Series: Latest on Hamstring Strain Injuries Part 2

Why We Can’t Predict a Hamstring Strain.

Every preseason, somewhere, a physio or S&C coach lines a squad up in front of a dynamometer, tests hamstring strength, ranks the results, and flags the weakest few as “high risk.” It feels rigorous. It feels like exactly the kind of thing screening should look like. And the uncomfortable truth, backed by some fairly large studies now, is that it doesn’t actually work.

The most convincing of these followed 367 professional footballers across more than 500 player-seasons, measuring how quickly they could generate torque in their hamstrings during standard preseason testing. Over that time there were 65 hamstring strains. When the researchers went back and compared the injured players’ preseason numbers to everyone else’s, there was essentially nothing there — no meaningful difference in how fast they produced force, no meaningful difference in muscle activation timing. The same story turns up again when you look at simple eccentric strength testing, or the classic hamstring to quadriceps ratio that’s been a screening staple for decades. None of them reliably separate the athletes who go on to strain a hamstring from the ones who don’t.

This tends to land awkwardly, because we know these same measures are genuinely useful in other contexts. Rate of force development is a legitimately good tool for tracking whether a previously injured hamstring has actually recovered its explosive capacity, and it’s sensitive enough to pick up fatigue after a hard match or a heavy sprint session. It’s just not a crystal ball. A test can be a perfectly good measure of where an athlete currently sits, without being any good at forecasting where they’re headed.

What does seem to carry more signal is something more dynamic: how an athlete is actually producing force during sprinting itself, particularly the horizontal component of that force, tracked across a season rather than measured once in preseason and filed away. Drops in that capacity through the season have shown a closer relationship to strain risk in the weeks that follow. It makes intuitive sense when you think about it — a single test in November tells you very little about the accumulated fatigue, the change in training load, or the technical breakdown that’s building in an athlete’s sprint mechanics come June.

The other consistent finding across this research is a fairly humbling one: the strongest predictors of a future hamstring strain remain the boring, non-modifiable ones — being older, and having strained it before. That’s not a satisfying answer for anyone wanting a slick screening protocol, but it’s an honest one.

None of this means we should throw out strength and RFD testing. It means we should be honest about what it’s for. It’s a rehabilitation tool, a return to play tool, and a fatigue monitoring tool. It is not, on its own, a crystal ball for who gets injured next. The moment we start using it as one, we risk giving athletes and coaches false reassurance on the ones who test well, and unnecessary alarm over the ones who don’t.

References

B., S. M. (2023). A review of the epidemiology of CrossFit-related injuries. American Journal of Health, Medicine and Nursing Practice. https://doi.org/10.47672/ajhmn.1469

Bernstorff, M., Schumann, N., Maai, N., Schildhauer, T., & Königshausen, M. (2021). An analysis of sport-specific pain symptoms through inter-individual training differences in CrossFit. Sports, 9. https://doi.org/10.3390/sports9050068

Elmahgoub, S., Debes, W. A., Mabrouk, M. I., Melczer, C., Bekheet, A. B., Affan, I., & Ács, P. (2026). Patterns, predictors, and mechanisms of injury in Libyan CrossFit athletes: a cross-sectional analysis. International Journal of Environmental Research and Public Health, 23. https://doi.org/10.3390/ijerph23030286

Feito, Y., Burrows, E. K., Tabb, L., & Ciesielka, K.-A. (2020). Breaking the myths of competition: a cross-sectional analysis of injuries among CrossFit trained participants. BMJ Open Sport & Exercise Medicine, 6. https://doi.org/10.1136/bmjsem-2020-000750

Felippe Martinez, P. (2024). Sports injury prevalence and associated factors in functional fitness: a cross-sectional study. Human Movement. https://doi.org/10.5114/hm/190500

Fernandes, J. (2021). Incidence of CrossFit related injuries: a meta-analysis. https://doi.org/10.53902/sojor.2021.01.000503

Lenz, J., Szymski, D., Krueckel, J., Weber, J., Krieger, F., Karius, T., Meffert, R., Alt, V., & Fehske, K. (2024). From sweat to strain: an epidemiological analysis of training-related injuries in CrossFit. Open Access Journal of Sports Medicine, 15, 91–100. https://doi.org/10.2147/oajsm.s469411

Mehrab, M., Wagner, R. K., Vuurberg, G., Gouttebarge, V., De Vos, R., & Mathijssen, N. (2022). Risk factors for musculoskeletal injury in CrossFit: a systematic review. International Journal of Sports Medicine, 44, 247–257. https://doi.org/10.1055/a-1953-6317

Naderi, A., Shokri, M., Mokaberian, M., & Tranaeus, U. (2025). Understanding sports injury risks in CrossFit: a prospective cohort study on athletic demographics, training profiles, injury history, and psychological factors. Scandinavian Journal of Medicine & Science in Sports, 35. https://doi.org/10.1111/sms.70100

Rodríguez, M. A., García-Calleja, P., Terrados, N., Crespo, I., Del Valle, M., & Olmedillas, H. (2020). Injury in CrossFit: a systematic review of epidemiology and risk factors. The Physician and Sportsmedicine, 50, 3–10. https://doi.org/10.1080/00913847.2020.1864675

Simmons, N. (2024). An injury profile of musculoskeletal injuries in CrossFit athletes in KwaZulu-Natal. https://doi.org/10.51415/10321/5943

 

Our Physios

Mia Bailey

MPhysio, BExSpSc

Australian Rules

FIELD SPORTS

Running

Mia is a physiotherapist with a particular interest in team sport injuries, having worked in local AFL and regularly managing soft tissue conditions such as hamstring, calf and Achilles complaints.

Key Areas:

Achilles

Hamstring

Calf

Soft tissue

ACL

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James Elwin

Physiotherapist (B.Physiotherapy)

Olympic Lifting

Crossfit/Functional Fitness

Football/Cricket

James is a keen footballer in winter and cricket physio in Summer and is also a competitive Olympic lifter and Crossfit gym owner.

Key Areas:

Hamstring injuries

Calf injuries

Quad strains

Shoulder injuries

Back pain/injuries

achilles

Side strains

Lydia McCloskey

Physiotherapist (B.Sci, D.Physiotherapy)

MMA / Jiu Jitsu

Weightlifting

Crossfit/Functional Fitness

Lydia is a national level weightlifting athlete & University of Melbourne graduate who has been with the clinic for 4 years.

Key Areas:

Back pain/injuries

Shoulder injuries

Hamstring injuries

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Post surgery rehab

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