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Ruiz, J.T.; Gaunaurd, I.A.; Best, T.M.; Feeley, D.; Mann, J.B.; Feigenbaum, L.A. Multi-Modal Approach to Mitigating Hamstring Injuries in Division I College Football Athletes. Encyclopedia. Available online: https://encyclopedia.pub/entry/57164 (accessed on 05 December 2025).
Ruiz JT, Gaunaurd IA, Best TM, Feeley D, Mann JB, Feigenbaum LA. Multi-Modal Approach to Mitigating Hamstring Injuries in Division I College Football Athletes. Encyclopedia. Available at: https://encyclopedia.pub/entry/57164. Accessed December 05, 2025.
Ruiz, Jeffrey T., Ignacio A. Gaunaurd, Thomas M. Best, David Feeley, J. Bryan Mann, Luis A. Feigenbaum. "Multi-Modal Approach to Mitigating Hamstring Injuries in Division I College Football Athletes" Encyclopedia, https://encyclopedia.pub/entry/57164 (accessed December 05, 2025).
Ruiz, J.T., Gaunaurd, I.A., Best, T.M., Feeley, D., Mann, J.B., & Feigenbaum, L.A. (2024, September 30). Multi-Modal Approach to Mitigating Hamstring Injuries in Division I College Football Athletes. In Encyclopedia. https://encyclopedia.pub/entry/57164
Ruiz, Jeffrey T., et al. "Multi-Modal Approach to Mitigating Hamstring Injuries in Division I College Football Athletes." Encyclopedia. Web. 30 September, 2024.
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Hamstring injuries (HSIs) are prevalent in sports that involve changes in direction, kicking, and sprinting. These injuries are a major cause of time lost from competition, practice, and training, as well as increased healthcare costs. In a Division I collegiate football program, the authors implemented a multifactorial approach that included repeated performance assessments, detailed data analysis, and a flexible strength and conditioning regimen. Over a three-year period, this resulted in no game time loss due to HSI. This model can be adapted and implemented across sports settings.
force plates
GPS
IMU
hamstring
injury mitigation
training load
Hamstring injuries (HSIs) are common in sports requiring kicking, high-speed running, and sprinting, and are a significant reason for time loss in training, practice, and competition [1][2][3][4][5][6][7]. In 2015, in an epidemiological review across 25 National Collegiate Athletic Association (NCAA) sports, there were a reported 1142 HSIs [3]. Most (72.3%) HSIs were due to non-contact mechanisms, with 12.6% being recurrent in nature, and 6.3% resulting in time loss of greater than 3 weeks [3]. Additionally, pre-season rates of HSI (5.00 per 10,000 AEs) were greater than the regular season/postseason rates (2.34 per 10,000 AEs; RR = 2.14; 95% CI, 1.90–2.40) [3]. Lastly, men’s football contributed the greatest proportion (35.3%) of HSIs among all NCAA sports [3]. A recent epidemiological study spanning several seasons of collegiate football found that HSI was one of the most commonly reported injuries, with increasing rates in the later years of the study [2]. HSI placed the second highest burden on National Football League (NFL) players, accounting for approximately 5800 player-days lost each season, with only anterior cruciate ligament tears having a higher burden, with approximately 12,400 total player-days lost per season [6]. The majority of HSIs occur in skilled-position players such as running backs, defensive backs, and wide receivers, as they have more athletic exposure to higher-speed deceleration actions and quick changes in direction during training, practice, and games [6].
In the NCAA and NFL, time loss due to HSI places a significant burden on the players, as it affects playing time, and subsequently could potentially affect name, image, and likeness rights at the collegiate level, as well current and future employment at the professional level. The nature of HSI for collegiate and NFL football players is multifactorial, with contributing factors including age, training loads, training stimulus, peak quadriceps torque, inter- and intralimb asymmetries, and previous injury [7][8].
Strikingly, the incidence of muscle injuries, like HSI, remains unchanged despite prospective interventional studies [4]. Ekstand et al. retrospectively reviewed 18 years of injury rates in European soccer and found that the incidence of muscle injury had not changed over time, either in training or in games [4]. This suggests that a priority for sports medicine clinicians and researchers is identifying risk-causative factors for HSI, the strategic implementation of objective measures to assess risk, and establishing injury reduction strategies that are continuous, actionable, and efficient, so that a reduction in the incidence and time loss due to HSI can be achieved.
The approach taken by the authors using an interdisciplinary framework of engaging athletic trainers, engineers, programmers, researchers, strength and conditioning coaches, sports board-certified physical therapists, and sports medicine physicians has been a successful in addressing HSI. This collaboration has included, but is not limited to, GPS-directed load analysis and management, a comprehensive strength and conditioning program, and the repeated administration of performance-based outcome measures with sensor metrics for injury profile risk assessment. This interdisciplinary approach resulted in no game time loss due to HSI over a consecutive three-year period. This approach was particularly successful when considering that an American collegiate football roster consists of 85 scholarship players, with an additional number of walk-ons, totaling between 100 and 120 players. Roster turnover occurs annually as a result of early departures for professional leagues, eligibility limitations, graduation, and transfers. The underlying premise of this approach was that continuous risk factor monitoring, load management, and an evidence-based strength and conditioning program reduced time loss due to HSI.
The intention of this work is to present a multi-modal approach to assessing and improving the management of HSI that can be implemented across a variety of settings. By combining practical low-cost tools, such as wearable sensors, smartphone-based apps, and common balance or strength tests, with more advanced technologies when available, this approach aims to provide accessible strategies for the management of HSI. The purpose of this manuscript is to provide a broad overview of HSI in terms of anatomy and injury description, theoretical models of injury severity mitigation, and a comprehensive rehabilitation model that was implemented. The model called for daily programmatic re-evaluation, which included risk factor identification and monitoring using various technologies, load analysis, management during the various training seasons, and the strategic implementation of strength and conditioning programs to maximize adaptability while preventing physiological plateauing.
References
- Al Attar, W.S.A.; Soomro, N.; Sinclair, P.J.; Pappas, E.; Sanders, R.H. Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis. Sports Med. 2017, 47, 907–916.
- Chandran, A.; Morris, S.N.; Powell, J.R.; Boltz, A.J.; Robison, H.J.; Collins, C.L. Epidemiology of Injuries in National Collegiate Athletic Association Men’s Football: 2014–2015 Through 2018–2019. J. Athl. Train. 2021, 56, 643–650.
- Dalton, S.L.; Kerr, Z.Y.; Dompier, T.P. Epidemiology of Hamstring Strains in 25 NCAA Sports in the 2009–2010 to 2013–2014 Academic Years. Am. J. Sports Med. 2015, 43, 2671–2679.
- Ekstrand, J.; Spreco, A.; Bengtsson, H.; Bahr, R. Injury Rates Decreased in Men’s Professional Football: An 18-Year Prospective Cohort Study of Almost 12,000 Injuries Sustained During 1.8 Million Hours of Play. Br. J. Sports Med. 2021, 55, 1084–1091.
- Green, B.; Bourne, M.N.; van Dyk, N.; Pizzari, T. 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. Br. J. Sports Med. 2020, 54, 1081–1088.
- Mack, C.D.; Kent, R.W.; Coughlin, M.J.; Shiue, K.Y.; Weiss, L.J.; Jastifer, J.R.; Wojtys, E.M.; Anderson, R.B. Incidence of Lower Extremity Injury in the National Football League: 2015 to 2018. Am. J. Sports Med. 2020, 48, 2287–2294.
- Poudel, B.; Pandey, S. Hamstring Injury; StatPearls Publishing: Treasure Island, FL, USA, 2021.
- Wing, C.E.; Turner, A.N.; Bishop, C.J. Importance of Strength and Power on Key Performance Indicators in Elite Youth Soccer. J. Strength Cond. Res. 2020, 34, 2006–2014.
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