Hamstring Strain Injury (HSI) Prevention in Professional and Semi-Professional Football Teams: A Systematic Review and Meta-Analysis

Abstract

Hamstring Strain Injuries (HSIs) are the most common type of lesion in professional footballers and the leading cause of absence days from sports. However, recent studies have shown that high-level football teams apparently do not apply any HSI prevention protocol. The aim of the study was to determine the effect of preventive strategies and protocols in reducing the incidence of hamstring muscle injuries in professional and semi-professional football teams. A literature search of PubMed/MEDLINE, ISI/Web of Science and Scopus databases was conducted with the keywords “hamstring* and (injury* or strain) and prevent* and (soccer or football)”. Quality and bias assessment was completed through the Kennelly modified scale. The Injury Incidence Rate (IIR) and the Incidence Rate Ratio (IRR) were assessed in the statistical analysis. In the meta-analysis, data were extracted, pooled and analysed with “Comprehensive Meta-Analysis Version 3.3.070” software. In total, 8 of the 1017 original search studies met the inclusion criteria of this review. The total exposure of the studies was 170,221.8 h, while the number of HSIs recorded was 165 in the intervention groups and 224 in the control groups. The average score of the quality assessment was 23.6/34. The meta-analysis of six of the eight included studies provided strong evidence that interventions are effective in reducing hamstring injuries. The IRR of the effect size was 0.443, with p-value = 0.001. The studies analysed applied different preventive strategies: the Nordic hamstring exercise, the FIFA 11+ programme and exercises for core stability or balance training. All these interventions proved to have a successful effect on prevention of hamstring injuries.

Still poorly adopted in male professional football: but teams that used the Nordic Hamstring Exercise in team training had fewer hamstring injuries – a retrospective survey of 17 teams of the UEFA Elite Club Injury Study during the 2020–2021 season

“…Our findings indicate that teams that implemented NHE in team training and used it with most players had fewer hamstring injuries than teams that only used the NHE for individual players with current or a history of a hamstring injury. We acknowledge that the generalisability of our findings outside of the study cohort is uncertain although a previous study on top-tier clubs in Norway showed similar adoption rates as in the ECIS clubs,10 and preventive efficacy of the NHE has mainly been documented in subelite teams 5–8…”

“…We acknowledge that the generalisability of our findings outside of the study cohort is uncertain although a previous study on top-tier clubs in Norway showed similar adoption rates as in the ECIS clubs, 10 and preventive efficacy of the NHE has mainly been documented in subelite teams. [5][6][7][8] Player availability is a key indicator for team performance, 24 and absence due to hamstring injuries is a big problem for most teams. Our study shows that teams that implemented NHE in team training had a lower injury burden 100 days fewer injury absence days per team and season on average.…”

“…The Nordic Hamstring Exercise (NHE) programme has been reported to reduce acute hamstring injuries in football by 50%–70%,5–8 and recurrent injuries by 86% 5. A recent meta-analysis found the same point estimate as van Dyk et al 8 but both authors pointed out that the expectations around what this might result in in practice should be tempered, since there is a large amount of variability in the data 9.…”

“…[1][2][3] Additionally, recurrences within the same season are common and constitute 13%-18% of all hamstring injuries. 2 4 The Nordic Hamstring Exercise (NHE) programme has been reported to reduce acute hamstring injuries in football by 50%-70%, [5][6][7][8] and recurrent injuries by 86%. 5 WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Hamstring injury is the most common injury subtype in male professional football players.…”

Impact of COVID on Sports Injury Patterns, Changes in Mental Well-Being, and Strategies to Prepare for Future Pandemics in Sport

“…Table 1 provides specific details on implementation of these practices. At the initial onset of a lockdown, standardized neuromuscular training programs such as the Fédération Internationale de Football Association (FIFA 11+), Nordic Hamstring exercise, or Oslo Sports Trauma Research Center (OSTRC) Shoulder Injury Prevention Program should be rapidly implemented to help protect against injury with re-engagement into sport (85,93,94). Continuation of high-intensity training maneuvers will help maintain explosive performance and protect against vulnerable tissues.…”