Intervention components, training dose, and adherence in exercise-based prevention of hamstring strain injury in football: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but CI excludes null

• Effect Size: Risk ratio 0.51 (49% relative risk reduction)

• Primary Outcome: Hamstring strain injury incidence

• Nnt Or Sensitivity: Number needed to treat = 26 (based on 3.8% absolute risk reduction)

• Confidence Interval: 95% CI 0.36-0.71

Clinical Application

Implementation requires sustained adherence (≥75%) for meaningful benefit; shorter programmes (1-6 months) may be more effective than longer interventions Relevant to Australian football codes and sports medicine practice; aligns with Sports Medicine Australia injury prevention guidelines and could inform Football Australia player welfare initiatives Football players at all levels, with stronger effects observed in elite/semi-professional players and shorter intervention periods

Abstract

OBJECTIVE: To quantify associations between exercise-based prevention programmes and hamstring strain injury (HSI) risk in football participants, and whether training dose and adherence modify effects. METHODS: Six databases were searched to 1 October 2025. Randomised and cluster-randomised trials comparing HSI prevention programmes with usual practice or warm-up in football participants were included. Random-effects meta-analysis pooled risk ratios (RRs); subgroup analyses and meta-regression assessed effect modification. RESULTS: Fifteen trials (n = 7,465) were analysed. Programmes reduced HSI risk (RR = 0.51, 95% CI 0.36-0.71), with I²=57% and a prediction interval crossing the null (0.18-1.40). Based on a control event rate of 7.8%, absolute risk reduction was 3.8% (38 fewer HSIs per 1000 participants; 95% CI 23-50 fewer). Effects were stronger for shorter interventions (1-6 months; RR = 0.43) than longer interventions (7-10 months; RR = 0.77; P for interaction=0.04), and for elite/semi-professional players (RR = 0.38) than amateur players (RR = 0.77; P for interaction = 0.02). Training frequency and weekly volume did not modify effects, whereas adherence did. High adherence (≥75%) was associated with lower HSI risk (RR = 0.36, 95% CI 0.28-0.48), whereas low adherence (<75%) showed no clear benefit (RR = 0.92, 95% CI 0.68-1.23; P for interaction <0.00001). Each 10% increase in adherence corresponded to an RR multiplier of 0.83 (approximately 17% lower RR). Certainty of evidence was low. CONCLUSION: Exercise-based programmes reduce HSI risk in football when implementation supports sustained adherence. Effects may be stronger in shorter interventions and elite populations, but evidence remains insufficient to differentiate programme types or components.

References

1. 1.Gu, J., Li, Y., Wang, Y., & Zhang, Y. (2026). Intervention components, training dose, and adherence in exercise-based prevention of hamstring strain injury in football: a systematic review and meta-analysis. Annals of Medicine. https://doi.org/10.1080/07853890.2026.2652116