Injury prevention: reading the runes for hamstring injuries

Hamstring strain injuries (HSIs) are one of the most common injuries in soccer players⁽¹⁾. Research suggests that HSIs account for around one in seven of all injuries sustained in the sport⁽²⁾, and up to 47% of all muscle injuries⁽³⁾! Furthermore, research on professional soccer players in Europe has found that on average, a player will miss 18 days and three matches per season due to an HIS, and that HSIs account for around 25% of all player absences from games⁽⁴⁾.

Interventions to prevent hamstring injury

Given the high rates of muscle (especially hamstring) injury and re-injury among soccer players, and the financial pressures of the modern game, it’s perhaps unsurprising that coaches, trainers and clinicians caring for players find that treatment of injuries in players is a frustrating and a never-ending challenge. And then of course, there’s the frustration experienced by players! Unsurprisingly therefore, there’s been an increasing drive in soccer circles to try and indentify they key risk factors and injury mechanisms related to HSIs, and to use this knowledge to firstly detect injury-prone players and then to design intervention measures to successfully prevent injuries.

One of the most widely-adopted general injury prevention program deployed in soccer was FIFA’s ‘The 11+’ - a series of running and proprioception (the ability to sense one’s own movement and position in space) drills to be used as a warm-up routine for amateur players with progressions for more advanced players (see figure 1). This program is now used by professionals and amateurs all around the world (for a free and fully downloadable copy of FIFA’s 11+ program in PDF form, visit this link). While the 11+ program has been judged to be beneficial, research suggests that it primarily impacts the incidence of mild, overuse, and training injuries in teams with low-skill (ie amateur) players⁽⁵⁾. However, for professional players, this kind of intervention seems not produce significant injury-reduction benefits when assessed on injury risk per hour played, with no noticeable reduction in hamstring injuries^(6,7).

Figure 1: Overview of the FIFA 11+ program*