Jan Ekstrand, Peter Ueblacker, Wart van Zoest, Raymond Verheijen, Bruno Vanhecke, Maikel van Wijk, Håkan Bengtsson. Risk factors for hamstring muscle injury in male elite football: Medical expert experience and conclusions from 15 European Champions League clubs.
The full article can be found here
Tell us more about yourself and the author team.
I, the first author Jan Ekstrand, usually introduce myself as a football doctor. I have worked with football and football medicine all my life and wrote my Ph.D. thesis about “Soccer injuries and their prevention” in the early 80ties. I even had a football coach education in Sweden at that time. Later, I served as team doctor for the Swedish male national football team during the 80 ties and 90ties (I do have a bronze medal from the WC 1994 in the US). I was then appointed as a member of the UEFA Medical Committee and was asked to be the lead expert of the UEFA Elite Club injury studies starting in 1991.
Concerning the author team, Håkan Bengtsson and I belong to the ¨Football Research Group (FRG)¨ working close to and with the support of UEFA. In this study, we were supported by an experienced coach and coach educator, Mr. Raymond Verheijen but also by 4 team doctors from European elite teams, Prof Peter Ueblacker at Bayern Munich, Dr. Wart van Zoest at PSV Eindhoven, Dr. Bruno Vanhecke at Bruges and Dr. Maikel van Wijk from Ajax.
What is the story behind your study?
What we have found in our time trend studies is that muscle injuries are the big problem at the male elite level and the proportion of muscle injuries is increasing over the years. Actually, during the latest season /2021-22) muscle injuries constituted over 50% of all injuries among muscle injuries. Hamstring injuries are the most common and the consequence of absences due to hamstring injuries is a major problem for clubs and players at the male elite level.
During the recent eight seasons (2014/15 to 2021/22), the incidence and burden of hamstring injuries during training and match play have increased significantly, and the proportion of injuries diagnosed as hamstring injuries increased from 12% in 2001/02 to 24% in 2021/22. Various risk factors for hamstring injuries have been proposed.
The aim of this study was to assess the educated opinions and current knowledge on preventable risk factors for hamstring injuries based on information from fifteen Chief Medical Officers (CMOs) at European male elite clubs. A second aim was to compare the opinion of risk factors between teams that had lower than average hamstring injury rates with teams that had higher than average hamstring injury rates during seasons 2019/20 and 2020/21.
In your own words, what did you find?
Several risk factors may contribute to hamstring injuries. The club doctors suggested 21 modifiable risk factors. The majority were extrinsic in nature, associated with the coaching staff, team, or club rather than players themselves.
“Lack of communication between medical staff and coaching staff” had the highest average importance followed by “Lack of regular exposure to high-speed football during training sessions”. The teams that had higher than average hamstring injury rates perceived the player factors fatigue and wellness as more important than the teams that had lower than average hamstring injury rates.
Most of the risk factors proposed are associated with factors controlled by coaches such as excessive training, too many matches, and overloading with subsequent increases in fatigue or poor training leading to undertraining and muscular dysfunction.
What was the main challenge you faced in your study?
The challenge in these types of studies is always to get information and data for those invited to participate. However, since UEFA and FRG have carried out these injury studies for 20 years, we have very good contact with the participating teams and their medical staff. Several teams have sent us data every month for 20 years. They don’t do that to be nice to UEFA or FRG, they do it because they get a lot of information back that they can compare with other teams and evaluate their strength and weaknesses on the injury side. Creating a win-win situation or participating teams and UEFA and the research group has been our philosophy with the aim of receiving feedback and data
If there is one take-home message from your study, what would that be?
This study highlights the responsibility of the club and coaching staff in reducing the risk of hamstring injury in professional football. A better understanding of the importance of communication between the medical and coaching staff and improvement in load management and training content during the football season could potentially lead to a fall in the rate of hamstring injuries amongst professional players.
The experience from studies and our contacts with clubs is that the coaches are the most important persons for the injury situation in an elite club, medical staff can only realize suggestions for preventative training implementation across the whole team if the coach and coaching staffs are positive about the suggestions. Coaches are key persons, we need the coaches on-board injury prevention train.