This document discusses proposals for rehabilitation programs for rectus femoris injuries. It provides background on the anatomical features and functions of the rectus femoris muscle as well as risk factors and mechanisms of injury. The proposals aim to design rehabilitation programs based on scientific evidence regarding injury risk factors, appropriate exercises and progression. They involve standardized criteria and protocols to minimize bias and optimize loading during rehabilitation.

1. 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

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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).

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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:

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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?

22. 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.

23. 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

24. 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?

25. 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?

26. 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.

27. 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

28. 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:

29. 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

30. 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

31. 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