Background Lower limb muscle strain is also a common injury in elite volleyball athletes and lead to sport absence. A proper assessment is crucial to understand injury risk and which factors we should modify to prevent it.

Objective To identify the contribution of lower limb strength, range of motion (ROM), alignment and functional stability on lower limb muscle strain in elite volleyball athletes.

Design Cross-sectional study.

Setting One volleyball team facility.

Patients (or Participants) Twenty-five male elite volleyball athletes.

Interventions (or Assessment of Risk Factors) All data were collected before the beginning of the competitive season. Athletes were aleatory selected in some stations with physiotherapists previously trained to apply the following tests: Shank-forefoot alignment, passive hip internal rotation ROM, Y-Test, hip extensors strength, knee flexors and extensors strength. Injuries were collected from the historic of past seasons.

Main Outcome Measurements Injuries were considered when the athlete had any muscle complaint and stayed absent from the sport for at least one training or match sessions.

Results 9 muscle strains were found, which represents 41% of all injuries on the team. The regression model revealed that hip extensor strength was associated with muscle strain in elite volleyball athletes (F= 8.050; r = 0.518; R²= 0.235; p= 0.010). Specifically, weakness of hip extensors increases the chance of lower limb muscle strain in elite volleyball athletes (B= -0.250).

Conclusions Hip extensor weakness explains 23% of lower limb muscle strains in elite volleyball athletes. Prevention programs should include hip extensor strengthening to decrease the chance of lower limb muscle strain in elite volleyball athletes.