Abstract:

For this 8th Muscletech Network Workshop, I have been asked to show a proposal for rehabilitating Rectus Femoris Injuries, within the Treatment and Rehabilitation block of the program.

Scientific evidence provides information regarding biological repair processes; fusiform and biarticular anatomical features of this muscle (Mariluis et al. 2015) and its high percentage of type II fibers (Johnson et al. 1973) typical of those muscles who have to perform actions that require large changes in length at high speeds (Mendiguchía et al. 2013); its functions in regards to knee extension, hip flexion and stabilizing the pelvis in monopodales supports (Shu and Safran 2011; Bordalo-Rodriguez and Rosenberg, 2005); injury mechanisms, among the actions that occur during accelerations, decelerations and kicking the ball (Mendiguchía et al. 2013.); the modifiable risk factors, among which include: length/tension relationship, core stability (Mendiguchía et al. 2013; Witvrouw, et al. 2003; Bradley and Portas, 2007; Fousekis et al. 2011), weakness and shortening of the iliopsoas (Sanmarco and Stephens, 1991; Sahrmann, 2002; Lewis and Sharmann, 2007); inadequate eccentric strength of the rectus femoris especially in relation to the dominant knee with hip involvement (Mendiguchia et al. 2013.); along with other risk factors (Konstantinos et al. 2010).

Similarly, scientific evidence also provides us with the most adjusted measures to address these factors, the moments and steps to develop a proposal for rehabilitation and the characteristics of the exercises (Pincivero et al. 2000; Thorborg et al. 2015; Jansen et al. 2012; Mendiguchia et al. 2013).

Therefore my intention for this talk is to show a practical proposal of a rehabilitation program based on this efficacy given by scientific evidence, and transfer this evidence into practice using as support the creative capacity and adaptation to the work context (Cos et al. 2010; Finch, 2006; Hanson et al. 2015).

Short-CV:

Extensive experience with professional soccer teams of international category. Experience with individual athletes: swimmers, athletes, etc. Specialties: Sports and Exercise Medicine,.High Performance in Sports, Manual Medicine, (Orthopaedic and Osteopathic), Acupuncture and TCM and Sport Psychology. My scientific concerns are NeuroMuskuloskeletal System, Pain, Biology&Physiology and Sudden Death Prevention in Sports.

Adolfo Muñoz Team Doctor, Sevilla FC

Spain

Title:

Rehabilitation of rectus femoris injuries. Experience at Sevilla FC

Abstract:

Varying injury characteristics have been suggested to potentially influence the time to return to play for athletes with acute rectus femoris muscle injuries. The current evidence however is very limited, and as perceptions of certain critical elements evolve, these might influence the treatment, as well as the decision on readiness to return to play. In order to minimize bias of the initial expectations on elements related to prognosis, a standardized criteria-based progression protocol is necessary. In this presentation, the development of such protocol will be discussed along with our experiences using this protocol in a larger prospective study. Included in this will be a structural division of elements considered in the rehabilitation program, and a discussion on optimal loading after injury, including elements such as exercise selection, intensity, pain acceptance, and criteria to return to play.

Short-CV:

Andreas Serner is a physiotherapist from Copenhagen, Denmark, with a Master’s degree in Medical Sciences (Sports Sciences/Sports Medicine) from Lund University, Sweden. He has previously worked as a physiotherapist in private practice, as well as in both academy and senior football. Andreas is currently employed as a physiotherapist and researcher at Aspetar Sports Medicine Hospital, and is currently completing a PhD in Clinical Research with a focus on diagnosis and treatment of acute groin injuries in athletes.

Andreas Serner Physiotherapist/Researcher

ASPETAR Sports Medicine Hospital

Doha, Qatar

Title:

Standardized Criteria-based Rehabilitation for Rectus Femoris injuries

Abstract:

The quadriceps apparatus is a complex conglomeration of multiple muscles with certain unique features when compared to other muscles in the body. The current presentation will cover the MR imaging appearance of the dominant components of the quadriceps muscle group with special focus on the rectus femoris and the distal quadriceps tendon.

Short-CV:

Musculoskeletal radiologist with extensive experience in MRI and MR arthrography in both academic and private settings including former appointment as Assistant Professor of Radiology at Harvard Medical School and Division of Musculoskeletal Radiology and Intervention at Massachusetts General Hospital. Over 40 publications in scientific journals.

Currently involved in the care of elite and professional athletes in the United States since 2002 and Europe since 2006 including serving as a tournament physician at the Madrid Open Tennis tournament since 2008. On faculty for over 50 national and international radiology and orthopaedics courses/conferences.

Ara Kassarjian, MD, FRCPC Consultant Musculoskeletal Radiologist

Corades LLC, Boston, MA, USA and Madrid, Spain

Tournament Physician, Madrid Open Tennis, Madrid, Spain

Title:

MRI anatomy of the quadriceps

Abstract:

High-resolution ultrasound (US) is able to provide a comprehensive evaluation of the complex anatomic architecture of the quadriceps femoris. In the rectus femoris muscle (RF), US can provide accurate depiction of the origin of the direct tendon (DT) from the AIIS and of the indirect tendon (IT) from the groove above the lateral acetabulum. In distal continuity with its proximal tendon origins, the RF shows a complex internal structure that influences type and location of its tears. It consists of a “muscle-within-muscle” structure made up of a smaller inner belly (IM) enveloped by a larger outer belly (OM). The OM arises from a flat coronal-oriented superficial aponeurosis that derives from the DT. Muscle fibers arising from the lower aspect of this aponeurosis travel deep and distally to reach the deep distal aponeurosis which continues in the superficial layer of the quadriceps tendon (QT). The orientation of the muscle fibers gives a unipennate appearance to the OM. The IM originates from the central aponeurosis, a thin sagittal-oriented fibrous band which derives from the IT and is located within the cranial two-thirds of the muscle belly. Muscle fibers from the external and internal surface of the central aponeurosis run distally to insert into the deep distal aponeurosis, together with the OM fibers. Therefore, the US appearance of the RFM is that of a small inner bipennate muscle surrounded by a large unipennate muscle. The vastus medialis (VM) and lateralis (VL) muscles originate from the linea aspera and insert distally into the middle layer of the QT. The proximal tendon of the VL is located in close relationship with the distal insertion of the gluteus minimus and some fibers can be seen blending among these tendons. With respect to the RF, some distal fibers of the vastus medialis and lateralis can be seen extending away from the midline to insert into the patellar retinacula and reach, for the VL, the iliotibial band. The vastus intermedius is the deepest of the four muscle bellies and is located in the midline deep to the RF and superficial to the femoral shaft, between the VM and the VL. It arises more distally than the VL and can be seen inserting into the deep layer of the QT.

Short-CV:

Carlo Martinoli received his medical degree in 1986 and became a specialist in diagnostic radiology in 1989 at the University of Genoa, Italy. He has since held positions of Staff Radiologist, Assistant Professor of Radiology and Associate Professor of Radiology at this University. Carlo Martinoli received the national qualification degree as full Professor of Radiology in 2013. He has devoted more than 20 years to musculoskeletal radiology education and is author of a preeminent textbook on Musculoskeletal Ultrasound that has been listed within the top 10 best-selling scientific books of Springer Verlag for 2010. He has published over 200 scientific articles in international peer reviewed medical journals in which manuscript decisions are based on peer review.

Carlo Martinoli Associate Professor of Radiology

Radiologia III - DISSAL - University of Genoa, Italy

Title:

Ultrasound architecture of Quadriceps Femoris Muscles

Carlo Martinoli is actively involved with the European Society of Musculoskeletal Radiology - ESSR and has served this Society as Member of the Executive Committee, Chairman for Ultrasound, and Chairman of the Educational Committee. He also chaired the ESSR Annual Congress in Genoa, Italy, in 2009. He was also member-at-large of the Executive Committee (2010-2012) of the "International Skeletal Society - ISS" and is currently member of the Educational Committee Board of the "European Society of Radiology - ESR" for Musculoskeletal Radiology. In 2012 he founded the International Society of Peripheral Neurophysiological Imaging (ISPNI), a multidisciplinary society that aims to forward global education and research in peripheral nerve imaging.

Abstract:

Muscle injuries have a tremendous impact in sports due to time lost in competition and decrease in performance. The risk of re-injury in muscle injuries is not low, making it really a big issue for athletes, coaches, athletic trainers, physical therapists, and physicians. The best management strategy for muscle injuries is its actual prevention. To accomplish this goal, an adequate and deep understanding of the risk factors for injury is crucial. The purpose of this communication is to provide an up-to-date review of the literature regarding risk factors for rectus femoris muscle injuries in sports.

Short-CV:

· 1998-2002: Bachelor’s degree (BSc) in Sciences of Physical Activity and Sports, National Institute of Physical Education, University of Barcelona, Barcelona, Spain. · 2003-2005: Pre-Doctoral Dissertation, Doctoral program of Biopathology in Medicine, Department of Medicine, University of Barcelona Medical School, Barcelona, Spain. · 2002-2007: Licensed in Medicine (MD), University of Barcelona Medical School, Barcelona, Spain. · 2006-2008: Master of Science (MSc) in Training of elite athletes of team sports, National Institute of Physical Education, University of Barcelona, Barcelona, Spain. · 2006-2008: Master of Science (MSc) in Clinical Biomechanics of the Musculoskeletal System, Rovira i Virgili University, Reus, Spain. · 2003-2008: Degree of Philosophal Doctor (PhD), Department of Medicine, University of Barcelona Medical School, Barcelon, Spain. · 2009-2014: Orthopaedic Surgery and Traumatology Residency Program. Department of Orthopaedic Surgery and Traumatology, Parc de Salud Mar - Hospital del Mar & Hospital de l’Esperança, Autonoma University of Barcelona, Barcelona, Spain. · 2014: Title of Orthopaedic Surgeon and Traumatologist. · 2014: Fellow of the European Board of Orthopaedics and Traumatology (FEBOT) · 2014-2015: Clinical Fellowship (Accredited Council of Graduate Medical Education), Orthopaedic Sports Medicine, Duke University, Durham, NC, USA. · 2015-2016: Clinical Fellowship (Accredited Council of Graduate Medical Education), Adult Reconstructive Surgery, Upper extremity (Shoulder and Elbow), Mayo Clinic, Rochester, MN, USA (currently).

Eduard Alentorn-Geli Clinical Fellow, Department of Orthopedic Surgery, Mayo Clinic

Rochester MN

USA

Title:

Risk factors for rectus femoris muscle injuries

Abstract:

Quadriceps muscle strains frequently occur in sports that require repetitive kicking and sprinting efforts and are common in football in its different forms around the world. The rectus femoris is the most commonly injured muscle of the quadriceps muscle group. According to Ekstrand et al 17% of the lower limb muscle injuries are to the rectus femoris

In our hospital we have a unique project: the National Sports Medicine Program wherein we provide sports medicine service to all clubs and federations for all registered athletes in the country. The Qatar football federation contains approximately 420 professional players and around 4500 amateurs. Each of these athletes has their medical care administered by a member of our team, and the results of any medical encounters are available for review. In a 5-year cohort (2010-2014) we found 17% of the overall lower limb muscle injuries to be rectus femoris injuries, matching the incidence documented by Ekstrand et al (2) which suggests similar mechanisms and burdens are present in this cohort as to the one documented by Ekstrand et al.

The football players of the Qatar Stars League annually perform a pre-season physical screening which includes isokinetic testing of the knee flexors and extensors, at 60°/sec concentric, and 300°/sec concentric, as well as eccentric testing of the knee flexors at 60°/sec. Data will be presented on the utility of such testing in identifying players at risk of injury to their rectus femoris muscle in the subsequent season. These data may inform risk identification and injury prevention strategies in other professional football players.

Short-CV:

Frank van Hellemondt joined the Aspetar Sports Medicine team in August 2012. He is on the Dutch specialist register as a Sports Medicine physician.

Dr. van Hellemondt has acquired extensive experience as Team Physician of numerous professional sporting teams and was Medical Director of FC Utrecht Premier League Football, for more than 10 years. The past years he works as a Team Physician for the first and under 23, Qatar National Football teams. Nowadays, he works as an all round Sports Medicine Physician in the outpatient department, with special interest in managing acute muscle injuries.

Frank van Hellmondt Sports Medicine Physician

Aspetar Orthopedics and Sports Medicine Hospital

Doha, Qatar

Title:

Epidemiology of Rectus Femoris at Aspetar

Abstract:

Injuries to the Quadriceps Muscle Complex (QMC) forms a considerable part of athletic injuries and is therefore frequently seen in clinical and imaging sports medicine clinics. The MR imaging anatomy of the QMC is pertinent to understanding injury patterns, as well as severity and will be reviewed. MR imaging is particularly useful in the elite athlete due to its high sensitivity to localise and characterise injuries, as well as having the ability to prognosticate, thereby ensuring optimal patient outcome by assisting clinical colleagues in tailoring treatment regimens specific to the injury sustained.

Short-CV:

George Koulouris completed his radiology training at The Alfred Hospital in Melbourne in 2004. He then worked at Victoria House Medical Imaging and undertook further training in musculoskeletal MR imaging at Thomas Jefferson University Hospital, Philadelphia.

Throughout his career, George has maintained a determined focus on research. He now is the director of his own private clinic, Melbourne Radiology Clinic in East Melbourne, where he pursues his areas of interest, such as the imaging assessment and treatment of muscle injuries, such as hamstring, calf and groin strains, tendinosis, back and neck pain, as well as musculoskeletal intervention. Imaging of articular cartilage as well as foot and ankle imaging are further areas of interest.

George Koulouris MMBS, FRANZCR, MMed (Radiology) GrCertSpMed

Musculoskeletal Radiologist, Melbourne Radiology Clinic

Melbourne, Australia

Title:

MR Imaging of the Quadriceps Muscle Complex (QMC).

Abstract:

Quadriceps muscle is situated in the anterior side of the thigh. It is formed by four muscles, rectus femoris muscle vastus medialis, vastus intermedius and vastus lateralis with different origin each one. Nevertheless, this last year it has been described a new muscle, the tensor of vastus intermedius muscle between the vastus lateralis and the vastus intermedius. They join in the inferior part of the thigh in the quadriceps tendon when they arrive to the patella. Several descriptions have been demarcated about the quadriceps tendon. It is formed by laminas although there were distinct lamination patterns bilaminar, trilaminar even four-layered that comes from the different parts of the muscle, and also with different patterns. Finally the tendon follows until achieve the anterior tuberosity of the tibia bone as quadriceps ligamentous. It is the extensor of the knee. And it is innervated by the femoral nerve a nerve off the lumbar plexus.

Of the different parts of the quadriceps muscle, the rectus femoris muscle is the most superficial and the sole biarticular, and it is the muscle that most frequently has injuries. The origin of the rectus femoris is by three different tendons. The direct tendon origin is in the anteroinferior iliac spine. The indirect tendon origin comes from the acetabular ridge. And the reflected tendon arise the major trochanter of the femur bone. These three different tendon parts converge and muscular fibbers continue then, but each one of this origin form a part of the muscle. The direct tendon follows down by a superficial aponeurosis which covers the anterior aspect of the proximal muscle (superficial aponeurosis); the indirect tendon forms a sagittal-oriented band (also called central aponeurosis) that is located inside the proximal muscle belly.

Our aim is to describe the human anatomy of the quadriceps muscle and its principal characteristics with special care for the possibility of injuries.

Short-CV:

Graduate in Medicine in 1986 at the Faculty of Medicine of the University of Barcelona and PhD in Medicine by University of Barcelona in 1993. Sport medicine specialist in 1992. Since 1988 I have worked in musculoskeletal system as a human anatomy teacher for medical students in the Faculty of Medicine at University of Barcelona and also for physiotherapy students at Catalunya Internacional University. The last 25 years I have participated as musculoskeletal anatomist specialist in several national and international courses aimed at anaesthesiologists, radiologists, sports medicine specialists, rheumatologists.

Finally several publications are included in the curriculum vitae about musculoskeletal anatomic variations and musculoskeletal ultrasound studies.

Isabel Miguel-Pérez MD PhD. Human anatomy Lecture

Unit of Human Anatomy and Embryology. Department of Experimental Patholo-gy and Therapeutic.

Faculty of Medicine (HSC Bellvitge). University of Barcelona. Spain

Title:

Architecture of the Quadriceps Muscles

Abstract:

The session will consist of a detailed review of the structural anatomy and the functional implications, it will explore the aspects of both the myokinematics and arthrokinematics influences on rehabilitation for such injuries, and how this can further influence biomechanics and muscle physiology in the rehabilitation process.

This will then be applied in a real time example of case study of an Olympic Gold Medallist, who suffered a complete rupture (80%) of both the long head and short head of Rectus Femoris, with a 10cm retraction. This injury was managed conservatively and the athlete return to full competition to win a Olympic silver medal in 2012 and go on to break their personal best time in the World Championships Final to win the Gold medal in 2013.

The lessons learnt from conservative management; to functional application of the science; to integration into sport with specific return to function markers and ongoing sensitive management tools to ensure no re-injury at the vulnerable site will be discuss and imparted onto the audience.

Short-CV:

James is employed by the British Olympic Association and has the role of Deputy Chef de Mission for Performance Services Team GB at the Rio 2016 Olympic Games. In addition to this, he has been the Head of Performance Services for Team GB at the inaugural European Games in Baku 2015 and is currently the manager for the Intensive Rehabilitation Unit at Bisham Abbey.

James sits on the strategic board for the Institute of Sport Exercise & Health, a legacy from London 2012. The International Olympic Committee has awarded the National Centre’s, through ISEH, a grant to become an International Research Centre’s.

James has worked throughout the UK, USA and Australia. Holding positions such as Head of Medical at Saracens RFC; Consultant Clinical Lead Physiotherapist for UKA through Beijing 2008 and London 2012; Consultant Physiotherapist for the RFU for the Rugby World Cup in 2011. James is a Founder and Director for Sports and Exercise Medicine at the Centre for Health & Human Performance (CHHP) in Harley Street, London.

He completed his Masters in advanced Physiotherapy at University of Queensland in 2000, and has further qualifications in Strength & Conditioning, Pilates and Biomechanics.

James Moore Deputy Chef de Mission Performance Services Team GB

British Olympic Association (BOA),

Centre for Health & Human Performance (CHHP)

Institute for Sport & Exercise Health (ISEH)

London, UK

Title:

Quadriceps muscle Injuries: from injury day to Return To Play

Abstract:

In Australian football punt kicking, the foot-ball impact occurs without the ball touching the ground. Rectus femoris strains may occur in the kicking cycle but before foot-ball contact. If quadriceps strains occurred due to foot-ball impact, the furthest kicks would cause more injuries, whereas it is generally shorter kicks when running at top speed that lead to quadriceps strain. The amount of foot-ball impact force is roughly proportional to the distance that the ball travels, yet long kicks with a slow run-up do not tend to cause rectus femoris strain in Australian football. In soccer football, goalkeepers generally do not get quadriceps strains, despite kicking the ball the furthest distance. They are also rare in punters in American football and goalkickers in rugby union and league, where kicks for maximum distance are often attempted. Finally there is evidence from Australian football that quadriceps strains are not related to ball inflation pressure or wet weather (where the ball is heavier)1. Video analysis of the stance leg during a running kick shows the challenge for the quadriceps of slowing down the speed of body movement but with a slightly short step in order to raise the hips to provide clearance for the kicking leg. Like the hamstring strain it is not clear whether the actual muscle failure occurs during the ground contact phase or swing phase. As with the hamstring, the swing phase is associated with the greatest muscle length (stretch), whereas the ground phase is associated with the greatest potential impact of external force (ground reaction force). In contrast to the hamstring strain injury, in rectus femoris strain injury the ground contact phase of risk precedes, rather than follows, the swing phase of greatest stretch.

Analysis of in vivo patella tendon forces with direct intratendinous measurement in jumping has shown high forces during ground contact phases and minimal forces during swing phases 2. If it is presumed both that internal rectus femoris forces are “in phase” with patella tendon forces and that kicking, like jumping, would have higher patella tendon forces during the ground contact phases, it is most likely that rectus femoris strains actually occur during deceleration in the ground contact phase prior to the backswing on the kicking leg.

Short-CV:

John Orchard is an Australian Sports Physician with a combination career in elite sport, clinical sports medicine practice and research. He is currently the Chief Medical Officer of Cricket Australia. His main area of clinical specialisation is in muscle and tendon injuries of the lower limb. In research his greatest interests are sports injury epidemiology and prevention. He maintained the Australian Football League injury database for 23 years (1992-2014) which has one of the world’s largest series of muscle strains. In 2001 he undertook a project looking specifically at the Biomechanics of Quadriceps Strains in Australian Football.

John Orchard Adjunct Associate Professor and sports physician

School of Public Health, University of Sydney,

Australia.

Title:

Mechanism of rectus femoris muscle injuries

Abstract:

For this 8th Muscletech Network Workshop, I have been asked to show a proposal for rehabilitating Rectus Femoris Injuries, within the Treatment and Rehabilitation block of the program.

Scientific evidence provides information regarding biological repair processes; fusiform and biarticular anatomical features of this muscle (Mariluis et al. 2015) and its high percentage of type II fibers (Johnson et al. 1973) typical of those muscles who have to perform actions that require large changes in length at high speeds (Mendiguchía et al. 2013); its functions in regards to knee extension, hip flexion and stabilizing the pelvis in monopodales supports (Shu and Safran 2011; Bordalo-Rodriguez and Rosenberg, 2005); injury mechanisms, among the actions that occur during accelerations, decelerations and kicking the ball (Mendiguchía et al. 2013.); the modifiable risk factors, among which include: length/tension relationship, core stability (Mendiguchía et al. 2013; Witvrouw, et al. 2003; Bradley and Portas, 2007; Fousekis et al. 2011), weakness and shortening of the iliopsoas (Sanmarco and Stephens, 1991; Sahrmann, 2002; Lewis and Sharmann, 2007); inadequate eccentric strength of the rectus femoris especially in relation to the dominant knee with hip involvement (Mendiguchia et al. 2013.); along with other risk factors (Konstantinos et al. 2010).

Similarly, scientific evidence also provides us with the most adjusted measures to address these factors, the moments and steps to develop a proposal for rehabilitation and the characteristics of the exercises (Pincivero et al. 2000; Thorborg et al. 2015; Jansen et al. 2012; Mendiguchia et al. 2013).

Therefore my intention for this talk is to show a practical proposal of a rehabilitation program based on this efficacy given by scientific evidence, and transfer this evidence into practice using as support the creative capacity and adaptation to the work context (Cos et al. 2010; Finch, 2006; Hanson et al. 2015).

Short-CV:

PhD in Sport Science (University of Granada, Spain), Master´s Degree in Prevention and Rehabilitation Injury in Football (COE, RFEF, UCLM), Bachelor´s Degree in Physical Activity and Sport Science (University of Granada, Spain). Rehab Coach of Sevilla FC in seasons 2013-2014 and 2014-2015. Associate Professor (University of Sevilla, Spain).

José Conde Associate Professor, PhD INEF and physical trainer

University of Sevilla

Spain

Title:

Rehabilitation of rectus femoris injuries. Experience at Sevilla FC

Abstract SESSION 5 (Linde & Brau)

The purpose of this presentation is to describe the rehabilitation treatment process received by a professional soccer player who suffered a complete tear of rectus femoris, involving direct and indirect head of his left leg (shooting leg is right side). The subject describes is a man 20 years old, 1,75 cm height and 71 kg weight. During the complete rehabilitation and return to play process, that took a total period of 10 weeks until the reintroduction to normal training with the group, we are going to focus in this presentation in describing the techniques applied regarding to physiotherapy and regarding to strengthening in the gym.

When we talk about the treatment of physiotherapy, it has been based in many different therapeutical options, based in lower limb manual manoeuvres, massage and stretching and elastification techniques basically, as well as the application of hyperthermia in the specific segment during the scar solving process. In that treatment stage we will introduce as well analytic muscle strengthening of the affected thigh, that will be done in the table. How we choose the applied technique will depend on the moment of the injury evolution, and on the moment of the application, that means before or after the workout. Regarding to strengthening stage, we describe the performed exercise’s evolution, based on their functionality anb range of movement, with different king of machines or implements, as elastic resistance bands, functional workout machines, pneumatic machines or instable surfaces, in example. We stand out in this workout performed in the gym, the importance of combining strengthening with active tension stretching, by which the player can achieve new barriers in range of motion by player’s own muscle contraction. About recovery measures after training session or treatment, the most commonly applied were cryotherapy, combination of cold and hot water, and presotherapy mainly.

Abstract SESSION 6 (Yanguas & Brau)

Quadriceps muscle injuries are common in professional football. Well design protocols of physiotherapy and controlled specific football exercises during this time are a key point for a successful rehabilitation and to decrease the risk of reinjuries.

We propose an example of rehabilitation in a grade 3 muscle tear of proximal rectus femoris in a professional football player. We tried to introduce specific exercises as soon as possible if these are well tolerated and pain-free by the player.

Juanjo Brau Physiotherapist at 1st Barcelona FC Team

Barcelona, Spain.

SESSION 5 (Linde & Brau)

Title: Rehabilitation of rectus femoris injuries. Experience at Barcelona FC.

SESSION 6 (Yanguas & Brau)

Title: Return to play in rectus femoris muscle injuries. Our experience with professional foot-ball players

Traditionally water exercises have been used in the first stages of the rehabilitation due to their low impact characteristics. We proposed the use of another surface, sand, to begin running and football specific exercises because sand surface can offer lower impact training stimulus compared with grass and can limit muscle damage. In later stages, strength (concentric and eccentric) has been running in an uphill/downhill ramp trying to reproduce functional specific football movements during all the process. GPS have been used to record all the data to control de loads and the quality of the training.

After three months the player returned to play without problems in a medical situation where the surgical treatment had a lot of probabilities to be proposed.

Short-CV:

Abstract:

Quadriceps injury and concretly its rehabilitation represents a major problem in modern football. The rectus femoris is the most commonly injured muscle and cause more missed games and reinjure rates than do hamstring and groin muscle injuries. In-depth knowledge around rectus femoris injuries together with a contextualized (football) approach will allow us to develop a new practical rehabilitation model that will guide us to move through the treatment process until return to sport.

Short-CV:

Jurdan Mendigutxia Physiotherapist

ZENTRUM Clinical Sport Center

Navarra, Spain

Title:

New Rehabilitation concept applied to the rectus femoris injuries in football

Abstract:

The importance of muscle injuries in athletes is related to its personal cost, the injury rate, the injury's severity, the reinjury risk and the availability of the athlete during competition. Hamstring strains are related to the speed and the range of motion and they are widely studied because they are so common in athletes and footballers (50 - 70% of thigh strains reported in the literature). 61% of thigh strains in pro-football players in FCB are related to hams, and 32% in academy players. Adductor strains are typical in football, and they have been linked up to pubic dysfunctions. Adductors are injured in 25-30% of thigh muscle strains, and this frequency is not related to age.

Rectus femoris (RF) strains appear during kick and severe changes in speed during the sprint. RF is directly involved in football kicking by hip flexion and knee extension. The injury affects the structure of the injured muscle. RF injury rate among FCB players varies depending on age, 43% of thigh strains in U-18 and 11% in pro. The prevalence of RF strains increases from 8 to 13 years old and from 15 to 18 years old. But among the 13 to 15 players the RF strain rate is lower because the skeletal maturity makes the epiphysis of the anterior inferior iliac spine more prone to avulsion.

RF strains in young players are important because they are so frequent. Its healing and scarring can affect the intrinsic functions of connective and contractile tissue of the muscle.

Short-CV:

Lluis Til started his career as a Junior Orthopaedic Surgeon at Hospital General de Vic and Hospital del Pallars from 1989 till 1997. Since 1998, he has been working as sports physician and orthopaedic surgeon for Consorci Sanitari de Terrassa ‘www.cst.cat’ at the Spanish Olympic Training Center in Sant Cugat (Barcelona) ’www.car.edu’ and for the last 13 years at FC Barcelona ‘www.fcbarcelona.cat’. In both positions, he works on the health and performance of elite athletes. He focuses on several topics including sports injuries, ultrasound diagnosis and regenerative therapies. He also works in continual training for junior sports physicians and young physiotherapists. Finally, he spends a significant part of his time facilitating the transference of knowledge between sports medicine, primary care and hospital specialists.

Lluis Til, MD Sports Medicine and Orthopedics

Barcelona FC, Centre d'Alt Rendiment, Consorci Sanitari of Terrassa

Barcelona, Spain.

Title:

The magnitude of the injury in relation to the age of the player

Abstract:

Rectus femoris injuries are common in sprinting and jumping athletes. Dr Pollock will discuss the British Athletics Muscle Injury Classification published in the British Journal of Sports Medicine in 2014 with reference to its use in classifying rectus femoris injuries in elite Track and Field. The British Athletics Muscle Injury Classification grades injuries from 0 to 4 based on MRI features, with Grades 1-4 including an additional suffix (‘a’, ‘b’ or ‘c’) if the injury is myofascial, musculo-tendinous junction or intratendinous. In particular, injuries that extend into the tendon seem to take longer to RTP and are associated with a higher reinjury rate.

Short-CV:

Dr Noel Pollock graduated with Honours in Medicine from Queen's University Belfast and completed an MSc with Distinction in Sport & Exercise Medicine at Bath University. He works as a Sports Medicine doctor for British Athletics, providing medical services to the Great Britain Track and Field team, at the Hospital of St John and St Elizabeth, Lee Valley Athletics Centre and Loughborough National Performance Institute. Since 2006 he has been the Great Britain team doctor at 17 European and World Championships, including the IAAF World Championships in Berlin, Moscow and Beijing and Portland and CWG England Team doctor at the 2014 Commonwealth Games. He was a sports medicine lead doctor in the London 2012 Olympics Athletics Stadium. He has completed Specialist training in Sport & Exercise Medicine and is a Consultant in SEM. He is also a Fellow of the Faculty of Sport & Exercise Medicine. His special interests are tendon and muscle, particularly hamstring, injuries. He is a former endurance athlete and won national titles and international honours for Northern Ireland in cross country, 5k and 1500m.

Dr. Noel Pollock Team Doctor for British Athletics

Consultant in Sport & Exercise Medicine

United Kingdom

Title:

Quadriceps Muscle Injuries: British Athletics classification

Abstract:

Physical exercise in the form of resistance training (RT) has consistently been shown to induce adaptive changes in nervous system function that in turn contribute to the training induced increase in maximal contractile muscle force and power. The adaptive plasticity in neural function with training has been evaluated by use of muscle electromyography (EMG) measurements, including single motor unit recording and measurements of evoked spinal reflex responses (H-reflex, V-wave) and corticospinal excitability by transcranial magnetic stimulation (TMS). Parallel increases in explosive muscle strength (rate of force development: RFD) and EMG activity have been observed in the very initial contraction phase (0-200 milliseconds) following RT. The specific neural adaptation mechanisms responsible for the training-induced increase in RFD include increased spinal motoneuron firing frequency and elevated incidence of discharge doublets. In addition, muscle fiber hypertrophy and changes in muscle architecture contribute to the training induced increase in RFD. A neural regulatory mechanism that limits the recruitment and/or discharge rate of motor units has been demonstrated to exist during maximal voluntary eccentric muscle contraction. Notably, this apparent inhibition in spinal motoneuron activation during maximal eccentric (ECC) contraction can be downregulated by use of resistance training, in turn leading to elevated levels of maximal ECC strength that are vital for an optimal athletic performance. In turn, the above training induced changes in neuromechanical muscle function provide a strong fundament for achieving gains in sprint and kicking performance, and for preventing overuse injury in muscles, tendons and joints. Further, in non-athletes such as frail elderly adults similar adaptive responses can be evoked that result in an improved functional capacity during activities of daily living, such as stair walking and chair rising. Thus, the adaptive plasticity in neuromechanical function can be exploited to yield significant benefits in both athletes and non-athletes alike.

Short-CV:

Per Aagaard serves a position as Professor in Biomechanics at the Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark. Overall taken his research activities have addressed the adaptive plasticity in neuromuscular function and muscle morphology/architecture induced by training and detraining/inactivity, including aging and immobilization. Specifically, a number of studies have been conducted to examine topics such as the effect of resistance training on skeletal muscle morphology and neuromuscular function in young and aging adults, myogenic stem cell activation with acute exercise and long-term training, muscle-aponeurosis-tendon function in vivo, neuromechanical aspects of knee ligament (ACL) injury and subsequent rehabilitation, rehabilitation and prevention of muscle-tendon-joint injury in exercise and sports, and exercise/training/biomechanical analysis in elite sports. Per Aagaard currently has authored 210 peer-reviewed publications in international scientific journals and textbooks, which have been cited 7717 times in total, averaging 367 citations per year and an H-index of 54 (ISI Web of Science).

Per Aagaard Professor in Biomechanics and Exercise Physiology

Muscle Physiology and Biomechanics Research Unit (MoB),

Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark

Odense, Denmark

Title:

Neuromuscular plasticity in quadriceps function in response to training and how this might affect sprinting ability and kicking performance

Abstract:

INDIRECT INJURY MECHANISMS Rectus femoris (RF) injury causes severe pain in the anterior thigh when running or kicking a ball, though sometimes the onset may be surreptitious. RF injury can be objectified by ultrasound (US) or magnetic resonance (MR).

There are several types of injuries with predictive values depending on their location.

AIIS injuries. The view of the Rectus Femoris origin with complementary tests is usually complex, both by MRI and US. MR is considered to be the test of choice in this type of injury.

Central tendon injuries. These are the most frequent and characteristic RF injuries. In grade 1 a 'feather pattern' is observed. In grade 2 there is more bleeding and the image may appear in a "bull’s eye". The characteristics of this sign explain different degrees of evolution. Thus, in the early lesion there is edema and bleeding around the central tendon that evolves into increased vascularization and scarring. When atrophy and fatty infiltration around the tendon are observed, the lesion has usually been evolving over a very long period. US is useful both for diagnosing and monitoring this type of injury.

Superficial injures. In the proximal lesions of the superficial aponeurosis, a small fluid collection is observed along the RF anterior portion, between the anterior fascia and its muscle body.

Distal peripheral injuries.

The distal myotendinous ruptures affect the posterior fascia and may cause proximal muscle stump and interfascial hematoma between the RF and vastus intermedius. Sometimes they can develop into a pseudocyst. Progressive resorption allows a fibrous lamellar repair between the RF and the vastus intermedius. US allows evacuation of the interfascial hematoma.

INJURIES BY DIRECT MECHANISM

The clinical study and exploration provide a basic classification. US allows lesion evolution monitoring and is therefore the imaging test of choice whilst MR is reserved for doubtful cases or in the event of surgical advice.

Ramón Balius PhD Medicine and Surgery specializing in Sport Medicine.

Consell Català de l'Esport (Generalitat de Catalunya) and Diagonal Clinic

Barcelona, Spain.

Title:

Quadriceps Muscle Injurie diagnosis

COMPLICATIONS OF MUSCLE INJURY IN QUADRICEPS

The most characteristic quadriceps complication is Myositis ossificans (MO). It is a heterotopic ossification, i.e., an abnormal formation of mature lamellar bone within the soft skeletal tissues where there is usually no bone. The pathogenesis is unknown although it is usually a secondary occurrence from an initial muscle injury by direct mechanism. In the quadriceps the muscle that is affected is the Vastus intermedius.

Short-CV:

Ramon Balius PhD, a sports physician, born in 1960 in Barcelona. He is working in Consell Català de l'Esport (Generalitat de Catalunya) and Clínica Diagonal, Barcelona. Dr. Balius is Editor and Chief of Journal tittled Apunts. Medicina de l'esport.

He is specialized in muscle injuries and its prognosis, specifically by ultrasound. He has published six Spanish books about sonography and muscle injuries and has collaborated in 20 additional publications. Moreover he has published around 30 articles placed in PubMed and a hundred cited in Scopus, most of them about sports medicine topics.

He is collaborating with Spanish Tennis Federation since 1991. Now, he is working on sonographic procedures of tendinopathies and chronic muscle injuries.

Abstract:

The Rectus Femoris is very important in football because the players sprinting and kicking the ball with this muscle.

The muscle injuries treated during three consecutive seasons in the Mutualitat de Futbolistes were: 2.209 in 2012-2013; 1.922 in 2013-2014 and 2.266 in 2014-2015.

The more often injured muscles are:

However, the rectus femoris injuries requiring surgical treatment are few.

From January 2015 to May 2016, the surgery was only required in 7 cases.

In the published series1 of 10 surgical cases treated from 1999 to 2009, it was already stated that the vast majority of these injuries are solved with conservative treatment, needing surgery only in those cases when the results were not satisfactory or when the type of rupture demanded it or the impossibility of sprinting and kicking.

Seasons N of Injuries N muscle Injuries Percentage

2012 - 13 25.350 2.209 8.71%

2013 - 14 26.990 1.922 7.12%

2014 - 15 25.730 2.266 8.80%

Hamstrings: proximal region 221 (9.75%)

Hamstrings: distal region 51 (2.25%)

Rectus Femoris 208 (9.17%)

Adductors 98 (4.32%)

Gastrocnemius 72 (3.17%)

Ramón Cugat Traumatology and Orthopaedic Surgeon Department Director

Quiron Hospital

Barcelona, Spain

Title:

Rectus femoris injuries: what and when?

The surgical techniques performed are:

Reattachment of the tendon when avulsed

Muscle-tendon suture when the injury is near to its insertion, 3 to 4 cm.

Total freedom and relaxation of the muscle when the injury is more than 4 cm distal to the tendinous insertion.

The sutures performed are always injected with leukocytes-free PRP (PRGF-Endoret®) creating a favourable environment for tissue regeneration.

Short-CV:

Ramon Cugat MD, PhD and Orthopaedic Surgeon, is President of the Board of Trustees for the Garcia Cugat Foundation for Biomedical Research, President of the medical council and member of medical staff for the Catalan Soccer Delegation’s Health Insurance Company under the Spanish Soccer Federation, Head of Trauma and Orthopaedic Surgery for the “Mutua Patronal Montañesa” and Co-Director of the Orthopaedic Surgical Department, Hospital Quiron Barcelona. He collaborates as Associated Professor at the Medical School at Barcelona University, UIC (Catalonian International University). He studied at UB (University of Barcelona) and completed the Post-graduate and doctorate studies on Arthroscopy and Sports Medicine at the Department of Sports Medicine (Orthopaedic Surgery Department, Massachusetts General Hospital, Harvard Medical School Massachusetts-U.S.A.) Visiting professor-Sports Medicine Massachusetts General Hospital. Harvard Medical School 1995. First Augustus Thorndike Visiting Lecturer in Sports Medicine at Massachusetts General Hospital 1998. He is a member of many national and international societies. Sports activity: He was Orthopaedic Surgeon of the Barcelona Dragons Team in the NFL International, Medical Assessor for the Catalan Soccer Federation, Director of the Arthroscopic Service at the Orthopaedic Department, Hospital Universitario del Mar. In 1992 he collaborated as “Orthopaedic Surgeon” in the Summer Olympic Games held in Barcelona. Educational activity: He has given lectures in congresses and collaborates in Teaching Courses of Arthroscopic Surgical Techniques and Sports Medicine around the world. He has Publications in Journals and books about Arthroscopy, Sports Medicine and New Biological Treatments. Since 1999 the Orthopaedic Surgical Department directed by him, Artroscopia GC, has been an ISAKOS-Approved Teaching Centre. Since June 2013 the Garcia Cugat Foundation holds the Surgery & Regenerative Medicine Chair at the CEU Cardenal Herrera University where in recognition of his contributions has been conferred the title of Honorary Professor.

Abstract:

Skeletal muscle represents a classic example of a structure-function relationship1. Thus, structural studies of muscle often inform its function. In the case of the quadriceps complex, the major structural feature of these muscles is their design for high force production. Skeletal muscle architecture dominates a muscle’s force generating properties2, and the vastus lateralis, vastus medialis, and vastus intermedius have a highly pennated structure resulting in very large cross-sectional area (CSA)3. Specifically, the pennation angle of about 25°, the fiber length/muscle length ratio of about 0.25, and the CSA of about 25 cm2 predict that this is the largest combined muscle group in the human body. Intraoperative sarcomere length measurements4 demonstrate unique roles for the vastus lateralis and vastus medialis heads. Rectus femoris, as the only biarticular quadriceps plays a unique role it force distribution across the knee and hip5,6 and may render it vulnerable to eccentric contraction-induced muscle injury.7,8 Finally, the fact that all four heads of the quadriceps are approximately 50% type 1 (slow) fibers and are highly oxidative9 reflect the high level of use of this muscle group as well as its potential for plasticity. These structural properties will be discussed in light of the injury and rehabilitation of quadriceps muscles.

Short-CV:

Rick Lieber earned his Ph.D. in Biophysics from U.C. Davis developing a theory of light diffraction that was applied to mechanical studies of single muscle cells. He joined the faculty at the University of California, San Diego in 1985 where he spent the first 30 years of his academic career, achieving the rank of Professor and Vice-Chair of the Department of Orthopaedic Surgery. He received his M.B.A. in 2013 and is currently Chief Scientific Officer and Senior Vice President at the Rehabilitation Institute of Chicago.

Dr. Lieber’s work is characterized by its interdisciplinary nature—an approach that is relevant to those who study biomechanics and Orthopaedic Surgery. He has published over 250 articles in journals ranging from the very basic such as The Biophysical Journal and The Journal of Cell Biology to those more applied such as The Journal of Hand Surgery and Clinical Orthopaedics and Related Research. Dr. Lieber’s research has traditionally focused on design and plasticity of skeletal muscle. Currently, he is focused on developing state-of-the-art approaches to understanding muscle contractures that result from cerebral palsy, stroke and spinal cord injury.

Richard L. Lieber, PhD Senior Vice President & Chief Scientific Officer Rehabilitation Institute of Chicago

345 East Superior St, Chicago, IL 60611

USA

Title:

The Design of the Quadriceps Muscles

Abstract:

I present experiences of rectus femoris muscle injury operations. During years 1999 -2015 57 operations were done to treat rectus femoris tears in 56 patients. One had a total avulsion of the muscle at AIIS on both sides with an interval of 1.5 years between operations. There were 24 rectus femoris muscle avulsions at AIIS, 15 total and 9 subtotal tears. The mean age of these patients was 23.5 years (range 15 – 31 years). All were men. There were 19 professional soccer players in the series. 2 were soccer players at a lower level and 3 represented 110 hurdles, and sprinting. These all were treated with refixation using Mitek´s superanchors or Juggerknot anchors. The operation was done in less than three weeks in 17 cases and between 4 and 15 weeks in 7 cases. In three cases calcification (small bony or periost avulsion) was removed. The final result was good or excellent in 20 cases and moderate in four cases.

Of the six proximal tears five were recurrent tears and after operative treatment the results were good only in three cases, others had a moderate result. In three cases bone anchor was used in addition to suturation. Three times suturation and proximal central tendon repair/lengthening was done.

27 operations were done to the total tears in the middle and distal third of the rectus femoris muscle. In all patients symptoms continued after the initial conservative treatment. The patients complained continued pain, weakness, spasms and deficient control of the leg during sports. There were 12 soccer players, 11 track and field athletes and 4 indoor ball players in this series. Two of them were females. The mean age of the patients was 27.1 years (range 19 – 46 years). The final results were good or excellent in 20 cases. Others had a moderate result. Muscle gap often remained, but did not affect to end result.

Short-CV:

Studied medicine at Oulu University, Finland from year 1965. Licenced physician 1972, specialist in general surgery 1977, specialist in orthopaedics and traumatology 1980 and specialist in sports medicine 1986. MD 1972, PhD 1980, senior lecturer, University of Oulu 1984, University of Turku, 1996. Honorary professor, University of Murcia, Spain, 2000. Degree of professor, Finland 2001. Currently consulting orthopaedic surgeon, Hospital NEO and Hospital Aava, Finland.

Member of medical commission of Finnish Track and Field Federation 1972 – 2002. Member of Finnish Olympic Committee Medical Commission 1982 – 2000. Chief physician of summer Olympic Games from 1988 to 2000.

Research interest overuse injuries in sports, stress fractures, tendon disorders, muscle and tendon injuries, arthroscopy and operative treatment of sports injuries. 650 publications on these topics.

Sakari Orava, MD, PhD Professor in orthopaedic surgeon, chief of sports trauma and research

NEO Hospital

Turku,

Finland

Title:

Rectus femoris injuries: what and when?

Abstract Session 3:

Abstract Session 7:

William E. Garrett Jr., M.D., PhD Professor of Orthopaedic Surgery

Duke Sport Sciences Institute, F-MARC FIFA Centre of Medical Excellence

Duke University, Durham, N.C. USA

Session 3:

Quadriceps Muscle Injuries.

Session 7:

Rectus femoris injuries: what and when?

Short-CV:

Dr. William E. Garrett, Jr. is Professor of Orthopaedic Surgery at the Duke Sport Sciences Institute F-MARC FIFA Centre of Medical Excellence at Duke University. He received his M.D., Ph.D. and did Orthopaedic residency training at Duke University. He has had long involvement with the U.S. Soccer teams being Team Physician for both Men’s and Women’s World Cups and a member of the Sports Medicine Committee. He has also taken care of the University teams at Duke University. He has been Past President of the American Orthopaedic Society for Sports Medicine. He has received a number of national and international awards as well as research grants on the Biomechanics of Sport Injury with the emphasis being on muscle injury and anterior cruciate ligament injury. He has over 200 research publications in peer review journals. He is involved with a very busy clinical and research program still at Duke.

Abstract:

INDIRECT INJURY MECHANISMS

Rectus femoris (RF) injury causes severe pain in the anterior thigh when running or kicking a ball, though sometimes the onset may be surreptitious. RF injury can be objectified by ultrasound (US) or magnetic resonance (MR).

There are several types of injuries with predictive values depending on their location.

AIIS injuries. The view of the Rectus Femoris origin with complementary tests is usually complex, both by MRI and US. MR is considered to be the test of choice in this type of injury.

Central tendon injuries. These are the most frequent and characteristic RF injuries. In grade 1 a 'feather pattern' is observed. In grade 2 there is more bleeding and the image may appear in a "bull’s eye". The characteristics of this sign explain different degrees of evolution. Thus, in the early lesion there is edema and bleeding around the central tendon that evolves into increased vascularization and scarring. When atrophy and fatty infiltration around the tendon are observed, the lesion has usually been evolving over a very long period. US is useful both for diagnosing and monitoring this type of injury.

Superficial injures. In the proximal lesions of the superficial aponeurosis, a small fluid collection is observed along the RF anterior portion, between the anterior fascia and its muscle body.

Distal peripheral injuries.

The distal myotendinous ruptures affect the posterior fascia and may cause proximal muscle stump and interfascial hematoma between the RF and vastus intermedius. Sometimes they can develop into a pseudocyst. Progressive resorption allows a fibrous lamellar repair between the RF and the vastus intermedius. US allows evacuation of the interfascial hematoma.

INJURIES BY DIRECT MECHANISM

The clinical study and exploration provide a basic classification. US allows lesion evolution monitoring and is therefore the imaging test of choice whilst MR is reserved for doubtful cases or in the event of surgical advice.

Dr. Xavier Alomar Serrallach Responsible for Radiology Department

Creu Blanca Medical Center

Barcelona, Spain.

Title:

Quadriceps Muscle Injurie diagnosis

COMPLICATIONS OF MUSCLE INJURY IN QUADRICEPS

The most characteristic quadriceps complication is Myositis ossificans (MO). It is a heterotopic ossification, i.e., an abnormal formation of mature lamellar bone within the soft skeletal tissues where there is usually no bone. The pathogenesis is unknown although it is usually a secondary occurrence from an initial muscle injury by direct mechanism. In the quadriceps the muscle that is affected is the Vastus intermedius.

Short-CV:

Abstract (Linde & Brau)

The purpose of this presentation is to describe the rehabilitation treatment process received by a professional soccer player who suffered a complete tear of rectus femoris, involving direct and indirect head of his left leg (shooting leg is right side). The subject describes is a man 20 years old, 1,75 cm height and 71 kg weight. During the complete rehabilitation and return to play process, that took a total period of 10 weeks until the reintroduction to normal training with the group, we are going to focus in this presentation in describing the techniques applied regarding to physiotherapy and regarding to strengthening in the gym.

When we talk about the treatment of physiotherapy, it has been based in many different therapeutical options, based in lower limb manual manoeuvres, massage and stretching and elastification techniques basically, as well as the application of hyperthermia in the specific segment during the scar solving process. In that treatment stage we will introduce as well analytic muscle strengthening of the affected thigh, that will be done in the table. How we choose the applied technique will depend on the moment of the injury evolution, and on the moment of the application, that means before or after the workout. Regarding to strengthening stage, we describe the performed exercise’s evolution, based on their functionality and range of movement, with different king of machines or implements, as elastic resistance bands, functional workout machines, pneumatic machines or instable surfaces, in example. We stand out in this workout performed in the gym, the importance of combining strengthening with active tension stretching, by which the player can achieve new barriers in range of motion by player’s own muscle contraction. About recovery measures after training session or treatment, the most commonly applied were cryotherapy, combination of cold and hot water, and presotherapy mainly.

Short-CV:

Xavier Linde Cot, born in Puigcerda (10th July 1984). Started his career studying his degree in Physioteraphy 2002/05 (Universitat de Vic), and then moved to Barcelona to study his degree in Sport Sciences 2005/10 (Universitat de Barcelona-INEFC Barcelona). While finishing his second degree studied a master in High Performance 2009/10 (COE-Universidad Autónoma de Madrid).

Working in High Level Sport professionals since 2006, started working in FCBarcelona since 14/15 season, developing his job in Football's First Team.

Francisco Javier Linde Cot Physiotherapist 1st Barcelona FC Team

BARCELONA FC

Spain

Title:

Rehabilitation of rectus femoris injuries. Experience at Barcelona FC

Abstract:

For many years muscle injuries have been causing athletes time loss and being a common situation to face for sport

physicians, indeed they are still not well known. The muscles most commonly involved are biarticular muscles with high

proportion of fast-twitch fibers and complex architecture. In professional soccer, between 92% and 97% of all muscle

injuries are located in the lower extremity: hamstrings (28%-37%), quadriceps (19%-32%), adductors (19%-23%), and

calf muscles (12%-13%).

How to classify muscle injuries is a main stone to better understand and manage them; at present it is the reason of a

deep discussion far from consensus. There are several reasons to explain why we are still debating about how to classify

muscle injuries; a failure to communicate it is being one of the main reasons in our opinion due to ambiguous

definitions in several fields. Our goal is to improve communication between health professionals when talking about

muscle injuries with a new muscle injuries classification. Our proposal describes the injury anatomical location and its

relationship with the extracellular matrix (ECM), it evaluates the ECM damage, offers several grading options, and

provides information about the injury chronology.

The proposal is based on expert opinions but incorporating the existing scientific evidence about muscle; we organize and resume this concept in a 4 letters acronym structure. We offer a new classification system for muscle injuries involving the mechanism of injury, location of injury, grading of severity, and number of previous muscle injuries, to grade it and describe its chronology. It also has a flexible and open structure capable to adapt to future knowledge.

Short-CV:

MSc University of Barcelona “Investigation in Clinical Sciences”; 2010-2011. Consultant in Sports and Exercise Medicine from EMEFiE at Hospital Clínic, University of Barcelona; 2001-2004. MSc in Physical activity and Sports performance at University of Baleares, scholarship Fondo Social Europeo y el Gobierno Balear (Dirección General de la Conselleria de Treball i Formació); 1999. Licence in Medicine and Surgery, Barcelona University; 1989-1996. ECOSEP Chair and Scientific Committee. Member of FEMEDE (Spanish federation of Sports Medicine). Medical Services of FC Barcelona from July 2004, as a team doctor. Teaching at School of Sports and Exercise medicine (University Barcelona), from Sep 2004. Also involved in the Research department, organising and planning educative calendars, and sponsor for courses within the programs. Clínica Mapfre de Medicina del Tenis injuries (National Spanish Tennis Federation).

Xavier Valle Team Doctor. Barcelona FC Medical Department

Barcelona. Spain

Title:

Rectus Femoris: a new evidence-based and expert consensus-based

classification with clinical application

Abstract:

Quadriceps muscle injuries are common in professional football. Well design protocols of physiotherapy and controlled specific football exercises during this time are a key point for a successful rehabilitation and to decrease the risk of reinjuries. We propose an example of rehabilitation in a grade 3 muscle tear of proximal rectus femoris in a professional football player. We tried to introduce specific exercises as soon as possible if these are well tolerated and pain-free by the player. Traditionally water exercises have been used in the first stages of the rehabilitation due to their low impact characteristics. We proposed the use of another surface, sand, to begin running and football specific exercises because sand surface can offer lower impact training stimulus compared with grass and can limit muscle damage. In later stages, strength (concentric and eccentric) has been running in an uphill/downhill ramp trying to reproduce functional specific football movements during all the process. GPS have been used to record all the data to control de loads and the quality of the training. After three months the player returned to play without problems in a medical situation where the surgical treatment had a lot of probabilities to be proposed.

Short-CV:

PhD investigation: Assessement and follow-up of muscle injuries in lower limb by segmental bioimpedance in high performance athletes. Universitat Autònoma de Barcelona (2011-2014). Specialist in Sports Medicine and Physical Education. Universitat de Barcelona. (2001-2004). Degree in Medicine and Surgery. Universitat Autònoma de Barcelona (1993-1999).

Laboral Sports Medicine Experience: Football: Medical staff of Futbol Club Barcelona (From June 2008 to present). Medical staff of Udinese Calcio (Season 2007-2008).

FIELD HOCKEY: Team doctor of the Spanish Absolute Male National Team (2004 to July 2007). Team doctor of the Spanish U21 and U18 Male National Team (2002 to December 2003).

Xavier Yanguas Leyes Physician, Specialist in sport medicine

Medical Services Barcelona FC,

Barcelona, Spain.

Title:

Return to play in rectus femoris muscle injuries. Our experience with profes-sional football players