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Its not all about sprinting: mechanisms of acute hamstring strain injuries in professional male rugby union—a systematic visual video analysis
  1. Fearghal Kerin1,2,
  2. Garreth Farrell3,
  3. Peter Tierney4,
  4. Ulrik McCarthy Persson5,
  5. Giuseppe De Vito6,
  6. Eamonn Delahunt7
  1. 1Fearghal Kerin, Leinster Rugby, Dublin, Ireland
  2. 2Fearghal Kerin, University College Dublin, Dublin, Ireland
  3. 3Leinster Rugby, Dublin, Ireland
  4. 4Sports Science, Football Association, London, UK
  5. 5School of Public Health Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
  6. 6Department of Biomedical Sciences, University of Padova School of Sciences, Padova, Veneto, Italy
  7. 7School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
  1. Correspondence to Fearghal Kerin, Fearghal Kerin, Leinster Rugby, Dublin 4, Ireland; Fearghal.Kerin{at}


Objectives The mechanisms of hamstring strain injuries (HSIs) in professional Rugby Union are not well understood. The aim of this study was to describe the mechanisms of HSIs in male professional Rugby Union players using video analysis.

Methods All time-loss acute HSIs identified via retrospective analysis of the Leinster Rugby injury surveillance database across the 2015/2016 to 2017/2018 seasons were considered as potentially eligible for inclusion. Three chartered physiotherapists (analysts) independently assessed all videos with a consensus meeting convened to describe the injury mechanisms. The determination of the injury mechanisms was based on an inductive process informed by a critical review of HSI mechanism literature (including kinematics, kinetics and muscle activity). One of the analysts also developed a qualitative description of each injury mechanism.

Results Seventeen acute HSIs were included in this study. Twelve per cent of the injuries were sustained during training with the remainder sustained during match-play. One HSI occurred due to direct contact to the injured muscle. The remainder were classified as indirect contact (ie, contact to another body region) or non-contact. These HSIs were sustained during five distinct actions—‘running’ (47%), ‘decelerating’ (18%), ‘kicking’ (6%), during a ‘tackle’ (6%) and ‘rucking’ (18%). The most common biomechanical presentation of the injured limb was characterised by trunk flexion with concomitant active knee extension (76%). Fifty per cent of cases also involved ipsilateral trunk rotation.

Conclusion HSIs in this study of Rugby Union were sustained during a number of playing situations and not just during sprinting. We identified a number of injury mechanisms including: ‘running’, ‘decelerating’, ‘kicking’, ‘tackle’, ‘rucking’ and ‘direct trauma’. Hamstring muscle lengthening, characterised by trunk flexion and relative knee extension, appears to be a fundamental characteristic of the mechanisms of acute HSIs in Rugby Union.

  • running
  • hamstring muscles
  • Rugby

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Twitter @fearghalkerin, @petertierney93, @Ulrikmccarthype, @EamonnDelahunt

  • Contributors The idea for the study was co-developed by FK, ED, GF, PT, UMP and GDV. Data for the study were sourced by FK and PT. The injury assessment form (online supplemental file 1) was developed by Fearghal Kerin and approved by ED and F. ED, FK and GF analysed all the videos and reached consensus on the details of the injury assessment forms. The consensus meeting was mediated by UMP. ED developed the qualitative description of each injury case (online supplemental file 2). ED and FK drafted the initial manuscript, which was edited and agreed upon by all authors.

  • Funding FK is the recipient of an Irish Research Council Employment-Based Postgraduate Scholarship (EBPPG/2018/100), with Professor Delahunt being the PI of the award.

  • Competing interests ED is an Associate Editor of the British Journal of Sports Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.