History Of Hamstring Strain Injury Research Articles

Biceps femoris long head muscle and aponeurosis geometry in males with and without a history of hamstring strain injury.

Hamstring strain injuries (HSIs) commonly affect the proximal biceps femoris long head (BFlh) musculotendinous junction. Biomechanical modeling suggests narrow proximal BFlh aponeuroses and large muscle-to-aponeurosis width ratios increase localized tissue strains and presumably risk of HSI. This study aimed to determine if BFlh muscle and proximal aponeurosis geometry differed between limbs with and without a history of HSI. Twenty-six recreationally active males with (n = 13) and without (n = 13) a history of unilateral HSI in the last 24 months underwent magnetic resonance imaging of both thighs. BFlh muscle and proximal aponeurosis cross-sectional areas, length, volume, and interface area between muscle and aponeurosis were extracted. Previously injured limbs were compared to uninjured contralateral and control limbs for discrete variables and ratios, and along the relative length of tissues using statistical parametric mapping. Previously injured limbs displayed significantly smaller muscle-to-aponeurosis volume ratios (p = 0.029, Wilcoxon effect size (ES) = 0.43) and larger proximal BFlh aponeurosis volumes (p = 0.019, ES = 0.46) than control limbs with no history of HSI. No significant differences were found between previously injured and uninjured contralateral limbs for any outcome measure (p = 0.216-1.000, ES = 0.01-0.36). Aponeurosis geometry differed between limbs with and without a history of HSI. The significantly larger BFlh proximal aponeuroses and smaller muscle-to-aponeurosis volume ratios in previously injured limbs could alter the strain experienced in muscle adjacent to the musculotendinous junction during active lengthening. Future research is required to determine if geometric differences influence the risk of re-injury and whether they can be altered via targeted training.

A retrospective comparison of the biceps femoris long head muscle structure in athletes with and without hamstring strain injury history.

Hamstring strain injuries (HSI) and re-injuries are endemic in high-speed running sports. The biceps femoris long head (BFlh) is the most frequently injured muscle among the hamstrings. Structural parameters of the hamstring muscle are stated to be susceptible to strain injuries at this location. This retrospective study targeted comparing the BFlh's structural parameters between previously injured and uninjured athletes. Nineteen male athletes with previous BFlh strain injury history and nineteen athletes without former lower extremity injury history were included in this study. Fascicle length, mid-muscle belly and distal musculotendinous (MTJ) passive stiffnesses of the biceps femoris long head (BFlh) were examined via b-mode panoramic ultrasound scanning and ultrasound-based shear-wave elastography. Parameter comparisons of both legs within and between athletes with and without injury history were performed. Comparison of the BFlh fascicle length between the injured leg of the injured group and the legs of the controls revealed a trend to shorter fascicle lengths in the injured leg (p = 0.067, d = -0.62). However, the mid-muscle belly passive stiffness of the BFlh was significantly higher in the injured legs (p = 0.009, d = 0.7) compared with the controls. Additionally, the distal MTJ stiffness was much higher in the previously injured legs compared with controls (p < 0.001, d = 1.6). Outcomes support the importance of BFlh properties related to stiffness, and fascicle length for injury susceptibility in athletes. Future prospective studies should determine whether the higher stiffness in the injured athletes is a cause or consequence of the HSI. Physical therapy and rehabilitation programmes after HSI should focus on BFlh muscle properties i.e., elasticity and fascicle length for reducing re-injury and increasing sports performance.

Changes in passive and active hamstrings shear modulus are not related after a warmup protocol

This study aimed to determine whether changes in hamstrings passive and active shear modulus after a warmup protocol are correlated. Twenty males without a history of hamstring strain injury participated. Muscle shear modulus was assessed using ultrasound-based shear wave elastography at rest and during isometric contractions at 20% of maximal voluntary isometric effort before and immediately after a warmup protocol. Changes in passive shear modulus did not seem to be associated with changes in active shear modulus. The results of this study suggest that changes in passive and active hamstring shear modulus are not associated after a standardized warmup intervention.

Is there a difference in biceps femoris long head muscle and aponeurosis geometry between males with and without a history of hamstring strain injury?

Is there a difference in biceps femoris long head muscle and aponeurosis geometry between males with and without a history of hamstring strain injury?

Hamstring activation deficits in different jumping directions in athletes with a history of hamstring strain injuries: a cross-sectional laboratory study

ABSTRACT This study aimed to investigate the hamstring onset time and recruitment level during jumping tasks in athletes with chronic hamstring strain injuries. Thirteen hamstring injured athletes and thirteen matched healthy athletes were recruited. Activation onset time and muscle recruitment (median frequency of the EMG) of the lateral hamstring (LH) and medial hamstring (MH) was measured during double leg jumps in vertical and horizontal directions on the force platforms. The peak vertical ground reaction force and loading rate were obtained for all jumps. The injured group showed a delayed onset time (p = 0.029) and a lower recruitment of the LH during the landing (p = 0.018) than the control group. Activation deficits in the injured group led to a higher landing force and loading rate. Additionally, the LH and MH were lesser recruited in the vertical direction than the horizontal directions in the landing. In conclusion, athletes with hamstring injuries show hamstring activation deficits of the injured leg during jumping leading to degrading jump-landing performance. Also, jumping in different directions play a role to modify the recruitment of the hamstrings in the injured athletes. Therefore, movement plane is suggested to be considered in clinical rehabilitation for the hamstring injury.

Effects of Repeated Sprints on Hamstring Active Shear Modulus Pattern and Neuromuscular Parameters in Football Players with and without Hamstring Strain Injury History—A Retrospective Study

The aim of the present study is to compare the effects of a (i) repeated sprint protocol on the sprint performance, hamstrings shear modulus pattern, and neuromuscular parameters between players with and without previous hamstring strain injury (HSI); and (ii) between limbs with HSI and their healthy contralateral limbs on the hamstrings shear modulus pattern and neuromuscular parameters. One-hundred-and-five professional and semiprofessional football field players were invited to participate in this study during the pre-season 2021/2022 (June–July), resulting in a sample size of 210 limbs with 46 sustaining HSI in the previous 2 years. No differences were seen between previously injured and healthy control players regarding their sprint performance, hamstrings shear modulus pattern, and neuromuscular parameters, except for the early rate of torque development (0–50 ms) with previously injured limbs in the biceps femoris long head (BFlh) displaying higher rates than their contralateral muscle (injured: 496.93 ± 234.22 Nm/s; contralateral 422.72 ± 208.29 Nm/s; p = 0.005; η2p = 0.469). Overall, the present study provides evidence for no differences regarding sprint performance, hamstrings load sharing pattern, and major neuromuscular parameters between players with previous HSI in the last 2 years and healthy control players. Therefore, the results can possibly suggest that the duration between injury and screening could recover the differences between injured-control and injured-contralateral groups.

Hamstring muscle fibre typology is not associated with hamstring strain injury history or performance in amateur male soccer players: a retrospective magnetic resonance spectroscopy study.

Hamstring strain injuries (HSI) are still the most common injuries in soccer. Recent research has been focusing on the role of hamstring muscle morphology and architecture. The hamstring's fibre type composition might play a role as well, but this has never been investigated in the light of HSI risk in an athletic population. The purpose of this study was to investigate the association between hamstring muscle fibre type, hamstring strain injury history (HSIH), performance and isokinetic strength in a population of amateur male soccer players. In this cross-sectional observational study, 44 male soccer players (22 with and 22 without HSIH) participated. The research consisted of a non-invasive fibre composition evaluation using proton magnetic resonance spectroscopy (1H-MRS), functional performance (evaluated by means of maximal jumping height, maximal sprinting speed and hamstring muscle strength endurance (single leg hamstring bridge testing)), and isokinetic strength testing. The results revealed that hamstring carnosine concentration demonstrated a high inter-individual variability within this soccer population and was not significantly associated with either HSIH or with any of the functional performance parameters. The only secondary outcome measure presenting a significant association with the intramuscular carnosine content was the hamstrings' explosive strength production capacity, objectified by means of the time to peak torque (TPT), measured concentrically at an angular velocity of 240 degrees/second (°/s) during isokinetic strength testing. This TPT was significantly shorter in players presenting higher carnosine concentrations (p = 0.044). The findings indicate that in male amateur soccer players (1) the hamstrings have no distinct fibre type dominance and (2) fibre typology in this population does not relate to HSIH or performance.

Knee Flexor Eccentric Strength, Hamstring Muscle Volume and Sprinting in Elite Professional Soccer Players with a Prior Strained Hamstring.

Simple SummaryGiven the link between a prior hamstring injury and the increased risk of suffering a subsequent injury in professional soccer, an understanding of the features displayed by previously injured players is important. The aim of the present study was to investigate if players with a history of hamstring injury exhibit bilateral deficits in knee flexor eccentric strength, hamstring muscle volume, and sprinting performance. The eccentric knee flexor strength was greater in the previously injured limbs compared to both the contralateral uninjured limbs in the previously injured group and the uninjured limbs in the previously uninjured players. Previously injured limbs showed possibly larger short heads of the biceps femoris and likely semitendinosus muscle volumes. Sprinting performances in the 5-m were possibly worse in players with a history of hamstring muscle strain injury compared to the previously uninjured players.The aim was to determine if players with a prior hamstring strain injury (HSI) exhibit bilateral deficits in knee flexor eccentric strength and hamstring muscle volume and differences in sprinting performance compared with players without a history of HSIs. Forty-six male professional soccer players participated in this study. Eccentric knee flexor strength, hamstring muscle volume (MRI), and a 20-m running sprint test (5- and 10-m split time) were assessed at the start of the preseason. Eccentric knee strength of the previously injured limbs of injured players was greater (ES: 1.18–1.36) than the uninjured limbs in uninjured players. Previously injured limbs showed possibly larger biceps femoris short heads (BFSh) and likely semitendinosus (ST) muscle volumes than the contralateral uninjured limbs among the injured players (ES: 0.36) and the limbs of the uninjured players (ES: 0.56), respectively. Players who had experienced a previous HSI were possibly slower in the 5-m (small ES: 0.46), while unclear differences were found in both the 10-m and 20-m times. Players with a prior HSI displayed greater eccentric knee flexor strength, possibly relatively hypertrophied ST and BFSh muscles, and possibly reduced 5-m sprinting performances than previously uninjured players. This can have implication for the design of secondary hamstring muscle injury prevention strategies.

The deficits of isometric knee flexor strength in lengthened hamstring position after hamstring strain injury

ObjectiveTo investigate the effects of knee flexion angle on peak torque, rate of torque development (RTD) during isometric contraction and hamstring flexibility after hamstring strain injury (HSI). DesignCross-sectional. SettingControlled laboratory research. ParticipantsFourteen male athletes with a history of HSI and 14 athletes without HSI (controls). Main outcome measuresHamstring flexibility was evaluated using active knee extension test. Isometric knee flexion peak torque and RTD were determined at 30°, 60°, and 90° of knee flexion measured by an isokinetic dynamometer. ResultsIndividuals with a history of HSI had statistically significant, moderate deficits in isometric peak torque at 30° of knee flexion (P = 0.037; effect size = 0.55) in the HSI limb than in the uninjured limb, but not at 60° and 90° of knee flexion. In the control group, no significant differences in isometric peak torque at any angle were found between limbs. No differences in peak RTD and flexibility were found between limbs in both groups. ConclusionsIsometric peak torque at 30° of knee flexion was lower in the injured limb than in the uninjured limb. Isometric strength deficits after HSI tended to be affected by lengthened hamstring angles.

The Effect of Ankle Position on Peak Eccentric Force during The Nordic Hamstring Exercise.

Peak eccentric force during the Nordic hamstring exercise (NHE) is recognized as a predictive factor for hamstring strain injury (HSI). During the NHE, the knee flexor muscles are eccentrically contracting to resist the knee joint extension. Therefore, it is thought that the action of the gastrocnemius muscle, and thus the ankle position, influences peak eccentric force during the NHE. However, the effect of ankle position on peak eccentric force during the NHE remains unclear. Therefore, we investigated the effect of ankle position on peak eccentric force during the NHE in a cohort of 50 healthy young male rugby players (mean age, 18.7 ± 1.2 years; mean body mass, 81.7 ± 15.2 kg; height, 1.72 ± 0.06 m) with no history of HSI. Each participant performed NHE strength testing with the ankle dorsiflexed or plantarflexed position and was instructed to fall forward as far as possible within 3 s. Peak eccentric force, reported relative to body mass (N/kg), of both legs was recorded, and the mean values of both legs were compared in both ankle positions. The mean peak eccentric force was significantly greater with the ankle plantarflexed position than the dorsiflexed position (3.8 ± 1.1 vs. 3.5 ± 1.1 N/kg, respectively, p = 0.049). These results indicate that ankle position should be carefully considered when measuring peak eccentric force during the NHE and performing NHE training.

Lower knee flexion and hip extension rate of torque development in athletes with previous hamstring strain injury

ABSTRACT Persistent deficits in strength and voluntary activation have been observed in athletes with a history of hamstring strain injury. The mechanisms contributing to these deficits are poorly understood and consequently may not be appropriately addressed during rehabilitation. This study aimed to investigate the impact of intended knee flexor contraction mode (concentric, eccentric or isometric) on the rate of torque development and surface electromyography (sEMG) rise in athletes with and without a history of unilateral hamstring strain injury. The impact of the previous injury on hip extensor rate of torque development was also investigated. Previously injured limbs exhibited a slower rate of torque development (mean difference = −31%, p = 0.02, Cohen’s d = 0.62) and biceps femoris rate of sEMG rise (mean difference = −181% · s−1, p = 0.003, Cohen’s d = 1.10) during intended eccentric knee flexor contractions compared with control limbs. Previously injured (mean difference = −29%, p = 0.01, Cohen’s d = 0.85) and contralateral uninjured limbs (mean difference = −31%, p = 0.007, Cohen’s d = 0.73) exhibited a slower rate of torque development during isometric hip extensor contractions compared with control limbs. These findings may highlight lower levels of descending input to hamstring motoneurons in previously injured athletes.

Neuromuscular responses of the hamstring and lumbopelvic muscles during unanticipated trunk perturbations

ABSTRACT Hamstring strain often occurs when an opponent unanticipatedly perturbs an athlete’s movements. We examined the neuromuscular responses of hamstring and trunk muscles during unanticipated trunk perturbations in athletes with and without a history of hamstring strain injury. Male college athletes (11 with a history of a unilateral hamstring injury and 10 without prior injury) knelt while wearing a chest harness attached to a cable that was pulled backward. They were instructed to resist the force isometrically and maintain their position when the perturbations were applied. The pressure was released with or without a cue (CUE or NoCUE). We measured trunk acceleration, three-dimensional kinematic data, and surface electromyography (EMG) signals of the erector spinae, internal oblique, gluteus maximus, biceps femoris long head, and semitendinosus muscles. Maximum trunk acceleration and displacement were greater with NoCUE in both groups (p < 0.05). EMG amplitude did not differ after perturbation of any investigated muscle. The injured group demonstrated a delayed onset of the gluteus maximus and erector spinae muscles in NoCUE versus CUE stimuli (p < 0.05). Athletes with a history of hamstring strain injury exhibited a reduced neuromuscular coordination of the lumbopelvic muscles in response to unanticipated trunk movement.

Previous hamstring muscle strain injury alters passive tissue stiffness and vibration sense

BackgroundHamstring strain is one of the most common among sports injuries. A previous history of this injury is considered a strong predictor of recurrent hamstring strain injury. It has been suggested that fascial tissue alters after muscle strain injury. However, the association between previous hamstring strain injury and tissue stiffness and vibration sense detection has not been investigated. ObjectivesWe aimed to determine whether a previous history of hamstring strain injury affects tissue stiffness and vibration sense in professional soccer players. MethodThe stiffness (MyotonPRO®) and vibration disappearance threshold (tuning fork) were measured in eight professional soccer players with previous history of hamstring strain and eight uninjured players. The differences between two groups’ means were analyzed. Side-to-side differences between injured and uninjured legs were also analyzed. Results: The tissue stiffness was higher, and the vibration disappearance threshold was lower, in previously injured players when compared to uninjured players. Similar differences were found between injured and uninjured legs. No significant relationship was detected between the age or body mass index (BMI) for both tissue stiffness and vibration disappearance threshold (all P < 0.05). ConclusionsSoccer players with a previous history of hamstring strain injury exhibited higher tissue stiffness and lower vibration sensitivity in the injured leg, regardless of the age and BMI. The results that players who have a previous hamstring strain injury with altered tissue stiffness and vibration sense will be useful and feasible evaluation for chronic muscle strain condition.

Hamstring strains in professional rugby players result in increased fascial stiffness without muscle quality changes as assessed using shear wave elastography

IntroductionHamstring strain injury is common among sports injuries. A previous history of this injury is considered a strong predictor of recurrent hamstring strain injury. Fascial tissue reportedly becomes stiffer after hamstring strain injury. However, the association between fascial stiffness and previous hamstring strain injury has not been investigated in clinical studies. We aimed to determine whether a previous history of hamstring strain injury affects fascial tissue and muscle tissues using shear wave elastography. MethodIn eleven male professional rugby players, the stiffness as a shear modulus (kPa) of fascial tissue and muscle was measured on the specific injured area measured by magnetic resonance imaging (MRI) at resting position by using shear wave elastography. The side-to-side differences between the injured and the uninjured side were analyzed. The length and area of the muscle scar tissue were evaluated by MRI in relation to fascial stiffness. ResultsThe shear elastic modulus of fascia was stiffer in the injured vs. the uninjured side; however, no difference was observed in the muscle. No significant relationship was detected between the length and area of the muscle scar tissue (all P > 0.05). DiscussionRugby players with a previous history of hamstring strain injury exhibited passive stiffness of fascial tissues in the injured leg, regardless of the length or area of the muscle scar tissue. However, the passive stiffness of muscles was same between the injured and the uninjured leg. ConclusionThe results can be beneficial to consider future risk for hamstring strain injuries.

Value of isokinetic strength testing for hamstring injury risk assessment: Should the ‘strongest’ mates stay ashore?

Although isokinetic strength testing is commonly used in hamstring strain injury (HSI) rehabilitation and prevention, research findings concerning its predictive value remain inconclusive. Existing research focuses on peak torque (PT) and angle of PT, not analysing the torque behaviour throughout the testing range of motion (ROM). This study intended to assess the value of isokinetic curve evaluation in association with HSI. A sample of 116 male football players with and without a recent HSI history was submitted to bilateral isokinetic assessment of the knee and hip muscles. Raw isokinetic data were filtered and normalized prior to curve analysis submission in MATLAB. Torque development of each muscle group throughout the entire testing ROM was assessed using HSI history as an independent variable. Curve analysis revealed significant differences in torque behaviour in function of injury history. Players with an HSI history demonstrated significantly stronger concentric knee flexion and extension, eccentric knee extension and concentric hip extension patterns compared to the controls and their uninjured limb. HSI history was also associated with lower concentric hip flexion torques and lower mixed H:Q ratios compared to the control group and their contralateral limb. HSI history was associated with altered knee and hip muscle strength profiles, potentially due to isolated focus on local strength training in rehabilitation or mechanisms of neuromuscular inhibition. Because the differences in torque amplitude were range-dependent and did not systematically concur with the point of PT achievement, isokinetic strength evaluation should most probably be conducted using curve analysis.

Flexibility, strength, and fascicle length of football players with and without history of hamstring strain injury in the prior season

ABSTRACT This study aimed to verify the hamstring flexibility, strength, and fascicle length of football (soccer) players with and without history of hamstring strain injury (HSI) in the prior season. Eighty male football players (45 from senior category and 35 from under-20 category) were included in this case–control trial: 20 with history of unilateral HSI in the prior season, and 60 free of HSI in the prior season. Passive straight-leg raise (PSLR) test, isokinetic dynamometry, and biceps femoris long head (BFLH) ultrasonography were performed at preseason to identify risk factors for HSI. No significant differences were found between injured and uninjured limbs of the previously injured players for any outcome (p > 0.05; trivial effect sizes). Uninjured players had higher values than both injured and uninjured limbs of previously injured players for hamstring-to-quadriceps (H/Q) conventional and functional ratios (p < 0.05; medium effect sizes), as well as BFLH fascicle length (p < 0.05; small to medium effect sizes). Football players that had sustained unilateral HSI in the prior season demonstrated lower H/Q strength ratios and shorter BFLH fascicles in both limbs compared to uninjured players.

Eccentric knee flexor strength of professional football players with and without hamstring injury in the prior season

Both injury history and eccentric knee flexor strength have been associated with risk of football players sustaining hamstring strain injury (HSI). However, it remains unclear whether football players who sustained HSIs in the prior season present persistent eccentric strength deficits. Therefore, the aim of the present study was to verify the eccentric knee flexor strength of professional male football players with and without history of HSI in the prior season. This case–control study assessed 210 professional male football players from 10 Brazilian clubs: 182 included in the control group and 28 in the previously injured group. Players from the injured group had suffered unilateral HSI in the prior season. We measured the knee flexors peak force during the Nordic hamstring exercise and calculated the between-limb asymmetry. Groups were similar for age, body mass and height (p > 0.05). Control group had similar strength values between left and right limbs (376.29 ± 61.77 N vs. 380.28 ± 61.77 N; p = 0.27; d = 0.06), while the previously injured limb was weaker than the contralateral uninjured limb in the injured group (350.87 ± 60.79 N vs. 385.75 ± 63.49 N; p < 0.01; d = 0.56). Thirty-seven percent of players in the control group and 50% in the injured group presented between-limb asymmetry >10%. This study demonstrates that players with history of HSI in the prior season present reduced eccentric knee flexor strength in the injured limb, but half of them have between-limb asymmetry within the most commonly adopted benchmark value of 10%.

Ultrasound-derived Biceps Femoris Long Head Fascicle Length: Extrapolation Pitfalls.

This study aimed to compare biceps femoris long head (BFlh) fascicle length (Lf) obtained with different ultrasound-based approaches: 1) single ultrasound images and linear Lf extrapolation, 2) single ultrasound images and one of two different trigonometric equations (termed equations A and B), and 3) extended field of view (EFOV) ultrasound images. Thirty-seven elite alpine skiers (21.7 ± 2.8 yr) without a previous history of hamstring strain injury were tested. Single ultrasound images were collected with a 5-cm linear transducer from BFlh at 50% femur length and were compared with whole muscle scans acquired by EFOV ultrasound. The intrasession reliability (intraclass correlation coefficient [ICC3,k]) of Lf measurements was very high for both single ultrasound images (i.e., Lf estimated by linear extrapolation; ICC3,k = 0.96-0.99, SEM = 0.18 cm) and EFOV scans (ICC3,k = 0.91-0.98, SEM = 0.19 cm). Although extrapolation methods showed cases of Lf overestimation and underestimation when compared with EFOV scans, mean Lf measured from EFOV scans (8.07 ± 1.36 cm) was significantly shorter than Lf estimated by trigonometric equations A (9.98 ± 2.12 cm, P < 0.01) and B (8.57 ± 1.59 cm, P = 0.03), but not significantly different from Lf estimated with manual linear extrapolation (8.40 ± 1.68 cm, P = 0.13). Bland-Altman analyses revealed mean differences in Lf obtained from EFOV scans and those estimated from equation A, equation B, and manual linear extrapolation of 1.91 ± 2.1, 0.50 ± 1.0, and 0.33 ± 1.0 cm, respectively. The typical extrapolation methods used for estimating Lf from single ultrasound images are reliable within the same session, but not accurate for estimating BFlh Lf at rest with a 5-cm field of view. We recommend that EFOV scans are implemented to accurately determine intervention-related Lf changes in BFlh.

Neuromuscular changes in football players with previous hamstring injury

BackgroundImpact of prior injury on myoelectrical activity of the hamstrings during isokinetic eccentric contractions has received increased literature attention. This cross-sectional study aimed to assess neuromuscular adaptations, namely proprioception, core stability, muscle strength, extensibility and activity, in football players with history of hamstring strain injury. MethodsSeventeen players, 10 with history of hamstring injury and 7 without prior injury underwent isokinetic strength testing, eccentric knee extension at 30 and 120°/s. Myoelectrical activity of bicep femoris and medial hamstrings was calculated at 30, 50 and 100 ms after onset of contraction. Functional tests included core stability, muscle strength, and knee proprioception tests. FindingDifferences were observed between Hamstring Group injured and uninjured and Control Group dominant limbs in the bicep femoris activity at almost all times in both velocities (p < 0.05). Joint position sense error was higher in the injured side compared to uninjured and control dominant limb; additionally there were also differences between injured and uninjured limb in the triple-hop test. InterpretationPreviously injured side showed deficits in bicep femoris myoelectrical activity after onset of contraction during eccentric testing, proprioceptive deficits, and functional asymmetry.

Prevalence of Hamstring Strain Injury Risk Factors in Professional and Under-20 Male Football (Soccer) Players.

Hamstring strain injury (HSI) is the most prevalent injury in football (soccer), and a few intrinsic factors have been associated with higher injury rates. To describe the prevalence of the main intrinsic risk factors for HSI in professional and under-20 football players. Cross-sectional study. Physiotherapy laboratory, Federal University of Health Sciences of Porto Alegre (Brazil). A total of 101 football players (52 professional and 49 under-20 players). An evidence-based testing protocol for screening HSI risk factors. Anamnesis, ultrasonography of the hamstrings, passive straight-leg raise test, Functional Movement Screen, and isokinetic dynamometry were performed. Eleven HSI risk factors for each leg were assessed, besides the player's age as a systemic risk factor. Reports were delivered to the coaching staff. Professionals had greater prevalence of HSI history compared with under-20 players (40% vs 18%). No between-group differences were found for the other screening tests. Altogether, 30% of players had already sustained at least one HSI; 58% had a history of injuries in adjacent regions; 49% had short biceps femoris fascicles; 66% and 21% had poor passive and active flexibility, respectively; 42% and 29% had deficits in functional movements and core stability, respectively; 7% and 26% presented bilateral imbalance for hamstring concentric and eccentric strength, respectively; 87% and 94% obtained low values for hamstring-to-quadriceps conventional and functional ratios, respectively. Two-thirds of players had 3 to 5 risk factors per leg. None of the players was fully free of HSI risk factors. Most football players present multiple risk factors for sustaining an HSI. Hamstring weakness is the most prevalent risk factor, but the teams should also be aware of deficits in flexibility, core stability, functional movements, and hamstring fascicle length.