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Similar Isokinetic Strength Preinjury and at Return to Sport after Hamstring Injury


Medicine & Science in Sports & Exercise: June 2019 - Volume 51 - Issue 6 - p 1091–1098
doi: 10.1249/MSS.0000000000001900

Introduction Side-to-side strength differences are often used in return to sport (RTS) decision making after hamstring injury. In football (soccer), there is little consensus, and a side-to-side difference of <10% is often suggested as a criterion. To date, no study has determined whether differences exist when comparing the strength of the injured limb at RTS with the preinjury level.

Purpose The aims of this study were to compare the isokinetic strength at RTS with preinjury strength in the injured limb and to investigate the side-to-side differences at RTS.

Methods This study was based on a pooled group of patients participating in two single-site randomized controlled trials. All eligible professional male soccer players who suffered a hamstring injury confirmed by magnetic resonance imaging were included. The isokinetic strength of the injured limb at RTS was compared with preinjury screening tests, and the side-to-side difference was determined at both time points.

Results In total, 41 hamstring injuries were included in the analyses. Side-to-side differences in isokinetic strength at RTS were similar to preinjury levels. At RTS, the average strength of the injured limb was >95% compared with preinjury strength. Overall, 63.4% of the players had a >10% negative strength difference (i.e., the injured limb being weaker), and 57.9% of the players had a >10% positive strength difference (i.e., the injured limb being stronger) in at least one of the five isokinetic variables.

Conclusion The distribution of isokinetic strength differences when comparing strength at RTS with preinjury measures was similar, urging clinical caution when interpreting these results. Small changes in the isokinetic strength of the injured limb at RTS compared with preinjury strength suggest that isokinetic cutoff values are not useful to guide the restoration of strength as a criterion for RTS after hamstring injury.

1Aspetar Orthopaedic and Sports Medicine Hospital, Doha, QATAR;

2Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, NORWAY;

3Amsterdam University Medical Centers, Academic Medical Center, Amsterdam Movement Sciences, Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, THE NETHERLANDS;

4Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, THE NETHERLANDS; and

5Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, BELGIUM

Address for correspondence: Nicol van Dyk, Ph.D., Aspetar Orthopaedic and Sports Medicine Hospital, PO Box 29222, Doha, Qatar; E-mail:

Submitted for publication October 2018.

Accepted for publication December 2018.

© 2019 American College of Sports Medicine