It’s not all about sprinting. Mechanisms of acute hamstring strain injuries in professional male rugby union: a systematic visual video analysis

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 2015/16 to 2017/18 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 upon 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 (i.e., 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 characterized 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 appear to be a fundamental characteristic of the mechanisms of acute HSIs in Rugby Union.