Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union

Background: The incidence of hamstring muscle injuries in professional rugby union is high, but evidence-based information on risk factors and injury-prevention strategies in this sport is limited. Purpose: To define the incidence, severity, and risk factors associated with hamstring muscle injuries in professional rugby union and to determine whether the use of hamstring strengthening and stretching exercises reduces the incidence and severity of these injuries. Study Design: Cohort study (prevention); Level of evidence, 3. Methods: Team clinicians reported all hamstring muscle injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury; loss of time from training and match play was used as the definition of an injury. Players' match and training exposures were recorded on a weekly basis. Results: The incidence of hamstring muscle injuries was 0.27 per 1000 player training hours and 5.6 per 1000 player match hours. Injuries, on average, resulted in 17 days of lost time, with recurrent injuries (23%) significantly more severe (25 days lost) than new injuries (14 days lost). Second-row forwards sustained the fewest (2.4 injuries/1000 player hours) and the least severe (7 days lost) match injuries. Running activities accounted for 68% of hamstring muscle injuries, but injuries resulting from kicking were the most severe (36 days lost). Players undertaking Nordic hamstring exercises in addition to conventional stretching and strengthening exercises had lower incidences and severities of injury during training and competition. Conclusion: The Nordic hamstring strengthening exercise may reduce the incidence and severity of hamstring muscle injuries sustained during training and competition.