Background During top-level international athletics championships, thigh muscle tear (hamstring muscle tear in particular) was the most commonly reported injury diagnosis. However, there has been no detailed characterisation of hamstring muscle injuries at this top level of athletics, which represent the main challenge for athletes and their stakeholders.

Objective To analyse the incidence and characteristics of hamstring muscle injuries (hamstring injuries) occurring during top-level international athletics championships.

Design Prospective study.

Setting 9 international athletics championships from 2007 to 2015; Elite athletics level.

Participants A total of 8212 registered athletes.

Main Outcome Measurements Prevalence and incidences of hamstring injuries in male and female athletes.

Results Hamstring injury frequencies were significantly higher in male (19.3%) than female (13.5%) athletes (Chi2=6.1; p=0.01). Hamstring injuries represented 39.8% of all muscle injuries and 74.6% of all thigh muscle injuries, without any differences in the distribution between male and female athletes. The rate of hamstring injuries per 1000 registered athletes was significantly higher in male (22.4±3.4) than in female (11.5±2.6) athletes (relative risk (RR)=1.94; 95% CI: 1.42–2.66, moderate effect size). Overuse with sudden onset was the main cause of hamstring injuries, followed by non-contact trauma. Hamstring injury incidences were higher in combined events, sprints, and hurdles than in other events for male athletes, and in combined events, sprints and hurdles than in other events for female athletes.

Conclusions During 9 top-level international Athletics championships, hamstring injury was the most common injury diagnosis (19.3% in male and 13.5% female athletes), with a two fold higher risk in males than females. Athletes in explosive-power events and male athletes seem to be more at risk of hamstring muscle injuries. Injury prevention strategies should be sex-specific including screening of athletes at risk, particular attention to athletes at risk and to small signs, and adapted physical and strengthening conditioning.