Consensus statements and percentage agreement for round 2 survey—global expert panel and return to sport
| Statements related to return to sport | True | False | Undecided | Samples of typical responses—discussion points or areas of disagreement |
| In hamstring injury, range of motion is a consideration for return to sport (RTS). If previous data is available, then within 10% of previous scores should be used otherwise within 20% of the other limb. | 45.0% | 23.3% | 31.7% | Flexibility was not considered a key factor by many clinicians—stretching did not always produce improvements in function or performance and less agreement over acceptable levels. |
| Kinetic chain strength/function is a consideration criterion for RTS. | 78.3% | 6.7% | 15.0% | All agreed kinetic chain was important—but panel did not agree on key kinetic chain factors. A clinical reasoning approach was advocated to assess each athlete based on the required sporting demand and key injury risk activities. |
| Progression to peak isometric force in mid and outer range, isotonic strength (eccentric only/eccentric and concentric) are all considerations for RTS. | 83.3% | 1.7% | 15.0% | Optimal types of exercise were controversial but consistent with literature—eccentric or isometric exercises at length were considered important and reached agreement. |
| Benchmarks for strength should reflect the end goal demands of the athlete but should be within 10% of previous data or population means. | 66.1% | 10.2% | 23.7% | The low agreement for this question reflected differences in opinion on strength benchmarks. |
| Athlete subjective apprehension is a consideration for RTS criteria. | 98.3% | 0.0% | 1.7% | The strong agreement reflects the importance the panel placed on the athletes leading the RTS/return to running process—and ensuring their opinion was prioritised. |
| Athlete self-assessment of their readiness to RTS is a key factor in the RTS decision-making process. | 86.7% | 5.0% | 8.3% | |
| Askling H-test is a useful test in the return to sprinting decision process. | 57.6% | 18.6% | 23.7% | The respondents were divided on use of pain provocation tests. Their usefulness was acknowledged but it was felt that no one specific test could assess readiness to return to sprinting—and the tests should form part of an ongoing assessment and clinical reasoning process. |
| Endurance capacity testing of the hamstrings should be a consideration for RTS. | 78.3% | 6.7% | 15.0% | Endurance was felt to be important, but it was harder to get agreement on which endurance tests were most important—running endurance was felt to be important but the panel suggested that the level of endurance related to the specific sporting demands. |
| Pain-free sprinting is a criterion for return to play. | 96.7% | 1.7% | 1.7% | The importance of sprinting in match play/competition was acknowledged, with high agreement. There was less agreement on the dosage of full sprinting. While some pain was permitted in running, sprinting in RTS—was expected to be pain free. |
| Completing full unrestricted training session should be a criterion for RTS. | 93.3% | 6.7% | 0.0% | Training sessions reached agreement—particularly as this assessed the athlete with sports-specific demands and endurance requirements. |
| The use of previous GPS metrics can guide the required dosage of appropriate metrics, that is, volume, sprints, speed, high-speed running. | 83.3% | 3.3% | 13.3% | Many in the panel were using GPS to measure running dosage—and their usefulness was thought to be key—with practice expertise moving faster than research evidence base—this was thought to be an area requiring greater research. |
| RTS should be a multidisciplinary process that involves all stakeholders ideally. | 98.3% | 0.0% | 1.7% | The importance of a whole MDT and coaching athlete stakeholder involvement reached hight level of agreement—but many clinicians acknowledged significant pressure from stakeholder groups to modify their clinical decision-making. |
GPS, global positioning system; MDT, multidisciplinary team.