Neuromuscular hamstring profile based on strength imbalance as a basis for injury prevention in youth football players
DOI:
https://doi.org/10.17977/um086v3i22025p107-115Keywords:
Hamstring strength, injury risk, max force risk, max impulse risk, muscle imbalanceAbstract
Background: Hamstring strength imbalance between the left and right sides has been identified as a factor contributing to increased injury risk in athletes. However, few studies have evaluated not only bilateral strength differences but also the magnitude of clinically significant imbalances in various hamstring strength parameters. Objective: This study aims to analyze bilateral hamstring muscle asymmetry in terms of maximum, average, and maximum impulse strength, and to evaluate whether the distribution of high imbalances reaches clinically relevant thresholds associated with potential injury risk. Methods: This study is a cross-sectional observational study. Twenty athletes (n = 20) underwent hamstring strength measurements using the NordBord Hamstring Testing System. The parameters analyzed included maximum force, average force, and maximum impulse on the left and right sides. Normality was assessed using the Shapiro–Wilk test. Bilateral comparisons were analyzed using paired t-tests or Wilcoxon signed-rank tests, depending on data distribution, and accompanied by effect size calculations (Cohen's d). Imbalance (%) was calculated for each parameter and classified into low-, moderate-, and high-risk categories. Risk category distribution was analyzed using a binomial test with a clinical reference value of 20%. Result: There were significant bilateral differences in several hamstring strength parameters (p < 0.05) with moderate to large effect sizes. The imbalance analysis showed that the proportion of athletes with high max impulse imbalance (45%) was significantly higher than the clinical threshold (p = 0.010). Conversely, the proportion of high imbalance in maximum force and average force did not differ significantly from the clinical reference value (p > 0.05). Conclusion: Although bilateral hamstring strength differences were found, only maximum impulse imbalance showed clinically relevant significance regarding potential injury risk. These findings emphasize the importance of including impulse analysis, in addition to force, in hamstring injury risk screening using NordBord.
References
Abate Daga, F., Panzolini, M., Allois, R., Baseggio, L., & Agostino, S. (2021). Age-Related Differences in Hamstring Flexibility in Prepubertal Soccer Players: An Exploratory Cross-Sectional Study. Frontiers in Psychology, 12.
Altarriba-Bartés, A., Vicens-Bordas, J., Peña, J., Alarcón-Palacios, F., Sixtos-Meliton, L. A., Matabosch-Pijuán, M., Giménez-Martínez, E., Beato, M., & Calleja-González, J. (2024). The effectiveness of two comprehensive recovery protocols on performance and physiological measures in elite soccer players: A parallel group-randomized trial. International Journal of Sports Science and Coaching, 19(1), 171–181.
Andrzejewski, M., Chmura, J., Pluta, B., & Konarski, J. M. (2015). Sprinting Activities and Distance Covered by Top Level Europa League Soccer Players. International Journal of Sports Science & Coaching, 10(1), 39–50.
Benson, E. M., Elphingstone, J. W., Paul, K. D., Schick, S., Shihab, Y. A., Barlow, D., Ponce, B. A., Brabston, E. W., & Momaya, A. M. (2024). Eccentric Hamstring Strength Imbalance among Football and Soccer Athletes. Southern Medical Journal, 117(4), 214–219.
Brink, M. S., Visscher, C., Arends, S., Zwerver, J., Post, W. J., & Lemmink, K. A. (2010). Monitoring stress and recovery: new insights for the prevention of injuries and illnesses in elite youth soccer players. British Journal of Sports Medicine, 44(11), 809–815.
Canton, A., Torrents, C., Ric, A., Gonçalves, B., Sampaio, J., & Hristovski, R. (2019). Effects of Temporary Numerical Imbalances on Collective Exploratory Behavior of Young and Professional Football Players. Frontiers in Psychology, 10.
Carling, C., Gregson, W., McCall, A., Moreira, A., Wong, D. P., & Bradley, P. S. (2015). Match Running Performance During Fixture Congestion in Elite Soccer: Research Issues and Future Directions. Sports Medicine, 45(5), 605–613.
Colby, M. J., Dawson, B., Heasman, J., Rogalski, B., & Gabbett, T. J. (2014). Accelerometer and GPS-Derived Running Loads and Injury Risk in Elite Australian Footballers. Journal of Strength and Conditioning Research, 28(8), 2244–2252.
Copland, S. T., Tipton, J. S., & Fields, K. B. (2009). Evidence-based treatment of hamstring tears. Current Sports Medicine Reports, 8(6), 308–314.
Coto Martín, R., Pérez-Mallada, N., Martínez-Beltran, M. J., Ríos Arroyo, I., & Cuéllar Marín, L. (2025). Influence of Knee Angle on Hamstring/Quadriceps Strength Ratio in Male Soccer Players. Applied Sciences (Switzerland), 15(6).
Elliott, M. C. C. W., Zarins, B., Powell, J. W., & Kenyon, C. D. (2011). Hamstring Muscle Strains in Professional Football Players. The American Journal of Sports Medicine, 39(4), 843–850.
Ferdinand, L., Hanief, Y. N., & Manimtim, R. M. (2025). Injury pattern and risk factors in grassroots football: A study of 10-year-old athletes. Sport, Exercise, and Injury, 1(1), 27-39.
Franklin, B. A., Thompson, P. D., Al-Zaiti, S. S., Albert, C. M., Hivert, M.-F., Levine, B. D., Lobelo, F., Madan, K., Sharrief, A. Z., & Eijsvogels, T. M. H. (2020). Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective–An Update: A Scientific Statement From the American Heart Association. Circulation, 141(13).
Garcia, A. G., Andrade, R., Afonso, J., Runco, J. L., Maestro, A., & Espregueira-Mendes, J. (2022). Hamstrings injuries in football. Journal of Orthopaedics, 31, 72–77.
Hanief, Y. N., Sumartiningsih, S., Rahayu, S., Jaskulski, K., Hadi, Fathoni, A. F., Cicone, Z. S., Azidin, R. M. F. R., & Firmansyah, A. (2026). Wearable-Monitored External Workload (GPS/GNSS/IMU) and Lower-Limb Muscle Injuries in Football: A Systematic Review and Exploratory Data Synthesis. Sport Mont, 24(19), 169-178.
Hanief, Y. N., Sannicandro, I., & Azidin, R. M. F. R. (2025). The effects of the FIFA 11+ program on lower limb functional outcomes: A systematic review. Sport, Exercise, and Injury, 1(2), 122-138.
Herman, K., Barton, C., Malliaras, P., & Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Medicine, 10(1), 75.
Hides, J. A., Brown, C. T., Penfold, L., & Stanton, W. R. (2011). Screening the lumbopelvic muscles for a relationship to injury of the quadriceps, hamstrings, and adductor muscles among elite australian football league players. Journal of Orthopaedic and Sports Physical Therapy, 41(10), 767–775.
Hübscher, M., Zech, A., Pfeifer, K., Hänsel, F., Vogt, L., & Banzer, W. (2010). Neuromuscular Training for Sports Injury Prevention. Medicine & Science in Sports & Exercise, 42(3), 413–421.
Huygaerts, S., Cos, F., Cohen, D. D., Calleja-González, J., Guitart, M., Blazevich, A. J., & Alcaraz, P. E. (2020). Mechanisms of Hamstring Strain Injury: Interactions between Fatigue, Muscle Activation and Function. Sports, 8(5), 65.
Jackson, J., Ankersen, J., Lambert, B., Hedt, C., Goble, H., Holderread, B., ... & Liberman, S. (2022). Fédération Internationale de Football Association 11+ Kids Program Improves Dynamic Balance in Youth Female Soccer Players—A Pilot Study. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 10-5435.
Kolodziej, M., Nolte, K., Schmidt, M., Alt, T., & Jaitner, T. (2021). Identification of Neuromuscular Performance Parameters as Risk Factors of Non-contact Injuries in Male Elite Youth Soccer Players: A Preliminary Study on 62 Players With 25 Non-contact Injuries. Frontiers in Sports and Active Living, 3.
Le Gall, F., Carling, C., Reilly, T., Vandewalle, H., Church, J., & Rochcongar, P. (2006). Incidence of Injuries in Elite French Youth Soccer Players. The American Journal of Sports Medicine, 34(6), 928–938.
Loose, O., Fellner, B., Lehmann, J., Achenbach, L., Krutsch, V., Gerling, S., Jansen, P., Angele, P., Nerlich, M., & Krutsch, W. (2019). Injury incidence in semi-professional football claims for increased need of injury prevention in elite junior football. Knee Surgery, Sports Traumatology, Arthroscopy, 27(3), 978–984.
Mitrotasios, M., Ispyrlidis, I., Mantzouranis, N., & Paraskeyopoulos, G. (2024). GPS-based performance analysis in amateur football: Match evaluation relative to players’ tactical roles. Journal of Physical Education and Sport, 24(5), 1275–1280.
Morgans, R., Oliveira, R., Ceylan, H. I., Teixeira, J., Ryan, B., Modrić, T., & Moreira, A. (2025). High-intensity running and sprint distance prior to hamstring injury in elite male soccer players. Is there a common theme in over-or under-loading in the weeks preceding hamstring injury? Journal of Physical Education and Sport, 25(5), 946–953.
Myer, G. D., Sugimoto, D., Thomas, S., & Hewett, T. E. (2013). The Influence of Age on the Effectiveness of Neuromuscular Training to Reduce Anterior Cruciate Ligament Injury in Female Athletes. The American Journal of Sports Medicine, 41(1), 203–215.
Osondu, S., & Hiba, A. (2025). Performance Analysis and Prediction in Grassroots Football: The Use of GPS Analytics, Machine Learning, and Deep Learning. International Journal of Research and Innovation in Applied Science, X(VI), 136–143.
Pilka, T., Grzelak, B., Sadurska, A., Górecki, T., & Dyczkowski, K. (2023). Predicting Injuries in Football Based on Data Collected from GPS-Based Wearable Sensors. Sensors, 23(3), 1227.
Small, K., McNaughton, L. R., Greig, M., Lohkamp, M., & Lovell, R. (2009). Soccer fatigue, sprinting and hamstring injury risk. International Journal of Sports Medicine, 30(8), 573–578.
Yu, B., Queen, R. M., Abbey, A. N., Liu, Y., Moorman, C. T., & Garrett, W. E. (2008). Hamstring muscle kinematics and activation during overground sprinting. Journal of Biomechanics, 41(15), 3121–3126.
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