Review written by Dr Teddy Willsey info


Hamstring muscle strains are one of the most common injuries seen in professional soccer, where athletes routinely sprint at near maximal speeds. The high rate of injury and recurrence represents a significant burden on sporting programs and the individual players. Although tremendous efforts have been made to prevent injury and improve rehabilitation, epidemiological research shows a continual rise in incidence and recurrence (1).

This increase in injury rates may be due to a variety of factors. Speed of play has increased in recent years, with athletes averaging 25.27 sprints per match in 2013-2014 compared with 17.3 sprints per match in the 2002-2004 seasons (2). Increased competition influences faster return to play times as well. The objective of this paper was to develop and validate a soccer-demand specific functional on-field program for the rehabilitation and re-adaptation of players after a hamstring strain.


A prospective, longitudinal study and rehabilitation protocol consisting of 13 progressive soccer and hamstring intensive demands was designed and validated by a panel of 15 industry experts (strength and conditioning and rehabilitation professionals). The experts were asked to rate each item on a scale from 1 to 5 based on its relevance. Items were required to have a 75% interrater agreeability. All 13 final items were determined to be valid amongst the experts. The drills and steps in this protocol are consistent with previously established methods for high level return to play hamstring rehab.

The rehabilitation protocol began with percutaneous needle electrolysis day 1, progressing to controlled mobilizations and isometric contractions on days 2 and 3. Days 4 and 5 involved dynamic extensor dominant drills: lateral hops, sled pushes, and running to tolerance. Days 6 and 7 initiated strength training: Bulgarian split squats, deadlifts, and single joint movements loaded to tolerance. Day 8 marked the initiation of the 13-item on-field re-adaptation program studied.


Players who suffered a grade 2 hamstring strain injury (n =19) returned competitively to play in an average of 23 days after undergoing this program, and zero players suffered a reinjury in 6 months following return to play. It is

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