Monitoring the effect of football match congestion on hamstring strength and lower limb flexibility: Potential for secondary injury prevention?

The impact of a mid-season FIFA World Cup™ on injury occurrence and patterns in French professional soccer clubs

This study retrospectively compared the effect of holding the 2022 FIFA World Cup™ (WC) mid-season (season 2022/23) on injury rates and patterns in French Ligue 1 soccer clubs. Epidemiological data in 17 clubs were prospectively recorded by their physicians. Time-loss injuries (injuries leading to a player being unable to fully participate in play over the following 72-hour period) were compared with those reported during a regular season (2021-22). In the WC season, an increase of approximately 23% (training + match-play) was observed for both the total number of injuries and knee, ankle and muscle injuries combined. Incidences for match-play injury overall and for the knee, ankle and muscle regions combined and the hamstrings and calf regions specifically also rose significantly (range: p < 0.05-p < 0.01). These results suggest that injury occurrence and patterns in French L1 soccer clubs were substantially affected during the 2022/23 season when a mid-season WC was held.

Monitoring modifiable injury risk factors over an in-season mesocycle in semi-professional female field hockey players

OBJECTIVE

This study aimed to determine changes of modifiable injury risk factors and fatigue parameters during a mesocycle (4 months of the competitive season) in semi-professional female field hockey players (Spanish 2nd Division).

METHODS

Fourteen female field hockey players (age: 22.6 ± 4.9 years) participated in the study over 4 months of the competitive season (September-December 2019). The players were tested each month for their: maximal isometric knee flexion, hip adduction, and abduction muscle strength; passive straight leg raise and ankle dorsiflexion range of motion (ROM); countermovement jump height; and perceptual fatigue (through a perceived well-being questionnaire).

RESULTS

Statistical differences were reported in isometric knee flexion torque in the dominant and non-dominant limb (p = < 0.001, ηp2 = 0.629,0.786 respectively), non-dominant isometric hip abductors torque (p = 0.016, ηp2 = 0.266) and isometric hip adductors torque in dominant and non-dominant limbs (p = < 0.001, ηp2 = 0.441-546). Also, significant differences were reported in the straight leg raise test (p = < 0.001, ηp2 = 0-523, 0.556) and ankle dorsiflexion (p = 0.001, ηp2 = 0.376, 0.377) for the dominant and non-dominant limb respectively. Finally, the jump height measured showed significant differences (p = <.001, ηp2 = 0.490), while no differences were reported in perceived well-being parameters (p = 0.089-0.459).

CONCLUSION

Increments in isometric muscle strength and fluctuations in ROM values and vertical jumping capacity are reported over an in-season mesocycle (i.e., 4 months of the competitive season). This information can be used to target recovery strategies to make them more efficient.

Rapid force generation during unilateral isometric hamstring assessment: reliability and relationship to maximal force

Limited research has reported the reliability of rapid force generation characteristics during isometric assessments of the hamstrings. Therefore, the purpose of the present study was to determine the between-session reliability of rapid force generating characteristics of the hamstrings and relationship to maximal force production. Twenty-three female soccer players (age: 20.7 ± 4.7 years; height: 168.7 ± 5.9 cm; body mass: 64.4 ± 6.7 kg) performed three unilateral trials of the 90-90 isometric hamstring assessment, on two separate occasions, separated by 7 days. Peak force, force at 100- and 200 ms and average rate of force development (aRFD) over 100- and 200 ms epochs were calculated. Absolute and fair-good reliability was observed for peak force and all rapid force generating measures (<8.33CV%, ICC >0.610). Significant and meaningful relationships (p < 0.001, r > 0.802) were observed for all rapid force generating measures and peak force. The 90-90 isometric assessment can be used to assess peak and rapid force generating reliably to enable practitioners to confidently track changes in performance over time as part of fatigue monitoring and management.

Does Restricted Ankle Joint Mobility Influence Hamstring Muscle Strength, Work and Power in Football Players after ACL Reconstruction and Non-Injured Players?

This study was aimed at observing how the limitation of ankle dorsiflexion ROM affects hamstring muscle Peak Torque/BW (%), Average Power (W), and Total Work (J), and whether this effect is similar in football players after ACL rupture and reconstruction and in those without injuries. The study included 47 professional football players who were divided into two groups: Group 1 (n = 24) after ACL reconstruction and Group 2 (n = 23) without injuries in the past 3 years. Based on the Weight-Bearing Lunge Test (WBLT), the following subgroups in Groups 1 and 2 were distinguished: N (normal ankle joint dorsiflexion) and R (restricted ankle joint dorsiflexion). The concentric isokinetic test (10 knee flexions and extensions at 60°/s) was performed on both limbs. Significantly lower values of Peak Torque/BW and Average Power were observed in Group 1 compared to Group 2, as well as in subjects with normal and restricted ankle dorsiflexion. However, no significant differences were noted for either group in any of the strength variables comparing subjects with normal and restricted ankle dorsiflexion. A poor and non-significant correlation was exhibited between the ankle joint range of dorsiflexion and all the strength variables. The area under the ROC curve (AUC) for all the evaluated variables in both groups was below 0.5, or very close to this value, indicating that ankle dorsiflexion ROM has no diagnostic accuracy for hamstring muscle strength. Based on the obtained results, it can be assumed that ankle dorsiflexion limitation, which is common in football players, is not a factor in weakening hamstring muscle strength, either in football players after ACL reconstruction or among those without injuries. However, some authors have reported that limited mobility of the ankle joint can have a destructive effect on the work of the lower limbs and may also be a factor in increasing the risk of football injuries in this area. Therefore, we have suggested that hamstring muscle weakness and increased risk of injury may occur due to factors other than limited ankle mobility. These observations may be of great importance in the selection of prevention methods by including a broad spectrum of physical techniques, not just exercises that focus on the improvement of mobility or stability of the lower limbs.

Hamstrings injuries in football

Background

Hamstrings injuries are a major concern in football (soccer), affecting both recreational players and professional athletes. Although being a recognized issue within the football community, its incidence has been increasing over the last years and still poses a challenge to all practitioners involved.

Study objectives and rationale

The goal of this narrative review is to outline hamstrings injuries epidemiology and mechanisms of injury, identify and discuss its risk factors, provide an approach to a proper early diagnosis, evaluate the efficacy of current treatment options and return to sports, and present the best strategies for hamstrings injury prevention. These guidelines will help the sports medicine staff team on how to better manage their players with or at risk of hamstrings injuries.

Conclusion

Despite several breakthroughs in research of hamstrings injuries, there is still heterogeneity across studies and lack of consensus in regards to classification, diagnosis, treatment and prevention. Hamstrings injuries compromise the athlete's performance with time loss due to injury, shortens their highest-level career longevity with higher risk of reinjury rates, and is a defying problem for clubs to balance financial losses due to having their players off the pitch. Further research is warranted to keep moving forward with evidence on treating and preventing hamstrings injuries to mitigate its high incidence and keep the players safe.

Effects of Football Training and Match-Play on Hamstring Muscle Strength and Passive Hip and Ankle Range of Motion during the Competitive Season

Deficits in hamstring muscle strength and in hip range of motion (ROM) have been considered risk factors for hamstring muscle injuries. However, there is a lack of information on how chronic exposure to regular football training affects hamstring muscle strength and hip ROM. The aim of this study was to examine the longitudinal effect of football training and competition during a complete season on hamstring muscle strength and hip ROM in football players. A total of 26 semi-professional football players underwent measurements of isometric hamstring muscle strength and passive hip flexion/extension, and internal/external hip rotation (IR/ER) ROM during the football season (pre-season, mid-season, end-season). Compared to pre-season, hamstring muscle strength increased in the dominant (+11.1%, p = 0.002) and non-dominant (+10.5%, p = 0.014) limbs in the mid-season. Compared to mid-season, hamstring strength decreased in the dominant (−9.3%, p = 0.034) limb at end-season. Compared to the pre-season, hip extension ROM decreased in mid-season in the dominant (−31.7%, p = 0.007) and non-dominant (−44.1%, p = 0.004) limbs, and further decreased at end-season (−49.0%, p = 0.006 and −68.0%, p < 0.001) for the dominant and non-dominant limbs. Interlimb asymmetry for hip IR ROM increased by 57.8% (p < 0.002) from pre-season to mid-season. In summary, while hamstring muscle strength increased during the first half of the football season in football players, a progressive reduction in hip extension ROM was observed throughout the season. The reduced hip extension ROM suggests a reduced mobility of the hip flexors, e.g., iliopsoas, produced by the continuous practice of football. Consequently, hip-specific stretching and conditioning exercises programs should be implemented during the football season.

Effects of congested fixture and matches' participation on internal and external workload indices in professional soccer players

This study aimed to verify the effects of congested fixture and matches’ participation on internal and external workload indexes in professional Brazilian soccer players. Rate of perceived exertion-based training load (sRPE), distance- and accelerometry-based measures were daily monitored over 119 training sessions and 33 matches performed by 29 male outfield players. Weeks were classified as congested (n = 11, two or more matches within a 7-day period) and regular (n = 10, one match or less within a 7-day period). The players were divided based on the matches’ participation: (1) players who played ≥ 60 min (G1); (2) players who played < 60 min (G2); (3) players who did not participate of the match (G3). The findings showed that independent of the levels of participation during the matches, regular weeks presented greater acute, monotony, and strain indices for internal and external workload measures than congested weeks. The G1 presented the highest values for most of the workload indices in both regular and congested weeks, except for monotony indices (internal and external load) that G2 showed greater values than G1 and G3. Coaches and practitioners should plan the training “doses” to reduce disparities of these different match’s participation and congested schedule weeks.

Effects of consecutive days of matchplay on maximal hip abductor and adductor strength in female field hockey players

Background

The purpose of this study was to examine the effects of two competitive field hockey matches, played on consecutive days, on maximal isometric hip adductor and abductor strength, wellness and fatigue.

Methods

Fourteen professional female field hockey players (age: 20.4 ± 5.4 years; body mass: 60.7 ± 7.2 kg; height: 167.0 ± 1.0 cm) volunteered to participate in this investigation. Maximal isometric hip adductor and abductor strength were obtained before (pre-match 1) and after the first match (post-match 1), after the second match (post-match 2), and 48 h after the second match. Locomotion patterns during the matches were obtained with portable Global Positioning System (GPS) and perceived exertion (RPE) was assessed after each match. In addition, Wellness Questionnaire (5-WQ) and the Total Quality Recovery Scale (TQR) were employed before the matches and 48 h after the second match.

Results

For the non-dominant limb, the maximal isometric hip adductor and abductor strength were lower after post-match 2 when compared to pre-match 1 (p = 0.011). Hip abductor strength in the non-dominant limb remained reduced 48 h after post-match 2 (p < 0.001). There were no differences in the total distance covered when comparing match 1 and match 2. Players reported more acute fatigue (5-WQ, p = 0.009) and increased muscle soreness on pre-match 2 compared to pre-match 1 (p = 0.015), while fatigue returned to pre-competition levels 48 h after post-match 2 (p = 0.027). No changes were observed in the TQR.

Conclusion

The assessment of maximal adductor and abductor strength before and after competitive matches, in addition to evaluating self-perceived fatigue by a wellness questionnaire can help to identify field hockey players with excessive fatigue responses during tournaments with a congested match program.

Eccentric Hamstring Muscle Strength during Home Confinement Due to the COVID-19 Pandemic, and Football Competition Resumption in Professional Football Referees: A Prospective Observational Study

The COVID-19 pandemic has produced a major disruption for professional football leagues that has affected the physical preparation of both football players and referees. In Spain, health authorities decreed home confinement for eight weeks, supressing the normal training routines of professional referees. After home confinement, referees had four weeks to retrain as the national football league was set to resume matches to complete the 11 games remaining. The aim of the present investigation was to assess changes in eccentric hamstring muscle strength during football competition suspension/resumption due to the COVID-19 pandemic in 21 professional football referees (mean ± SD, age: 33.4 ± 5.1 years; height: 182.4 ± 5.0 cm; body mass: 75.1 ± 4.4 kg). Eccentric hamstring muscle strength was measured with the Nordic hamstring exercise at four time points. During home confinement, referees presented the lowest value of bilateral eccentric muscle strength (300 ± 14 N). Eccentric muscle strength increased by 13.2 ± 3.7% one week after the end of home confinement (339 ± 16 N; p = 0.001, effect size (ES) = 2.8) and remained stable before the first match (343 ± 17 N; p = 0.001, ES = 3.1) and after the end of the national league (328 ± 13 N; p = 0.001, ES = 2.0). In summary, home confinement produced detraining effects in professional football referees associated with hamstring muscle weakness. In this regard, strength-based activities with body loads may be insufficient to avoid muscle weakness and other means (e.g., weights) may be necessary to maintain muscle strength. However, the 4-weeks retraining period was sufficient to resolve hamstring muscle weakness induced by the restrictions of home confinement. This information may be helpful in the case of future sport competition suspension or home quarantine due to new waves of COVID-19 pandemic.

The Hamstrings: Anatomic and Physiologic Variations and Their Potential Relationships With Injury Risk

The incidence and recurrence of hamstrings injuries are very high in sports, posing elevated performance and financial-related costs. Attempts to identify the risk factors involved in predicting vulnerability to hamstrings injury is important for designing exercise-based programs that aim to mitigate the rate and severity of hamstrings injuries and improve rehabilitation strategies. However, research has shown that non-modifiable risk factors may play a greater role than modifiable risk factors. Recognizing non-modifiable risk factors and understanding their implications will afford the prescription of better suited exercise programs, i.e., that are more respectful of the individual characteristics. In a nutshell, non-modifiable risk factors can still be acted upon, even if indirectly. In this context, an underexplored topic is how intra and inter- individual anatomic and physiologic variations in hamstrings (e.g., muscle bellies, fiber types, tendon length, aponeurosis width, attachment sites, sex- and age-related differences) concur to alter hamstrings injuries risk. Some anatomic and physiologic variations may be modifiable through exercise interventions (e.g., cross-sectional area), while others may not (e.g., supernumerary muscle bellies). This apparent dichotomy may hide a greater complexity, i.e., there may be risk factors that are partially modifiable. Therefore, we explored the available information on the anatomic variations of the hamstrings, providing a deeper insight into the individual risk factors for hamstrings injuries and contributing with better knowledge and potential applications toward a more individualized exercise prescription.

Accelerometry-Workload Indices Concerning Different Levels of Participation during Congested Fixture Periods in Professional Soccer: A Pilot Study Conducted over a Full Season

The aim of this study was to analyze the variations of acute load (AL), acute: chronic workload ratio (ACWR), training monotony (TM), and training strain (TS) of accelerometry-based GPS measures in players who started in three matches (S3M), two matches (S2M), and one match (S1M) during congested weeks. Nineteen elite professional male players from a Portuguese team (age: 26.5 ± 4.3 years) were monitored daily using global positioning systems (GPSs) over a full season (45 weeks). Accelerometry-derived measures of high metabolic load distance (HMLD), high accelerations (HA), and high decelerations (HD) were collected during each training session and match. Seven congested weeks were classified throughout the season, and the participation of each player in matches played during these weeks was codified. The workload indices of AL (classified as ACWR, TM, and TS) were calculated weekly for each player. The AL of HMLD was significantly greater for S2M than S1M (difference = 42%; p = 0.002; d = 0.977) and for S3M than S1M (difference = 44%; p = 0.001; d = 1.231). Similarly, the AL of HA was significantly greater for S2M than S1M (difference = 25%; p = 0.023; d = 0.735). The TM of HD was significantly greater for S2M than S3M (difference = 25%; p = 0.002; d = 0.774). Accelerometry-based measures were dependent on congested fixtures. S2M had the greatest TS values, while S3M had the greatest TM.

Technical match actions and plasma stress markers in elite female football players during an official FIFA Tournament

This study analyzed the impact of performing four consecutive football matches separated by 48-72 hours during a FIFA tournament on physical load, technical performance and plasma markers of redox state, muscle damage and inflammation in elite female players. Forty-eight players from three national teams were evaluated at seven time points: before (baseline) and throughout the tournament (after each match and before two training sessions). Only data from players who played all matches were included in the analyses (N = 13). The players were divided into high-rank (N = 6) and low-rank (N = 7) team players according to FIFA standards. Plasma creatine kinase (CK), C-reactive protein (CRP), total antioxidant status (TAS), and uric acid (UA) were analyzed at the selected time points. Technical performance and physical load were also quantified according to team rank. Players from low-rank teams played significantly more time than high-rank players (85 ± 10 vs 67 ± 15 minutes; P = .02; d = 1.51). Low-rank team players presented higher values in technical performance actions than the high-rank team players, but most of the differences were explained by the longer match time played. UA content differed across the matches, increasing from baseline (F_(4,40)  = 3.90; P = .01) and more in the high-rank team players (F_(1,10)  = 20.46; P = .001), while CRP only differed across the matches (F_(4,36)  = 2.66; P = .05), also increasing from baseline. A large time effect was shown for UA only in the high-rank players (η² _p  = 0.50; P = .02). Four consecutive matches did not result in considerable alterations in plasma stress markers, physical load, and technical performance in elite female football players from distinct rank levels.

Post-match recovery of eccentric knee flexor strength in male professional football players

OBJECTIVES

This study aimed at verifying the effect of a football match on the eccentric knee flexor strength of male professional players along a 72-h period.

STUDY DESIGN

Quasi-experimental study.

SETTING

Football club facilities.

PARTICIPANTS

Fifteen players were assessed in four timepoints: 24 h before, immediately after, 48 h and 72 h after the match.

MAIN OUTCOME MEASURES

The eccentric knee flexor strength was assessed during the Nordic hamstring exercise execution.

RESULTS

Players presented a significant strength reduction immediately after match (Δ = 12%; p = 0.001; large effect size, d = 1.10), and did not recover their strength capacity within a 48 h-period (Δ = 6%; p = 0.011; moderate effect size, d = 0.57). At 72 h after the match, strength was similar to baseline levels (Δ = 3.5%; p = 0.122; small effect size, d = 0.34). Secondarily, individual response analysis considered a player 'fully recovered' when his strength deficit compared to the baseline measure was lower than the measurement coefficient of variation (i.e., <5%). Only 6 (40%) and 9 (60%) players were 'fully recovered' at 48 h and 72 h after the match, respectively.

CONCLUSION

Professional football players experienced an immediately post-match drop on the eccentric knee flexor strength, and significant strength deficits persisted for a 48-h period. Some players were not recovered at 72 h after the match.

THE GAP BETWEEN RESEARCH AND CLINICAL PRACTICE FOR INJURY PREVENTION IN ELITE SPORT: A CLINICAL COMMENTARY

As clinicians strive to apply evidence-based principles, team-based practitioners have identified a large gap as it relates to published research, ideal applications of evidence-based practice, and actual clinical practice related to injury prevention in elite sport within the United States. For rehabilitation professionals, especially those intimately involved in the research of injury prevention, the solution often seems quite clear and defined. However, preventing injury by implementing the latest recommendation from the most recent prospective study on the using the FIFA 11 + warm-up, a Copenhagen Adduction exercise, or a plyometric drill with elite athletes may not be as effective as was seen among the cohort used in the study. In addition to extrapolating research, clinicians face additional challenges such as variance among professions, schedule density, and off-season contacts with athletes. There is an inherent difficulty in the application of research to practice in elite sport as it relies on the teamwork of not only the practitioner and athlete, but the entire sporting organizational structure and those involved in athlete participation. The purpose of this clinical commentary is to explore the difficulty with application of research in clinical practice and to discuss potential strategies for improving carry over from research to clinical practice.

Performance Effects with Injury Prevention Exercise Programmes in Male Youth Football Players: A Randomised Trial Comparing Two Interventions

BACKGROUND

Increased performance from injury prevention exercise programmes (IPEPs) may affect injury risks positively and support the implementation of IPEPs. The primary aim was to study the performance effects of injury prevention exercises from two different IPEPs, the Knee Control IPEP and the further developed Knee Control+ IPEP, in youth male football players, and the secondary aim was to compare potential differences in performance effects between the IPEPs.

METHODS

Four male youth football teams were tested for agility, hop and sprint performance at the start of the second half of the competitive season and after the end of the 8-week season. Per randomisation, two teams used Knee Control and two teams Knee Control+.

RESULTS

In total, 47 players executed a median of 13 IPEP sessions (range 11-21 sessions). No improvements in performance were seen in the group as a whole. The intervention groups showed small declines in sprint and agility performance. There was a significant between-group difference in change for the 505 agility test, with improved performance in the Knee Control and worse performance in the Knee Control+ group, ΔKC vs KC+ = - 0.012 (95% CI - 0.19 to -0.04), d = 0.98.

CONCLUSIONS

No clinically meaningful performance effects were seen from the Knee Control or Knee Control+ IPEP in youth male athletes and no meaningful differences were seen between Knee Control and Knee Control+ regarding effects on performance tests.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03251404 . Registered on 16 August 2017.

Players' physical performance in LaLiga across the season: insights for competition continuation after COVID-19

Due to the COVID-19 outbreak, professional football players competing in LaLiga were confined at home for ~8 weeks and then they were allowed to train to prepare the first competitive match for 4 weeks. As the duration of summer break in the prior four seasons of LaLiga (from 2015-2016 to 2018-2019) was of similar length to the suspension of the championship due to COVID-19 (~12 weeks), we have analysed the running performance of teams competing in LaLiga in these four seasons to anticipate players’ physical performance after the resumption of the competition. The analysis includes the average running distance per game for each of the 38 matchdays that compose LaLiga. One-way ANOVA revealed that there was a main effect of the matchday on total running distance per match (p = 0.001), and in the distance covered between 14.0 and 20.9 km/h (p < 0.001), between 21.0 and 23.9 km/h (p < 0.001) and at above 24.0 km/h (p < 0.001). Overall, the post-hoc analysis revealed that the running patterns progressively increased during the first 8-10 matchdays and then reached a plateau which was significantly different to matchday-1 (p < 0.05). This analysis reveals that, in the prior four competitive seasons of LaLiga, players’ physical performance was lower at the beginning of the season and the teams needed approximately 8-10 matchdays to reach a steady state running performance. These data suggest that football players will progressively increase their performance across the 11 matchdays remaining to complete LaLiga.

Reliability of a musculoskeletal profiling test battery in elite academy soccer players

The study aimed to quantify the measurement error / reliability of a musculoskeletal profiling test battery administered in young, elite academy soccer players, and to examine if the order in which the test battery was administered, and who it was administered by, influenced reliability. Players (n = 75; age 12–20 years; stature 1.47–1.95 m; body mass 36–89 kg) from U-12 to U-23 age groups were assigned to either: 1) intra-rater-fixed order; 2) intra-rater-non-fixed order; 3) inter-rater-fixed order; or, 4) inter-rater-non-fixed order groups. On two separate occasions separated by 3 to 7 days, 12 raters conducted a musculoskeletal profiling test battery comprising 10 tests (Supine Medial Hip Rotation, Supine Lateral Hip Rotation, Hamstring 90/90, Prone Medial Hip Rotation [degrees]; Combined Elevation, Thoracic Rotation, Weight-Bearing Dorsiflexion, Y-Balance [centimetres]; Beighton, Lumbar Quadrant [categorical]). The measurement error / reliability for tests measured in degrees and centimetres was evaluated using the intraclass correlation (relative reliability), coefficient of variation and ratio limits of agreement (absolute reliability). Intraclass correlations varied from 0.04 (“poor”) to 0.95 (“excellent”), coefficient of variation from 2.9 to 43.4%, and the ratio limits of agreement from 1.058 (*/÷ 1.020) to 2.026 (*/÷ 1.319) for the tests measured in degrees and centimetres. The intraclass correlation, coefficient of variation and ratio limits of agreement were smallest for five out of eight tests measured in degrees and centimetres when the tests were administered in an intra-rater-fixed test order. These findings emphasise that different testing methods, and the administration of a musculoskeletal profiling test battery using a less than optimal design, will influence measurement error and hence test reliability. These observations need to be considered when investigating musculoskeletal function and age, injury, training or asymmetry in young, elite academy soccer players.

The cumulative and residual changes in eccentric knee flexor strength indices following soccer-specific treadmill running: Novel considerations of angle specific torque

With potential implications for recovery and conditioning practices, the aim of this study was to assess the cumulative and residual response of angle specific eccentric knee flexor (eccKF) strength indices following soccer-specific activity. Thirteen semi-professional soccer players were therefore required to complete a 90-minute soccer-specific treadmill running. with eccKF isokinetic strength assessments completed pre-trial, immediately post-trial, and 48 hours post-trial. The strength assessments comprised the completion of 5 repetitions at angular velocities of 60 and 300 deg·s^-1. Isokinetic data was analysed for measures of peak torque (PT), angle of peak torque (APT), functional range (FR), and angle specific torque (AST). Significant post-trial impairments were observed for measures of slow velocity PT₆₀ (6.6%) and AST₃₀₀ (12.5%). Further significant differences were observed 48 hours post-trial for PT₃₀₀ (10.7%) and PT₆₀ (12.8%) PT, APT₆₀ (~15°), and AST₃₀₀ (>13.6%). These data have implications for post exercise recovery monitoring and the prescription of recovery modalities and conditioning practices in the 2 days following match-play. The AST and APT responses highlight the importance of analysis of the entire strength-angle curve and at a range of angular velocities.

Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport

OBJECTIVE

To systematically review risk factors for hamstring strain injury (HSI).

DESIGN

Systematic review update.

DATA SOURCES

Database searches: (1) inception to 2011 (original), and (2) 2011 to December 2018 (update). Citation tracking, manual reference and ahead of press searches.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies presenting prospective data evaluating factors associated with the risk of index and/or recurrent HSI.

METHOD

Search result screening and risk of bias assessment. A best evidence synthesis for each factor and meta-analysis, where possible, to determine the association with risk of HSI.

RESULTS

The 78 studies captured 8,319 total HSIs, including 967 recurrences, in 71,324 athletes. Older age (standardised mean difference=1.6, p=0.002), any history of HSI (risk ratio (RR)=2.7, p<0.001), a recent HSI (RR=4.8, p<0.001), previous anterior cruciate ligament (ACL) injury (RR=1.7, p=0.002) and previous calf strain injury (RR=1.5, p<0.001) were significant risk factors for HSI. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with HSI risk. The risk of recurrent HSI is best evaluated using clinical data and not the MRI characteristics of the index injury.

SUMMARY/CONCLUSION

Older age and a history of HSI are the strongest risk factors for HSI. Future research may be directed towards exploring the interaction of risk factors and how these relationships fluctuate over time given the occurrence of index and recurrent HSI in sport is multifactorial.

Field-based evaluation of hip adductor and abductor strength in professional male ice hockey players: Reference values and influencing factors

OBJECTIVES

To provide reference values and examine the influence of hip/groin pain on hip adductor and abductor strength in professional male ice hockey players, by using a straightforward 5-min procedure.

DESIGN

Cross-sectional study.

SETTING

On-field assessment of hip/groin muscle strength with dynamometry, together with the concomitant level of hip/groin pain with a visual analogue scale.

PARTICIPANTS

Professional male ice hockey players competing in the Swiss National League (n = 187).

MAIN OUTCOME MEASURES

Hip abductor strength, hip adductor strength and hip adductor:abductor ratio.

RESULTS

Reference values by playing position (goalkeepers, defenders and forwards) are provided for asymptomatic athletes. Players with hip/groin pain during adduction displayed lower hip adductor strength (p = 0.001) and hip adductor:abductor ratio (p = 0.012) than their symptom-free peers.

CONCLUSIONS

The presence of hip/groin pain during adductor testing may contribute to selective hip adductor weakness, whose cause-effect relation with possible groin problems remains to be demonstrated.