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Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial
Petersen J, Thorborg K, Nielsen MB, Budtz-Jorgensen E, Holmich P
The American Journal of Sports Medicine 2011 Nov;39(11):2296-2303
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: The incidence of acute hamstring injuries is high in several sports, including the different forms of football. PURPOSE: The authors investigated the preventive effect of eccentric strengthening of the hamstring muscles using the Nordic hamstring exercise compared with no additional hamstring exercise on the rate of acute hamstring injuries in male soccer players. STUDY DESIGN: Randomized controlled trial; level of evidence, 1. METHODS: Fifty Danish male professional and amateur soccer teams (942 players) were allocated to an intervention group (461 players) or a control group (481 players). Players in the intervention group conducted a 10-week progressive eccentric training program followed by a weekly seasonal program, whereas players in the control group followed their usual training program. The main outcome measures were numbers of overall, new, and recurrent acute hamstring injuries during 1 full soccer season. RESULTS: Fifty-two acute hamstring injuries in the control group compared with 15 injuries in the intervention group were registered. Comparing intervention versus the control group, overall acute hamstring injury rates per 100 player seasons were 3.8 versus 13.1 (adjusted rate ratio (RR) 0.293; 95% confidence interval (CI) 0.150 to 0.572; p < 0.001). New injury rates per 100 player seasons were 3.1 versus 8.1 (RR 0.410; 95% CI 0.180 to 0.933; p = 0.034), whereas recurrent injury rates per 100 player seasons were 7.1 versus 45.8 (RR 0.137; 95% CI 0.037 to 0.509; p = 0.003). Number needed to treat (NNT) to prevent 1 acute hamstring injury (new or recurrent) is 13 (95% CI 9 to 23) players. The NNT to prevent 1 new injury is 25 (95% CI 15 to 72) players, and NNT to prevent 1 recurrent injury is 3 (95% CI 2 to 6) players. CONCLUSION: In male professional and amateur soccer players, additional eccentric hamstring exercise decreased the rate of overall, new, and recurrent acute hamstring injuries.

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