The Hamstring Hold-Up: A Look into Professional Soccer’s Most Common Injury

Introduction

With the 2026 World Cup fast approaching, fans are looking forward to watching their favorite superstars play on the world’s biggest stage in soccer. Despite the growing excitement, there are several high-profile athletes whose tournament participation could be in jeopardy due to recent hamstring injuries, including Spain’s Lamine Yamal, Germany’s Marc-Andre Ter Stegen, and France’s Kylian Mbappe. Let’s take a dive into the data surrounding hamstring injuries in soccer athletes: Why are these injuries so common, what are the risk factors, how do we prevent them, and what is an athlete’s prognosis after a hamstring injury? 

The Commonality of Hamstring Injuries in Professional Soccer

Hamstring injuries are the most common injuries faced by professional soccer athletes, accounting for 12% of all-cause injuries¹⁵ and 37% of all muscle-specific injuries.¹⁰ These injuries are more common in matches than in training, occur mostly through non-contact mechanisms, and are likely due to the unique demands of soccer that impart eccentric moments to the hamstring muscles, which include rapid acceleration/deceleration, repetitive high-speed sprinting, and forceful kicking. Interestingly, the prevalence of hamstring injuries continues to rise within professional soccer. A recent study published in the  British Journal of Sports Medicineshowed an alarming increase in hamstring injuries in UEFA Champions League clubs, with injury rates doubling from 12% to 24% between 2014 and 2022.⁹ While the exact reasons underlying this trend are unclear, it is thought that the evolution of the modern game has brought about two changes that place athletes at higher risk. First, professional soccer players undertake larger volumes of high-intensity activities during matches, including longer sprint distances, pressing tactics, and more frequent transitional play. Second, an increasingly busy match schedule results in less time for recovery between league, cup, and international play. These changes increase the absolute load on the hamstrings while decreasing the amount of time to rest and recover; a “perfect storm” situation ripe for injuries to occur.

Risk Factors for Hamstring Injuries in Soccer Athletes

The risk factors for hamstring injuries in soccer athletes can be broken down into non-modifiable and modifiable risk factors. Among the non-modifiable risk factors, previous hamstring injury is the single most important factor that predicts recurrent injury. Multiple studies have demonstrated that previous hamstring injury increases risk of recurrent injury between two and six times that of an uninjured athlete.¹³ Other non-modifiable risk factors that have been associated with hamstring injuries in soccer athletes include increasing age,²⁰ male sex,⁵ playing a field position (as compared to goalkeeper),¹⁸ regular season competition (as compared to preseason),^11,18 and play during the final 15 minutes of a half.¹¹ The list of modifiable risk factors that have been suggested to affect the risk of hamstring injury tends to focus more on biomechanical and functional factors. Hamstring weakness is frequently reported to increase the risk of hamstring injury,^22,26 though comprehensive strength testing protocols have not been shown to effectively predict hamstring injuries.^7,17 Other factors such as shorter muscle fascicles,²⁶ eccentric hamstring strength asymmetries,¹⁶ and isokinetic strength imbalances⁴ have also been implicated with increased risk of hamstring injury. Interestingly, a recent survey of physicians from elite European male soccer clubs¹² identified a lack of communication between medical and coaching staff to be the most important factor associated with hamstring injury, suggesting that some “modifiable” risk factors may be entirely beyond an athlete’s control.

Preventing Hamstring Injuries

Many professional soccer clubs implement multifaceted approaches to preventing hamstring injuries, including structured warm-ups, load management, and progressive loading during workouts. Improved hamstring stamina may also be beneficial, as a recent study of elite Japanese soccer athletes found that increased preseason sprint distances were associated with lower rates of hamstring injury.²⁵ However, eccentric hamstring strengthening remains the gold standard for injury reduction, with many studies focusing specifically on the effects of Nordic hamstring exercise (NHE). The use of NHEs was first implemented in the Norwegian professional soccer league in 2001, and since that time both randomized trials^21,23 and systematic reviews¹ have demonstrated NHEs to be associated a 50-70% reduction of hamstring injuries in soccer athletes. Despite these clear benefits, survey data from the 2012-2014 UEFA Champions League and Norwegian professional seasons revealed a meager 17% rate of compliance with the recommended NHE program.³ More recent results from the 2020/2021 season showed a similar trend, with only 29% of participating teams reporting NHE program use for preventative measures.⁸

Prognoses After Hamstring Injury in a Professional Soccer Athlete

While most professional soccer athletes will make it back on the pitch following a hamstring injury, these injuries can cause delays in return to play (RTP). Though time to RTP can vary based upon various factors such as injury mechanism, injury severity, and time of season, the average time to RTP is reported to be between 13 and 21 days,^14,19 with most athletes missing approximately two games and six training sessions. Acute injuries that occur within match settings are associated with longer time to RTP, while factors such as player age, gender, and position do not appear to have significant effects on RTP.¹⁴ Athletes who sustain more proximal injuries (myotendinous junction or proximal tendon) may also take longer to return², and those with complete proximal tendon avulsions off the ischial tuberosity (5-10% of injuries) may require acute surgical repair that can keep them out of play for several months to a year. Even after athletes return from hamstring injuries, they may experience transient decreases in performance, including total distance covered and maximum sprint speed, that recover to baseline within one to two matches.²⁴ Given the repetitive high-intensity loads placed on the hamstrings during training and matches, reinjury is also a major issue with reported recurrence rates ranging between 4% and 68%.⁶ The majority of recurrent hamstring injuries occur in match settings within two months of the index injury, highlighting the importance of both thorough rehabilitation prior to RTP and load management during this critical early post-injury period.⁹

Conclusion

As the tactics and demands of modern soccer continue to evolve, athletes are exposed to increasing volumes of high-intensity efforts that leave them prone to developing hamstring injuries. Although many athletes will return to play after hamstring injury, professional clubs must focus on careful, evidence-based rehabilitation and load management strategies to mitigate the associated time loss and the significant risk of reinjury. Moreover, the increasing rate of hamstring injuries in professional soccer athletes despite well-established injury prevention protocols is worrying, and future research efforts should be targeted at improving adherence to such protocols to protect athletes’ performance and career longevity. 

References

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