Part Four:
Delivery of the Injury Reduction Protocol
Maintaining athlete strength, resilience, and readiness for competition is a top priority for performance coaches and exercise professionals alike. When key players are unavailable, the impact extends beyond their performance development — it can influence match results and even shape the course of an entire season. For this reason, forward-thinking practitioners place injury reduction at the core of their work, ensuring athletes remain healthy, consistently available for selection, and able to perform at their peak throughout the year.
Achieving this requires a comprehensive, integrated approach. In Part 1 of this series, we introduced a structured five-stage injury reduction model designed to create an individualized program which can be seamlessly embedded into the athlete’s regular training schedule. Part 2 explored how this framework could be applied in men’s soccer, using hamstring injuries as a case study. In Part 3 we examined the intrinsic and extrinsic risk factors which can contribute to hamstring injuries and outlined how to assess individual risk through a multifaceted screening process. Now, in this final instalment, we turn to the last stage of the framework — the practical delivery of injury reduction strategies
We left Part 3 having progressed through a comprehensive injury screening process. At this point, practitioners will have identified not only those athletes categorized as having a higher potential for injury, but also the specific injury risk factors that they are most vulnerable to. When this screening information is integrated into Apollo alongside athlete training loads and medical data, coaches are then empowered to design and implement highly specific and individualized injury reduction programs with each athlete in the squad. This represents Stage 5 of the process: Delivery of the injury reduction protocol.
Stage 5: Hamstring Strains in Men’s Soccer – Delivery of Injury Reduction Protocols
Training programs designed to reduce hamstring injury will only be effective if they are constructed using exercises which have been proven to have positive outcomes on the injury risk factors that were identified during Stage 3 of the process. In Stage 3 we discovered that one of the primary injury risk factors associated with hamstring injuries is a lack of lower body strength.
1. Lower Body Strength
General Lower Body Strength
The starting point in any hamstring specific injury reduction program is to build it around strength exercises which are designed to promote a healthy hamstring. This can be addressed in the initial stages by having the athlete perform general strength exercises which simultaneously extend the hip and flex the knee, recreating the action of the hamstring as it functions during running. These exercises, which include basic squats, deadlifts and their derivatives, are generally performed standing in a functional position, and are particularly effective with novice athletes or don’t have an extensive background in strength training.
The foot position adopted by the athlete during these exercises will have an effect on intramuscular coordination, and this has important consequences on the contribution these exercises make towards reducing injury risk. For example, if the back squat exercise is executed with the toes turned out, this will increase recruitment of the biceps femoris (BF). However, a more medial foot position will increase recruitment of the semitendinosus (ST). This has implications for the particular target muscle group which is being emphasised – and as we discussed previously in this series, neuromuscular control and the interaction between the BF and the ST has important implications on hamstring health.
Eccentric Hamstring Strength
These general exercises are very effective at increasing lower body strength, however, they should also be supported by specific exercises which load the hamstrings as they function whilst sprinting. This will reduce the likelihood of the forces generated during maximal sprints surpassing the tolerance of the muscle-tendon unit, and increase the probability that the hamstring will remain healthy. In function of this, the use of eccentric hamstring strength training is perhaps the most widely researched and recommended evidence-based strategy for hamstring injury prevention, and has been shown to significantly reduce the risk of primary and secondary hamstring injuries by between 65%–85%.
Eccentric strength training results in alterations of muscle architecture, specifically elongation of the BF long head, which has been shown to be the most common site of injury. Studies have shown that professional football players with short biceps femoris long head fascicles (<10.6 cm) were at four times greater risk of hamstring injury than players with longer fascicles. It is hypothesised that shorter fascicles, with fewer in series sarcomeres, may be more susceptible to being overstretched and sustaining damage via powerful eccentric actions, typical of the terminal swing phase of high-speed running. Studies have suggested that injury risk can be reduced by 75% for every 0.5 cm increase in fascicle length through eccentric exercise.
Eccentric exercises, including Nordics or hamstring sliders (which are knee dominant exercises) or Romanian Deadlifts (a hip dominant exercise), should be performed at longer lengths to maximise the increase in peak torque angle, which is when the strain on the hamstrings is at its highest. This will ensure the transfer of training gains from the weight room into competitive performance. Again, in terms of intramuscular coordination, the Romanian Deadlift involves a high activation of the ST, which the practitioner should be aware of when designing their injury reduction protocol.
Isometric Hamstring Strength
More recently, contemporary thinking has started to look at the role that the hamstrings play during sprinting and high-speed running in a different way. A growing number of practitioners now advocate that during the late swing phase (when the majority of sprint related hamstring injuries occur), the hamstrings don’t actually lengthen eccentrically as previously thought, but instead primarily contract isometrically while the tendon stretches and recoils in an elastic response. This means that hamstring injuries may in fact occur because the muscles are not strong enough to maintain an isometric contraction in long length positions when they are being exposed to high levels of force, such as in a sprint action. For this reason, practitioners are increasingly incorporating long length isometric exercises into their hamstring injury reduction protocols.
Hip Extension Exercises
Although the hamstrings function to extend the hip and flex the knee, at high speeds during the swing phase knee flexion is largely passive. This suggests that at peak velocities the hamstrings function primarily as hip extensors, with a secondary role in stabilizing the knee prior to foot strike. For this reason, hip extension exercises, such as weighted hip thrusts, reverse hypers, good mornings or kettlebell swings should be woven into the hamstring protocol to balance out the athletes exposure to the knee flexion-dominant Nordic exercise.
Unilateral Exercises
It is important that some of these exercises are performed on one leg, particularly where there is an imbalance or asymmetry between the left and right leg. Single leg exercises create greater demands on balance, control and trunk stability, and are much more effective at replicating sport-specific mechanics. In addition, unilateral exercises have both a greater neutral drive and less pelvic tilt, both of which are implicated in hamstring health.
2. Neuromuscular Control
A second injury risk factor which can also influence hamstring injury is neuromuscular control. The muscles in the posterior chain act as synergists to the hamstrings, and must function effectively to prevent the hamstrings from becoming overloaded. If there is a delay in the onset of hamstring activity and a primary activation of the lower back muscles, there will be an increased risk of hamstring injury. Improving neuromuscular control involves exposing the athlete to exercises of progressively increasing complexity and challenge, designed to create the appropriate firing patterns in the posterior chain. These exercises can include wiper lunges, wiper hurdle steps, and perturbation exercises using weights on a barbell suspended from elastic resistance bands.
3. Core Strength
A further injury risk factor that was identified during Stage 3 is the level of core strength and proximal control that the athlete has. The core muscles are used to modify the tilt of the pelvis during running, which in turn influences the length of the hamstring. For this reason, the core should be trained under functional loading conditions, in order to facilitate appropriate gluteal and trunk muscle recruitment and to ensure that the pelvis is stabilised during high level football activities.
4. Running Mechanics & Sprint Drills
Maximal Velocity Training
Probably the most effective form of injury reduction training for the hamstrings is maximal sprint training. Controlled exposure of an athlete to the high running speeds that they will have to produce in a game, and therefore to the associated torque and muscular forces involved in these actions, will increase the tolerance that the hamstrings will have to operate at these speeds, providing a protective mechanism against injury. Recent research indicates that regularly achieving peak or near-peak running speeds in training is associated with a lower risk of hamstring injury, with a recommendation that all players should be exposed to running speeds within 95% of their maximum speed one to two times per week in order to reduce injury.
Training to Improve Running Mechanics
The final injury risk factor involves the running mechanics of the player. An excessive forward trunk lean during sprinting induces an anterior pelvic tilt, which has been identified as a factor which increases the risk of a hamstring injury occurring. Therefore, training exercises which reinforce good running mechanics mitigate this injury risk, and reduces the potential of an athlete sustaining a hamstring injury.
Hamstring Strains in Men’s Soccer – Summary of Injury Reduction Program Content
To summarize – An effective injury reduction program designed to minimize the risk of hamstring strain may well feature any or all of the following exercises and drills:
Lower Body Strength Training
- General Lower Body Strength: Squats & Deadlifts
- Eccentric Hamstring Strength: Nordics, Sliders, Romanian Deadlift
- Isometric Hamstring Strength: Long Lever Isometric Holds
- Hip Extension Exercises: Kettlebell Swings, Hip Thrusts, Reverse Hypers, Good Mornings
- Unilateral Exercises: 1 Leg RDL, 1 Leg Squat, 1 Leg Iso’s, 1 Leg Hip Thrusts
Neuromuscular Control: Exercises to create appropriate firing patterns in the posterior chain: Wiper Lunge, Perturbation Exercises
Core Strength: Functional loading exercises to facilitate pelvic stability during high velocity activities: Deadbugs, Bridging exercises
Sprint Drills & Running Mechanics: Maximal sprint & explosive exercises which recreate the loading conditions in which hamstring demands are highest.
The challenge to the practitioner is this: how do we take all of these exercises and integrate them into each athletes weekly training plan, in a way which is specific to the unique requirements of each individual, in order to ensure that we are building our program as efficiently and effectively as possible? The answer can be found in Apollo.
Apollo is Critical to a Successful Injury Reduction Process
Effective injury reduction depends on more than training programs — it requires connected, reliable data. Apollo provides the backbone that makes this process efficient and actionable.
By centralizing athlete information, Apollo eliminates disconnected spreadsheets, handwritten notes, or siloed medical reports. Injury history, screening results, workload metrics, wellness feedback, and rehab progress are all stored in one platform. This allows practitioners to:
- Assess athlete specific injury risk factors
- Create effective training interventions
- Monitor at-risk athletes in real time
- Measure the effectiveness of injury reduction protocols
For example, a strength and conditioning coach can quickly compare sprint load data with hamstring injury incidents, or review landing force metrics in athletes after an ankle-prevention program.
With integrated AI-driven analytics, Apollo goes beyond storing data: it delivers actionable insights. Coaches and performance staff can make evidence-based decisions that reduce injury risk, improve athlete availability, and keep teams performing at their best.
To learn more about using Apollo for injury prevention, email info@apollov2.com.
Written by Adrian Lamb, Apollo Sports Scientist
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