On-field rehabilitation in football: Current knowledge, applications and future directions.

Injury reduction remains a hot topic in professional football due to the economic and competitive implications of time lost (1, 2). Current strategies to reduce injury burden involve either reducing primary injuries through prevention-based strategies or lowering the risk of secondary injuries when they occur. It appears that primary injury reduction strategies are largely effective (3, 4), and might have supported reduced incidence across the past two decades (5, 6). Strategies concerning re-injury risk, however, are less than optimal, particularly when concerning recurrent and/or high-grade muscle and ligament injuries (1, 5). Whilst return to play (RTP) rates for such injuries are high in elite football, players often return with heightened risk of re-injury and may experience lower performance levels, especially after severe injuries such as anterior cruciate ligament (ACL) ruptures (7–14). Injuries are thought to occur due to a complex web of determinants (15), with previous injury remaining one of the most reported risk factors (16). Re-injuries (i.e., to the same location) or subsequent injuries (i.e., in a different location) typically occur early in the RTP process, suggesting players might be returned too quickly for sufficient tissue healing, or they are inadequately prepared for RTP demands (6, 16–18). The role of previous injury as a risk factor for future injury can be mitigated through effective rehabilitation (19). As such, improving RTP practice and processes appears warranted to improve outcomes after certain injuries (e.g., high-grade muscle/severe ligament injuries).