Hamstring strength assessment methods in sport: A systematic review and meta-analysis of post-activity strength decrements, asymmetry benchmarks, and measurement reliability.

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Multiple modalities demonstrated good reliability; hamstring strength deficits persisted for 24-72 hours following on-field activity; normative inter-limb asymmetry approximately 3-4%

• Primary Outcome: Hamstring strength assessment reliability across modalities, post-activity strength decrements, and normative inter-limb asymmetry benchmarks in athletic populations

• Nnt Or Sensitivity: Reliability metrics (ICC, CV) reported qualitatively as 'good' across modalities; specific ICC values and CV thresholds not provided in abstract. Asymmetry benchmark of ~3-4% proposed as normative, below which clinical significance is questioned.

• Confidence Interval: Not reported in abstract

Clinical Application

The endorsement of field-based testing modalities (force platforms, Nordic hamstring devices) alongside isokinetic dynamometry increases feasibility across varied resource settings, from elite clubs with laboratory access to community-level programs. Individualised baseline monitoring is recommended, which requires longitudinal data infrastructure. Hamstring strain injuries are the most common non-contact injury in Australian Football League (AFL) competition, with significant burden also in rugby league (NRL), football (A-League), and athletics. The 24-72 hour post-match vulnerability window has direct implications for congested AFL and NRL fixture scheduling. Field-based testing modalities endorsed by this review are consistent with tools already in use by Australian high-performance programs. RACGP and Sports Medicine Australia guidelines on return-to-sport decision-making could be informed by the normative asymmetry benchmarks (~3-4%) identified. No specific PBS or TGA considerations apply, though physiotherapy and sports medicine assessment services are relevant to Medicare-funded care pathways. The findings align with the Australian Institute of Sport's emphasis on evidence-based athlete monitoring. Athletes across team and individual sports at risk of hamstring strain injury, including professional, semi-professional, and high-performance amateur athletes. Particularly relevant for sports with high HSI prevalence such as football codes, athletics (sprinting), and rugby.

Abstract

Hamstring strain injuries (HSI) represent one of the most prevalent and recurrent injuries in sport, making reliable strength assessment essential for neuromuscular monitoring in athletic populations. Despite the breadth of available testing modalities, no comprehensive synthesis of assessment methods, their reliability, post-activity strength responses, or normative asymmetry values has been undertaken. This systematic review and meta-analysis aims to evaluate the reliability of hamstring strength assessment methods, quantify the time-course of strength decrements following competition, establish normative inter-limb asymmetry benchmarks, and identify gaps to guide future assessment practices. PubMed, Scopus, SPORTDiscus, and Web of Science were searched from inception to November 1, 2025 following PRISMA guidelines. Methodological quality was assessed using a modified version of the Downs and Black checklist. A total of 161 studies were included in qualitative synthesis and 106 in quantitative analysis. Isokinetic dynamometry was the most frequently used modality, followed by force platform assessments and Nordic hamstring-based devices, with a clear upward trend in field-based testing observed after 2010. Multiple modalities demonstrate good reliability, sensitivity to post-activity fatigue, and comparable patterns to detect inter-limb asymmetries, supporting their use across varied applied settings. Hamstring strength deficits persisted for 24-72 hours following on-field activity, identifying a critical vulnerability window during congested schedules. Minor inter-limb asymmetries of approximately 3-4% appear normative and should not be considered clinically meaningful in isolation. Practitioners should establish individualized baselines and integrate routine monitoring with evidence-based recovery strategies to mitigate HSI risk throughout competitive seasons.

References

1. 1.Sundh, A. E., Ripley, N. J., Lamb, A. J., & Comfort, P. (2026). Hamstring strength assessment methods in sport: A systematic review and meta-analysis of post-activity strength decrements, asymmetry benchmarks, and measurement reliability. PLoS ONE. https://doi.org/10.1371/journal.pone.0352509