Part of Rugby injuries: where they come from and which ones matter
Rugby hamstring injury: why it happens and why it comes back
Warning signs, and when to get help
Why running and kicking produce it, not contact
Most of rugby's injuries come from the tackle, and the hamstring is the exception that proves the rule. In professional English rugby union, 68 percent of hamstring injuries happened while running, and the ones that happened while kicking were the most severe of the lot, at a mean of 36 days lost against an overall mean of 17 (Brooks and colleagues, 2006). The muscle gets hurt in the part of the stride where it is long and braking, which is the back of the thigh working hardest at its longest length.
That is why rugby finds hamstrings in the places it does. A winger chasing a kick, a full back turning and accelerating, a fly half striking a ball with the leg swinging through: all of them put the hamstring at length under speed. Forwards are not exempt, and the same study found second row forwards had both the lowest rate, at 2.4 per 1000 player hours, and the shortest absence, at 7 days.
The systematic review of this exact question in rugby union, covering 24 studies and 2,866 players, lists playing position among the risk factors it could identify, alongside fatigue, previous injury, a strength difference between the two legs, running actions and a lack of readiness to return to play after injury (Chavarro-Nieto and colleagues, 2023). The same review reports that professional players are stronger than amateurs and that forwards are stronger than backs, which is a reminder that a number from a professional squad is not a number about you.
How long does a rugby hamstring injury keep you out?
In the professional game, 17 days on average, and that average hides more than it tells you. Hamstring injury happened at 0.27 per 1000 player training hours and 5.6 per 1000 player match hours, so matches are where the exposure counts, and the spread of severity ran from a few days to the 36 day mean for kicking injuries (Brooks and colleagues, 2006). The study is 20 years old and it is still the clearest rugby specific picture anyone has published.
Two things keep that from becoming your own timetable. These were full time players with a physiotherapist on site every day, which changes both how early an injury is caught and how fast the rehab runs. And an average absence says nothing about the grade of the tear, which is what actually decides your weeks.
The plan for the meantime is on hamstring strain, which carries the first few days, the staged program from gentle holds through slow lowering work to running, and the criteria physios use before sprinting. Pain high at the back of the thigh that built up over weeks, rather than tearing in one stride, is more likely hamstring tendinopathy, which is a different problem with a different program, and pain that started in the groin belongs with groin strain.
Why does it keep coming back?
Because the first injury leaves the muscle and the player changed, and because of when people go back. Repeat injuries were 23 percent of all hamstring injuries in that professional squad data, and they cost a mean of 25 days against 14 days for a first injury, so a recurrence is not a smaller version of the original (Brooks and colleagues, 2006). Previous injury turns up as a risk factor in the rugby review as well (Chavarro-Nieto and colleagues, 2023).
The item on that risk factor list that players like least is the one they control: a lack of readiness to return to play after injury. It is the only risk factor there that is entirely a decision and not a characteristic, and it is made in the week when the hamstring has stopped hurting and the fixture looks winnable. Feeling fine jogging is not the same as being able to decelerate from a sprint with a hamstring at full length.
That is what the tests exist for. The return to sport test battery sets out what clinicians measure before clearing somebody, and the decision rules on going back into contact after a head injury, which run on a different system entirely, are on rugby return to play.
Does eccentric exercise prevent a hamstring injury?
This is the strongest prevention evidence anywhere in this hub, and it comes with a live argument inside it. One systematic review and meta-analysis pooled 15 studies and 8,459 athletes across sports, ages and both sexes, and found that injury prevention programs including the Nordic hamstring exercise were associated with a risk ratio of 0.49, with a confidence interval of 0.32 to 0.74. The effect held when the 8 randomized studies were pooled alone, at 0.52, and when the 8 studies judged at high risk of bias were removed, at 0.55 (van Dyk, Behan and Whiteley, 2019).
Then the method was challenged. A reanalysis found that only 5 of those 15 studies had randomized players to the Nordic exercise itself rather than to a package containing it, added one further study, and reported a risk ratio of 0.59 with a confidence interval of 0.27 to 1.29 and a prediction interval crossing 1. Its conclusion was that the preventive effect of the exercise remains inconclusive, and that at best a conditional recommendation can be made, in soccer (Impellizzeri, McCall and van Smeden, 2021). The argument did not stop there. Two letters followed in the same journal, a response from Ishoi and Thorborg arguing that clinical context and the actual protocols matter, and an author's reply from the reanalysis team. The Ishoi and Thorborg letter is behind the publisher's paywall and we have not read it, so it is listed in the references for its title only. The reply is open access, and in it the reanalysis team hold their position: dropping studies from the pool after the results are known is how a conclusion gets chosen rather than found, and removing the one study the letter argued hardest about leaves the estimate inconclusive anyway (Impellizzeri, McCall and van Smeden, 2022). The method is still being argued over, which is not the same as the exercise having been disproved.
Neither of those is a rugby study. What rugby has of its own on this is a cohort comparison inside the professional surveillance study: players who were doing Nordic hamstring exercises as well as conventional stretching and strengthening had a lower incidence and severity of hamstring injury than those who were not (Brooks and colleagues, 2006). That is an observation inside an observational study, not a trial, and the players who chose to do extra work may well have differed in other ways.
That does not leave you with nothing. Loading the hamstring while it lengthens is a reasonable thing to build into a season, the direction of the evidence favors it, and nobody can promise you a percentage. The library's eccentric hamstring exercise is a gentler way into that kind of loading, and it is not the Nordic. The Nordic is done kneeling upright with a partner or a strap holding your ankles while you lower your whole body toward the floor. Ours is done lying face down, bending one knee until the shin points at the ceiling, then lowering that foot back toward the mat and braking it just before it lands. One leg at a time, no partner, no body weight through the hamstring.
The numbers that follow are season work for a hamstring that is not hurt now. If you have strained that hamstring recently, or you have had a knee ligament reconstruction that used a hamstring tendon as the graft, start this only when your physio or surgeon says the muscle is ready for it, and stay on the slow lower until they clear you for anything faster. That graft is most often an ACL, and the tendon taken is usually the semitendinosus, sometimes with the gracilis next to it, which your operation notes will name. Check which leg it came from while you are at it, because some surgeons harvest the graft from the uninjured side, so the hamstring that needs the gate is not always the knee that was rebuilt. The same gate applies if a hamstring tendon was used to rebuild any other ligament, at that knee or anywhere else. If you are not sure whether yours counts as recent, treat it as recent and ask first: a hamstring that has not yet been through a full return to sprinting is still in rehabilitation, whatever the date on the calendar says. For an adult, many programs start with 2 to 3 sets of 6 to 10 slow lowers on each leg, a few days a week, with a rest day between sessions, then speed up the lower over a week or two once it is easy and pain free. That is the adult figure, the section below is why it is not a teenager's figure, and where the two differ for an adult, the exercise page wins. Neither number is a number for a player who is still growing: the exercise page carries the adult dose, and although it now asks a growing player to have a physiotherapist or qualified strength coach set it up first, it still gives no teenager's figure, because none has been tested. Soreness at the back of the thigh for a day or two after a new session is expected; pain during the lower itself means stop. Your physio will adjust this.
If you coach teenagers, read this part twice
The only randomized injury prevention trial in rugby was done in schoolboys, and the exercise this section is about was not in it. Forty independent schools, 118 teams and 3,188 players aged 14 to 18 were randomized to a pre-activity movement control program or to a reference program. The effect on overall injury was unclear on the main analysis and became clear in the teams that averaged three or more sessions a week (Hislop and colleagues, 2017). Movement control work, done often, is what that trial supports in this age group.
The Nordic hamstring exercise is a different proposition and is borrowed from adult soccer. It is a maximal effort for the hamstring at length, it produces days of deep soreness when it is introduced too fast, and in a squad of 15 year olds the range of physical maturity across one team is enormous. A number taken off a page and applied to a whole age group is how a session ends with half a team unable to sprint on Tuesday.
There is also an injury in this age group that an adult page will not warn you about. The hamstring attaches to a growth area on the bone you sit on, and in a player who is still growing a hard sprint or a kick can pull that growth area off the bone instead of tearing the muscle. In a series of 719 pelvic and hip avulsion fractures treated at one US children's hospital, at a mean age of 14.6, the sitting bone was the third most common site at 19.4 percent, and running at 27.8 percent and kicking at 26.7 percent were the two most common mechanisms (Ferraro and colleagues, 2023). Those were soccer, American football and baseball players and not rugby players, so take the proportions as the shape of the injury, but the two mechanisms are the ones this whole page is about. What makes it worth knowing is that it does not look dramatic. The big spreading bruise and the gap you can feel in an adult tear are usually absent, so it gets called a pulled hamstring and the player is sent away to stretch it. A plain X-ray settles it, a displaced fragment may be fixed surgically, and prompt treatment looks more promising than treating it late (Best and colleagues, 2021). A teenager with sudden pain right on the sitting bone who then cannot run or sit down on that side goes for that X-ray the same day, and that is its own line in the warning list below.
So the age gating on this page is deliberate. Below senior level, eccentric hamstring work belongs with a physiotherapist or a qualified strength coach who starts low, builds over weeks, and treats each player separately, and the volume is theirs to set, not ours. Nothing on this page is a program for a school team, and a young player who is already sore should be assessed, not loaded.
If what you actually want is the movement control program, take a published one rather than building it from this page. Activate is free on World Rugby's Passport site, and it comes as four separate programs, one for under 15s, one for under 16s, one for under 18s and one for adults, each built in levels a squad works through across a season. The age banding is the thing this page cannot give you, and it is the thing a mixed maturity squad needs.
When to see a physio
A hamstring that let go in one stride and left you limping is worth an assessment in the first week, because the grade of the tear is what sets the plan and a strain that is managed properly early is the one least likely to come back. A hamstring that grabs every time you sprint, or that has gone more than once in a season, needs one sooner than that, and the strength difference between your two legs is one of the first things a physio will measure.
One injury on this page is not a hamstring strain at all and needs the same day. A pop or snap high at the back of the thigh near the bone you sit on, with large bruising, a gap you can feel or clear weakness bending the knee, can mean the tendon has pulled off the bone, and the published repair window is early, so that one goes to urgent care or an emergency department and not to a program. In the warning list below it is the first line under "Get help today", under the emergency lines.
Which of these injuries actually gets operated on is not one rule. A complete avulsion, where the tendons have come off the sitting bone altogether, is usually repaired in an active person, because the leg left alone keeps a real deficit: in the largest published series managed without surgery, 19 people followed for a mean of 31 months, the injured leg made 62 and 66 percent of the other side's knee bending strength, 30 percent never got back to the same level of sport, and 47 percent said they wished they had been operated on at the time (Degen, 2019, reporting Hofmann and colleagues). A partial tear or a tendinopathy at the same spot runs the other way: rehabilitation first, with surgery kept for the ones that do not settle after a proper course of it. What tips a partial tear toward an operation is how many of the three tendons have torn and how far they have pulled back, which is the detail a scan is being asked for. One tendon, or two with less than 2 cm of pull-back, is usually treated without surgery; two with more pull-back than that, or all three, is usually repaired. In one cohort of 25 partial tears started without surgery, 40 percent had an operation in the end (Degen, 2019, reporting Piposar and colleagues). Not every complete tear is offered an operation either. Somebody less active, somebody with other medical problems, or somebody who cannot keep to the restrictions afterwards may reasonably be managed without one. None of those series is a rugby series, and the decision belongs to a surgeon who has seen your scan, which is what the same day line is for.
Two things follow for readers who are already past that point. If your injury happened more than 4 weeks ago, you have not missed your chance: later repair is still done and still works, it just takes longer to get back to sport and brings more nerve trouble with it, so the referral is still worth asking for. And if you have already had a proximal hamstring repair, nothing on this page is your program. The aftercare for that operation differs genuinely between surgeons, from no weight through the leg in a brace that limits how far the knee straightens, through to full weight bearing with no brace at all, and the published rehabilitation protocols differ with them (Degen, 2019). Your own surgeon's instructions are the ones that count, and the dates in them come from how your repair was done and how much the tendon had pulled back, not from a page.
Take the detail with you: what you were doing at the moment it happened, whether you felt it in the back of the thigh or up near the buttock, how many sprinting and kicking sessions you had done that week, and whether that leg has done this before. The rest of the sport's injuries, and where each one is covered, are set out at rugby injuries.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: a player who has gone down in contact has pain down the middle of the neck or back, numbness, tingling, burning or weakness in the arms or legs, limbs that feel heavy, a neck or back that looks out of shape, or trouble breathing. Treat it as a neck injury in the same way if the player has been knocked out, or has any injury above the collarbone, because somebody who is not fully awake cannot tell you their neck hurts. Do not move the player, and do not let anybody roll them onto their side. Call emergency services, keep the head and neck as still as possible, and wait for emergency healthcare professionals with spinal care training to move them, which is what World Rugby's own immediate care and first aid course material instructs. If you are not sure whether the neck is injured, treat it as though it is. If the player is not breathing, cannot keep their airway clear, for example because there is blood or vomit in their mouth, or you cannot be sure whether the airway is open and they are breathing, that comes first, and the emergency call handler will tell you what to do.
- Emergency: if chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.
- Emergency: if you faint while exercising, call emergency services, even if you feel fine again quickly.
- Emergency: any sign of a stroke, even if it goes away. That means a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or falling over, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack). Call emergency services straight away.
- Emergency: after a knock to the head, being very drowsy or finding it hard to keep your eyes open, confusion, a fit (seizure), new weakness or numbness anywhere in your body, new trouble understanding, speaking, walking or keeping your balance, new problems seeing or hearing, clear fluid coming from your ears or nose, bleeding from your ears or bruising behind them, a black eye when your eye was not hit, a dent in your head or a wound with something stuck in it, or a change in behavior. Call emergency services straight away. These can be signs of an injury to the brain.
- Emergency: after a knock to the head, you were knocked out, even for a moment, you cannot remember what happened just before or after, you have had a headache ever since, or you are being sick (vomiting). The same applies, even if you feel fine, if you take medicine that thins your blood, other than aspirin on its own, have a bleeding or clotting condition, have had brain surgery in the past, or had been drinking alcohol or taking drugs when it happened. Go to an emergency department straight away, and do not drive yourself.
- Emergency: severe neck pain after a knock to the head, whatever the fall or the knock was like. Keep still and call emergency services, and do not let anyone move you until someone trained has checked your neck. If the neck pain only starts later and nobody has checked your neck since, go to an emergency department straight away, and do not drive yourself.
- Emergency: after a knock to the head, swelling, a deep cut or severe pain at the exact spot that was hit. Call emergency services or go to an emergency department straight away, and do not drive yourself. These can be signs of a broken skull.
- Emergency: after a ball, a boot, a hand or elbow, a collision or a fall to the face, any change to your sight, severe pain in the eye, a headache or finding light hard to bear, feeling sick or being sick, an eye you cannot move or keep open, or blood or pus coming from the eye. The same applies if something has pierced the eye or hit it at high speed, or if a strong chemical has gone into it. Go to an emergency department or call emergency services straight away, and do not drive yourself.
- Emergency: numbness, tingling or altered feeling around or under your genitals, between your inner thighs, or around your bottom (anus), for example it feels different when you wipe after using the toilet. Call emergency services or go to an emergency department straight away, and do not drive yourself. This can be a sign of pressure on the bundle of nerves at the base of the spine (cauda equina syndrome), which needs emergency treatment.
- Emergency: you find it hard to start peeing, cannot pee, cannot feel yourself peeing or cannot control when you pee, or you do not notice when you need to poo or cannot control when you poo, and this is not normal for you. The same applies to a new change in how your genitals feel during sex, new trouble getting or keeping an erection, new trouble ejaculating, or new trouble reaching orgasm. Call emergency services or go to an emergency department straight away, and do not drive yourself. These can also be signs of cauda equina syndrome.
- Emergency: sciatica in both legs, or pain, tingling, numbness or weakness in both legs. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away, and do not drive yourself.
Get help today
- Same day: you have had a knock to the head and you take aspirin on its own, without any of the emergency signs above. Get medical advice the same day. Aspirin on its own is the only blood thinning medicine left out of the emergency line above, and the NHS still asks anybody taking a medicine that thins the blood to get urgent advice after a head injury.
- Same day: you felt or heard a pop or snap high at the back of your thigh, near the buttock or the bone you sit on, and now have large bruising spreading down the back of the thigh, a gap or dip you can feel, a stiff-legged walk, or clear weakness when you bend the knee. Get assessed the same day at urgent care or an emergency department, and ask whether you need a scan and a surgeon's opinion. The tendon may have pulled away from the bone (proximal hamstring avulsion). When surgery is needed, repair within the first 4 weeks is favored over later repair, so do not wait to see if it settles. If it already happened longer ago than that, do not decide you have missed your chance, because later repair is still done and still works: it takes longer to get back to sport and carries more nerve trouble, which is a reason to go now and not a reason to stay home. This page does not cover this injury.
- Same day: a player who is still growing, which in rugby mostly means the early to middle teens, felt a sudden sharp pain right on the bone they sit on while sprinting or kicking, and afterwards cannot run, cannot sit down on that side, or walks with a stiff leg. Get assessed the same day and ask for an X-ray. At that age the hamstring can pull the growth area off the bone (ischial apophyseal avulsion), and the large bruising and the gap you can feel in an adult injury are often missing, so this one gets missed as a pulled hamstring.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
- Same day: you cannot walk or put weight on the leg, whether or not there was a fall or injury, or you have very bad knee pain after a fall or injury, or very bad knee pain that came on suddenly with no injury at all. Get medical advice the same day.
- Same day: the pain is there at night or at rest and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: the pain is there at night or at rest and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: the pain is there at night or at rest and keeps getting worse. See your doctor within a few days.
Common questions
How long will I be out with a rugby hamstring injury?
In professional English rugby union the average was 17 days, and the averages hide a wide spread. In that study, hamstring injury happened at 0.27 per 1000 player training hours and 5.6 per 1000 player match hours, repeat injuries made up 23 percent of the total and cost a mean of 25 days against 14 days for a new injury, and the injuries that happened while kicking were the most severe of all at a mean of 36 days lost (Brooks and colleagues, 2006). Those are professional men with daily access to a medical team, and no comparable published dataset exists for club or school rugby. Treat them as the shape of the injury and not as your dates, and use the staged program on hamstring strain and the readiness tests rather than a calendar.
Why does my hamstring keep going?
Because a previous hamstring injury is one of the risk factors the sport's own review was able to identify, and because the way players come back makes it worse. A systematic review of 24 studies and 2,866 rugby union players names playing position, fatigue, previous injury, a strength difference between the two legs, running actions, and a lack of readiness to return to play after injury as the risk factors it could identify (Chavarro-Nieto and colleagues, 2023). The professional surveillance data puts a cost on it: repeat injuries were 23 percent of all hamstring injuries and kept players out nearly twice as long as first ones (Brooks and colleagues, 2006). The practical reading is that the few weeks after you go back are the risky part, and that the strength work does not stop on the day you are selected again.
Do Nordic hamstring exercises actually work?
Two readable reviews of overlapping evidence reach different conclusions, and an honest answer gives both. Pooling 15 studies and 8,459 athletes across sports, ages and both sexes, injury prevention programs that included the Nordic hamstring exercise were associated with a risk ratio of 0.49, confidence interval 0.32 to 0.74, which is roughly halving the rate, and the result held at 0.52 when only the 8 randomized studies were pooled and 0.55 with the 8 studies at high risk of bias removed (van Dyk, Behan and Whiteley, 2019). A reanalysis found that only 5 of those 15 studies had actually randomized players to the Nordic exercise itself, added one more, and reported a risk ratio of 0.59 with a confidence interval of 0.27 to 1.29 and a prediction interval crossing 1, concluding that the preventive effect is inconclusive and that at best a conditional recommendation can be made, in soccer (Impellizzeri, McCall and van Smeden, 2021). Two letters followed in that journal, one disputing the reanalysis and one replying to it. The dispute itself is paywalled and we have not read it, so it is cited for its title only; the reply is open access and holds the original position. The reanalysis is therefore a methodological challenge still being argued over, not a settled refutation. Neither review is a rugby study.
Should a 15 year old rugby player be doing Nordic hamstring exercises?
Not as something a coach adds to a warm-up on the strength of a page, and the reason is in the evidence itself. The only randomized injury prevention trial in rugby was a pre-activity movement control program in 3,188 schoolboys aged 14 to 18, and that program is not the Nordic hamstring exercise (Hislop and colleagues, 2017). The Nordic evidence comes from other sports, mostly senior soccer, and the exercise is a maximal effort for the hamstring while it lengthens, which is exactly why it leaves people very sore for several days when it is introduced too quickly. In an age group whose bones and tendons are still maturing, that belongs with a physiotherapist or a strength coach who can start light, build over weeks and watch each player, not with a fixed number from the internet. If your club has nobody in that role, the safer version of the same idea is the movement control work the rugby trial actually tested, done regularly, which is the part of that study that produced the clear results. World Rugby publishes a program of that kind free on its Passport site, called Activate, with separate versions for under 15s, under 16s and under 18s, so the age banding comes from the governing body and not from a number a coach found online.
References
- World Rugby Passport. Activate, Injury Prevention and Risk Management. https://passport.world.rugby/injury-prevention-and-risk-management/activate/
- World Rugby Passport. First Aid in Rugby, Chapter 5: Neck and spinal injuries in Rugby Union. https://passport.world.rugby/player-welfare-medical/first-aid-in-rugby/chapter-5-neck-and-spinal-injuries-in-rugby-union/
- World Rugby Passport. Immediate Care in Rugby, Spinal Injuries: recognition, assessment and management. https://passport.world.rugby/player-welfare-medical/immediate-care-in-rugby/spinal-injuries/recognition/
- Brooks JH, Fuller CW, Kemp SP, Reddin DB. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. American Journal of Sports Medicine. 2006;34(8):1297-1306. https://doi.org/10.1177/0363546505286022
- Chavarro-Nieto C, Beaven M, Gill N, Hebert-Losier K. Hamstrings injury incidence, risk factors, and prevention in Rugby Union players: a systematic review. The Physician and Sportsmedicine. 2023;51(1):1-19. https://doi.org/10.1080/00913847.2021.1992601
- van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. British Journal of Sports Medicine. 2019;53(21):1362-1370. https://doi.org/10.1136/bjsports-2018-100045
- Impellizzeri FM, McCall A, van Smeden M. Why methods matter in a meta-analysis: a reappraisal showed inconclusive injury preventive effect of Nordic hamstring exercise. Journal of Clinical Epidemiology. 2021;140:111-124. https://doi.org/10.1016/j.jclinepi.2021.09.007
- Ishoi L, Thorborg K. Why clinical context and relevant protocols matter: response to Impellizzeri et al. Journal of Clinical Epidemiology. 2022;144:206-208. Cited for its title and existence only; the full text is behind the publisher's paywall and was not read. https://doi.org/10.1016/j.jclinepi.2021.10.021
- Impellizzeri FM, McCall A, van Smeden M. Why clinical context and relevant protocols matter: author's reply. Journal of Clinical Epidemiology. 2022;144:209-210. Open access through the Utrecht University repository and read in full on 6 November 2026. https://doi.org/10.1016/j.jclinepi.2021.10.020
- Hislop MD, Stokes KA, Williams S, McKay CD, England ME, Kemp SPT, Trewartha G. Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. British Journal of Sports Medicine. 2017;51(15):1140-1146. https://doi.org/10.1136/bjsports-2016-097434
- West SW, Starling L, Kemp S, Williams S, Cross M, Taylor A, Brooks JHM, Stokes KA. Trends in match injury risk in professional male rugby union: a 16-season review of 10 851 match injuries in the English Premiership (2002-2019): the Professional Rugby Injury Surveillance Project. British Journal of Sports Medicine. 2021;55(12):676-682. https://doi.org/10.1136/bjsports-2020-102529
- Fuller CW, Molloy MG, Bagate C, Bahr R, Brooks JH, Donson H, Kemp SP, McCrory P, McIntosh AS, Meeuwisse WH, Quarrie KL, Raftery M, Wiley P. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. British Journal of Sports Medicine. 2007;41(5):328-331. https://doi.org/10.1136/bjsm.2006.033282
- Degen RM. Proximal Hamstring Injuries: Management of Tendinopathy and Avulsion Injuries. Current Reviews in Musculoskeletal Medicine. 2019;12(2):138-146. Full text read on 6 November 2026. https://doi.org/10.1007/s12178-019-09541-x
- Ferraro SL, Batty M, Heyworth BE, Cook DL, Miller PE, Novais EN. Acute Pelvic and Hip Apophyseal Avulsion Fractures in Adolescents: A Summary of 719 Cases. Journal of Pediatric Orthopaedics. 2023;43(4):204-210. https://doi.org/10.1097/BPO.0000000000002355
- Best R, Meister A, Huth J, Becker U, Meier M. Surgical repair techniques, functional outcome, and return to sports after apophyseal avulsion fractures of the ischial tuberosity in adolescents. International Orthopaedics. 2021;45(7):1853-1861. https://doi.org/10.1007/s00264-021-04959-w
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Written and checked by the PocketPhysio editorial team. Last updated 2026-11-06.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.