Effective But Not Adhered to: How Can We Improve Adherence to Evidence-Based Hamstring Injury Prevention in Amateur Football?

Abstract

To investigate adherence to a Nordic hamstring exercise (NHE) program in a real-world context of male amateur football, and the perceptions of end users (players) and intervention deliverers (coaches and medical staff) about adherence to this proven effective program. Retrospective cohort study. Dutch amateur football. Two hundred sixty-four players, 23 coaches, and 29 medical staff from Dutch amateur football teams that participated in a national randomized controlled trial 2 years earlier. Nordic hamstring exercise program. Nordic hamstring exercise program adherence during 2014 and 2015. Intervention or control group allocation during the trial, transfers, and personal perception about adherence to the program were also examined. Of all players, 69% reported never, 16% sometimes, 6% frequently, 5% often, and 4% always performing exercises of the NHE program. Adherence to the NHE program was higher among players who had been in the NHE arm of the previous trial and among players who had not been transferred to another club compared with players who had been transferred. Key factors in stimulating players to adhere to the NHE program were knowledge of the NHE and personal motivation. Coaches and medical staff members also mentioned personal motivation and consensus with team staff as key factors to encourage NHE adherence. Among high-level male amateur football players, adherence to an evidence-based hamstring injury-prevention program was very low. It is essential to recognize factors that stimulate or limit adherence to injury-prevention programs for effective programs to actually lead to a reduction in hamstring injuries in a real-world context.