Returning to play, regaining the performance the athlete wants, and being able to keep playing. We think through the issues that lie between these together with the athlete’s team.
Supporting return from injury involves several issues: regaining playing opportunities and competitive level, responding to injuries after return, and decisions on increasing load and sharing information.
Here we summarise what football research, including studies from Germany, has reported, and show what support Zeroka Seitai could propose for those issues.
1. What studies in Germany have reported
Issues remain in playing time and competitive level after return
An ACL (anterior cruciate ligament) injury registry study of men’s football in Germany compared matches played, minutes played and competitive level in the season before injury, the injury season and the three following seasons, for 607 injuries across professional, semi-professional and amateur levels (120 of them professional).
In the professional group, two seasons after the injury season, no statistically significant difference from before the injury was found in minutes or matches played. On the other hand, a decline in competitive level was also reported in each of the professional, semi-professional and amateur groups.
However, the absence of a significant difference does not prove that every player fully recovered or was at the same level as before the injury. The study also did not directly examine players’ movement capacity or muscle condition.
From this result, we consider that return to matches and recovery of competitive activity afterwards need to be checked separately. Szymski et al.: return to sport after ACL injury in Germany (published 2023; online 2022)
Non-contact injuries also occur after return
A study covering the German Bundesliga and 2. Bundesliga in the 2022–23 to 2024–25 seasons examined non-contact subsequent injuries after return from lower-limb muscle injuries.
For returns from acute hamstring injury, the following results were reported.
Scroll sideways to read the full table.
| Point | What the study reported |
|---|---|
| Population | 154 returns from acute hamstring injury |
| Returns in which a subsequent injury was observed | 43 of 154 = 27.9% |
| Injuries counted | Non-contact injuries involving time lost from training or matches |
| Observation period | Within the same season as the return |
| Same-site reinjury only? | Includes injuries other than reinjury at the same site |
This is not a “reinjury rate” based on following all players for a uniform period.
The study also describes different trends in how risk changed after return, depending on the muscle group and on whether injuries were classed as acute or overuse. However, differences in the shape of the risk curves were not statistically established. Zhang et al.: subsequent injury risk after return from muscle injury (2026)
We see this result as information pointing to the importance of continuing to follow the response to training and matches after return, in addition to the checks made at the time of return.
2. What is difficult for the people who support athletes?
In practice, staged return assessments and decisions involving several people are already in place. Even so, issues with decision criteria and information sharing have been reported.
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| Survey population | What was reported |
|---|---|
| A survey of 131 teams in top leagues worldwide on return support after hamstring injury | 124 teams (about 95%) reported a staged return framework and 105 teams (about 80%) reported shared decision-making. On the other hand, pressure from management and others, reaching agreement among staff, and circumstances relating to matches and players were cited as challenges in decision-making |
| A survey of 81 practitioners in men’s professional football | There was variation in how the end of rehabilitation was defined and how the period after it was handled. A lack of agreement on, and validation of, objective criteria for progressing on-field rehabilitation was indicated, and information sharing was also cited as an area for improvement |
Sources: Dunlop et al.: survey of return support after hamstring injury (2020), Dixon et al.: survey of injury recording, on-field rehabilitation and return criteria (2026)
Both are surveys based on respondents’ reports. They do not show the situation in Germany alone. For Dixon et al., we have checked only the published abstract, and details such as the breakdown by country have not been confirmed.
In Germany, the VBG also recommends not deciding return on the number of days elapsed alone, but using individual assessments of function and performance. This is a recommendation resource to support practitioners, not a survey showing what all clubs actually do. VBG: Return-to-Competition
3. What can we add to address these issues?
What follows is a proposal from Zeroka Seitai, linking the issues reported in research with the concerns we have encountered in supporting athletes.
Responding to muscle stiffness and muscle lock is not an intervention whose effect was tested in the studies above. It is what we have worked on, based on our experience and interpretation, while checking changes with athletes and staff.
The concerns in the table are not direct quotations from study participants either; they are phrased to convey situations in which support is needed.
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| Concerns of athletes and their teams | What we check and respond to | Further reading |
|---|---|---|
| Back from injury, but cannot run, step in or change direction as before | Check stiffness in the muscles involved in the movement. Respond according to our interpretation, including muscle lock, and check with the athlete and staff how the actual movement changes | A-1 · A-2 · A-3 |
| In matches or training, without contact, the athlete gets hurt again in the same area or another area | Check not only the injured area but also stiffness and movement in the areas that were compensating. Consider the area and sequence of the response from our interpretation that load is concentrating on the parts that can move | A-4 · B-5 |
| After increasing load, we want information on whether the athlete is coping with it | During the return to training, repeatedly check whether stiffness or difficulty moving has returned. Share information together with the athlete’s own sense and the team’s own measurements and assessments | B-2 · C-1 |
| We want to check whether changes from hands-on work carry over to later training and matches | Link the changes before and after hands-on work with the condition afterwards. Provide ongoing support, including self-care and review at the next session | B-2 · B-4 |
| We want to use what the care side sees in coaching and training | Share which movement is difficult, what was checked, what was responded to and how it changed. Where needed, connect this to practitioner training for care practitioners | D-1 · D-3 · D-4 |
We propose sharing observations from palpation together with the functional tests and load data used in that setting and the athlete’s own sense. Palpation alone is not used to judge tolerance to load or the likelihood of reinjury; our observations feed into assessment and decisions by the medical and coaching staff and the athlete.
4. The process of checking and collaboration we propose
The following is a proposal for support based on our experience. It does not show an intervention procedure tested in research.
• Is the athlete coping with the load at that stage?
• Is load being shifted onto another area?
We check the immediate change together with how things develop afterwards. If the change is insufficient or stiffness returns, we rebuild our interpretation and response.
Through this repeated process, we aim to support overall performance, including movement, explosive power and endurance, together with the athlete’s team.
5. How we position research and experience in practice
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| Type of information | What this page conveys |
|---|---|
| What research has reported | Changes in playing time and competitive level after ACL injury; non-contact injuries after return from lower-limb muscle injuries; issues with return-decision criteria and information sharing |
| Our experience in practice | Repeatedly checking athletes’ muscles and movement, and reviewing our response through hands-on work, self-care and collaboration with staff |
| Zeroka Seitai’s interpretation | The view that remaining muscle lock or stiffness may restrict movement and lead to load on other parts |
| What we will check with teams in future | What changes are achieved for individual athletes, and how those changes hold up in training and matches |
We would like to share the checks and responses we have developed with the staff on site, and build support while confirming together the changes that matter for the athlete.