Introduction
Hamstring injuries are a significant concern for athletes, particularly those engaged in sports that require explosive sprints and abrupt changes in direction, such as football. These injuries not only hinder athletic performance but also pose a risk for re-injury if not properly managed. Effective rehabilitation is essential to ensure a safe return to play and to prevent future occurrences. The complexity of hamstring injuries necessitates a multifaceted approach to assessment and monitoring, combining various technologies to provide comprehensive insights into the recovery process.
This case report presented in Isokinetic Conference 2024, presents an in-depth case report of a professional football player who sustained a grade 2c injury to the long head of the biceps femoris muscle, diagnosed through MRI and monitored with ultrasound. The rehabilitation process for this athlete was supported by an integrated approach utilizing infrared thermography, tensiomyography (TMG), countermovement jump (CMJ) analysis, cortisol level measurements, and GPS tracking. Each of these technologies offers unique advantages in monitoring different aspects of the rehabilitation process.
Infrared thermography allows for non-invasive monitoring of skin temperature asymmetries, which can indicate underlying physiological changes in muscle tissue. Tensiomyography provides insights into muscle contractile properties, helping to assess muscle function and recovery. CMJ analysis offers valuable data on explosive power and neuromuscular performance, essential for evaluating the readiness of an athlete to return to high-intensity activity. Cortisol measurements can indicate physiological stress levels, providing a broader understanding of the athlete's overall condition. Finally, GPS tracking offers detailed information on the external load and physical demands placed on the athlete during training sessions.
The integration of these technologies creates a robust framework for monitoring rehabilitation progress, allowing for a more precise and individualized approach to recovery. This case report aims to demonstrate the effectiveness of this comprehensive monitoring strategy in supporting the rehabilitation of a hamstring injury and facilitating a safe return to play for professional athletes. Through detailed tracking and analysis, the use of these advanced technologies ensures that rehabilitation is both effective and aligned with the specific needs and responses of the athlete.
A professional football player (25 years old, 183 cm heigh, 76kg) from the English Championship sustained a BAMIC grade 2c injury of right long head biceps femoris muscle involving the medial intramuscular tendon on his right leg, as diagnosed with MRI and monitored using ultrasound. Following the injury, a multidimensional monitoring approach was adopted to assess the player's progress during rehabilitation (figure 1)
Figure 1. Rehab Calendar.
GPS data was recorded each day of training using Statsport Apex Team Series. Infrared Thermography assessments were performed, at least once a week, in the early morning before the treatment or training session started, using a FLIR T540-EST (Teledyne FLIR, Sweden) and analyzing the results with ThermoHuman software (PEMA THERMO GROUP S.L., Spain). CMJ were performed at least once a week (VALD, Australia). Tensomiography (TMG, BMR, Slovenia) and Cortisol (SOMA Bioscience, UK) were used just one day during the rehab but could be compare with his baseline data.
Thermography revealed a decrease in skin temperature asymmetry in the hamstring area post-injury (-0,4ºC), with values returning to normal (-0,03ºC) just before the player's return to play on Day 26 (Figure 2). Concurrently, CMJ measurements showed improvements in peak power and jump height (from 4083 to 4179W and 42,7 to 45,9cm respectively), indicating rehabilitation progress. Additionally, TMG values became more symmetrical on Day 26. However, cortisol levels increased (from 18,60 before the injury to 26,90 on day 26), suggesting potential physiological stress associated with the impending return to competitive action.
GPS data provided valuable insights into the external load placed on the player during rehabilitation. Progressive increases in total distance, maximal velocity, number of accelerations and decelerations, and high-speed running distance were observed, reflecting the gradual return to full training intensity.
The integration of thermography with CMJ, TMG, cortisol analysis, and GPS tracking offers a comprehensive approach to monitoring hamstring injury rehabilitation in professional athletes. Thermography, TMG and CMJ provide objective and non-invasive assessments of physiological and biomechanical changes (1,2), while GPS data offer insights into external load management (3). Likewise, Cortisol analysis measurements contribute valuable information regarding physiological stress but could not be match with the RTP process.
Overall, GPS, thermography and TMG emerge as the most practical technologies for supporting return-to-play decisions due to their ease of use and high relevance to rehabilitation progress. CMJ, while slightly more invasive, also provides valuable biomechanical insights. Cortisol analysis, although informative, may require more specialized resources and interpretation and can be influenced by other different factors rather than the rehabilitation.
ThermoHuman has had the support of the Funds of the European Union and the Community of Madrid through the Operational Programme on Youth Employment. Likewise, ThermoHuman within the framework of the Export Initiation Program of ICEX NEXT, had the support of ICEX and the co-financing of the European Regional Development Fund (ERDF).
Thermohuman has received funding from the Centre for the Development of Industrial Technology (CDTI), in participation with the European Regional Development Fund (ERDF), for the R+D activities involved in creating a new tool, based on thermography, for the prediction and prevention of rheumatoid arthritis. See project detail.
