Skip to main content
PMC home page
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2004 Feb;38(1):36–41. doi: 10.1136/bjsm.2002.002352

The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of hamstring injuries

C Woods 1, R Hawkins 1, S Maltby 1, M Hulse 1, A Thomas 1, A Hodson 1
PMCID: PMC1724733  PMID: 14751943

Abstract

Objective: To conduct a detailed analysis of hamstring injuries sustained in English professional football over two competitive seasons.

Methods: Club medical staff at 91 professional football clubs annotated player injuries over two seasons. A specific injury audit questionnaire was used together with a weekly form that documented each clubs' current injury status.

Results: Completed injury records for the two competitive seasons were obtained from 87% and 76% of the participating clubs respectively. Hamstring strains accounted for 12% of the total injuries over the two seasons with nearly half (53%) involving the biceps femoris. An average of five hamstring strains per club per season was observed. A total of 13 116 days and 2029 matches were missed because of hamstring strains, giving an average of 90 days and 15 matches missed per club per season. In 57% of cases, the injury occurred during running. Hamstring strains were most often observed during matches (62%) with an increase at the end of each half (p<0.01). Groups of players sustaining higher than expected rates of hamstring injury were Premiership (p<0.01) and outfield players (p<0.01), players of black ethnic origin (p<0.05), and players in the older age groups (p<0.01). Only 5% of hamstring strains underwent some form of diagnostic investigation. The reinjury rate for hamstring injury was 12%.

Conclusion: Hamstring strains are common in football. In trying to reduce the number of initial and recurrent hamstring strains in football, prevention of initial injury is paramount. If injury does occur, the importance of differential diagnosis followed by the management of all causes of posterior thigh pain is emphasised. Clinical reasoning with treatment based on best available evidence is recommended.

Full Text

The Full Text of this article is available as a PDF (295.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agre J. C. Hamstring injuries. Proposed aetiological factors, prevention, and treatment. Sports Med. 1985 Jan-Feb;2(1):21–33. doi: 10.2165/00007256-198502010-00003. [DOI] [PubMed] [Google Scholar]
  2. Bennell K., Wajswelner H., Lew P., Schall-Riaucour A., Leslie S., Plant D., Cirone J. Isokinetic strength testing does not predict hamstring injury in Australian Rules footballers. Br J Sports Med. 1998 Dec;32(4):309–314. doi: 10.1136/bjsm.32.4.309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Best T. M. Soft-tissue injuries and muscle tears. Clin Sports Med. 1997 Jul;16(3):419–434. doi: 10.1016/s0278-5919(05)70033-8. [DOI] [PubMed] [Google Scholar]
  4. Brockett C. L., Morgan D. L., Proske U. Human hamstring muscles adapt to eccentric exercise by changing optimum length. Med Sci Sports Exerc. 2001 May;33(5):783–790. doi: 10.1097/00005768-200105000-00017. [DOI] [PubMed] [Google Scholar]
  5. Burkett L. N. Investigation into hamstring strains: the case of the hybrid muscle. J Sports Med. 1975 Sep-Oct;3(5):228–231. doi: 10.1177/036354657500300504. [DOI] [PubMed] [Google Scholar]
  6. Cibulka M. T., Rose S. J., Delitto A., Sinacore D. R. Hamstring muscle strain treated by mobilizing the sacroiliac joint. Phys Ther. 1986 Aug;66(8):1220–1223. doi: 10.1093/ptj/66.8.1220. [DOI] [PubMed] [Google Scholar]
  7. Croisier Jean-Louis, Forthomme Bénédicte, Namurois Marie-Hélène, Vanderthommen Marc, Crielaard Jean-Michel. Hamstring muscle strain recurrence and strength performance disorders. Am J Sports Med. 2002 Mar-Apr;30(2):199–203. doi: 10.1177/03635465020300020901. [DOI] [PubMed] [Google Scholar]
  8. Devlin L. Recurrent posterior thigh symptoms detrimental to performance in rugby union: predisposing factors. Sports Med. 2000 Apr;29(4):273–287. doi: 10.2165/00007256-200029040-00005. [DOI] [PubMed] [Google Scholar]
  9. Engström B., Forssblad M., Johansson C., Törnkvist H. Does a major knee injury definitely sideline an elite soccer player? Am J Sports Med. 1990 Jan-Feb;18(1):101–105. doi: 10.1177/036354659001800118. [DOI] [PubMed] [Google Scholar]
  10. Garrett W. E., Jr, Califf J. C., Bassett F. H., 3rd Histochemical correlates of hamstring injuries. Am J Sports Med. 1984 Mar-Apr;12(2):98–103. doi: 10.1177/036354658401200202. [DOI] [PubMed] [Google Scholar]
  11. Garrett W. E., Jr Muscle strain injuries. Am J Sports Med. 1996;24(6 Suppl):S2–S8. [PubMed] [Google Scholar]
  12. Garrett W. E., Jr Muscle strain injuries: clinical and basic aspects. Med Sci Sports Exerc. 1990 Aug;22(4):436–443. [PubMed] [Google Scholar]
  13. Garrett W. E., Jr, Rich F. R., Nikolaou P. K., Vogler J. B., 3rd Computed tomography of hamstring muscle strains. Med Sci Sports Exerc. 1989 Oct;21(5):506–514. [PubMed] [Google Scholar]
  14. Hartig D. E., Henderson J. M. Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees. Am J Sports Med. 1999 Mar-Apr;27(2):173–176. doi: 10.1177/03635465990270021001. [DOI] [PubMed] [Google Scholar]
  15. Jönhagen S., Németh G., Eriksson E. Hamstring injuries in sprinters. The role of concentric and eccentric hamstring muscle strength and flexibility. Am J Sports Med. 1994 Mar-Apr;22(2):262–266. doi: 10.1177/036354659402200218. [DOI] [PubMed] [Google Scholar]
  16. Kujala U. M., Orava S., Järvinen M. Hamstring injuries. Current trends in treatment and prevention. Sports Med. 1997 Jun;23(6):397–404. doi: 10.2165/00007256-199723060-00005. [DOI] [PubMed] [Google Scholar]
  17. Nielsen A. B., Yde J. Epidemiology and traumatology of injuries in soccer. Am J Sports Med. 1989 Nov-Dec;17(6):803–807. doi: 10.1177/036354658901700614. [DOI] [PubMed] [Google Scholar]
  18. Orchard J., Marsden J., Lord S., Garlick D. Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. Am J Sports Med. 1997 Jan-Feb;25(1):81–85. doi: 10.1177/036354659702500116. [DOI] [PubMed] [Google Scholar]
  19. Orchard J., Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997-2000. Br J Sports Med. 2002 Feb;36(1):39–44. doi: 10.1136/bjsm.36.1.39. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Pinniger G. J., Steele J. R., Groeller H. Does fatigue induced by repeated dynamic efforts affect hamstring muscle function? Med Sci Sports Exerc. 2000 Mar;32(3):647–653. doi: 10.1097/00005768-200003000-00015. [DOI] [PubMed] [Google Scholar]
  21. Speer K. P., Lohnes J., Garrett W. E., Jr Radiographic imaging of muscle strain injury. Am J Sports Med. 1993 Jan-Feb;21(1):89–96. doi: 10.1177/036354659302100116. [DOI] [PubMed] [Google Scholar]
  22. Stauber W. T., Knack K. K., Miller G. R., Grimmett J. G. Fibrosis and intercellular collagen connections from four weeks of muscle strains. Muscle Nerve. 1996 Apr;19(4):423–430. doi: 10.1002/mus.880190402. [DOI] [PubMed] [Google Scholar]
  23. Stauber W. T., Smith C. A., Miller G. R., Stauber F. D. Recovery from 6 weeks of repeated strain injury to rat soleus muscles. Muscle Nerve. 2000 Dec;23(12):1819–1825. doi: 10.1002/1097-4598(200012)23:12<1819::aid-mus4>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  24. Turl S. E., George K. P. Adverse neural tension: a factor in repetitive hamstring strain? J Orthop Sports Phys Ther. 1998 Jan;27(1):16–21. doi: 10.2519/jospt.1998.27.1.16. [DOI] [PubMed] [Google Scholar]
  25. Upton P. A., Noakes T. D., Juritz J. M. Thermal pants may reduce the risk of recurrent hamstring injuries in rugby players. Br J Sports Med. 1996 Mar;30(1):57–60. doi: 10.1136/bjsm.30.1.57. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Verrall G. M., Slavotinek J. P., Barnes P. G., Fon G. T., Spriggins A. J. Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging. Br J Sports Med. 2001 Dec;35(6):435–440. doi: 10.1136/bjsm.35.6.435. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Vleeming A., Pool-Goudzwaard A. L., Stoeckart R., van Wingerden J. P., Snijders C. J. The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Spine (Phila Pa 1976) 1995 Apr 1;20(7):753–758. [PubMed] [Google Scholar]
  28. Worrell T. W. Factors associated with hamstring injuries. An approach to treatment and preventative measures. Sports Med. 1994 May;17(5):338–345. doi: 10.2165/00007256-199417050-00006. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES