Biologia

Physiotherapy 97 (2011) 91–99

Systematic review

Interventions for preventing hamstring injuries: a systematic review
Elliott F. Goldman a,∗ , Diana E. Jones b
a

Synergy Healthcare, 1–4 Stokers Buildings, Front Street East, Bedlington, Northumberland NE22 5DS, UK
School of Health, Community and Education Studies, Northumbria University, Newcastle upon Tyne, UK

b

AbstractObjectives To assess, by systematic review, the effects of interventions used for preventing hamstring injuries in physically active individuals.
Selection criteria Randomised or quasi-randomised trials of interventions for preventing hamstring injuries were included, as were
trials testing interventions for the prevention of lower limb injuries, provided that hamstring injuries were reported. Riskratios
(RRs) and 95% confidence intervals (95% CIs) were calculated for dichotomous variables and are reported for individual and pooled
data.
Main results Seven randomised controlled trials involving 1919 participants were included. Some trials were compromised by poor methodology, including lack of blinding and incomplete outcome data. Four trials, including 287 participants, examinedinterventions directly targeted
at preventing hamstring injuries. Three of these trials, which tested hamstring strengthening protocols, had contradictory findings, with one
small trial showing benefit, although the control rate of mainly minor hamstring injury was unusually high. The other two trials found no benefit, with a greater incidence of hamstring injury in the intervention group. One unpublished andunderpowered trial provided some evidence
that manual therapy may prevent lower limb muscle strain (RR 0.13, 95% CI 0.02 to 0.97), although the finding for hamstring injury did not
reach statistical significance (RR 0.21, 95% CI 0.03 to 1.66).
Conclusions There is insufficient evidence from randomised controlled trials to draw conclusions on the effectiveness of interventions used to
preventhamstring injuries in people participating in football or other high-risk activities. The findings for manual therapy need confirmation.
© 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Keywords: Hamstring; Injury; Prevention; Interventions; Muscle; Strain

Introduction
Hamstring injuries are commonplace in many mainstream
sports and occupations involvingphysical activity [1]. The
initial Football Association Audit of Injuries study [2] found
that 12% of all injuries reported over two seasons were
hamstring strains. The causes of hamstring injuries are complicated and multifactorial [3].
The hamstring muscle group comprises three separate muscles: semitendinosus, semimembranosus and biceps
femoris. Hamstring injury is defined by theanatomical site within the muscle that is affected, and injury
This paper is based on a Cochrane review published in The Cochrane
Library 2010, Issue 1 (see www.thecochranelibrary.com for information).
Cochrane reviews are regularly updated as new evidence emerges and in
response to feedback, and The Cochrane Library should be consulted for the
most recent version of the review.
∗ Correspondingauthor. Tel.: +44 1670 531 144; fax: +44 01670531144.
E-mail address: elliottfgoldman@hotmail.com (E.F. Goldman).

must be present in one or more of the component muscles.
Hamstrings are capable of producing large forces [4,5]
that are most beneficial during periods of increased activity
requiring bursts of speed or rapid acceleration and deceleration. Recent evidence has suggested that thehamstring
muscles are most vulnerable to injury in the late swing phase
of running, where there is a rapid change from eccentric to
concentric function, where the leg is decelerating to strike
the ground [6]. Indirect trauma can also result from an overstretch of the musculotendinous unit leading to a strain, tear
or avulsion [7]. It is generally claimed that strain injuries
most often occur...