Proximal Neuromuscular Control Protects Against Hamstring Injuries in Male Soccer Players: A Prospective Study With Electromyography Time-Series Analysis During Maximal Sprinting

Background: With their unremittingly high incidence rate and detrimental functional repercussions, hamstring injuries remain a substantial problem in male soccer. Proximal neuromuscular control (core stability) is considered to be of key importance in primary and secondary hamstring injury prevention, although scientific evidence and insights on the exact nature of the core-hamstring association are nonexistent at present. Hypothesis: The muscle activation pattern throughout the running cycle would not differ between participants based on injury occurrence during follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: Sixty amateur soccer players participated in a multimuscle surface electromyography (sEMG) assessment during maximal acceleration to full-speed sprinting. Subsequently, hamstring injury occurrence was registered during a 1.5-season follow-up period. Hamstring, gluteal, and trunk muscle activity time series during the airborne and stance phases of acceleration were evaluated and statistically explored for a possible causal association with injury occurrence and absence from sport during follow-up. Results: Players who did not experience a hamstring injury during follow-up had significantly higher amounts of gluteal muscle activity during the front swing phase (P = .027) and higher amounts of trunk muscle activity during the backswing phase of sprinting (P = .042). In particular, the risk of sustaining a hamstring injury during follow-up lowered by 20% and 6%, with a 10% increment in normalized muscle activity of the gluteus maximus during the front swing and the trunk muscles during the backswing, respectively (P < .024). Conclusion: Muscle activity of the core unit during explosive running appeared to be associated with hamstring injury occurrence in male soccer players. Higher amounts of gluteal and trunk muscle activity during the airborne phases of sprinting were associated with a lower risk of hamstring injuries during follow-up. Hence, the present results provide a basis for improved, evidence-based rehabilitation and prevention, particularly focusing on increasing neuromuscular control of the gluteal and trunk muscles during sport-specific activities (eg, sprint drills, agility drills).