Risk 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.

Effects of Static Hamstring Stretching on Maximal Sprint Speed and Relationship With Nordic Hamstring Strength.

This study aimed to determine the acute effects of static stretching of the hamstrings on maximal sprint speed and its spatiotemporal variables and lower-limb kinematics during the late swing phase, as well as the relationship with Nordic hamstring strength. The study had a within-participant experimental design. Sixteen healthy male college sprinters were asked to sprint 80m without static stretching and with static stretching of the hamstrings for 4 × 30s per leg before the sprint; both conditions were counterbalanced. The knee flexion peak torque was measured using the Nordic hamstring. The differences between no static stretching and static stretching as well as their relationship with Nordic hamstring strength were investigated. The results showed that the touchdown distance (p = .036) significantly increased following static stretching. Although not significant, maximal sprint speed decreased (p = .086), and the theoretical hamstring length (difference between knee angle and hip angle) at ipsilateral touchdown was greater (p = .069) following static stretching. In addition, a lower peak torque of the Nordic hamstring resulted in a more significant decrease in maximal sprint speed following static stretching. Therefore, static stretching of the hamstring just before sprinting may increase the theoretical hamstring length during the late swing phase at maximal sprint speed and induce kinematics that increases the hamstring strain injury risk. Moreover, it is suggested that improving the Nordic hamstring strength may help minimize the negative effects of static stretching on the hamstrings.

Effects of Nordic versus Sprint Exercise Program in Prevention of Hamstring Injuries in Football Players

Background: Hamstring strain injuries (HSI) are frequent in football and other high-speed running sports. Nordic hamstring exercise (NHE) has been found to increase eccentric hamstring strength and decrease the risk of hamstring strain injury (HSI). Sprint exercise, which includes maximal eccentric contractions, is supposed to engage the hamstrings and prevent HSI. Objective: The aim of this randomized controlled trial was to compare the effectiveness of Nordic and sprint exercise programs in preventing hamstring injuries in football players. Methods: The study involved 26 male football players aged 18-25 years, who exercised regularly for 2-3 times a week in the preceding 3 months. They were randomly divided into two groups. One group received Nordic exercise and conventional treatment, while the other group received sprint training exercises and conventional treatment. The duration of the program was 6 weeks, with two 30-minute sessions per week. The evaluation was based on the 40m sprint test and active knee extension test, which were measured using a goniometer. The 40m sprint was timed, and the active knee extension test measured the range of motion. The results were analyzed based on these measurements. Results: The participants' average ages, heights, and weights were respectively 21.1538 1.91191, 1.74 0.029, and 74.8462 4.18275. Shapiro-Wilk test was applied showed data to be non-parametric distributed (P < 0.05). Wilcoxon and Mann Whitney tests were used to analyze the difference between pre- and post-treatment scores in the experimental and control groups. which were found to significanlty improved in experimental group, while both groups found to be improved significantly in a pre-post analysis, p value < 0.05. Conclusion: Both Nordic and sprint exercise programs were effective in reducing the risk of hamstring injuries. However, the Nordic exercise program showed significantly greater improvement in preventing HSI in football players.

Relationship Between Nordic Hamstring Strength and Single Leg Bridge Test in University Soccer Players.

Nordic hamstring strength (NH strength) and single leg bridge test (SLBT) scores are used to predict the risk of hamstring strain injury. Although NH strength and SLBT scores may be related, the relationship between NH strength and SLBT score remains unknown. This study investigated the relationship between NH strength and SLBT scores in university soccer players. Cross-sectional study. Research laboratory. 38 male university soccer players. NH strength and SLBT scores. A participant was instructed to lean forward gradually at the slowest possible speed from a kneeling posture with the knee joint flexed 90° for the NH strength measurement. Participants in the SLBT crossed their arms over their chests, pushed down from their heels, and lifted their hips off the ground as many times as they could until they failed. We investigated the relationship between NH strength and SLBT scores in the left and right sides using Spearman rank correlation coefficient. Additionally, we calculated the percentage of left-right asymmetry in NH strength and SLBT scores and investigated the relationship between these variables using Pearson correlation coefficient. There were no significant correlations between NH strength and SLBT scores in the right (rs = .239, P = .16) and left (rs = .311, P = .065) legs. Furthermore, there was no significant relationship between NH strength and SLBT between-limb asymmetry (r = .073, P = .671). NH strength and SLBT scores could be different indexes, indicating either maximal muscle strength or muscle endurance. Thus, the findings suggested that when assessing risk factors for hamstring strain injury, both NH strength and SLBT scores should be measured.

Relationships Between Modifiable Risk Factors of Hamstring Strain Injury.

Ripley, NJ, Comfort, P, and McMahon, JJ. Relationships between modifiable risk factors of hamstring strain injury. J Strength Cond Res 38(3): 510-516, 2024-The aims of this study were to determine whether any relationship exists between eccentric hamstring strength and isokinetic strength imbalances and bicep femoris long head (BF LH ) architecture. Eighteen physically active men (age 24.7 ± 4.3 years, height 181.9 ± 7.2 cm, mass 84.9 ± 12.9 kg) had resting BF LH muscle architecture assessed using ultrasound, with images taken at the midmuscle belly. Measures of isokinetic strength of the knee extensors and flexors involved subjects performing 3 maximal effort repetitions of concentric knee extension and eccentric knee flexion at 60°·s -1 . Good-excellent relative reliability (intraclass correlation coefficient ≥0.86) and low variability (coefficient of variation <10%) were observed for all variables. Relative BF LH fascicle length (FL) demonstrated significant moderate-to-nearly-perfect associations with isokinetic measures identified as hamstring strain injury risk factors ( p < 0.05, r = 0.38-0.92), whereas absolute BF LH FL was not significantly or meaningfully associated with isokinetic measures ( p = 0.07-0.961, r = 0.01-0.30). Relative BF LH FL should be considered when assessing resting BF LH muscle architecture because it is potentially a more appropriate measure of injury risk because of its greater association with strength measures. However, absolute BF LH FL may have a greater usefulness during growth, maturation, and individual proportions.

Hamstring Strain Injury Risk Factors in Australian Football Change over the Course of the Season.

This study aimed to determine which factors were most predictive of hamstring strain injury (HSI) during different stages of the competition in professional Australian Football. Across two competitive seasons, eccentric knee flexor strength and biceps femoris long head architecture of 311 Australian Football players (455 player seasons) were assessed at the start and end of preseason and in the middle of the competitive season. Details of any prospective HSI were collated by medical staff of participating teams. Multiple logistic regression models were built to identify important risk factors for HSI at the different time points across the season. There were 16, 33, and 21 new HSIs reported in preseason, early in-season, and late in-season, respectively, across two competitive seasons. Multivariate logistic regression and recursive feature selection revealed that risk factors were different for preseason, early in-season, and late in-season HSIs. A combination of previous HSI, age, height, and muscle thickness were most associated with preseason injuries (median area under the curve [AUC], 0.83). Pennation angle and fascicle length had the strongest association with early in-season injuries (median AUC, 0.86). None of the input variables were associated with late in-season injuries (median AUC, 0.46). The identification of early in-season HSI and late in-season HSI was not improved by the magnitude of change of data across preseason (median AUC, 0.67). Risk factors associated with prospective HSI were different across the season in Australian Rules Football, with nonmodifiable factors (previous HSI, age, and height) mostly associated with preseason injuries. Early in-season HSI were associated with modifiable factors, notably biceps femoris long head architectural measures. The prediction of in-season HSI was not improved by assessing the magnitude of change in data across preseason.

Hamstring strain injury prevention: current beliefs and practices of practitioners working in Major League Baseball.

Hamstring strain injuries (HSIs) are the most frequently sustained injury in Major League Baseball (MLB). However, the beliefs and practices of MLB practitioners regarding HSI risk factors and prevention strategies in baseball athletes, have not been documented. To document the current beliefs and practices of MLB practitioners in relation to HSI prevention. cross-sectional study. Major League Baseball via an online survey. Athletic trainers, physical therapists and strength and conditioning coaches employed in MLB during the 2021 season. An online survey was conducted with participants completing the survey once. Questions pertained to risk factor identification, the use and perceived effectiveness of preventative strategies, and barriers to implementation. Descriptive statistics were calculated for each question. 91 responses were received featuring respondents from 28 of 30 MLB organizations. The perceived most important intrinsic risk factor for first-time HSI was tolerance to high-speed running and previous HSI for recurrent injury. The perceived most important extrinsic risk factor for both first-time and recurrent HSI was internal communication between staff.The perceived most effective prevention strategies were managing overall workload, exposure to high-speed running, and periodization. The most used prevention strategies were core/lumbopelvic strengthening, resistance training and workload management.Approximately half (53%) of respondents reported barriers to effective implementation of HSI prevention strategies, including player and coach buy-in, compliance, training time constraints, and in-season scheduling/reduced recovery time. This was the first survey to investigate MLB practitioner beliefs and practices regarding HSI prevention. Responses from practitioners regarding their beliefs about risk factors and appropriate prevention strategies were varied, and discrepancies existed between the perceived most effective strategies and those most frequently employed.

The effects of hip- vs. knee-dominant hamstring exercise on biceps femoris morphology, strength, and sprint performance: a randomized intervention trial protocol

BackgroundThe hamstrings are an important muscle group that contribute to horizontal force during sprint acceleration and are also the most injured muscle group in running-based sports. Given the significant time loss associated with hamstrings injury and impaired sprinting performance following return to sport, identifying exercises that drive adaptations that are both protective of strain injury and beneficial to sprint performance is important for the strength and conditioning professional. This paper describes the study protocol investigating the effects of a 6-week training program using either the hip-dominant Romanian deadlift (RDL) or the knee-dominant Nordic hamstring exercise (NHE) on hamstring strain injury risk factors and sprint performance.MethodsA permuted block randomized (1:1 allocation) intervention trial will be conducted involving young, physically-active men and women. A target sample size of 32 will be recruited and enrolled participants will undergo baseline testing involving extended-field-of-view ultrasound imaging and shear wave elastography of the biceps femoris long head muscle, maximal hamstrings strength testing in both the RDL and NHE, and on-field sprint performance and biomechanics. Participants will complete the 6-week training intervention using either the RDL or NHE, according to group allocation. Baseline testing will be repeated at the end of the 6-week intervention followed by 2 weeks of detraining and a final testing session. The primary outcome will be regional changes in fascicle length with secondary outcomes including pennation angle, muscle cross sectional area, hamstring strength, and maximal sprint performance and biomechanics. An exploratory aim will determine changes in shear wave velocity.DiscussionDespite extensive research showing the benefits of the NHE on reducing hamstring strain injury risk, alternative exercises, such as the RDL, may offer similar or potentially even greater benefits. The findings of this study will aim to inform future researchers and practitioners investigating alternatives to the NHE, such as the RDL, in terms of their effectiveness in reducing rates of hamstring strain injury in larger scale prospective intervention studies.Trial RegistrationThe trial is prospectively registered on ClinicalTrials.gov (NCT05455346; July 15, 2022).

Effects of sprint versus strength training on risk factors for hamstring injury in football players.

This study aimed to compare the effects of in-season sprint training vs. Nordic hamstring exercise (NHE) training on risk factors for hamstring strain injuries (HSI). Eighteen male university football players (20.9±2.5 years; 181±7 cm; 75.8±9.1 kg; 15.2±3.5% of body fat) were randomly allocated to a sprint group or NHE group. They completed baseline isokinetic strength and sprint mechanics assessments prior to their assigned intervention performed twice weekly for 4-weeks, before post-testing. A mixed design ANOVA with repeated measures assessed time, group and interaction effects for all risk factors. There were significant increases in hamstring eccentric peak torque at 60°·s-1 (+8% - 9.9%), the torque produced at 20° (+15%) and 10° (+21% - 31%), as well as a rightward shift in angle of peak torque towards knee extension (-27% - -36%) in both groups (P<0.05). We also observed a significant increase (+24.5%) in hamstring eccentric peak torque at 180°·s-1 in the strength group only and significant improvements (+29.4%) in the rate of torque development of the dominant leg at 60°·s-1 in the sprint group only (P<0.05). No significant effect was noted on sprint performance or sprint mechanics (P>0.05). These findings suggest that both training programs can be effective to mitigate the risk of HSI, but through different mechanisms.

Impact of an isometric or eccentric hip extension exercise intervention on hamstring strength, architecture, and morphology: a randomised intervention trial

Introduction: Hamstring strain injury (HSI) is the leading cause of time lost from competition in running-based sports. Following return to sport, individuals with previous HSI often have persistent deficits in hamstring muscle strength, architecture and morphology. Considerable research effort has gone into identifying ways to address these variables, as they have been associated with future HSI risk. Eccentric knee flexion exercises have been shown to modify these variables, although implementation of these interventions in injury prevention programs is not widespread.

The Effects of Training Interventions on Modifiable Hamstring Strain Injury Risk Factors in Healthy Soccer Players: A Systematic Review

ABSTRACT Despite promising research on various soccer-specific injury prevention programs, hamstring strain injuries (HSIs) persist in being a major problem in the sport. Therefore, in an attempt to expand the current knowledge on the prevention of HSIs, this systematic review aimed to identify how modifiable risk factors for HSIs (hamstring strength, hamstring:quadriceps [H:Q] strength ratios, biceps femoris long head fascicle length, and hamstring angle of peak torque) were altered following various training interventions. The protocol was preregistered on PROSPERO (CRD42020177363). The literature search was conducted on PubMed, SportDISCUS, and Web of Science. Following the search process, 20 studies were included in the systematic review, and the methodological quality of these studies was reported. Interventions were categorized based on exercise characteristics (movement velocity and contraction type), and the effects of each intervention subgroup were analyzed separately for all proposed risk factors for HSIs. Our findings show that a broad variety of exercise types (i.e., high- and low-velocity movements, eccentric only and traditional exercises) improves all risk factors for HSIs compared with fewer exercise types. Therefore, these findings suggest that hamstring injury risk factors can best be modified using a wide variety of exercises compared with, for example, only 1 or 2 specific exercises.

The development of a HAMstring InjuRy (HAMIR) index to mitigate injury risk through innovative imaging, biomechanics, and data analytics: protocol for an observational cohort study

BackgroundThe etiology of hamstring strain injury (HSI) in American football is multi-factorial and understanding these risk factors is paramount to developing predictive models and guiding prevention and rehabilitation strategies. Many player-games are lost due to the lack of a clear understanding of risk factors and the absence of effective methods to minimize re-injury. This paper describes the protocol that will be followed to develop the HAMstring InjuRy (HAMIR) index risk prediction models for HSI and re-injury based on morphological, architectural, biomechanical and clinical factors in National Collegiate Athletic Association Division I collegiate football players.MethodsA 3-year, prospective study will be conducted involving collegiate football student-athletes at four institutions. Enrolled participants will complete preseason assessments of eccentric hamstring strength, on-field sprinting biomechanics and muscle–tendon volumes using magnetic-resonance imaging (MRI). Athletic trainers will monitor injuries and exposure for the duration of the study. Participants who sustain an HSI will undergo a clinical assessment at the time of injury along with MRI examinations. Following completion of structured rehabilitation and return to unrestricted sport participation, clinical assessments, MRI examinations and sprinting biomechanics will be repeated. Injury recurrence will be monitored through a 6-month follow-up period. HAMIR index prediction models for index HSI injury and re-injury will be constructed.DiscussionThe most appropriate strategies for reducing risk of HSI are likely multi-factorial and depend on risk factors unique to each athlete. This study will be the largest-of-its-kind (1200 player-years) to gather detailed information on index and recurrent HSI, and will be the first study to simultaneously investigate the effect of morphological, biomechanical and clinical variables on risk of HSI in collegiate football athletes. The quantitative HAMIR index will be formulated to identify an athlete’s propensity for HSI, and more importantly, identify targets for injury mitigation, thereby reducing the global burden of HSI in high-level American football players.Trial Registration The trial is prospectively registered on ClinicalTrials.gov (NCT05343052; April 22, 2022).

Preseason Eccentric Strength Is Not Associated with Hamstring Strain Injury: A Prospective Study in Collegiate Athletes.

Established risk factors for hamstring strain injuries (HSI) include older age and prior HSI. However, these are nonmodifiable and have a limited role in injury prevention. Eccentric hamstring strength is a common component of HSI prevention programs, but its association with injury is less clear. This study aimed to determine if eccentric hamstring strength was prospectively associated with HSI among collegiate athletes, while controlling for sex, age, and prior HSI. We hypothesized that athletes with lower eccentric hamstring strength or greater between-limb strength asymmetry at preseason would have an increased risk of HSI. Hamstring eccentric strength measures, maximum total force ( FTotal ) and between-limb asymmetry in maximum force ( FAsym ), were measured at preseason on male and female athletes. HSIs were tracked over the subsequent 12 months. Generalized estimating equations were used to identify univariable and multivariable associations between athlete demographics, eccentric hamstring strength, and HSI risk. Data for 326 athletes (85 female; 30 track, 43 basketball, 160 American football, 93 soccer) were included, and 64 HSIs were observed. Univariable associations between eccentric hamstring strength and subsequent HSI were nonsignificant ( FTotal : odds ratio [OR], 0.99 (95% confidence interval (CI), 0.93-1.05); P = 0.74; FAsym : OR, 1.35 (95% CI, 0.87-2.09); P = 0.23). No relationship between eccentric hamstring strength and HSI ( FAsym : OR, 1.32 (95% CI, 0.84-2.08); P = 0.23) was identified after adjusting for confounders including sex, age, and prior HSI. No association between preseason eccentric hamstring strength and risk of subsequent HSI was identified after controlling for known risk factors and sex among collegiate athletes. Eccentric hamstring strengthening may continue to serve as a preventative approach to HSI, but it does not provide additional insight into HSI risk beyond factors such as age and prior HSI.

The Efficacy of Flywheel Inertia Training to Enhance Hamstring Strength.

The purpose of this narrative review is to examine the efficacy of flywheel inertia training to increase hamstring strength. Hamstring strain injury is common in many sports, and baseline strength deficits have been associated with a higher risk of hamstring strain injury. As a result, strength and conditioning professionals actively seek additional techniques to improve hamstring strength with the aim of minimising the incidence of hamstring strain injury. One method of strength training gaining popularity in hamstring strength development is flywheel inertia training. In this review, we provide a brief overview of flywheel inertia training and its supposed adaptions. Next, we discuss important determinants of flywheel inertia training such as familiarisation, volume prescription, inertia load, technique and specific exercise used. Thereafter, we investigate its effects on hamstring strength, fascicle length and hamstring strain injury reduction. This article proposes that hamstring specific flywheel inertia training can be utilised for strength development, but due to the low number of studies and contrary evidence, more research is needed before a definite conclusion can be made. In addition, as with any training modality, careful consideration should be given to flywheel inertia training determinants. This review provides general recommendations of flywheel inertia training determinants that have value when integrating flywheel inertia training into a hamstring strengthening program.

A comparison of acceleration and maximum speed sprint training on eccentric hamstring strength and hamstring muscle architecture

Background: Hamstring strain injuries (HSI) are prevalent in field sports with a high-speed running component. It is widely believed that sprint training can have a HSI preventative effect due to the relatively high muscle activation. However, it is not known whether acceleration or maximum speed training is more effective for influencing HSI risk indicators such as eccentric strength or fascicle length. Therefore, the purpose was to investigate the differences between acceleration and maximum speed sprint training on eccentric hamstring strength and BFLH architecture.

Anterior Cruciate Ligament Reconstruction Increases the Risk of Hamstring Strain Injury Across Football Codes in Australia.

The aim of this study was to determine the impacts of anterior cruciate ligament reconstruction (ACLR) and recent (< 12months) hamstring strain injury (HSI) on (1) future HSI risk, and (2) eccentric knee flexor strength and between-limb imbalance during the Nordic hamstring exercise. A secondary goal was to examine whether eccentric knee flexor strength was a risk factor for future HSI in athletes with prior ACLR and/or HSI. In this prospective cohort study, 531 male athletes had preseason eccentric knee flexor strength tests. Injury history was also collected. The main outcome was HSI occurrence in the subsequent competitive season. Overall, 74 athletes suffered at least one prospective HSI. Compared with control athletes, those with a lifetime history of ACLR and no recent HSI had 2.2 (95% confidence interval [CI] 1.1-4.4; p = 0.029) times greater odds of subsequent HSI while those with at least one HSI in the previous 12months and no history of ACLR had 3.1 (95%CI 1.8-5.4; p < 0.001) times greater odds for subsequent HSI. Only athletes with a combined history of ACLR and recent HSI had weaker injured limbs (p = 0.001) and larger between-limb imbalances (p < 0.001) than uninjured players. An exploratory decision tree analysis suggested eccentric strength may protect against HSI after ACLR. ACLR and recent HSI were similarly predictive of future HSI. Lower levels of eccentric knee flexor strength and larger between-limb imbalances were found in athletes with combined histories of ACLR and recent HSI. These findings may have implications for injury rehabilitation.

The Effect of Exercise Compliance on Risk Reduction for Hamstring Strain Injury: A Systematic Review and Meta-Analyses.

Eccentric strength training can reduce the risk of hamstring strain injury (HSI) occurrence; however, its implementation can be impacted by athlete compliance and prescription. The aim of this review was to investigate the effects of intervention compliance, consistency and modality, on the prevention of HSIs among athletes. A literature search was conducted. 868 studies were identified prior to the application of the exclusion criteria which resulted in 13 studies identified. Random effects models were used to produce log odds ratios and 95% confidence intervals. Very high (>75.1%), moderate-high (50.1–75%), low-moderate (25.1–50%) and very low (<25%) and <1-, 1.01–3.00-, >3.01-weeks/session were used as thresholds of compliance and consistency, respectively. Modality was also observed. A positive effect on HSI incidence -0.61 (−1.05 to −0.17), favoring the intervention treatments (Z = −2.70, p = 0.007). There were non-significant, large differences between compliance (p = 0.203, Z = −1.272) and consistency (p = 0.137, Z = −1.488), with increased compliance and consistency showing greater effectiveness. A significant difference between intervention modalities was observed (p < 0.001, Z = −4.136), with eccentric interventions being superiorly effective. Compliance of >50.1% and consistent application with <3 weeks/session having positive effects on HSI incidence. Training interventions that can achieve high levels of compliance, and can be consistently performed, should be the objective of future practice.

Prediction of Hamstring Injuries in Australian Football Using Biceps Femoris Architectural Risk Factors Derived From Soccer

Background: Hamstring strain injuries are the most common injuries in team sports. Biceps femoris long head architecture is associated with the risk of hamstring injury in soccer. To assess the overall predictive ability of architectural variables, risk factors need to be applied to and validated across different cohorts. Purpose: To assess the generalizability of previously established risk factors for a hamstring strain injury (HSI), including demographics, injury history, and biceps femoris long head (BFlh) architecture to predict HSIs in a cohort of elite Australian football players. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic, injury history, and BFlh architectural data were collected from elite soccer (n = 152) and Australian football (n = 169) players at the beginning of the preseason for their respective competitions. Any prospectively occurring HSIs were reported to the research team. Optimal cut points for continuous variables used to determine an association with the HSI risk were established from previously published data in soccer and subsequently applied to the Australian football cohort to derive the relative risk (RR) for these variables. Logistic regression models were built using data from the soccer cohort and utilized to estimate the probability of an injury in the Australian football cohort. The area under the curve (AUC) and Brier score were the primary outcome measures to assess the performance of the logistic regression models. Results: A total of 27 and 30 prospective HSIs occurred in the soccer and Australian football cohorts, respectively. When using cut points derived from the soccer cohort and applying these to the Australian football cohort, only older athletes (aged ≥25.4 years; RR, 2.7 [95% CI, 1.4-5.2]) and those with a prior HSI (RR, 2.5 [95% CI, 1.3-4.8]) were at an increased risk of HSIs. Using the same approach, height, weight, fascicle length, muscle thickness, pennation angle, and relative fascicle length were not significantly associated with an increased risk of HSIs in Australian football players. The logistic regression model constructed using age and prior HSIs performed the best (AUC = 0.67; Brier score = 0.14), with the worst performing model being the one that was constructed using pennation angle (AUC = 0.53; Brier score = 0.18). Conclusion: Applying cut points derived from previously published data in soccer to a dataset from Australian football identified older age and prior HSIs, but none of the modifiable HSI risk factors, to be associated with an injury. The transference of HSI risk factor data between soccer and Australian football appears limited and suggests that cohort-specific cut points must be established.

Hamstrung: Do Sex Differences in Hamstring Injury Profile Necessitate a Different Approach to Rehabilitation and Prevention Programs in Female Athletes?

Hamstring strain injury (HSI) is one of the most common injuries encountered in running sports and can lead to significant morbidity, with time lost from participation and high rates of recurrence. Though the incidence is high in both sexes, male athletes appear to have a two to four-fold greater risk of HSI compared to female athletes, with a longer recovery. Multiple potential risk factors have been studied and age, history of hamstring injury, ACL injury and calf injury appear to be the most significant factors in predicting index injury and recurrence. Female athletes may be relatively protected by less hamstring unit stiffness and greater muscle endurance. Other potential sex-influenced risk factors including differences in pelvic, hip and knee structural morphology and limb alignment, musculotendinous flexibility and joint mobility, and kinetic chain (primary posterior) strength imbalances require further investigation. Further research focusing both exclusively on female athlete as well as more robust comparative studies with male athletes will help us to better understand differences in HSI profile. Future investigation is necessary to determine whether a sex-specific approach to HSI rehabilitation and prevention programs will optimize clinical care for both male and female athletes.

Agreement between methods and terminology used to assess the kinematics of the Nordic hamstring exercise

ABSTRACT The Nordic hamstring exercise (NHE) is employed as a component of preventative training programmes to minimise hamstring strain injury risk. Variation in the methods and terminology used to assess the NHE makes comparison between studies difficult. We aimed to compare the utility of kinetic and kinematic metrics by comparing several collected concurrently. 18 male recreational rugby union participants completed 3 bilateral NHE repetitions on a hamstring device equipped with in-line strain gauge load cells, integrated with a 3-dimensional motion tracking system. Mean break-point angle occurred after the angle at first acceleration (121.5 ± 10.4° vs. 119.2 ± 7.1°) whereas break-torque angle (BTA) occurred later in the NHE action (126.0 ± 9.8°) showing highest correlation to the angle at greatest acceleration (123.9 ± 7.9°, r = 0.85). Future research should consider movement quality as the angular velocity of the knee joint at BTA demonstrated large variation (range = 3.6–93.4 deg·s1), with high intrasubject variability of relative trunk-to-thigh angle at peak-torque (range = 0.4–44.7°). This study proposes standardisation of methods and terminology used to define the NHE. Measuring BTA is recommended to represent the point at which hamstring muscle failure occurs, specific to the proposed injury mechanism during high-speed running.