{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T19:11:27Z","timestamp":1770750687493,"version":"3.50.0"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Muscles"],"abstract":"<jats:p>Objectives: This clinical commentary presents a four-pillar rehabilitation framework implemented in the elite football setting of OFI Crete FC and designed to facilitate the return of football players to training and competitive play. The framework is structured around five core components: (a) effective load management during training and matches, (b) individualized rehabilitation programs and injury prevention strategies integrated within the recovery phase, (c) a novel on-field rehabilitation framework, and (d) an extended secondary prevention plan. Methods: This comprehensive approach was implemented over a three-year period with the OFI Crete FC football team and involved 87 elite professional players between the ages of 17 and 35. Throughout this time, 180 injuries were documented, ranging from mild to severe injuries. Results: The outcome illustrated that only 40% of these injuries led to players missing official matches, while the recurrence or follow-up injury rate was limited to just 10%. Over the course of the three years, a steady 60% decline in injury rates was observed. Conclusions: These findings emphasize the crucial importance of training load management, the integration of injury prevention strategies throughout the rehabilitation process, and the early initiation of on-field rehabilitation. Within the clinical setting of OFI Crete FC, the implementation of this integrated rehabilitation framework was associated with favorable observations in injury incidence, player absence days, and return-to-play timelines, which may reflect that the approach has potential benefits while remaining observational in nature.<\/jats:p>","DOI":"10.3390\/muscles5010011","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T15:38:12Z","timestamp":1770046692000},"page":"11","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Injury to Impact: Optimizing Return-to-Play Outcomes and Reinjury Prevention via Four-Pillar Rehabilitation Strategy in Elite Football\u2014A Clinical Study in a Sports Scenario"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9222-0910","authenticated-orcid":false,"given":"Ioannis","family":"Stathas","sequence":"first","affiliation":[{"name":"OFI Crete FC, 71303 Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikos","family":"Koundourakis","sequence":"additional","affiliation":[{"name":"OFI Crete FC, 71303 Heraklion, Crete, Greece"},{"name":"Faculty of Sports Science and Physical Education, Metropolitan College, 71202 Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charalampos","family":"Christoforidis","sequence":"additional","affiliation":[{"name":"OFI Crete FC, 71303 Heraklion, Crete, Greece"},{"name":"Orthopedic Clinic, University General Hospital of Heraklion, 71500 Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Kouvidis","sequence":"additional","affiliation":[{"name":"OFI Crete FC, 71303 Heraklion, Crete, Greece"},{"name":"Orthopedic Clinic, University General Hospital of Heraklion, 71500 Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6744-2979","authenticated-orcid":false,"given":"Anna","family":"Christakou","sequence":"additional","affiliation":[{"name":"Laboratory of Biomechanics, Department of Physiotherapy, University of Peloponnese, 23100 Sparta, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Rossi, A., Pappalardo, L., Cintia, P., Iaia, F.M., Fern\u00e1ndez, J., and Medina, D. (2018). Effective injury forecasting in soccer with GPS training data and machine learning. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0201264"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1136\/bjsports-2013-092215","article-title":"Injuries affect team performance negatively in professional football: An 11-year follow-up of the UEFA Champions League injury study","volume":"47","author":"Magnusson","year":"2013","journal-title":"Br. J. Sports Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Nieto Torrej\u00f3n, L., Mart\u00ednez-Serrano, A., Villal\u00f3n, J.M., and Alcaraz, P.E. (2024). Economic impact of muscle injury rate and hamstring strain injuries in professional football clubs. Evidence from LaLiga. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0301498"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1136\/bjsports-2018-099577","article-title":"Epidemiology of injuries in professional football: A systematic review and meta-analysis","volume":"54","author":"Myer","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.jsams.2022.06.003","article-title":"incidence, severity, and burden in elite youth soccer players: A 3-year prospective study","volume":"25","author":"Ruf","year":"2022","journal-title":"J. Sci. Med. Sport"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1177\/0363546510395879","article-title":"Epidemiology of muscle injuries in professional football (soccer)","volume":"39","author":"Ekstrand","year":"2011","journal-title":"Am. J. Sports Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2519\/jospt.2021.9305","article-title":"Incidence of acute hamstring injuries in soccer: A systematic review of 13 studies involving more than 3800 athletes with 2 million sport exposure hours","volume":"51","author":"Diemer","year":"2021","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"23259671221080815","DOI":"10.1177\/23259671211055136","article-title":"Incidence of Injury for Professional Soccer Players in the United States: A 6-Year Prospective Study of Major League Soccer","volume":"10","author":"Forsythe","year":"2022","journal-title":"Orthop. J. Sports Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1136\/bjsports-2023-107133","article-title":"UEFA Women\u2019s Elite Club Injury Study: A prospective study on 1527 injuries over four consecutive seasons 2018\/2019 to 2021\/2022 reveals thigh muscle injuries to be most common and ACL injuries most burdensome","volume":"58","author":"Ekstrand","year":"2024","journal-title":"Br. J. Sports Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1136\/bjsports-2016-096278","article-title":"2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern","volume":"50","author":"Ardern","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1136\/bjsports-2021-105384","article-title":"London International Consensus and Delphi study on hamstring injury\u2019s part 3: Rehabilitation, running and return to sport","volume":"57","author":"Paton","year":"2023","journal-title":"Br. J. Sports Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1136\/bjsm.2005.025270","article-title":"Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries","volume":"40","author":"Fuller","year":"2006","journal-title":"Br. J. Sports Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"284","DOI":"10.70252\/NEWP3625","article-title":"Orchard Sports Injury Classification System 10.1 Plus: An end-user study","volume":"10","author":"Crossway","year":"2017","journal-title":"Int. J. Exerc. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1136\/bjsports-2020-103159","article-title":"Injury rates decreased in men\u2019s professional football: An 18-year prospective cohort study of almost 12,000 injuries sustained during 1.8 million hours of play","volume":"55","author":"Ekstrand","year":"2021","journal-title":"Br. J. Sports Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1136\/bjsports-2021-105407","article-title":"Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men\u2019s professional football: The UEFA Elite Club Injury Study from 2001\/02 to 2021\/22","volume":"57","author":"Ekstrand","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1136\/bjsports-2012-091448","article-title":"Terminology and classification of muscle injuries in sport: The Munich consensus statement","volume":"47","author":"Haensel","year":"2013","journal-title":"Br. J. Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1136\/bjsports-2017-098885","article-title":"Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the international ankle consortium","volume":"52","author":"Delahunt","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"17","DOI":"10.21037\/aoj.2020.01.03","article-title":"Evaluation and treatment of groin pain syndromes in athletes","volume":"5","author":"Arner","year":"2020","journal-title":"Ann. Jt."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/0736-4679(86)90076-4","article-title":"Evaluation of the knee","volume":"4","author":"Sternbach","year":"1986","journal-title":"J. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Spanish Group for Tendon Consensus, Fernandez-Ja\u00e9n, T., Rey, G.\u00c1., Angulo, F., Cuesta, J.A., Loureda, R.A., Espa\u00f1a, F.\u00c1., Ayala, J., Matas, R.B., and Pazos, F.B. (2017). Spanish consensus statement: Clinical management and treatment of tendinopathies in sport. Orthop. J. Sports Med., 5, 2325967117734127.","DOI":"10.1177\/2325967117734127"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1136\/bjsports-2015-095788","article-title":"The training-injury prevention paradox: Should athletes be training smarter and harder?","volume":"50","author":"Gabbett","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hamstra-Wright, K.L., Huxel Bliven, K.C., and Napier, C. (2021). Training load capacity, cumulative risk, and bone stress injuries: A narrative review of a holistic approach. Front. Sports Act. Living, 3.","DOI":"10.3389\/fspor.2021.665683"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jshs.2020.11.003","article-title":"Physical exercises for preventing injuries among adult male football players: A systematic review","volume":"11","author":"Adsuar","year":"2022","journal-title":"J. Sport Health Sci."},{"key":"ref_24","first-page":"643","article-title":"The problem of recurrent injuries in collegiate track and field","volume":"18","author":"Hopkins","year":"2022","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e001849","DOI":"10.1136\/bmjsem-2023-001849","article-title":"Effectiveness of an on-field rehabilitation framework for return to sports in injured male professional football players: A single-blinded, prospective, randomised controlled trial","volume":"10","author":"Stathas","year":"2024","journal-title":"BMJ Open Sport Exerc. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bangert, Y., Jaber, A., Trefzer, R., Zietzschmann, S., Koch, K.-A., Kern, R., Spielmann, J., Renkawitz, T., and Weishorn, J. (2024). The impact of injury on career progression in elite youth football\u2014Findings at 10 years. J. Clin. Med., 13.","DOI":"10.3390\/jcm13071915"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1007\/s40279-015-0468-7","article-title":"Return to play after hamstring injuries: A Qualitative Systematic Review of Definitions and Criteria","volume":"46","author":"Reurink","year":"2016","journal-title":"Sports Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"82","DOI":"10.2165\/00007256-199214020-00002","article-title":"Incidence, severity, aetiology and prevention of sports injuries. A review of concepts","volume":"14","author":"Hlobil","year":"1992","journal-title":"Sports Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jsams.2006.02.009","article-title":"A new framework for research leading to sports injury prevention","volume":"9","author":"Finch","year":"2006","journal-title":"J. Sci. Med. Sport"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1080\/24733938.2018.1512752","article-title":"A new model for injury prevention in team sports: The Team-sport Injury Prevention (TIP) cycle","volume":"3","author":"Finch","year":"2019","journal-title":"Sci. Med. Footb."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1136\/bjsports-2017-098160","article-title":"Why we should focus on the burden of injuries and illnesses, not just their incidence","volume":"52","author":"Bahr","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1136\/bjsports-2019-100666","article-title":"Time before return to play for the most common injuries in professional football: A 16-year follow-up of the UEFA Elite Club Injury Study","volume":"54","author":"Ekstrand","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3","DOI":"10.5114\/biolsport.2020.89935","article-title":"Methods may matter in injury surveillance: \u201cHow\u201d may be more important than \u201cwhat, when or why\u201d","volume":"37","author":"Tabben","year":"2020","journal-title":"Biol. Sport"},{"key":"ref_34","unstructured":"Vilella, R., Kumar, A., and Reddivari, R. (2023). Musculoskeletal Examination. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"331","DOI":"10.2519\/jospt.2023.11824","article-title":"Using randomized controlled trials in the sports medicine and performance environment: Is it time to reconsider and think outside the methodological box?","volume":"53","author":"Bullock","year":"2023","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/0895-4356(92)90040-T","article-title":"Population prevalence estimates from complex samples","volume":"45","author":"Beckett","year":"1992","journal-title":"J. Clin. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1136\/bjsports-2016-096040","article-title":"How do training and competition workloads relate to injury? The workload-injury aetiology model","volume":"51","author":"Windt","year":"2017","journal-title":"Br. J. Sports Med."}],"container-title":["Muscles"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2813-0413\/5\/1\/11\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T12:04:15Z","timestamp":1770725055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2813-0413\/5\/1\/11"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["muscles5010011"],"URL":"https:\/\/doi.org\/10.3390\/muscles5010011","relation":{},"ISSN":["2813-0413"],"issn-type":[{"value":"2813-0413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]}}}