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The Criteria and Design for Return-to-Play Following Muscle Injury in Football are Not Standardized: A Systematic Review Including Descriptive Analysis of RTP Criteria Distribution and Study Design Heterogeneity
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DOI：10.1007/s40279-026-02523-3.png)
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Abstract
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Return-to-play (RTP) decisions after muscle injury in professional football are complex, influenced by biological healing, functional recovery, and sport-specific demands. RTP models have evolved towards multifactorial and individualized frameworks; however, supporting evidence remains largely consensus-based. This systematic review aimed to describe RTP criteria and study design heterogeneity and integration within RTP frameworks in football. This study was conducted as a systematic review. Studies investigating RTP criteria, RTP decision-making, or rehabilitation frameworks following muscle injuries in football players were included. Searches were performed in five databases. Two reviewers assessed risk of bias using Joanna Briggs Institute appraisal tools. Ten studies included were classified as Classical–Physical, Consensus–Multifactorial, or Individualized RTP models. Studies reported a median of six RTP criteria (range 4–8); most commonly the absence of pain, ≥ 90% strength symmetry, and functional testing. Psychological readiness and GPS/on-field monitoring were reported after 2020 and were more frequent in multifactorial and individualized frameworks. A gradual shift towards multifactorial and individualized RTP frameworks was observed. No significant associations were identified between RTP model classification and individual RTP criteria (p > 0.05). Reinjury outcomes were rarely reported. The literature shows heterogeneity in RTP criteria and study design after muscle injury, with consensus-based and low-level evidence predominating. RTP decision-making is grounded in expert opinion rather than outcome validation. RTP is a dynamic, multifactorial, and context-dependent process, integrating biological healing, functional recovery, psychological readiness, and load tolerance. Future research should prioritize prospective validation of integrated RTP frameworks and standardized outcome reporting. CRD420251250364.
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