Article Text

Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport – grading the evidence: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)
  1. Lasse Ishøi1,
  2. Kasper Krommes1,
  3. Rasmus Skov Husted2,3,
  4. Carsten B Juhl4,
  5. Kristian Thorborg1,2
  1. 1 Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark
  2. 2 Department of Orthopedic Surgery and Physical Therapy, Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
  3. 3 Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
  4. 4 Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Lasse Ishøi, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre 2650, Denmark; lasse.ishoei{at}


This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.

  • muscle injury
  • diagnosis
  • treatment
  • prevention
  • review

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  • Twitter @LasseIshoei, @krommes, @@Husted_RS, @@BoghJuhl, @KThorborg

  • Contributors The paper has been commissioned by the Danish Society of Sports Physical Therapy (DSSF). All authors are part of the association, and has contributed substantially to the work.

  • Funding The Danish Society of Sports Physical Therapy initiated the project and provided financial support to authors (LI, KK, RSH).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.