Hamstring Muscle Strains in

Professional Football Players

A 10-Year Review
Marcus C. C. W. Elliott,* MD, Bertram Zarins,y MD,
John W. Powell,z PhD, ATC, and Charles D. Kenyon*§
Investigation performed at Peak Performance Project, Santa Barbara, California

Background: Investigations into hamstring strain injuries at the elite level exist in sports such as Australian Rules football, rugby,
and soccer, but no large-scale study exists on the incidence and circumstances surrounding these injuries in the National Football
League (NFL).
Hypothesis: Injury rates will vary between different player positions, times in the season, and across different playing situations.
Study Design: Descriptive epidemiology study.
Methods: Between 1989 and 1998, injury data were prospectively collected by athletic trainers for every NFL team and recorded
in the NFL’s Injury Surveillance System. Data collected included team, date of injury, activity the player was engaged in at the time
of injury, injury severity, position played, mechanism of injury, and history of previous injury. Injury rates were reported in injuries
per athlete-exposure (A-E). An athlete-exposure was defined as 1 athlete participating in either 1 practice or 1 game.
Results: Over the 10-year study period 1716 hamstring strains were reported for an injury rate (IR) of 0.77 per 1000 A-E. More
than half (51.3%) of hamstring strains occurred during the 7-week preseason. The preseason practice IR was significantly ele-
vated compared with the regular-season practice IR (0.82/1000 A-E and 0.18/1000 A-E, respectively). The most commonly injured
positions were the defensive secondary, accounting for 23.1% of the injuries; the wide receivers, accounting for 20.8%; and spe-
cial teams, constituting 13.0% of the injuries in the study.
Conclusion: Hamstring strains are a considerable cause of disability in football, with the majority of injuries occurring during the
short preseason. In particular, the speed position players, such as the wide receivers and defensive secondary, as well as players
on the special teams units, are at elevated risk for injury. These positions and situations with a higher risk of injury provide foci for
preventative interventions.
Keywords: National Football League; NFL; injury; muscle strain; hamstring

According to recent epidemiological studies, football has
the highest injury rate of any team sport in the United
States, at both the high school and collegiate levels.18,31
The high risk of injury makes it imperative to identify
players and environments at risk for specific injuries so
that scientifically supported injury prevention programs
may be developed and implemented.36
§
Address correspondence to Charles D. Kenyon, Peak Performance
Project, 110 Santa Barbara Street, Santa Barbara, CA 93101 (e-mail:
charlie.kenyon@gmail.com).
*Peak Performance Project, Santa Barbara, California.
y
Department of Orthopaedic Surgery, Children’s Hospital Boston,
Harvard Medical School, Boston, Massachusetts.
z reported that muscle strains account for 46% of practice
Graduate Athletic Training Program, Michigan State University, East
Lansing, Michigan.
One or more of the authors has declared the following potential con-
flict of interest or source of funding: A grant from NFL Charities was used
to support this study.
The American Journal of Sports Medicine, Vol. 39, No. 4
DOI: 10.1177/0363546510394647
Ó 2011 The Author(s)
Muscle strain injuries are a cause of considerable dis-
ability in football. In high school football, muscle strains
have been reported to comprise between 12% and 24% of
all injuries.8,23,29,34 Muscle strains in a major college foot-
ball team were reported by Heiser et al17 to occur at
a rate of 7.7% per player-year. Furthermore, muscle strain
injuries accounted for 18.9% of spring practice and 22.2%
of fall practice injuries in collegiate football across all divi-
sions over the course of 16 seasons from 1988 to 2004.10 Of
these, the thigh accounted for nearly half of all strain inju-
ries during practice.
In a recent 10-year study of preseason injuries of 1
National Football League (NFL) team, Feeley et al11
injuries and 22% of preseason game injuries. Hamstring
strains were the second most common preseason injury,
with an injury rate of 1.79 per 1000 athlete-exposures
for practices and 4.07 per 1000 athlete-exposures for
games.
A growing amount of research categorizing risk factors
associated with hamstring strain injuries at the elite level

843
844 Elliott et al
exists for sports such as soccer43 and rugby.4,9 In particu-
lar, a recent emphasis on hamstring strains can be found
in the literature concerning Australian Rules Foot-
ball.12,25,41 Despite their high frequency and potential for
prevention, there have been few attempts to characterize
the specific relationships between hamstring strains and
the factors associated with playing the competitive grid-
iron football season. Of these, most studies have suffered
from small sample sizes, unreliable injury definition, and
short surveillance periods.34,38
The purpose of this study was to characterize the factors
that are associated with hamstring injuries in NFL players
during a 10-year period. We were particularly interested in
whether injuries were incurred in activities related to foot-
ball’s ballistic collisions, whether they were similar to
those experienced in noncontact activity, and whether
identifiable periods or activities of higher injury density
exist. We hoped that identifying player characteristics
and activities associated with a high incidence of ham-
string strains would provide foci for preventative
interventions.
MATERIALS AND METHODS
The NFL athletic trainers collected the injury and expo-
sure data prospectively between 1989 and 1998. The data
included all players on each team’s roster and focused on
activities from the first practice day through the last
game. The NFL added 2 teams in 1995, and thus the
data reflect 28 teams from 1989 to 1994 and 30 teams
from 1995 to 1998. The teams’ data reports were submitted
to the central database every 2 weeks throughout the year.
The athletic trainers conformed to uniform reporting defi-
nitions of injuries and exposures that were established by
the NFL Injury Surveillance System. These measures
resulted in a high level of compliance, standardization,
and consistency of data.
Data regarding recorded injuries included team, date of
injury, activity the player was engaged in at time of injury,
position played, mechanism of injury, and history of ham-
string strain injuries. From 1989 to 1995, a reportable
injury in the NFL Injury Surveillance System was any
injury that caused the athlete to miss at least 2 days of par-
ticipation in either practices or games. Beginning in 1996,
this definition was modified to reflect 1 day of lost time. For
consistency, the data in this article reflect only those cases
that met the definition for reporting used before the 1996
season. For the purpose of this study, hamstring strains
were defined as any muscle strain injury to the posterior
thigh resulting in a minimum 2 days of lost participation
in either practice or games. Injury severity was calculated
and identified as minor, moderate, and major. Injuries that
resulted in less than 7 days of missed participation were
defined as minor, those that resulted in between 7 and
21 days missed were defined as moderate, and those result-
ing in more than 21 days missed were defined as major.
Injuries classified as reinjuries reflected injuries in which
the athlete reported previously straining the hamstring
muscle group on the same side during the current season.
The American Journal of Sports Medicine
The number of players available during preseason activ-
ities is variable by week, with the final team roster set
before the first regular season game. To account for this
and other seasonal variations in number of players practic-
ing or playing at any one time, the number of players who
participated in each session (practice or game) was
recorded along with the number of games and practices.
The total numbers of games and practices are used to esti-
mate injury rates per session. Aggregating the man-
sessions creates an estimate of the number of opportunities
for injury and is referred to as athlete-exposures (A-E).
This provides for a denominator with which to calculate
injury rates at different times during the season and to
compare relative injury risk for practice versus games, var-
ious positions, and different types of plays. By dividing
injury incidence by both the number of years (10) and the
number of NFL teams (28-30), we get the mean injury inci-
dence per NFL team in one competitive year, referred to as
the injury rate per team-season. In all, 288 team-seasons
were studied.
The analysis includes a review of the injury patterns for
player position, player activities, onset of injury, time lost
from participation, injury rates per session, injury rates
per team-season, and injury rates per 1000 A-E. Data anal-
ysis used SPSS 10.0 (SPSS, Inc, an IBM Company, Chi-
cago, Illinois).
RESULTS
Between 1989 and 1998, 1716 hamstring strains were
reported among players on NFL teams (Table 1). The per
season range over the 10-year study was 132 to 210.
From 1993 through 1998, the number of injuries remained
consistent at about 183 injuries per year (Figure 1) with
a range of 160 to 210. During the study years, 1129 differ-
ent players incurred the 1716 reported injuries. Annually,
a mean of 144 different players sustained a mean number
of 172 hamstring muscle injuries.
Severity
Hamstring strains resulted in a mean of 2222 days lost
annually. A mean of 13.2 and a median of 9 days were
lost per injury. The average season showed 213 man-games
lost because of hamstring injuries with a median of 1.2
man-games per injury. Injury severity was classified as
minor in 40.6% of the injuries, moderate in 41.0%, and
major in 18.3% of all hamstring muscle injuries.
Type of Session
During the study, a majority (52.7%; n = 904) of the
reported hamstring injuries occurred in practices, with
47.3% (n = 812) occurring in games. This translates to an
injury rate per 1000 A-E of 0.47 for practices and 2.7 for
games and reflects a 5.74 relative risk of hamstring injury
during games relative to practice sessions.
Vol. 39, No. 4, 2011 Hamstring Muscle Strains in Professional Football Players 845

250

200
Injuries per Year

150

100

50

0
89 90 91 92 93 94 95 96 97 98
Year

Figure 1. Injury incidence per year over 10-year study period.

TABLE 1 TABLE 2
Total Injuries and Exposures Over 10-Year Study Perioda Injury Rate by Session Type and Time of Yeara

Practice Game Total Injuries Exposures IR/1000 A-E

Injuries 904 812 1716 Preseason

Exposures 1 921 960 297 053 2 219 013 Game 199 80 691 2.47
IR/1000 A-E 0.47 2.70 0.77 Practice 713 872 202 0.82
Regular season
a
A-E, athlete-exposure; IR, injury rate. Game 603 206 696 2.92
Practice 182 999 999 0.18

Temporal Aspects a
A-E, athlete-exposure; IR, injury rate.

The data were analyzed in relation to the month in which

the injury occurred. The majority of reported injuries
(53.1%; n = 912) occurred during the preseason months of
July and August despite the fact that the preseason period
is approximately 7 weeks long compared with the 16-week
regular season. Of the total hamstring muscle strain inju-
ries, 45.7% (n = 785) occurred in the regular season. Of all
practice injuries, 79.8% (injury rate [IR] = 0.82/1000 A-E)
occurred in the preseason (Table 2); 56.0% of the
practice-related injuries occurred in July, 23.8% occurred
in August, and only 20.3% occurred after September 1
(Figure 2). Of all practice-related injuries, 20.1% (n = 182;
IR = 0.18/1000 A-E) occurred during the regular season.
Of the game-related injuries, 21.8% (n = 191; IR = 2.47/
1000 A-E) occurred in the preseason, and 74.3% (n = 603;
IR = 2.92/1000 A-E) occurred in the regular season.
Reinjuries
In total, 16.5% (n = 283) of total hamstring injuries, includ-
ing 19.7% of regular-season injuries and 13.8% of presea-
son injuries, were reinjuries. During the preseason, the
reinjury rate was 12.7% (n = 91) for practices and 17.6%
(n = 35) for games. For the regular season, the reinjury
rate rose to 22.0% (n = 40) for practices and 19.1% (n =
115) for games.
Player Position
Of the 1716 injuries, 0.4% (n = 7) did not report a position.
For the remaining 1709 injuries, position played proved to
be a significant factor in the incidence of injury (Table 3).
Offensive players sustained more injuries (45.1%; n = 771)
than defensive players (41.7%; n = 716), whereas the play-
ers working on the special teams unit sustained 13.0%
(n = 222) of the injuries during the study period. When
the units are more clearly defined, the defensive second-
ary alone accounts for 23.1% of the hamstring injuries
and shows an injury rate per team-season of 1.37. Offen-
sively, the wide receivers represent 20.8% of the injuries,
with a corresponding injury rate per team-season of 1.23.
An estimate of the annual number of hamstring
injuries expected in the NFL equals the injury rate per
team-season multiplied by the 30 teams and is 178.
By position, the defensive secondary group in the NFL
has a mean hamstring injury frequency of 41 per season,
846 Elliott et al The American Journal of Sports Medicine

300

250

200
Injuries/Week

150

100

50

Week

Practice Injuries Game Injuries

Figure 2. Injury incidence by week of season for both practice and games sessions of 10-year study period.
a
The first 2 weeks of the preseason do not necessarily reflect participation by all teams.

TABLE 3 practice injuries and 73.0% of game injuries (Figure 3).

Injuries by Position Among the player positions contributing to the noncon-
tact injuries, the defensive secondary accounted for
Total IR per Estimated 26.4% (n = 287) of the reported noncontact injuries and
Injuries, Team Injuries the wide receivers 20.8% (n = 298). For those respective
No. (%) Season per Seasona
positions, noncontact injuries accounted for 92.0% and
Offense 93.5% of their total injuries. In contrast, the offensive
Quarterback 21 (1.2) 0.07 2.2 and defensive linemen cited 69.7% and 43.2%, respec-
Running back 211 (12.3) 0.73 22.0 tively, of their injuries as having occurred as a result of
Wide receiver 355 (20.8) 1.23 37.0 contact. When analyzing hamstring injuries sustained
Tight end 95 (5.5) 0.33 9.9 during noncontact, 981 (74.4%) were attributed to sprint-
Offensive line 89 (5.2) 0.31 9.3 ing. Noncontact skill drills accounted for 10.2% (n = 135)
Defense of strain injuries.
Secondary 394 (23.1) 1.37 41.0
Linebacker 196 (11.5) 0.68 20.4
Defensive line 126 (7.4) 0.44 13.1 Team Activity
Special teams 222 (13.0) 0.77 23.1
Total 1709b (100.0) 5.93 178.0 For injuries occurring during all NFL games, more ham-
string muscles were strained during passing plays (n =
a
Estimated injuries across 30-team National Football League 295; 36.8%) than during running plays (n = 147; 18.4%).
season. Special teams injuries accounted for 189 (23.3%), with
b
Total injuries for which player position was reported. the kickoffs accounting for 140 (74.1%) of those injuries.
In the passing play injuries, 225 (77%) of them were non-
the wide receivers 37, the running backs 22, and the contact, whereas 69 (45.1%) of the rushing play injuries
linebackers 20. were noncontact. Of the 140 injuries sustained during
the kickoff, 120 (85.7%) were noncontact.
During regular-season games, we found that 230
Player Activity (42.9%) muscle strains occurred during passing plays,
102 (19.0%) of the injuries occurred during rushing plays,
The reported injuries were grouped into those that and 204 (38.1%) occurred during special teams play (kick-
occurred as a result of contact or collision and those in off and punt). Based on 129 314 running plays, 148 566
which there was no contact. During the study period, passing plays, and 62 341 special teams plays, these repre-
81.5% (n = 1318) of the hamstring injuries were identified sented injury rates per 1000 plays of 0.79, 1.55, and 3.27,
as a noncontact player activity, and this included 88.5% of respectively.
Vol. 39, No. 4, 2011
A 0.82 per 1000 A-E versus 0.18 per 1000 A-E, in the presea-
Injury Rate per 1000 Practice A-E
0.8 Contact
0.7 Noncontact
0.6
0.5
0.4
0.3
0.2
0.1
0 have a high risk of more severe4 reinjury during the com-
Preseason
Time of Year
B
Injury Rate per 1000 Game A-E
2.5 Contact
Noncontact
2
1.5
1
0.5
0
Preseason
Time of Year
Figure 3. Injury mechanism by preseason and regular sea-
son for practice (A) and games (B). A-E, athlete-exposure.
Of the special teams injuries, 106 occurred during
21 633 kickoffs for an injury rate per 1000 plays of 4.90,
whereas 85 occurred during 21 783 punts for an injury
rate per 1000 plays of 3.90. Among the kickoff and punt
coverage teams, the kicking team incurred a higher injury
rate than the kick receiving teams, with the kickoff team
incurring 53 of 65 injuries (81.5%) and the punt coverage
team incurring 41 of the 54 injuries (75.9%).
DISCUSSION
The most striking finding in this 10-year study is that a dis-
proportionately higher number of hamstring muscle
strains occurred during the preseason time period. Our
data showed that more than half (53.1%) of all hamstring
injuries occurred in the 7-week preseason, before the teams
had even played their first regular-season game. These
data are striking when compared with the 16-week regular
season, in which only 45% of the injuries occurred, and the
postseason, in which only 1.1% of injuries occurred. If we
consider only primary hamstring strains, we find that an
impressive 57.3% occur in this short preseason versus
41.4% in the regular season. Despite the high preseason
injury rate in our study, this rate is approximately half
of that reported by Feeley et al11 (0.82/1000 A-E vs 1.79/
1000 A-E for practice and 2.47/1000 A-E vs 4.07/1000 A-E
for games) in their 10-year report on preseason injuries
in 1 team.
Almost 4 of 5 (78.9%) practice injuries occurred in the
preseason, with more than 70% of those occurring in
July, the first month of football participation. Further-
more, the injury rate during practice is 449% higher,
Hamstring Muscle Strains in Professional Football Players 847
son as compared with the regular season. The first month
of NFL preseason games, August, is also the month with
the highest incidence of game injuries, 192 or 23.7% of
the total. These high preseason injury incidences are dev-
astating not only for their immediate impact but also
because primary hamstring strains are associated with
decreased performance upon return to competition39 and
Regular Season petitive season.12,15,17
The data presented here confirm the findings of Feeley
et al11 that the preseason is a period during which NFL
athletes are at particular risk for injury. These findings
are also consistent with those of Whiteside et al,42 who
found that the frequency of hamstring muscle strains
was heavily weighted toward the spring preseason prepa-
ration. We believe that a number of factors contribute to
this high hamstring strain incidence during the preseason,
but most revolve around the relative deconditioning that
occurs in the off-season. Muscle weakness has been impli-
Regular Season cated as a predisposing factor for both primary7,26 and
recurring6 hamstring strain injuries. Studies have also
cited the role of fatigue in causing muscle strains,20,43,45
suggesting that fatigued muscles are more vulnerable to
injury.
Protection against muscle strain is provided not only by
strong muscles but also by the appropriate timing and
magnitude of neural control. Activated muscle complexes
are able to absorb larger eccentric forces,13 and high-
intensity sprinting involves intricate neuromuscular
coordination in the hamstrings.37 Recent biomechanical
studies of sprint mechanics suggest that the posterior
thigh is most susceptible to such strains near the end of
the swing phase, when the hamstrings reach maximal
length and undergo eccentric contraction just prior to
heel strike.16,33,44 It has also been shown that fatigue
alters neuromuscular activity in the hamstrings during
sprinting.28 Although Pinniger et al28 hypothesized that
hamstring fatigue-related changes in sprint mechanics
may serve as a protective mechanism to reduce stress on
the hamstrings during sprinting, changes such as
decreased hip and knee flexion could also be associated
with a temporary loss of athleticism, decreasing the ability
of the athlete to safely and efficiently change direction or
accelerate. Fatigue has been shown to significantly delay
activation of the lateral hamstrings during a landing
task, thereby compromising knee control strategies.14 It
is possible that fatigue-induced dysynergistic neuromuscu-
lar activation, resulting in suboptimal absorption of eccen-
tric forces,13,20 may be responsible for many hamstring
strain injuries in sports that involve not only high-velocity
sprinting but also multidirectional acceleration. Although
the role of these complex sports-specific neuromuscular fir-
ing patterns that occur during athletic activities has not
been fully elucidated, we believe that following the off-sea-
son, sports-specific neural deconditioning, relative muscle
weakness, and fatigability make some athletes particularly
vulnerable to hamstring strain in the NFL preseason.
This study also showed that despite the ballistic, contact
nature of professional football, the majority of hamstring
848 Elliott et al
strains (81.5%) were sustained by players during noncon-
tact activities, with 71.0% citing sprinting as the primary
activity at the time of injury. Although most previous
attempts to describe the injury setting in football dealt
with all types of injuries, our findings are in stark contrast
to those earlier reports, which found that most injuries in
football are due to contact.8,24 At the college level, contact
has been found to account for 77.9% of fall game, 56.5% of
fall practice, and 69.2% of spring practice injuries.10 A
recent report on high school football injuries in California
found that more than 78% of all injuries occurred during
player contact.30 By contrast, within player positions
most frequently injured in our study, the defensive second-
ary and wide receivers, 92.0% and 93.5% of injuries were
noncontact. Because a wide majority of the injuries we
studied occurred during sprinting, independent of the con-
tact element frequently present in football injuries, our
findings and injury prevention strategies may be applica-
ble to other less contact-intense sports with similar activity
patterns.
Hamstring muscle strains were distributed with strik-
ing inequity among players who played different posi-
tions. Wide receivers had significantly more hamstring
strains than did offensive linemen (n = 355 vs n = 89,
respectively) and injury rates per team-season (1.23 vs
0.31). Thus, despite the fact that the standard formation
in football uses 5 offensive linemen and only 2 wide
receivers, those wide receivers sustain 403% more inju-
ries annually than the offensive linemen. This difference
was even more striking in view of previous studies that
reported offensive lineman to be among the most fre-
quently injured players and wide receivers among the
lowest.8,30,38
We found that all of the ‘‘speed positions’’ (receivers,
defensive backs, and running backs) had high injury rates
for hamstring muscle strains compared with the ‘‘strength
positions’’ (offensive and defensive linemen). It is likely
that this disparity is primarily because of the increased
exposure to the injurious activity—namely, sprinting—by
receivers and other members of the ‘‘speed positions.’’ How-
ever, we cannot conclude that this is solely the case
because perhaps some intrinsic physical quality—for
instance, absolute hamstring muscle strength—may be
protective in these generally larger strength position ath-
letes. This possibility becomes apparent when we consider
that all football players do a substantial amount of sprint-
ing, especially during early season practices and condition-
ing, and that many of the ‘‘strength position’’ athletes are
capable of high-velocity sprinting, thus exposing them to
a similar environment in which the speed position players
incurred most of their injuries. It is hoped that future stud-
ies will continue to delineate the intrinsic and extrinsic fac-
tors that are responsible for this considerable variability in
muscle injury rates.
Although passing plays resulted in almost twice as
many hamstring muscle strains per thousand plays as run-
ning plays (1.55/1000 A-E vs 0.79/1000 A-E, relative risk
[RR] = 1.96), the risk of being injured during a special
teams play was considerably higher than either (3.27/
1000 A-E), with an RR of 2.11 and 4.14 as compared with
The American Journal of Sports Medicine
the passing and rushing plays. Within the special teams
data, we found the highest injury rates for the kickoff
and punt plays, with injury rates of 4.9 and 3.9 injuries
per 1000 plays. Of these, the vast majority occurred in
the kick coverage teams, with the coverage teams sustain-
ing 81.5% and 75.9% of the injuries. It is not unexpected to
have high injury rates in the kick coverage teams, as most
players in this setting are exposed to high levels of full-
speed sprinting. Special teams plays also frequently use
players who are not regularly involved in offensive or
defensive plays and thus are only intermittently involved
in game activity. Proper warm-up is critical in injury pre-
vention because an increase in muscle temperature results
in increased muscle elasticity.32 Irregular participation
allows muscles to cool down, which decreases muscle elas-
ticity and ability to absorb energy. In lieu of rule changes,
we recommend greater attention to warm-up of kick cover-
age teams before entering the game. This can take the form
of progressively more intense sideline sprinting or progres-
sive warm-up on a stationary exercise machine (eg, cycle
ergometer, elliptical trainer) that uses the hamstring mus-
cle group adequately.
It has been reported that muscle strain reinjury occurs
at a high prevalence in the hamstring group.12,15 Reinju-
ries accounted for 16.5% of total injuries in our study,
with almost one-fifth (19.7%) of the regular-season injuries
being reinjuries. Thus, primary injuries in the preseason
appear to account for a large number of the injuries sus-
tained during the regular season. Comparatively, these
reinjury rates are similar to those reported at the elite
level in other sports. Reinjury rates have been reported
at 12% in soccer,43 23% in rugby,4 and as high as 34% in
Australian Rules Football.27
On the basis of these findings, we strongly recommend
an increased effort by athletes to enter the NFL preseason
in a high state of sport-specific conditioning, particularly
with regard to strengthening and full-velocity sprinting.
An injury prevention program in Australian Rules Football
had success by integrating sport-specific high-intensity
interval running and acceleration drills into preseason
conditioning programs.40 Also, movement-specific neural
training with an emphasis on sprint technique has been
shown to enhance neuromuscular control in elite athletes.5
As activated muscles are able to absorb greater amounts of
force,13 increased neural control should lead to an increase
in absorbed energy without tearing. By exposing an athlete
to progressively intense bouts of sprinting and sport-
specific neuromuscular training during the off-season
and early in the preseason, injury risk may be mitigated.
Neural conditioning may be even more important than pre-
viously thought in preventing reinjuries. A study by
Sherry and Best35 demonstrated that a program of pro-
gressive agility drills and trunk stabilization proved to be
significantly more effective at protecting an athlete from
reinjury when compared with a program focused on static
stretching and isolated resistance training. Such preventa-
tive measures are especially important for those groups
determined to be at high risk for injury, specifically the
‘‘speed positions’’ (ie, wide receivers and defensive second-
ary) and special teams players.
Vol. 39, No. 4, 2011
Evidence suggests conditioning should include not only
concentric strength training for the hamstring muscle
group but also an emphasis on eccentric loading.1,22 Eccen-
tric exercise has been shown to produce greater strength
gains than similar concentric hamstring movements.19
Also, eccentric hamstring movements were shown to result
in an increase in the optimum angle for torque generation
after just 1 session.3 Such a change may make the ham-
strings stronger in a more functional position during
sprinting and increase the ability of the hamstrings to
absorb repeated eccentric loads prior to and during heel
strike. The authors successfully reduced muscle injuries
by an order of magnitude in an NFL team by implementing
a program focused on high-force eccentric loading of the
hamstrings, as well as identifying and correcting muscle
weakness and progressive sprint training for identified
high-risk athletes.
The athlete’s hamstring muscle group needs to be not
only strong with appropriate neural timing but also fatigue
resistant because fatigued muscles appear vulnerable to
strain injury.20 Hamstring fatigue correlates with
decreased sprint speed and an alteration in sprint mechan-
ics.28 Also, hamstring fatigue has been associated with
increased anterior tibial translation and a mechanical
loss of knee stability,21 thus compounding the risk of strain
injuries with risk of traumatic injuries to the knee.
We have provided a number of foci for preventive inter-
vention in this large descriptive study of hamstring inju-
ries in football. Coupled with recent advances in our
understanding of muscle function and injury mechanism,
we hope this will support the continued development of
hamstring injury prevention programs in sport. It is impor-
tant to note that the benefits of a preseason training pro-
gram with a focus on preventing hamstring strains go
above and beyond injury prevention. Many of the factors
associated with reducing the risk of hamstring strain inju-
ries are also closely associated with overall athletic perfor-
mance.2,13 Thus, in addition to reducing the risk of
hamstring strains, the principal side effect of a well-
orchestrated muscle injury prevention program is gener-
ally faster, stronger, and more athletic athletes.
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