Eccentric Hamstring Strength Monitoring to Predict Injury Risk in Men’s Non-League Professional Football: An Exploratory Cox Regression Study

Jackson, Daniel T. and Blagrove, Richard C. and Thain, Peter and Weldon, Anthony and Jadhakhan, Ferozkhan and Clark, Cain and Kelly, Adam L. (2025) Eccentric Hamstring Strength Monitoring to Predict Injury Risk in Men’s Non-League Professional Football: An Exploratory Cox Regression Study. Applied Sciences, 15 (24). ISSN 2076-3417

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Abstract

Hamstring-strain injuries (HSIs) are the most prevalent time-loss injuries in professional football. While player monitoring of muscular strength is ubiquitous in professional football, the utility of in-season testing for predicting HSI in non-league football (NLF) settings is unclear. This study aimed to investigate if short-term, in-season changes in eccentric hamstring strength are associated with HSI risk and compare the predictive performance to a baseline model. This was a single-season prospective cohort study (36 weeks) in 20 male professional NLF players (nine HSI events). Eccentric hamstring strength was measured twice weekly during Nordic hamstring exercise (NHE) using a NordBord device. Cox proportional hazard models (Andersen–Gill) evaluated the association of HSI with bilateral peak force and inter-limb asymmetry as time-varying and baseline predictors. Nine HSIs occurred (29% of all time-loss injuries; n = 31). The predictive analysis revealed that the baseline model with hazard ratio (HR) of 0.20 (95% CI: 0.09–0.46; C-index = 0.824) outperformed the time-varying model (HR 0.29; 95% CI: 0.15–0.56; C-index = 0.776), with higher bilateral peak force protective across both models. Conversely, inter-limb asymmetry showed no association with HSI risk (HR 1.10; 95% CI: 0.95–1.27; C-index = 0.527). A key related finding was that while single test inter-limb asymmetry measurements were unreliable, stability across the season was good (ICC(1,k) = 0.895). In this cohort, a greater bilateral peak force was protective against HSI, with baseline testing more effective than twice-weekly in-season testing. Inter-limb asymmetry did not predict HSI, and the utility of its isolated use remains unclear despite the stability of players’ season-long profiles. These exploratory findings require confirmation in larger cohorts.

Item Type:	Article
Identification Number:	10.3390/app152412872
Dates:	Date Event 3 December 2025 Accepted 5 December 2025 Published Online
Uncontrolled Keywords:	soccer, muscle strength, survival analysis, risk factors, Nordic hamstring exercise
Subjects:	CAH03 - biological and sport sciences > CAH03-02 - sport and exercise sciences > CAH03-02-01 - sport and exercise sciences
Divisions:	Life and Health Sciences > Life and Sports Sciences
Depositing User:	Gemma Tonks
Date Deposited:	05 Dec 2025 16:10
Last Modified:	05 Dec 2025 16:10
URI:	https://www.open-access.bcu.ac.uk/id/eprint/16766

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