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Hamstring injury risk factors in sport

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Summary of a review of risk factors for the first-time hamstring strain injury and recurrent hamstring strain injury in sport.


71,324 athletes; 8,319 total hamstring strain injuries including 967 recurrent injuries. 179 potential risk factors analyzed


Systematic review and meta-analysis of 78 studies.

Outcome measures/tests

  • index (first-time injury during a period of time)
  • recurrent hamstring strain injury (HSI)

Main results

  • Non-modifiable risk factors:

    • older age (based on the results from 19 studies)
    • history of HSI (the highest risk for within the same season), ACL injry, knee injury, calf strain injury, or ankle ligament injury
    • position played a role in American football, rugby, Gaelic football and cricket. Positions with more running had greater risk of index HSI.
    • international travel (in cricket)
  • Modifiable risk factors for index HSI:

    • hamstring muscle-tendon unit stiffness and bicept femoris fascicle length
    • reduced hamstring strength and strength endurance
    • reduced single leg hop for distance
    • decreased trunk muscle and increased gluteus medius electromyographic activity during sprinting/running
    • trunk and hamstring motor control (3 studies)
    • increase in high-speed running exposure
    • increased in thoracis side-bending during running
  • Modifiable risk factors for recurrent HSI:

    • decreased active knee extension just after return to play

    • reduced hamstring strength and strength endurance

    • No increase in risk for HSI in relation to:

      • athlete weight and biceps femoris or glueal muscles size
      • quadricept strain or chronic groin pathology, osteitis pubis
      • eccentric hamstring strength on Nordic hamstring exercise
      • hight and power output of countermovement jump
      • flexibility, mobility and range of motion
      • aerobic, YoYo, 40m sprinting and agility tests
    • Conflicting relation for:

      • decreased hip extension
      • decreased ankle dorsiflexion
      • gluteus maximus electromyographic activity in sprinting and running
      • reduced between-game recovery
      • increased congestion in game schedule
      • level of competition
      • MRI finding of intratendinous injury, intramuscular tendon disruption

Take home message

For a clinician & coach
Reduced hamstring strength and strength endurance were associated with both first-time and recurrent hamstring strain injury in sport.
For a parent
Reduced hamstring strength and strength endurance were associated with hamstring strain injury in sport.
For an athlete
Reduced hamstring muslces strength can relate to hamstring strain injury in sport.

Original article

Green B, Bourne MN, van Dyk N, Pizzari T. Recalibrating the risk of hamstring strain injury (HSI)-A 2020 systematic review and meta-analysis of risk factors for index and recurrent HSI in sport. British Journal of Sports Medicine. 2020 Apr 15.

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