Okay, I'll just start everything with this video and then you'll understand why. This player went for the ball and suddenly feel a pop, some pain, and that's where we doctors always start our work from this point. So it's very clear there that something happened. And the question that we always have as a surgeon, doc, when can he get back into the game? So that's the first question that people ask us when something happened in the field. So my name is Lucio Erland, I'm from Brazil. It's a pleasure to be here at the OSSM. Thanks very much for inviting us. So it's hamstring lesions in elite athletes. I have nothing to disclose about my talk and I just want to acknowledge my two mentors here in US, Dr. Charles Rockwood and Dr. Freddy Fu, who both passed away last year. So when we talk about the incidence of lesions in sports, and mainly in soccer where I worked for 16 years, it's very clear that everything related to muscles are number one injury. Muscles injuries and tendon injuries are the most common injuries throughout the season. And it is, again, in mid-season is even worse. So Brazilian soccer season is a whole year, soccer season is one single one. And it's very clear that we have the first semester right in the middle of it and right in the middle of the second semester is when we have the worst cases. This is just an example of one of the Brazilian top teams with 59% of all injuries are related to muscles. And again, on the muscle field, 49%, 45% are related to hamstrings. If we compare our numbers with Europe, they are quite similar, except for the fact that Brazil has much more games per season. And then our injury rate of muscle injuries are up higher. This study from, this longitudinal studies from the Young Extrant, showed that there was an increase of about 4% annually on the amount of new cases of muscle injuries throughout the years since 2001. This was my paper, and hamstring muscle injuries are the most common injury in sports. They are correlated to long rehabilitation, they have a great tendency to reoccur. The risk factors, age, and previous injuries are number one, and every time we hear that. There's a classification, the Munich classification, the British, then the Barcelona, but everything, all this information is just to help us to put better guidance on the way we treat our patients. Imaging is paramount, and we can use either ultrasound or MRI. But then we go to the real cases. This is two examples, player one and player two. They have the same injury location and severity, so the normal return to play time that we would suspect would be around four weeks for both of them. But then, there is a difference between these two players. Player number one is facing the first injury in this location, and player two is the third injury in the same location. Player one is a center fielder, player two is a wing back. The risk tolerance, for instance, in player one, he's a key player for the team, and player two, not normally in the starting 11. So then the estimated return to play time will be different between these two guys, even though the injury is exactly the same. So one is three weeks, the other is seven weeks. So this is very important for us to understand that we not just go through classifications that we'll be able to give an answer for that first question that I just made. And treatment has to be return to play based. That means that we have to start treating the patient from the very, very moment, very moment of the injury. And I love this peace and love thing. I think this way of treating muscle injuries is very interesting and really help us to go through all the phases of it. This other paper shows something very interesting. There is a comparison between two different types of physical therapy and rehabilitation protocol consisting of mailing lengthening type of exercises more effective than a conventional protocol in promoting return to full training after acute hamstring injuries in Swedish elite sprinters and jumpers. And then we can put this to the Brazilian field as well that works the same way. It's return to play is a multidisciplinary decision. It's not just a doctor's decision. It's athlete, team coach, physical therapist, sport physician, and the fitness trainer all together have to make a decision when to return to play safely. So it's really a teamwork. And it's really a complex injury. You cannot say that this is a simple thing. It's just a simple muscle strain. It's much more than that. This is another example. There are two players. This first player here had a hamstring lesion. This one had rectus femoris. And there is a difference in between the position they play, the amount of load and amount of exercise that I can give them throughout this program of return to play. And it also has a big difference in terms of the position that they have on the field. So the criteria for return to play are absence of pain, ability to make the movements of the sport without hesitation, recovery of strength and strengthening of the muscles group involved, athlete's own safety in returning to physical activity, evaluation of muscle force can be determined by isokinetic testing, and restoration of the limb force compared to the contralateral side between 9% and 95%. And the relationship between IT and quad tendon between 50% and 60% is desired. So again, the question, Doc, when can he get back into the game? Well, this is a return to play sports is a complex issue. There is no simple answer for that question. Interdisciplinary involvement is mandatory. Rely on rehabilitation protocols started early after the injury in the treatment of the ruptured muscle. Scientific progress has been made in terms of validating early rehabilitation as the gold standard. We have standardized battle-tested rehabilitation protocols have been introduced to the field recently to provide a framework for safe and efficient rehabilitation. By adhering to these protocols, the injured athlete can recover from serious skeletal muscle injuries as fast and efficiently as possible. And we can enjoy being a champion with our athletes. Thank you so much.

hamstring lesions

elite athletes

muscle injuries

rehabilitation

return-to-play criteria