Rethinking recovery after hamstring muscle injury in elite football: speed exposure normalised to maximal speed reveals hidden sprint reductions after return to play
Sports Research Centre, Miguel Hernandez University of Elche, Alicante, Spain
Translational Research Centre of Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine,
Miguel Hernandez University, Alicante, SpainDepartment of Physical Education and Sports, Faculty of Education and Sport Sciences, University of Granada,
Melilla, SpainSport Sciences Research Centre, Rey Juan Carlos University, Spain
Institute of Health and Sport Sciences, Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid,
SpainInstitute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernández University of Elche, Spain
FC Barcelona Medical Department (FIFA Medical Center of Excellence), Barcelona, Spain
Medical Department Villarreal Club de Fútbol, Villarreal, Spain
Medical Department Elche Club de Fútbol, Elche, Spain
Department of Competitions and Mediacoach, LaLiga, Madrid, Spain
Biol Sport. 2027;44:75–84
- Ekstrand J, Bengtsson H, Waldén M, Davison M, Khan KM, Hägglund M. Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22. Br J Sports Med. 2023; 57:292–8. https://doi.org /10.1136/BJSPORTS-2021-105407.
- Jones A, Jones G, Greig N, Bower P, Brown J, Hind K, et al. Epidemiology of injury in English Professional Football players: A cohort study. Phys Ther Sport. 2019; 35:18–22. https://doi.org /10.1016/J.PTSP.2018.10.011.
- Raya-González J, Ponce-Bordón JC, García-Calvo T, Polo-Tejada J, Sanabria-Pino B, Lobo-Triviño D. What Are the Consequences of Hamstring Injuries on Soccer Players’ Match Running Performance? A Systematic Review. Sports Health. 2025. https://doi .org/10.1177/19417381251350919.
- Torrejón LN, Martínez-Serrano A, Villalón JM, Alcaraz PE. Economic impact of muscle injury rate and hamstring strain injuries in professional football clubs. Evidence from LaLiga. PLoS One. 2024; 19(6):e0301498. https://doi.org/10.1371/JOURNAL. PONE.0301498.
- Hoppen MI, Reurink G, De Boode VA, Van Der Kaaden L, Jagtman L, Glazenburg T, et al. Return to match running performance after a hamstring injury in elite football: a single-centre retrospective cohort study. BMJ Open Sport Exerc Med. 2022;8(1):e001240. https://doi.org/10.1136/ BMJSEM-2021-001240.
- Fernandez-Jaén TF, Álvarez Rey G, Ardevol Cuesta J, Arriaza Loureda R, Ávila España F, Balius Matas R, et al. Spanish Consensus Statement: The Treatment of Muscle Tears in Sport. Orthop J Sports Med. 2015; 3:2325967115622434. https://doi .org/10.1177/2325967115622434.
- Opar DA, Williams MD, Shield AJ. Hamstring strain injuries: Factors that Lead to injury and re-Injury. Sports Med. 2012; 42:209–26. https://doi.org/10 .2165/11594800-000000000-00000.
- De Visser HM, Reijman M, Heijboer MP, Bos PK. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med. 2012; 46:124–30. https://doi.org/10.1136/ BJSPORTS-2011-090317.
- Morgans R, Rhodes D, Bezuglov E, Etemad O, Di Michele R, Teixeira J, et al. The impact of injury on match running performance following the return to competitive match-play over two consecutive seasons in elite European soccer players. J Phys Educ Sport. 2023; 23:1142–9. https://doi.org/10.7752 /JPES.2023.05142.
- Raya-González J, García-Calvo T, Rojas-Valverde D, Campo RL Del, Resta R, Diaz-García J. Understanding the impact of hamstring injuries on match performance in Spanish professional soccer players. Kinesiology. 2023; 55:375–82. https://doi.org/10 .26582/K.55.2.18.
- Pecci J, Sánchez-Trigo H, Mancha-Triguero D, Sañudo B, Reverte-Pagola G, Ojo-López JJ Del, et al. Return to performance: machine learning insights into how absence time following muscle injuries affects match running performance in LaLiga soccer players. Biol Sport. 2025; 42:275. https://doi.org /10.5114/BIOLSPORT.2025.151651.
- Whiteley R, Gregson W, Bahr R, Tabben M, Chamari K, Lolli L, et al. Highspeed running during match-play before and after return from hamstring injury in professional footballers. Scand J Med Sci Sports. 2022; 32:1502–9.https://doi.org/10.1111/SMS.14219.
- Whiteley R, Massey A, Gabbett T, Blanch P, Cameron M, Conlan G, et al. Match High-Speed Running Distances Are Often Suppressed After Return From Hamstring Strain Injury in Professional Footballers. Sports Health. 2021; 13:290–5. https://doi.org/10.1177 /1941738120964456.
- Moreno-Pérez V, Miralles-Iborra A, Coso J, Agulló F, Soler A, Courel-Ibáñez J. Return of match running performance following muscle strain injuries of varying severity in professional football. Biol Sport. 2026; 43:887–97. https://doi.org /10.5114/BIOLSPORT.2026.159530.
- Jiménez-Rubio S, Navandar A, Rivilla-García J, Paredes-Hernández V, Gómez-Ruano MÁ. Improvements in Match-Related Physical Performance of Professional Soccer Players After the Application of an on-Field Training Program for Hamstring Injury Rehabilitation. J Sport Rehabil. 2020; 29:1145–50. https://doi.org/10.1123 /JSR.2019-0033.
- Pimenta R, Antunes H, Maia F, Ribeiro J, Nakamura FY. Sprint and High-Speed Running in Soccer: Should We Use Absolute or Normalized Thresholds? J Hum Kinet. 2025. https://doi.org /10.5114/JHK/209540.
- Pimenta R, Antunes H, Ribeiro J, Nakamura FY. Should GPS data be normalized for performance and fatigue monitoring in soccer? A theoretical– practical discussion on sprinting. Ger J Exerc Sport Res. 2025. https://doi. org/10.1007/S12662-025-01048-7.
- Freeman BW, Talpey SW, James LP, Opar DA, Young WB. Common High-Speed Running Thresholds Likely Do Not Correspond to High-Speed Running in Field Sports. J Strength Cond Res. 2023; 37:1411–8. https://doi.org /10.1519/JSC.0000000000004421.
- Aiello F, Di Claudio C, Fanchini M, Impellizzeri FM, McCall A, Sharp C, et al. Do non-contact injuries occur during high-speed running in elite football? Preliminary results from a novel GPS and video-based method. J Sci Med Sport. 2023; 26:465–70. https://doi.org /10.1016/J.JSAMS.2023.07.007
- Moreno-Perez V, Sotos-Martínez V, Lopez-Valenciano A, Lopez Del-Campo R, Resta R, Coso J Del. Hamstring muscle injury is preceded by a short period of higher running demands in professional football players. Biol Sport. 2023; 41:227. https://doi.org/10.5114 /BIOLSPORT.2024.127387.
- Gregson W, Di Salvo V, Varley MC, Modonutti M, Belli A, Chamari K, et al. Harmful association of sprinting with muscle injury occurrence in professional soccer match-play: A two-season, league wide exploratory investigation from the Qatar Stars League. J Sci Med Sport. 2020; 23:134–8. https://doi.org/10.1016/J.JSAMS.2019 .08.289.
- Gronwald T, Klein C, Hoenig T, Pietzonka M, Bloch H, Edouard P, et al. Hamstring injury patterns in professional male football (soccer): a systematic video analysis of 52 cases. Br J Sports Med. 2022;56:165–71. https://doi. org/10.1136/BJSPORTS-2021-104769.
- Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, et al. International Olympic Committee Consensus Statement: Methods for Recording and Reporting of Epidemiological Data on Injury and Illness in Sport 2020 (Including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). Br J Sports Med. 2020; 54:372–89. https://doi.org/10.1136 /BJSPORTS-2019-101969.
- Felipe JL, Garcia-Unanue J, Viejo-Romero D, Navandar A, Sánchez-Sánchez J. Validation of a Video-Based Performance Analysis System (Mediacoach®) to Analyze the Physical Demands during Matches in LaLiga. Sensors (Basel). 2019; 19:4113. https://doi.org/10.3390/S19194113.
- Pons E, García-Calvo T, Resta R, Blanco H, del Campo RL, García JD, et al. A comparison of a GPS device and a multi-camera video technology during official soccer matches: Agreement between systems. PLoS One. 2019; 14(8):e0220729. https://doi.org/ 10.1371/JOURNAL.PONE.0220729.
- Paul S, Zhang X. Small sample GEE estimation of regression parameters for longitudinal data. Stat Med. 2014;33:3869–81. https://doi. org/10.1002/SIM.6198.
- Ekstrand J, Waldén M, Hägglund M. Hamstring injuries have increased by 4% annually in men’s professional football, since 2001: A 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med. 2016; 50:731–7. https://doi.org/10.1136 /bjsports-2015-095359.
- Duhig S, Shield AJ, Opar D, Gabbett TJ, Ferguson C, Williams M. Effect of high-speed running on hamstring strain injury risk. Br J Sports Med. 2016; 50:1536–40. https://doi.org/10.1136 /BJSPORTS-2015-095679.
- Chumanov ES, Schache AG, Heiderscheit BC, Thelen DG. Hamstrings are most susceptible to injury during the late swing phase of sprinting. Br J Sports Med. 2012;46:90. https://doi.org/10.1136/ bjsports-2011-090176.
- Schache AG, Dorn TW, Blanch PD, Brown NA, Pandy MG. Mechanics of the human hamstring muscles during sprinting. Med Sci Sports Exerc. 2012;44(4):647-658. doi:10.1249/ MSS.0b013e318236a3d2.
- Malone JJ, Lovell R, Varley MC, Coutts AJ. Unpacking the Black Box: Applications and Considerations for Using 84 Víctor Moreno-Pérez et al. GPS Devices in Sport. Int J Sports Physiol Perform. 2017; 12:18–26. https://doi .org/10.1123/IJSPP.2016-0236.
- Pimenta R, Antunes H, Ribeiro J, Nakamura FY. Should GPS data be normalized for performance and fatigue monitoring in soccer? A theoreticalpractical discussion on high-speed running. Front Sports Act Living. 2025; 7:1603767. https://doi.org/10.3389 /FSPOR.2025.1603767.
- Vanrenterghem J, Nedergaard NJ, Robinson MA, Drust B. Training Load Monitoring in Team Sports: A Novel Framework Separating Physiological and Biomechanical Load-Adaptation Pathways. Sports Med. 2017; 47:2135–42. https://doi.org/10.1007 /S40279-017-0714-2.
- Paton BM, Read P, Van Dyk N, Wilson MG, Pollock N, Court N, et al. London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport. Br J Sports Med. 2023; 57:278–91. https://doi.org/10.1136 /BJSPORTS-2021-105384.
- Choice E, Hooker K, Downey R, Haugh G. A Return to Performance Framework to Effectively Complete the Rehabilitation Continuum for Elite Soccer. Strength Cond J. 2024; 46:667–85. https://doi.org/10.1519/SSC .0000000000000844.
- Timmins RG, Bourne MN, Shield AJ, Williams MD, Lorenzen C, Opar DA. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study. Br J Sports Med. 2016; 50:1524–35. https://doi.org/10.1136 /BJSPORTS-2015-095362.
- Guitart M, Alonso-Callejo A, Rodas G, Cos F, Martin-Garcia A, Franquesa X, et al. How do muscle injuries relate to return-to-performance metrics in male elite football players? Biol Sport. 2025; 43:165–75. https://doi.org/10.5114 /BIOLSPORT.2026.153532.
- Jiménez-Rubio S, Navandar A, Rivilla-García J, Paredes-Hernández V. Validity of an On-Field Readaptation Program Following a Hamstring Injury in Professional Soccer. J Sport Rehabil. 2019; 28:1–7. https://doi.org/10.1123 /JSR.2018-0203.
- Hägglund M, Waldén M, Bahr R, Ekstrand J. Methods for epidemiological study of injuries to professional football players: developing the UEFA model. Br J Sports Med. 2005; 39:340–6. https://doi.org/10.1136/BJSM .2005.018267.
- González-Rodenas J, Moreno-Pérez V, Castaño-Zambudio A, López-Del Campo R, Nevado F, Del Coso J. Locomotor characteristics of intense accelerations according to the playing position in top Spanish football teams during competition. Biol Sport. 2025; 42:299–310. https://doi.org/10.5114 /BIOLSPORT.2025.151652.
- Shield AJ, Bourne MN. Hamstring Injury Prevention Practices in Elite Sport: Evidence for Eccentric Strength vs. Lumbo-Pelvic Training. Sports Med. 2018; 48:513–24. https://doi.org /10.1007/S40279-017-0819-7.
- Coso J Del, de Souza DB, Moreno-Perez V, Buldú JM, Nevado F, Resta R, et al. Influence of players’ maximum running speed on the team’s ranking position at the end of the Spanish Laliga. Int J Environ Res Public Health. 2020; 17:1–11. https://doi.org/10 .3390/ijerph17238815.
