Towards a decision-making framework for returning to sport after hamstring strain injuries: Integrating the perspective of stakeholders and athletes

The concept of return to sport (RTS) represents a foundational element in sports medicine, particularly in the management of musculoskeletal injuries such as hamstring strain injuries (HSI). HSI are prevalent in sports that involve high-speed running and explosive movements— for instance football, athletics, and rugby—making them one of the most frequent and complex injuries to manage in elite athletic populations. Due to their recurrent nature and their financial impact (€11 million annual cost per club in soccer), HSIs pose not only a physical burden but also a significant challenge in designing effective RTS strategies that mitigate the risk of reinjury and outlays.

The overarching aim of this doctoral research is to investigate how psychological, social, and contextual factors could be systematically integrated into the clinical decision-making process for return to sport (RTS) following hamstring injuries in elite athletes. This project seeks to generate a deeper understanding of the non-physical dimensions that influence RTS. Ultimately, the thesis aspires to contribute to the development of more comprehensive, evidence-informed approaches that enhance both the quality and individualisation of RTS pathways in elite sport contexts.