Hamstring rate of torque development is more affected than maximal voluntary contraction after a professional soccer match

Acute effects of Nordic hamstring exercise on hip and knee joints proprioception

BACKGROUND AND OBJECTIVES

Nordic Hamstring Exercise (NHE) is one of the best exercises proposed for injury prevention of hamstring muscles. However, its effects on lower extremity proprioception are unclear. The aim of this study was to investigate the immediate effects of a single bout of NHE on hip and knee joints' proprioception.

METHODS

Forty collegiate male soccer players participated in this study with a mean age of 22.85 ± 1.82 years and were randomized into either control (n = 20) or experimental (n = 20) groups. Each subject participated in pre-test measurements in which hip and knee active joints position sense (JPS) were assessed in standing and lying tasks using the image-capturing method. The experimental group then performed three sets of NHE with 10 repetitions in each set, while the control group rested for 10 min. Paired and independent t-tests were used for calculating the differences within and between groups on SPSS software, respectively. The level of significance was P ≤ 0.05.

RESULTS

Hip JPS in the lying task and knee JPS in both of the standing and lying tasks were impaired significantly after performing a single bout of NHE (P ≤ 0.05). However, the effects of this exercise on hip JPS in the standing task were not significant (P ≥ 0.05).

CONCLUSIONS

NHE performing with three sets of 10 repetitions can significantly impair hip and knee JPS immediately after exercise and reduce the proprioception acuity of the lower limbs. It is recommended to perform this exercise at a time rather than before training or match sessions.

Explainable Machine Learning Techniques to Predict Muscle Injuries in Professional Soccer Players through Biomechanical Analysis

There is a significant risk of injury in sports and intense competition due to the demanding physical and psychological requirements. Hamstring strain injuries (HSIs) are the most prevalent type of injury among professional soccer players and are the leading cause of missed days in the sport. These injuries stem from a combination of factors, making it challenging to pinpoint the most crucial risk factors and their interactions, let alone find effective prevention strategies. Recently, there has been growing recognition of the potential of tools provided by artificial intelligence (AI). However, current studies primarily concentrate on enhancing the performance of complex machine learning models, often overlooking their explanatory capabilities. Consequently, medical teams have difficulty interpreting these models and are hesitant to trust them fully. In light of this, there is an increasing need for advanced injury detection and prediction models that can aid doctors in diagnosing or detecting injuries earlier and with greater accuracy. Accordingly, this study aims to identify the biomarkers of muscle injuries in professional soccer players through biomechanical analysis, employing several ML algorithms such as decision tree (DT) methods, discriminant methods, logistic regression, naive Bayes, support vector machine (SVM), K-nearest neighbor (KNN), ensemble methods, boosted and bagged trees, artificial neural networks (ANNs), and XGBoost. In particular, XGBoost is also used to obtain the most important features. The findings highlight that the variables that most effectively differentiate the groups and could serve as reliable predictors for injury prevention are the maximum muscle strength of the hamstrings and the stiffness of the same muscle. With regard to the 35 techniques employed, a precision of up to 78% was achieved with XGBoost, indicating that by considering scientific evidence, suggestions based on various data sources, and expert opinions, it is possible to attain good precision, thus enhancing the reliability of the results for doctors and trainers. Furthermore, the obtained results strongly align with the existing literature, although further specific studies about this sport are necessary to draw a definitive conclusion.

Preparing to Land: Hamstring Preactivation Is Higher in Females and Is Inhibited by Fatigue

The hamstring plays an important role in reducing loads born by the anterior cruciate ligament. As anterior cruciate ligament injuries occur rapidly after ground contact, how the hamstring is activated prior to landing can influence injury risk. The purpose was to determine sex-related differences in hamstring activation immediately before landing and the effect of fatigue on "preactivation." Twenty-four participants (13 males and 11 females, age = 24.3 [6.5] y, mass = 72.2 [19.3] kg, height = 169 [9.7] cm) participated in this study. Participants completed a drop-vertical jump protocol before and after a lower body fatigue protocol. Hamstring electromyography (EMG) amplitude at 5 periods prior to landing, peak vertical ground reactions forces (in newtons/body weight), rate of loading (in body weight/second), and landing error scoring system were measured. Females had higher EMG amplitude before and after fatigue (P < .024), with decreased EMG amplitude for both sexes after fatigue (P = .025). There was no change on vertical ground reaction force, rate of loading, or landing error scoring system. Males and females demonstrated similar landing performance before and after fatigue but have different hamstring neuromuscular coordination strategies. The acute reduction in hamstring EMG amplitude following fatigue may increase loading on the anterior cruciate ligament.

Hamstring Stiffness and Strength Responses to Repeated Sprints in Healthy Nonathletes and Soccer Players With Versus Without Previous Injury

BACKGROUND

The effect of 10 × 30 m repeated sprints on passive and active stiffness of semitendinosus (ST) and biceps femoris long head (BFlh), and knee flexor maximal voluntary isometric contraction (MVIC) and rate of force development (RFD), and whether athletes with previous hamstring injury have a different response, is unknown.

HYPOTHESIS

Repeated sprints would (1) increase BFlh stiffness and decrease ST stiffness and knee flexors MVIC and RFD in healthy participants; and (2) greater magnitude of response would be seen in athletes with previous hamstring injury.

STUDY DESIGN

Case series (experiment I) and case control (experiment II) study designs.

LEVEL OF EVIDENCE

Level 3.

METHODS

Healthy nonathletes attended 2 replicated sessions (experiment I, n = 18), while soccer players with (n = 38) and without (n = 67) previous hamstring injury attended 1 testing session (experiment II).

RESULTS

In both experiments, the knee flexors MVIC and RFD decreased after the sprints (P < 0.05). In experiment I, the ST and BFlh passive stiffness reduced after the sprints (P < 0.02), while a small BFlh active stiffness increase was noted (P = 0.02); however, no correlation was observed between the 2 testing sessions for the postsprint muscle stiffness responses (r = -0.07-0.44; P > 0.07). In experiment II, only an ST passive stiffness reduction was observed after the sprints (P < 0.01). No differences were noted between injured and noninjured lower limbs for any variable (P > 0.10).

CONCLUSION

Repeated sprints are likely to decrease the knee flexor's maximal and rapid strength, and to alter the hamstring stiffness in the nonathlete population. Previous hamstring injury does not apparently affect the footballer's hamstring functional and mechanical responses to repeated sprints.

CLINICAL RELEVANCE

The responses of hamstring stiffness and knee flexor strength to repeated sprints are unlikely to be associated with hamstring injury.

The Addition of Sprint Interval Training to Field Lacrosse Training Increases Rate of Torque Development and Contractile Impulse in Female High School Field Lacrosse Players

Field lacrosse requires sudden directional changes and rapid acceleration/deceleration. The capacity to perform these skills is dependent on explosive muscle force production. Limited research exists on the potential of sprint interval training (SIT) to impact explosive muscle force production in field lacrosse players. The purpose of this study is to examine SIT, concurrent to field-lacrosse-specific training, on the rate of torque development (RTD), contractile impulse, and muscle function in female high school field lacrosse players (n = 12; 16 ± 1 yrs.). SIT was performed three times per week, concurrent to field-lacrosse-specific training, for 12 weeks. Right lower-limb muscle performance was assessed pre-, mid-, and post-SIT training via isometric and isokinetic concentric knee extensor contractions. Outcomes included RTD (Nm·s^-1), contractile impulse (Nm·s), and peak torque (Nm). RTD for the first 50 ms of contraction improved by 42% by midseason and remained elevated at postseason (p = 0.004, effect size (ES) = -577.3 to 66.5). Contractile impulse demonstrated a training effect across 0-50 ms (42%, p = 0.004, ES = -1.4 to 0.4), 0-100 ms (33%, p = 0.018, ES = 3.1 to 0.9), and 0-200 ms (22%, p = 0.031, ES = -7.8 to 1.6). Isometric (0 rad·s^-1) and concentric (3.1 rad·s^-1) strength increased by 20% (p = 0.002, ES = -60.8 to -20.8) and 9% (p = 0.038, ES = -18.2 to 0.0) from SIT and field-lacrosse-specific training, respectively (p < 0.05). SIT, concurrent to field-lacrosse-specific training, enhanced lower-limb skeletal muscle performance, which may enable greater sport-specific gains.

Effects of Moderate-to-Heavy Sled Training Using Different Magnitudes of Velocity Loss in Professional Soccer Players

ABSTRACT

Grazioli, R, Loturco, I, Lopez, P, Setuain, I, Goulart, J, Veeck, F, Inácio, M, Izquierdo, M, Pinto, RS, and Cadore, EL. Effects of moderate-to-heavy sled training using different magnitudes of velocity loss in professional soccer players. J Strength Cond Res 37(3): 629-635, 2023-This study investigated the effects of a 11-week moderate-to-heavy sled training intervention with different magnitudes of velocity loss on sprint and jump performance, mechanical muscle function, and body composition in professional soccer players. Seventeen players (age 25.8 ± 4.3 years; height 180.0 ± 8.6 cm; mass 77.7 ± 9.7 kg) were randomly allocated into 2 groups, based on different magnitudes of velocity loss: 10% of velocity decrease (G10, n = 8) and 20% of velocity decrease (G20, n = 9). The velocity-based sled training consisted of 20-m resisted sprints with a progressive loading increase from 45 to 65% of body-mass throughout the intervention. Pre-intervention and postintervention sprint and jump performance, hamstring and quadriceps peak torque and isometric rate of torque development, and lower-limb lean mass measured by dual X-ray absorptiometry were assessed and compared. Two-way repeated measures analysis of variance revealed a significant time-effect for decreases in 10- and 20-m sprint times ( p = 0.018 and p = 0.033, respectively), but without a time-group interaction. The G10 showed greater beneficial effects than G20 for both 10-m (-5.5 ± 3.3%, magnitude-based inference [MBI]: possibly vs. -1.7 ± 5.9%, MBI: possibly trivial) and 20-m (-2.5 ± 2.1%, MBI: possibly vs. -1.4 ± 3.7%, MBI: likely trivial) sprint times. Moreover, there was a significant time effect for countermovement jump height and quadriceps isometric peak torque, which decreased significantly after training ( p = 0.019 and p = 0.010, respectively), with no within-group effect of time vs. group interaction for these respective outcomes. The novel velocity-based sled model proposed here, especially under lower magnitudes of velocity loss, was able to significantly improve linear sprint performance in professional soccer players.

Effects of a Football Simulated Exercise on Injury Risk Factors for Anterior Cruciate Ligament (ACL) Injury in Amateur Female Players

Females are more at risk of Anterior Cruciate Ligament (ACL) injuries than males; however, there is limited literature on neuromuscular risk factors such as angle-specific hamstring/quadriceps functional strength ratios (H_ecc/Q_con) and rate of torque development (RTD) in female footballers. The aim of this study was to investigate the effects of fatigue on these neuromuscular risk factors. Thirty-three amateur players (20.3 ± 2.0 years old, 1.67 ± 9.31 m, 63.4 ±8.1 kg, 23.6 ± 5.7% body fat) performed strength assessments of the quadriceps (concentrically, Q_con) and hamstrings (eccentrically, H_ecc) on both legs on an isokinetic dynamometer, before and immediately after a football-specific exercise. Results showed significantly lower peak H_ecc (-15.1 to -15.5%), peak H_ecc/Q_con (-8.8 to -12.9%) and RTD (-14.0 to -17.0%) for hamstring eccentric contractions after fatigue in the dominant and non-dominant legs. Furthermore, significant decreases in H_ecc/Q_con were observed at 10° only in the dominant leg (-15.5%), and at 10°, 20° and 30° in the non-dominant leg (-15.1 to -21.8%). These results suggest a reduced capacity of the hamstrings to stabilise the knee joint with fatigue. Unlike results previously shown on men, the non-dominant leg seemed more affected, highlighting the need to consider specific prevention measures in females.

Alterations in biceps femoris long head fascicle length, Eccentric hamstring strength qualities and single-leg hop distance throughout the ninety minutes of TSAFT90 simulated football match

INTRODUCTION

Football matches show higher hamstring strain injuries (HSIs) than football training. The occurrence of HSIs increases in the last fifteen minutes of both halves of football matches and shows an incremental trend towards the end of the ninety minutes.

OBJECTIVES

This study aimed to examine football-specific fatigue-induced alterations in risk factors of the HSIs, including biceps femoris long head fascicle length via ultrasonography (BFlh FL), single-leg hop distance, hamstrings' maximal eccentric strength, and single-leg hamstring bridge test (SLHB) performance.

METHODOLOGY

During ninety minutes of the TSAFT90 football simulation, the BFlh FL and single-leg hop distance were measured three times (before, at half-time and after 90 minutes of simulated match-play), and maximal hamstrings eccentric strength and SLHB test scores were recorded twice (before and after simulated match-play) for both legs in physically active participants (n = 15).

RESULTS

Maximal eccentric hamstrings' strength (dominant leg (D): p < 0.001, Hedges' (adjusted) g effect size = -0.969; non-dominant leg (ND): p < 0.001, g = -0.929) and the SLHB performance (D: p < 0.001, g = -1.249; ND: p < 0.001, g = -1.108) showed large decrements immediately after the TSAFT90 intervention. There were no significant alterations in the BFlh FL, and the single-leg hop distance.

CONCLUSIONS

Maximal eccentric strength and the SLHB performance of hamstrings are reduced after 90 minutes of simulated football match-play. Practitioners may consider focusing on improving eccentric strength and the SLHB performance. Future studies should examine alterations in the BFlh fascicles' dynamic lengthening and shortening ability during a football match.

High-volume intermittent maximal intensity isometric exercise caused great stress, although central motor fatigue did not occur

To establish whether very high-volume, high-intensity isometric exercise causes stress to the body and how it affects peripheral and central fatigue. Nineteen physically active healthy male subjects (21.2 ± 1.7 years; height – 1.82 ± 0.41 m, body weight – 79.9 ± 4.5 kg; body mass index – 24.3 ± 2.1 kg/m2) volunteered to participate in this study. They participated in two experiments 3–5 days apart. Each experiment comprised six series of 60-s maximum voluntary contraction (MVC) force (knee extension) achieved as rapidly as possible. This very high-volume, high-intensity exercise (HVHIE) was performed at different quadriceps muscle lengths: short (SL) and long (LL). The MVC and the electrically stimulated contractile properties of the muscle were measured prior to HVHIE, immediately after and 3 min after each series, and at 3, 10, and 30 min after the end of HVHIE. We found that HVHIE caused high levels of stress (cortisol levels approximately doubled, heart rate and the root mean square successive difference of interval (RMSSD) decreased by about 75%); lactate increased to 8–11 mmol/L, voluntary and 100 Hz stimulation-induced force (recorded immediately after HVHIE) decreased by 55% at LL and 40% at SL. However, the central activation ratio during MVC did not change after either exercise. Isometric HVHIE performed using one leg caused high levels of stress (RMSSD decreased, cortisol increased after HVHIE equally at SL and LL; La increased more while exercising at LL) and the voluntary and electrostimulation-induced muscle force significantly decreased, but muscle central activation during MVC did not decrease.

Associations between Hamstring Fatigue and Sprint Kinematics during a Simulated Football (Soccer) Match

PURPOSE

Neuromuscular fatigue is considered to be important in the etiology of hamstring strain injuries in football. Fatigue is assumed to lead to decreases in hamstring contractile strength and changes in sprinting kinematics, which would increase hamstring strain injury risk. Therefore, the aim was to examine the effects of football-specific fatigue on hamstring maximal voluntary torque (MVT) and rate of torque development (RTD), in relation to alterations in sprinting kinematics.

METHODS

Ten amateur football players executed a 90-minute running based football match simulation. Before and after every 15 minutes of simulated play MVT and RTD of the hamstrings were obtained in addition to the performance and lower body kinematics during a 20 m maximal sprint. Linear mixed models and repeated measurement correlations were used to assess changes over time and common within participant associations between hamstring contractile properties and peak knee extension during the final part of the swing phase, peak hip flexion, peak combined knee extension and hip flexion, and peak joint angular velocities, respectively.

RESULTS

Hamstring MVT and sprint performance were significantly reduced by 7.5% and 14.3% at the end of the football match simulation. Unexpectedly, there were no indications for reductions in RTD when MVT-decrease was considered. Decreases in hamstring MVT were significantly correlated to decreases in peak knee angle (R = 0.342) and to increases in the peak combined angle (R = -0.251).

CONCLUSIONS

During a football match simulation, maximal voluntary isometric hamstring torque declines. This decline is related to greater peak knee extension and peak combined angle during sprint running, which indicates a reduced capacity of the hamstrings to decelerate the lower leg during sprint running with fatigue.

Rate of Force Development as an Indicator of Neuromuscular Fatigue: A Scoping Review

Because rate of force development (RFD) is an emerging outcome measure for the assessment of neuromuscular function in unfatigued conditions, and it represents a valid alternative/complement to the classical evaluation of pure maximal strength, this scoping review aimed to map the available evidence regarding RFD as an indicator of neuromuscular fatigue. Thus, following a general overview of the main studies published on this topic, we arbitrarily compared the amount of neuromuscular fatigue between the “gold standard” measure (maximal voluntary force, MVF) and peak, early (≤100 ms) and late (>100 ms) RFD. Seventy full-text articles were included in the review. The most-common fatiguing exercises were resistance exercises (37% of the studies), endurance exercises/locomotor activities (23%), isokinetic contractions (17%), and simulated/real sport situations (13%). The most widely tested tasks were knee extension (60%) and plantar flexion (10%). The reason (i.e., rationale) for evaluating RFD was lacking in 36% of the studies. On average, the amount of fatigue for MVF (−19%) was comparable to late RFD (−19%) but lower compared to both peak RFD (−25%) and early RFD (−23%). Even if the rationale for evaluating RFD in the fatigued state was often lacking and the specificity between test task and fatiguing exercise characteristics was not always respected in the included studies, RFD seems to be a valid indicator of neuromuscular fatigue. Based on our arbitrary analyses, peak RFD and early phase RFD appear even to be more sensitive to quantify neuromuscular fatigue than MVF and late phase RFD.

Acute Hamstring Injury Prevention Programs in Eleven-a-Side Football Players Based on Physical Exercises: Systematic Review

(1) Objective: To analyze the exercise programs used to prevent of acute hamstring injuries in eleven-a-side football players, and their effectiveness. (2) Methods: A systematic review (PRISMA) was conducted (2008-2020), including RCTs, that exclusively used physical exercises as a prevention method. (3) Results: Ten studies were selected considering 14 interventions, including nine different programs: FIFA11+ (11+), Harmoknee, eccentric Nordic Hamstring Exercise (NHE) exclusively, with eccentric exercises, with stretching or with proprioceptive, New Warm-up Program (NWP), Bounding Exercise Program (BEP), the only one with no positive results, and proprioceptive exercises. Incidence of injuries and strength were the most considered variables, both with favorable evidences. Programs including NHE, which assessed injury incidence, were always effective. The 11+ program was effective in injury incidence and strength; NWP was effective in balance, stability, and strength. (4) Conclusions: The exercise programs discussed were effective to prevent acute hamstring injuries in football players except BEP and partially Harmoknee. Exercises mostly used to reduce the risk of hamstring injuries are those of eccentric force due to its functionality, especially NHE. Only concentric contractions and isometric contractions obtained significant favorable results. The most complete and promising programs were 11+ (in injury incidence and strength) and NWP (strength, balance, and stability). NWP was the best in strength.

Muscle Damage and Performance after Single and Multiple Simulated Matches in University Elite Female Soccer Players

The present study aimed to compare changes in muscle damage and performance parameters after playing single versus multiple soccer matches to examine fixture congestion effects on performance. Twelve elite female university soccer players performed single, three and six consecutive 90-min bouts of the Loughborough Intermittent Shuttle Test (LIST) with ≥12-weeks between conditions in a pseudo-randomized order. Heart rate, blood lactate, rating of perceived exertion and covering distance in each LIST were examined. Changes in several types of muscle damage (e.g., maximal voluntary isometric torque of the knee extensors: MVC-KE) and performance measures (e.g., Yo-Yo Intermittent Recovery Test level 1: YYIR1) were taken before each LIST, 1 h, and 1–5 d after the last LIST. The total distance covered during the LIST was shorter (p < 0.05) in the 2nd–3rd, or 2nd–6th LISTs when compared with the 1st LIST. Changes (p < 0.05) in all measures were observed after the LIST, and the greatest changes were observed after the six than after the three LISTs followed by one LIST (e.g., largest changes in MVC-KE: −26 > −20 > −14%; YYIR1: −31 > −26 > −11%). Many of the variables did not recover to the baseline for 5 d after six LISTs. These suggest that fixture congestion induces greater muscle damage and performance decline than a single match.

Influence of Fatigue on the Rapid Hamstring/Quadriceps Force Capacity in Soccer Players

The objective of this study was to examine the effect of fatigue on maximal and rapid force capacities and muscular activation of the knee extensors and flexors. Seventeen professional soccer players volunteered to participate in this study. Peak torque (T_peak) and rate of torque development (RTD) of knee flexor (90°. s^-1, -30°. s^-1) and extensor (90°. s^-1) muscles were measured before and after fatigue (i.e., 30 maximal knee extension and flexion repetitions at 180°s^-1) performed on an isokinetic dynamometer. Hamstring to quadriceps peak strength and RTD ratios were calculated. Besides, using surface EMG, the mean level of activation (RMS_mean), Rate of EMG Rise (RER), and EMG Frequency-Time maps were measured on quadriceps and hamstring muscles. Following fatigue, T_peak, RTD, RER declined significantly in the two muscle groups (all p < 0.05) without modification of RMS_mean. No decrease in conventional and functional H/Q ratios was observed after fatigue except for a significant increase in the H _ecc30/Q _con180 ratios (1.03 ± 0.19 vs. 1.36 ± 0.33, p < 0.001). Besides, the RTD H/Q ratios decreased significantly after fatigue, and the statistical parametric mapping analysis (SPM) performed on the EMG/angle curves, and EMG Frequency-Time maps showed that fatigue strongly influenced the muscle activation during the first 100 ms of the movement, following the higher EMG frequency component shift toward the lower frequency component. Our results show that the reduction of RTD and RER during the first 100 ms of the contraction after fatigue exercise makes more sense than any H/Q ratio modification in understanding injury risk in soccer players.

High-velocity elastic-band training improves hamstring muscle activation and strength in basketball players

BACKGROUND

The aim of this study was use surface EMG activity to assess changes in co-activation of knee flexors and extensors muscle groups during elastic-band exercise after 5 weeks of high-velocity elastic-band training in basketball players.

METHODS

College male basketball players (N.=18) were randomly divided into one of two groups: 1) the elastic-band training group performed low-load and high-velocity - lying prone - hamstring curls training three times per week; 2) the control group did not do any training. Pre- and post- training assessment included concentric knee extension and flexion at 60°/s and 240°/s, and the frequency of knee flexion and extension with elastic bands in the prone position. The EMG of the rectus femoris, semitendinosus muscles and the long head of the biceps femoris were assessed during these activities, and 30-m sprint running speed was measured from a stationary start and a running start.

RESULTS

It was shown that high-velocity elastic-band training was 1) feasible, 2) increased movement velocity and 3) muscle strength, 4) altered neural control such that excessive lengthening of the hamstring muscle, and hence strain-injuries, may be prevented and 5) improved sprint performance in basketball players.

CONCLUSIONS

These results suggest that high-velocity elastic-band training may be a tool to prevent hamstring strain-injuries in basketball players.

Effects of Different Combinations of Concentric and Eccentric Resistance Training Programs on Traditional and Alternative Hamstrings-to-Quadriceps Ratios

Resistance training is often recommended for combined increases in traditional and alternative hamstrings-to-quadriceps (H:Q) ratios in order to reduce knee strength imbalance and associated hamstrings and knee ligament injury risk. The aim of this study was to investigate the effect of different concentric and eccentric resistance training programs on traditional and alternative H:Q ratios. Forty male volunteers were assigned to one of 4 groups: concentric quadriceps and concentric hamstrings (CON/CON, n = 10), eccentric quadriceps and eccentric hamstrings (ECC/ECC, n = 10), concentric quadriceps and eccentric hamstrings (CON/ECC, n = 10), or no training (control (CNTRL), n = 10). Traditional conventional (CR) and functional (FR), alternative rate of torque development (RTD), muscle size (MS), and muscle activation (MA) H:Q ratios were measured before and after six weeks of unilateral nondominant knee extension-flexion resistance training performed on an isokinetic dynamometer. The ECC/ECC training significantly increased FR (pre = 0.75 ± 0.11; post = 0.85 ± 0.15), whereas the lack of training (CNTRL) decreased the RTD H:Q ratio (pre = 1.10 ± 0.67; post = 0.73 ± 0.33). There were no differences between groups for the other traditional and alternative ratios following resistance training protocols. These findings suggest eccentric exercise for quadriceps and hamstrings as the most beneficial training program for inducing increases in the traditional FR. However, different resistance training strategies may be needed to also elicit increases in the alternative RTD, MS, and MA H:Q ratios for fully restoring muscle balance and reducing potential hamstrings and knee ligament injury risk.