In this blog, we outline and discuss the underlying injury patterns of muscle strains in sport. Our recent study, published in BJSM, included data from 21 studies reporting on real-world injury events by using video footage of 728 muscle strains [1].
Why is this study important?
Muscle strains are among the most common injuries in sports, and numerous preventive approaches have been developed to address them. Despite these efforts, incidence of muscle strains remains high [2]. With the growing availability of video footages capturing real-world injury events, videos analysis has emerged as a valuable research tool [3,4]. Examining the sequence of events, injury contact mechanisms, activities and joints kinematics underlying muscle strains may assist clinicians and practitioners in accurate diagnosis and treatment decision-making. Moreover, a clear understanding of underlying situational characteristics may help guide more targeted and effective preventive approaches for muscle strains [5].
How did the study go about this?
This study used a systematic literature review to identify 21 studies with 728 muscle strains detected on video.
What did the study find?
The study identified distinct injury patterns of muscle strains …
… for hamstring muscles (see A on infographic):
- Running/sprinting: Hamstring injuries are frequently seen during high-speed running or acceleration phases. Modelling studies and case reports identified the open-chain late swing phase as being most vulnerable to injury although video analysis is somewhat limited to detecting the exact phase during the gait cycle.
- Closed-chain lunging or stopping: The athlete performs a stopping manoeuvre. At the assumed time of injury, the knee joint is close to full extension, the hip joint is in a flexed position (i.e., lunging position). This pattern is often associated with indirect contact mechanisms and arises after perturbation, for example by an opponent.
- Open-chain kicking or reaching: These injury patterns are typically observed during kicking or reaching manoeuvres (e.g., towards the ball). Injury kinematics comprise a flexed hip joint combined with an extending knee joint movement.
… for adductor muscles (see B on infographic):
- Closed-chain change of direction: Changes of directions are common situational patterns for adductor muscle injuries. The athlete performs a change of direction opposite to the moving direction. At the assumed time of injury, the injured leg is abducted and externally rotated while the adductor muscles are simultaneously activated to perform the deceleration and change of direction manoeuvre.
- Open-chain kicking: This injury pattern shows similar injury kinematics (including hip abduction and external rotation) but is an open-chain injury pattern, e.g. due to the player’s intention of kicking a ball with the injury-sided leg.
- Closed-chain or open-chain reaching injury pattern: The athlete performs a reaching manoeuvre with the non-injured leg towards the ball. At the assumed time of injury, the adductor muscle-tendon unit of the injured leg is lengthening due to hip extension, hip abduction and hip external rotation.
… for calf muscles (see C on infographic)
- Closed-chain stepping back injury pattern: The athlete is setting off to take a run or accelerate (e.g., by performing a back-step manoeuvre). These manoeuvres are seen in running or football and are common in racquet sports (leading gastrocnemius muscle injury to be named ‘tennis leg’) or basketball. The underlying joint movements are ankle dorsiflexion and knee extension, thereby lengthening the calf muscle tendon unit. At the assumed time of injury, the knee is close to full extension, the ankle in >10° dorsiflexion and the foot in external rotation.
… for quadriceps muscles (see D on infographic)
- Open-chain kicking: A commonly observed injury kinematic of quadriceps injuries comprises a flexing hip joint and extending knee joint movement (e.g., kicking manoeuvre).
What are the key take-home points?
Most muscle strains are non-contact, and nearly half of all muscle injuries were related to running. The remaining injuries typically occurred during sport-specific manoeuvres that involve muscle-tendon unit lengthening with simultaneous muscle contraction. Findings from this study could be used for injury prevention based on the approach that injury risk can be reduced through exercise programmes that specifically target the underlying causes of injury (‘the problem is the solution’). Practically, preventive programs could incorporate high-speed running drills, sprinting, acceleration and deceleration exercises or muscle-specific programs (e.g., Nordic hamstring exercise for hamststrings, combined hip rotation/abduction/extension exercises for adductors).
References
[1] Finnern LS, Wilke J, Willwacher S, Pasanen K, Hollander K, Dalos D, Welsch GH, Krosshaug T, Edouard P, Gronwald T, Hoenig T. Qualitative and quantitative situational characteristics of muscle strains in sports: a systematic review and meta-analysis. Br J Sports Med. 2026 Feb 11;60(3):211-226. doi: 10.1136/bjsports-2025-110327.
[2] 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 Oct;55(19):1084-1091. doi: 10.1136/bjsports-2020-103159.
[3] Hoenig T, Rahlf L, Wilke J, Krauß I, Dalos D, Willwacher S, Mai P, Hollander K, Fohrmann D, Krosshaug T, Gronwald T. Appraising the Methodological Quality of Sports Injury Video Analysis Studies: The QA-SIVAS Scale. Sports Med. 2024 Jan;54(1):203-211. doi: 10.1007/s40279-023-01907-z.
[4] Palermi S, Vittadini F, Pedret C, et al. From the Field to the Screen: A Scoping Review of Video Analysis as a Tool for Understanding Thigh Muscle-Tendon Injuries in Football. Clin J Sport Med. 2025;35(6):675-686. doi:10.1097/JSM.0000000000001377
[5] Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med. 2005 Jun;39(6):324-9. doi: 10.1136/bjsm.2005.018341. PMID: 15911600; PMCID: PMC1725226.
Blog Author(s):
Tim Hoenig (1), Luca Sophie Finnern (1), Jan Wilke (2), Steffen Willwacher (3), Kati Pasanen (4), Karsten Hollander (5), Dimitris Dalos (1,5,6), Goetz H Welsch (1,6), Tron Krosshaug (7), Pascal Edouard (8,9), Thomas Gronwald (5)
Author Affiliations:
1 Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2 Department of Neuromotorics and Movement, University of Bayreuth, Bayreuth, Germany
3 Institute of Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
4 Integrative Neuromuscular Sport Performance Laboratory, University of Calgary, Calgary, Alberta, Canada
5 Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
6 UKE Athleticum – Center for Athletic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
7 Oslo Sports Trauma Research Center, Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
8 Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France
9 Department of Clinical and Exercise Physiology, Sports Medicine Unity, University Hospital of Saint-Etienne, Faculty of medicine, Saint-Etienne, France