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João Breno Ribeiro-Alvares, Maurício Pinto Dornelles, Carolina Gassen Fritsch, Felipe Xavier de Lima-e-Silva, Thales Menezes Medeiros, Lucas Severo-Silveira, Vanessa Bernardes Marques and Bruno Manfredini Baroni

Hamstring strain injury (HSI) is the most prevalent injury in football (soccer), representing 12% of all injuries in high-level players. 1 A professional team can expect 5 to 6 HSIs per season, 2 and these injuries typically have persistent symptoms 3 and high recurrence rates. 2 Players “off

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Ian B. Shadle and Paul A. Cacolice

Clinical Scenario:

Hamstring strains are a common sport-related injury, which may limit athletic performance for an extended period of time. These injuries are common in the soccer setting. As such, it is important to determine an appropriate prevention program to minimize the risk of such an injury for these athletes. Eccentric hamstring training may be an effective and practical hamstring strain prevention strategy.

Clinical Question:

What is the effect of eccentric exercises on hamstring strain prevention in adult male soccer players?

Summary of Key Findings:

Current literature was searched for studies of level 2 evidence or higher that investigated the effect of eccentric exercises in preventing hamstring strains in adult male soccer players. Three articles returned from the literature search met the inclusion criteria. A fourth article looked at differences in strength gains between eccentric and concentric hamstring strengthening exercises, but did not record hamstring strain incidence. A fifth article, a systematic review, met all the criteria except for the correct population. Of the 3 studies, 2 were randomized control trails and 1 was a cohort study.

Clinical Bottom Line:

There is robust supportive evidence that eccentric hamstring exercises can prevent a hamstring injury to an elite adult male soccer player. Therefore, it is recommended that athletic trainers and other sports medicine providers evaluate current practices relating to reducing hamstring strains and consider implementing eccentric exercise based prevention programs.

Strength of Recommendation:

All evidence was attained from articles with a level of evidence 2b or higher, based on the Center for Evidence-Based Medicine (CEBM) criteria, stating that eccentric exercises can decrease hamstring strains.

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Timothy F. Tyler, Brandon M. Schmitt, Stephen J. Nicholas and Malachy P. McHugh


Hamstring-strain injuries have a high recurrence rate.


To determine if a protocol emphasizing eccentric strength training with the hamstrings in a lengthened position resulted in a low recurrence rate.


Longitudinal cohort study.


Sports-medicine physical therapy clinic.


Fifty athletes with hamstring-strain injury (age 36 ± 16 y; 30 men, 20 women; 3 G1, 43 G2, 4 G3; 25 recurrent injuries) followed a 3-phase rehabilitation protocol emphasizing eccentric strengthening with the hamstrings in a lengthened position.

Main Outcome Measures:

Injury recurrence; isometric hamstring strength at 80°, 60°, 40°, and 20° knee flexion in sitting with the thigh flexed to 40° above the horizontal and the seat back at 90° to the horizontal (strength tested before return to sport).


Four of the 50 athletes sustained reinjuries between 3 and 12 mo after return to sport (8% recurrence rate). The other 42 athletes had not sustained a reinjury at an average of 24 ± 12 mo after return to sport. Eight noncompliant athletes did not complete the rehabilitation and returned to sport before initiating eccentric strengthening in the lengthened state. All 4 reinjuries occurred in these noncompliant athletes. At time of return to sport, compliant athletes had full restoration of strength while noncompliant athletes had significant hamstring weakness, which was progressively worse at longer muscle lengths (compliance × side × angle P = .006; involved vs noninvolved at 20°, compliant 7% stronger, noncompliant 43% weaker).


Compliance with rehabilitation emphasizing eccentric strengthening with the hamstrings in a lengthened position resulted in no reinjuries.

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Column-editor : Jeff G. Konin

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Michael D. Rosenthal and Danny J. McMillian

Column-editor : Jeff Allen

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Michael D. Rosenthal and Danny J. McMillian

Column-editor : Jeff Allen

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Ram Haddas, Steven F. Sawyer, Phillip S. Sizer, Toby Brooks, Ming-Chien Chyu and C. Roger James


Recurrent lower back pain (rLBP) and neuromuscular fatigue are independently thought to increase the risk of lower extremity (LE) injury. Volitional preemptive abdominal contraction (VPAC) is thought to improve lumbar spine and pelvis control in individuals with rLBP. The effects of VPAC on fatigued landing performance in individuals with rLBP are unknown.


To determine the effects of VPAC and LE fatigue on landing performance in a rLBP population.


Cross-sectional pretest-posttest cohort control design.


A clinical biomechanics laboratory.


32 rLBP (age 21.2 ± 2.7 y) but without current symptoms and 33 healthy (age 20.9 ± 2.3 y) subjects.


(i) Volitional preemptive abdominal contraction using abdominal bracing and (ii) fatigue using submaximal free-weight squat protocol with 15% body weight until task failure was achieved.

Main Outcome Measure(s):

Knee and ankle angles, moments, electromyographic measurements from semitendinosus and vastus medialis muscles, and ground reaction force (GRF) were collected during 0.30 m drop-jump landings.


The VPAC resulted in significantly earlier muscle onsets across all muscles with and without fatigue in both groups (mean ± SD, 0.063 ± 0.016 s earlier; P ≤ .001). Fatigue significantly delayed semitendinosus muscle onsets (0.033 ± 0.024 s later; P ≤ .001), decreased GRF (P ≤ .001), and altered landing kinematics in a variety of ways. The rLBP group exhibited delayed semitendinosus and vastus medialis muscle onsets (0.031 ± 0.028 s later; P ≤ .001) and 1.8° less knee flexion at initial contact (P ≤ .008).


The VPAC decreases some of the detrimental effects of fatigue on landing biomechanics and thus may reduce LE injury risk in a rLBP population.

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Sergio Jiménez-Rubio, Archit Navandar, Jesús Rivilla-García, Víctor Paredes-Hernández and Miguel-Ángel Gómez-Ruano

can help interpret the actual physical exertion of the player and give meaningful information about the adequacy of workloads in training and competition. Different authors have validated RTP criteria following hamstring strain injuries, 21 but no one has used performance parameters from competition

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Sergio Jiménez-Rubio, Archit Navandar, Jesús Rivilla-García and Victor Paredes-Hernández

complex contributed to 37% of all noncontact injuries, with a recurrence rate between 13% and 17%. 3 On an average, when a player suffers a hamstring strain injury, he/she missed 18 days and 3 to 3.5 matches, 4 with the number of days of layoff increasing based on injury severity. 5 Sprinting and

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Mary Lynn Manduca and Stephen J. Straub

Clinical Scenario Muscle injuries account for 30% to 50% of all athletic injuries, 1 with hamstring strains accounting for 15%. 2 Hamstring injuries are particularly common in endurance sports, soccer, rugby, hockey, football, and track—which has been attributed to the explosive and decelerating