Review written by Adam Johnson info


Hamstring injuries are a major problem in the world of elite football, and are regularly referenced in the literature as the greatest cause of time loss due to injury. There is also a suggestion within the literature that despite the wealth of high quality research and development of football medicine over the past decade, the burden of hamstring injuries is only getting worse.

The authors of this paper recognise a key issue at the beginning of this piece - despite strong evidence supporting certain injury prevention practices, they often aren’t adopted within elite sport. They also acknowledge that there is a complex interplay between a number of risk factors, which means that injury prevention programs and strategies must look to influence as many of these factors as possible. It is unlikely that one exercise would be sufficient to target and affect all proposed risk factors, and so this paper is an important discussion piece surrounding their own approach to the problem.

It is unlikely that one exercise would be sufficient to target and affect all proposed risk factors


The authors of the paper propose a five point strategy for hamstring injury prevention which is outlined below:

  1. Strengthen the hamstrings Eccentric hamstring training has recently become the most researched and discussed area of hamstring injury prevention, and the literature would suggest that there is strong rationale for inclusion of exercises such as the Nordic Hamstring Exercise (NHE). This exercise has been shown to induce favorable architectural changes within the Biceps Femoris, with resultant decreased injury incidence. The article acknowledges the difficulty of prescribing the full NHE protocol in elite sport, and so proposes exposing the athletes to regular max velocity runs at least once a week to compliment a NHE program.

  2. Optimize the training balance Emerging literature would suggest that a heightened acute:chronic workload ratio accompanied by congested match play is a key risk factor to hamstring injury. This fixture congestion is not something that can be managed by the medical and sports science teams in elite sport, however what can be managed is the training load leading up to the busy period, such as the Christmas period in the English footballing calendar. The authors therefore highlight the importance of accruing moderate to high chronic training loads in order to provide the players with the capacity to cope with busy periods of match play.

  3. Incorporate a lumbopelvic hip stability program This is an area that the authors acknowledge as having a lack of high quality evidence to support its inclusion. However, they suggest that the link to other injuries as well as anecdotal evidence is enough of a justification for its involvement in their strategy. There is discussion surrounding the theory of increased stretch of the hamstrings and inhibition of Glute Max with the pelvis in an anteriorly tilted position as further justification.

  4. Develop physical conditioning Physical conditioning is important in this injury prevention discussion with the authors referencing the fact that superior physical qualities provide players across a range of sports with a greater robustness to injury. In developing an athletes’ strength and cardiovascular fitness it is suggested that they would become more resistance to fatigue and the subsequent negative consequences of this.


  1. Focus on movement quality There should be a strong emphasis on developing movement quality through performing upper and lower body tasks with a stable pelvic base. These activities can be performed at a very simple level in the early stages before progressing through added layers of complexity and speed.


This article and its messages will appeal to a wide audience ranging from those who are interested in how elite sporting medical teams try to combat the challenge of hamstring injuries, through to those already working in elite/semi-professional sport who

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