Hamstring Injury Prevention Through Balance Training

Unfortunately hamstring injuries are all too common among soccer players. While the severity of hamstring pulls and the time lost to rehabilitation are not as great as ankle and knee sprains, they do pose a serious problem. Recovery from a strained hamstring can be as long as several weeks. In addition, the re-injury rate can be very high. In some cases, a torn hamstring can cause long-term problems that severely impact a player’s career. Given this, trainers have been interested in ways to reduce the risk of injury. A recent study, researchers at the Hannover Medical School in Germany found that a soccer-specific, balance training program can markedly lower the rate of hamstring injuries.

The study followed 24 premier league female players over the course of three seasons (average age 21 years). The first year, no balance training was used during first half of the season (control period). During the next 2.5 seasons, balance training was used as part of a regular training session. Coaches documented how many hours each season the balance training was used and how many hours were spent in soccer training and playing matches. All injuries, both contact and non-contact, were also recorded.

The balance-training program consisted of 12 exercises. The exercises involved activities such as balancing on a single foot, sitting and balancing the torso, running an obstacle course and jumping and landing on a single foot. All were performed with body weight only. Training followed a standard 10-15 minute warm-up.

During the control period, there were nearly 12 hamstring strains per 1000 hours of play (matches and training). After implementing the balance training, these dropped to less than 5, a reduction of 60%. Back muscle strains also declined from 3.5 per 1000 hours to 1, a reduction of 71%. Balance training also reduced the number of days lost due to both hamstring and back muscle injury.

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Adherence to the balance-training program was the key to reducing the injury rate. The more hours spent using the program (or the more sessions per week), the greater the reduction in injury rate.

This study is another in the growing body of evidence showing that a comprehensive warm-up program that includes balance training is an important part of soccer training. When these programs are implemented on a regular basis, they lower the injury risk for the players involved. One word of caution – this study does not suggest that balance training should be used exclusively to prevent hamstring injuries. Other types of training, such as increasing strength, flexibility and joint range of motion remain very important and should not be neglected. The results simply suggest balance training may be another strategy to avoid pulled hamstring muscles.

Balance training is a key part of other injury prevention programs such as the FIFA 11+. While the number of balance exercises included in FIFA’s program is less that what was used in the present study, there is a focus on developing balance. Researchers have shown that the FIFA program is effective in reducing the risk of ACL injuries. An added bonus may be a reduction in hamstring and back muscle injuries.

The authors raise a key point in terms of training athletes. They state, “Experience shows that compliance in interventional training should not be under estimated for injury prevention”. In other words, using injury prevention programs on a consistent basis is important for the health of the athlete. This is a critical issue for coaches and trainers working with young athletes. The costs of injury can be substantial. The financial costs of treatments and rehabilitation, missed playing time, elevated risks of long-term complications can be substantial. In order to protect players from injuries that can have both short- and long-term consequences (hamstring tears, ACL ruptures, ankle sprains), coaches should include these types of programs as part of their regular training session.


Kraemer R, Knobloch K (2010) A soccer-specific balance training program for hamstring muscle and patellar and Achilles tendon injuries. American Journal of Sports Medicine, 37:1384-1393

CLICK HERE for an article on hamstring injury prevention by Dr. Donald T. Kirkendall (US Soccer Federation website).

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Posted by Jay Williams, Ph.D.
Labels: Current Research, Injuries, Training

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