment of the exposure-response relationships between work-related physical and psychosocial factors and the occurrence of specific shoulder disorders in occupational populations. METHODS: A systematic review of the literature was conducted on the associations between type of work, physical load factors, and psychosocial aspects at work, on the one hand, and the occurrence of tendinitis of the biceps tendon, rotator cuff tears, subacromial impingement syndrome (SIS), and suprascapular nerve compression, on the other hand. Associations between work factors and shoulder disorders were expressed in quantitative measures as odds ratio (OR) or relative risk (RR). RESULTS: The occurrence of SIS was associated with force requirements >10% maximal voluntary contraction (MVC), lifting >20 kg >10 times/day, and high-level of hand force >1 hour/day (OR 2.8-4.2). Repetitive movements of the shoulder, repetitive motion of the hand/wrist >2 hours/day, hand-arm vibration, and working with hand above shoulder level showed an association with SIS (OR 1.04-4.7) as did upper-arm flexion > or =45 degrees > or =15% of time (OR 2.43) and duty cycle of forceful exertions > or =9% time or duty cycle of forceful pinch >0% of time (OR 2.66). High psychosocial job demand was also associated with SIS (OR 1.5-3.19). Jobs in the fish processing industry had the highest risk for both tendinitis of the biceps tendon as well as SIS (OR 2.28 and 3.38, respectively). Work in a slaughterhouse and as a betel pepper leaf culler were associated with the occurrence of SIS only (OR 5.27 and 4.68, respectively). None of the included articles described the association between job title/risk factors and the occurrence of rotator cuff tears or suprascapular nerve compression. CONCLUSIONS: Highly repetitive work, forceful exertion in work, awkward postures, and high psychosocial job demand are associated with the occurrence of SIS.