Background: Hamstring strain injuries are one of the most prevalent injuries in football (soccer). We examined the influence of accumulated match-play exposure on the occurrence of hamstring strain injury in professional football from 2 teams (Spanish 1st Division, LaLiga) over 3 seasons, and determined specific cut-off points as indicators of injury risk. Hypothesis: Overloaded players would be more likely to sustain a hamstring injury. Study Design: Prospective, controlled, observational study. Level of Evidence: Level 2b. Methods: Playing time, total running distance, and high-speed running (>24 km/h) distance during official matches of players that sustained a hamstring injury were compared with uninjured, paired controls. Cumulative playing time and running performance of 4 matches before the injury was computed. Relative risk (RR) of injury occurrence was estimated by generalized estimating equations. Diagnostic accuracy was determined by receiver operating characteristics and the area under the curve. Results: Thirty-seven hamstring strain injuries occurred, representing 23 ± 18 absence days per injury. Thirty-seven controls (uninjured players) were used as comparators. Low match-play exposures during 1 and 2 matches before injury were likely to explain injury occurrence (RR: 14-53%; P < 0.01). Metrics from the match before the hamstring muscle strain demonstrated the best accuracy to predict injury occurrence: high-speed running distance =328 m (sensitivity, 64%; specificity, 84%), playing time =64 min (sensitivity, 36%; specificity, 97%), and running distance =5.8 km (sensitivity, 39%; specificity, 97%). Conclusion: Relatively reduced competitive exposure in the previous 2 matches was associated with higher hamstring injury risk in professional football players. Clinical Relevance: Screening simple metrics such as the accumulated match exposure during official matches and considering specific cut-off points for some running variables may be good indicators of injury risk and may assist in better individual injury management in professional soccer players.
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