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

Abstract

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.

Hamstring Muscle Injuries and Hamstring Specific Training in Elite Athletics (Track and Field) Athletes

“…Hamstring strengthening seem to be performed in all disciplines without significant differences. This is consistent with the published knowledge that (i) reduced hamstring strength qualities and endurance were associated with increased HMI risk [ 15 ], and (ii) hamstring strengthening exercises were associated with reduced HMI risk [ 30 ]. However, it is important to note that 8 to 17% of athletes from disciplines with high HMI prevalence (i.e., sprints, hurdles and jumps) did not perform strengthening.…”

“…However, it is important to note that 8 to 17% of athletes from disciplines with high HMI prevalence (i.e., sprints, hurdles and jumps) did not perform strengthening. This may highlight the need to improve knowledge dissemination, education or other measures in order to improve adherence to risk reduction measures [ 30 , 31 ].…”

Effect of additional Nordic hamstring exercise or sprint training on the modifiable risk factors of hamstring strain injuries and performance

“…This observation could be due to the DOMS rating being of a total body soreness rather than specifically to the hamstrings, which was thought to be more relevant to practice and sport. A minimum of 75% compliance was demonstrated to have most positive beneficial effect of HSI incidence [ 7 ], and it would be suspected that a similar finding would be observed for the modifiable risk factors of HSI [ 6 ]. With regards to application, a low volume approach to the NHE and sprinting used within practice could achieve greater volumes of compliance, specifically as a low volume NHE appears to have minimal influence DOMS.…”

“…FIFA 11/11+ warm up protocol [ 5 ]). Incorporating the NHE has a meaningful ability to decrease the occurrence of HSI, however, the effectiveness of any intervention modality relies upon the compliance of the athletic population [ 6 , 7 ], with ≥75% compliance showing superior effectiveness within the literature [ 7 ]. Low levels of compliance within studies that have utilised the NHE as part of training interventions have frequently been reported due delayed onset muscle soreness (DOMS) and/or poor athlete support.…”

“…This is despite only a moderate level of DOMS being reported within NHE training interventions [ 1 , 8 ]. Furthermore, the NHE; one of the most extensively researched eccentric hamstring exercises, is continually poorly adopted within elite European soccer [ 9 ], despite showing superior effectiveness [ 4 , 7 , 10 ]. Bahr, Thorborg and Ekstrand [ 9 ], cited high levels of both player and coach complaints when implementing the NHE.…”