Preventing Non-Contact Hamstring Injuries in Elite Footballers: Eccentric vs Concentric Training

NCT07395583 | Recruiting

• 1 other identifier: MOHAP/DXB-REC/S.O.O/No178/2025
• Study Type: interventional
• Target: 275
• Locations: 1 country
• Sites: 1

Brief Summary

Football is a sport with a high risk of injury, and hamstring muscle injuries are among the most common problems faced by players. These injuries can reduce a player's performance, cause time away from training and matches, and place a burden on medical teams and clubs. Many training programs recommend eccentric hamstring exercises to prevent these injuries, but there is limited evidence comparing eccentric exercises with concentric exercises or a combination of both, especially in elite male football players. The purpose of this study is to compare the long-term effects of three different hamstring strengthening programs-eccentric training, concentric training, and a combination of both-on preventing non-contact hamstring injuries in elite male footballers. Each training program will last for three months, and the players will be followed for a total period of 12 months. The study will look at how these programs affect hamstring injury prevention, muscle strength and performance, flexibility, recurrence of injuries, and players' psychological satisfaction. The study is based on the following expectations: A three-month eccentric hamstring strengthening program will lead to long-term improvements in reducing hamstring injuries, improving muscle performance and flexibility, lowering injury recurrence, and increasing psychological satisfaction over a 12-month period. A three-month concentric hamstring strengthening program will also result in long-term improvements in injury prevention, muscle performance, flexibility, injury recurrence, and psychological satisfaction. A combined program of eccentric and concentric hamstring strengthening over three months will produce significant long-term benefits in injury prevention, muscle performance, flexibility, injury recurrence, and psychological satisfaction. There will be clear differences in outcomes between the eccentric, concentric, combined, and control groups over the 12-month follow-up period. Participants will be divided into four groups (A, B, C, and D) based on the type of training they receive. The study will include young male professional football players aged 18 to 30 years from the UAE who are citizens or permanent residents. All participants must speak English, have at least one year of football playing experience, and must not have had any hamstring injury in the past six months. Players who are interested in participating and provide written informed consent will be included. Players will be excluded if they have had a hamstring injury in the last six months, are female, are under 18 or over 30 years old, have restrictions in knee movement, have undergone previous hamstring surgery, are currently enrolled in another official rehabilitation program, or do not agree to participate in the study. Group A participants will perform eccentric hamstring exercises, including Nordic hamstring curls, dumbbell stiff-leg deadlifts, and barbell Romanian deadlifts. Group B participants will perform concentric hamstring exercises such as seated leg curls, lying leg curls, and prone hamstring curls using resistance bands. Group C participants will perform a combination of both eccentric and concentric hamstring exercises. Group D participants will continue with their usual football training only and will not perform any additional hamstring-specific exercises. Before each training session, all participants in Groups A, B, and C will complete a 10-minute warm-up, consisting of five minutes of cycling, three minutes of stretching, and two minutes of rope jumping. Each training session will last at least 30 minutes. The exercise groups will complete three additional training sessions per week alongside their regular football training for a total of 12 weeks. The results of this study will help determine which type of hamstring training program is most effective in preventing non-contact hamstring injuries and improving physical and psychological outcomes in elite male football players.

Conditions

Long-Term Eccentric, Concentric & Combined Hamstring Training Improves Strength, May Cut Injury Risk, and Enhances Performance in Elite Male Football Players

Keywords

Eccentric hamstring training, Concentric hamstring training, combined eccentric and concentric hamstring training

Outcome Measures

Primary Outcomes (1)

• Incidence of non-contact hamstring injuries

  The incidence of non-contact hamstring strain injuries will be systematically monitored using a prospective time-loss injury surveillance model, ensuring consistent and accurate tracking throughout the study period. All reported injuries will undergo comprehensive clinical assessment and verification, after which they will be categorized according to their mechanism, with specific identification of non-contact injuries. To facilitate objective and reliable comparison across the four intervention groups, injury incidence will be standardized and expressed per 1,000 player-hours of exposure, providing a uniform metric that accounts for variations in individual training and match participation.

  12 Months

Secondary Outcomes (6)

• Hamstring flexibility: Active Knee Extension

  12 Months

• Athletic Performance Assessment: 30-meter sprint test

  12 Months

• Recurrence Rates of Hamstring Injury

  12 Months

• Subjective Sports Performance Satisfaction

  12 Months

• Hamstring flexibility: Sit-and-Reach test

  12 Months

Study Arms (4)

ECCENTRIC HAMSTRING TRAINING

EXPERIMENTAL

Eccentric Training Barbell Romanian Deadlift: Stand hip-width apart with a slight knee bend. Hold the barbell shoulder-width apart, keep the spine neutral, and hinge at the hips to lower the barbell toward the shins. Engage the core, hamstrings, and glutes to return to standing. 3 sets × 10-12 reps. Nordic Hamstring Curl: Kneel with feet secured. Maintain a straight line from shoulders to knees and slowly lower the body under hamstring control. Use hands for support if needed and assist returning to start. 3 sets × 10-12 reps. Dumbbell Stiff-Leg Deadlift: Hold 10 kg dumbbells at the sides with minimal knee bend. Hinge at the hips, lowering the weights until a hamstring stretch is felt. Engage hamstrings and glutes to stand upright. 3 sets × 10-12 reps.

Other: Eccentric training + regular football practice

CONCENTRIC HAMSTRING TRAINING

EXPERIMENTAL

Concentric Training Seated Leg Curl: Sit on the leg curl machine with feet shoulder-width apart and knees aligned with the machine hinge. Place the pad on the lower calf, engage the core, and keep the spine neutral. Pull the toes upward and curl the heels toward the glutes without arching the lower back. Slowly return to the starting position. 3 sets × 10-12 reps. Lying Leg Curl: Lie prone on the machine with feet hip-width apart and knees aligned with the hinge. Keep the core and glutes engaged, head neutral, and shoulder blades retracted. Curl the heels toward the glutes without lifting the hips or arching the back, then return slowly. 3 sets × 10-12 reps. Prone Hamstring Curl with Resistance Band: Lie prone with one end of a resistance band secured and the other around the ankle. Start with the knee extended and bend the knee against resistance, then return slowly. 3 sets × 10-12 reps. Along with regular football training.

Other: Concentric training + regular football practice

COMBINED CONCENTRIC AND ECCENTRIC HAMSTRING TRAINING

EXPERIMENTAL

Barbell Romanian Deadlift: Stand hip-width with a slight knee bend, bar shoulder-width. Keep spine neutral, hinge at hips to lower the bar, then return using hamstrings and glutes. 3×10-12. Nordic Hamstring Curl: Kneel with feet secured, body straight. Slowly lower under control and assist back if needed. 3×10-12. Dumbbell Stiff-Leg Deadlift: Hold 10 kg dumbbells, minimal knee bend. Hinge at hips, lower until hamstrings stretch, then stand tall. 3×10-12. Seated Leg Curl: Sit with knees aligned, core engaged. Curl heels toward glutes and return slowly. 3×10-12. Lying Leg Curl: Lie prone with hips down and core tight. Curl heels toward glutes, then lower with control. 3×10-12. Prone Band Curl: Lie prone, band around ankle. Bend knee against resistance and return slowly. 3×10-12. Performed alongside regular football training.

Other: Eccentric training + regular football practice; Other: Concentric training + regular football practice

CONTROL GROUP

NO INTERVENTION

Control (regular football training only)

Interventions

Eccentric training + regular football practice OTHER

Eccentric Training Barbell Romanian Deadlift: Stand hip-width apart with a slight knee bend. Hold the barbell shoulder-width apart, keep the spine neutral, and hinge at the hips to lower the barbell toward the shins. Engage the core, hamstrings, and glutes to return to standing. 3 sets × 10-12 reps. Nordic Hamstring Curl: Kneel with feet secured. Maintain a straight line from shoulders to knees and slowly lower the body under hamstring control. Use hands for support if needed and assist returning to start. 3 sets × 10-12 reps. Dumbbell Stiff-Leg Deadlift: Hold 10 kg dumbbells at the sides with minimal knee bend. Hinge at the hips, lowering the weights until a hamstring stretch is felt. Engage hamstrings and glutes to stand upright. 3 sets × 10-12 reps. Along with regular football training.

COMBINED CONCENTRIC AND ECCENTRIC HAMSTRING TRAINING; ECCENTRIC HAMSTRING TRAINING

Concentric training + regular football practice OTHER

Concentric Training Seated Leg Curl: Sit on the leg curl machine with feet shoulder-width apart and knees aligned with the machine hinge. Place the pad on the lower calf, engage the core, and keep the spine neutral. Pull the toes upward and curl the heels toward the glutes without arching the lower back. Slowly return to the starting position. 3 sets × 10-12 reps. Lying Leg Curl: Lie prone on the machine with feet hip-width apart and knees aligned with the hinge. Keep the core and glutes engaged, head neutral, and shoulder blades retracted. Curl the heels toward the glutes without lifting the hips or arching the back, then return slowly. 3 sets × 10-12 reps. Prone Hamstring Curl with Resistance Band: Lie prone with one end of a resistance band secured and the other around the ankle. Start with the knee extended and bend the knee against resistance, then return slowly. 3 sets × 10-12 reps. Along with regular football training.

COMBINED CONCENTRIC AND ECCENTRIC HAMSTRING TRAINING; CONCENTRIC HAMSTRING TRAINING

Eligibility Criteria

• Age: 18 Years - 30 Years
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Players without any recent hamstring injuries (within the last 6 months) from certain clubs will be asked to join the trial.
• The trial will include young male professional football players aged 18-30 from the UAE who are citizens or permanent residents, English speaking, with no hamstring injuries in the last six months.
• Participants must have at least one year of experience playing football and be interested in participating in the study.

You may not qualify if:

• Players who have had hamstring injuries within the last 6 months, women, individuals under 18 and over 30 years old will be disqualified.
• Individuals who have any restrictions in exercising the knee, have undergone prior surgery on their hamstring, or decline to give written informed consent for the study are not eligible.
• Furthermore, we will not include player who are currently enrolled in other official rehabilitation programs.

Sponsors & Collaborators

• Emirates Health Services (EHS): lead
• Lincoln University College Malaysia: collaborator

Study Sites (1)

Physiotherapy and Sports Medicine Center

Ras al-Khaimah, Emirate of Ras Al Khaimah, United Arab Emirates

RECRUITING

Related Publications (15)

• Coudeyre E, Pereira B, Lechauve JB, Girold S, Richard R, Dobija L, Lanhers C. Eccentric Muscle Strengthening Using Maximal Contractions Is Deleterious in Knee Osteoarthritis: A Randomized Clinical Trial. J Clin Med. 2024 Jun 4;13(11):3318. doi: 10.3390/jcm13113318.

  PMID: 38893028 BACKGROUND

• Sato S, Yoshida R, Murakoshi F, Sasaki Y, Yahata K, Kasahara K, Nunes JP, Nosaka K, Nakamura M. Comparison between concentric-only, eccentric-only, and concentric-eccentric resistance training of the elbow flexors for their effects on muscle strength and hypertrophy. Eur J Appl Physiol. 2022 Dec;122(12):2607-2614. doi: 10.1007/s00421-022-05035-w. Epub 2022 Sep 15.

  PMID: 36107233 BACKGROUND

• Ruas CV, Latella C, Taylor JL, Haff GG, Nosaka K. Comparison between Eccentric-Only and Coupled Concentric-Eccentric Contractions for Neuromuscular Fatigue and Muscle Damage. Med Sci Sports Exerc. 2022 Oct 1;54(10):1635-1646. doi: 10.1249/MSS.0000000000002959.

  PMID: 36106831 BACKGROUND

• Magdalena PG, Bartlomiej B, Robert T, Malgorzata S, Hsing-Kuo W, Sebastian K. Acute fatigue-induced alterations in hamstring muscle properties after repeated Nordic hamstring exercises. Sci Prog. 2024 Apr-Jun;107(2):368504241242934. doi: 10.1177/00368504241242934.

  PMID: 38592327 BACKGROUND

• Evangelidis PE, Shan X, Otsuka S, Yang C, Yamagishi T, Kawakami Y. Fatigue-induced changes in hamstrings' active muscle stiffness: effect of contraction type and implications for strain injuries. Eur J Appl Physiol. 2023 Apr;123(4):833-846. doi: 10.1007/s00421-022-05104-0. Epub 2022 Dec 10.

  PMID: 36494585 BACKGROUND

• Corcelle B, Da Silva F, Monjo F, Gioda J, Giacomo JP, Blain GM, Colson SS, Piponnier E. Immediate but not prolonged effects of submaximal eccentric vs concentric fatiguing protocols on the etiology of hamstrings' motor performance fatigue. Eur J Appl Physiol. 2024 Nov;124(11):3215-3226. doi: 10.1007/s00421-024-05466-7. Epub 2024 Jun 7.

  PMID: 38847870 BACKGROUND

• Ekstrand J, Bengtsson H, Walden M, Davison M, Khan KM, Hagglund M. Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men's professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22. Br J Sports Med. 2022 Dec 6;57(5):292-8. doi: 10.1136/bjsports-2021-105407. Online ahead of print.

  PMID: 36588400 BACKGROUND

• Montalvo AM, Schneider DK, Webster KE, Yut L, Galloway MT, Heidt RS Jr, Kaeding CC, Kremcheck TE, Magnussen RA, Parikh SN, Stanfield DT, Wall EJ, Myer GD. Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification. J Athl Train. 2019 May;54(5):472-482. doi: 10.4085/1062-6050-407-16. Epub 2019 Apr 22.

  PMID: 31009238 BACKGROUND

• Ekstrand J, Askling C, Magnusson H, Mithoefer K. Return to play after thigh muscle injury in elite football players: implementation and validation of the Munich muscle injury classification. Br J Sports Med. 2013 Aug;47(12):769-74. doi: 10.1136/bjsports-2012-092092. Epub 2013 May 5.

  PMID: 23645834 BACKGROUND

• Vatovec R, Kozinc Z, Sarabon N. Exercise interventions to prevent hamstring injuries in athletes: A systematic review and meta-analysis. Eur J Sport Sci. 2020 Aug;20(7):992-1004. doi: 10.1080/17461391.2019.1689300. Epub 2019 Nov 13.

  PMID: 31680644 BACKGROUND

• Jones S, Almousa S, Gibb A, Allamby N, Mullen R, Andersen TE, Williams M. Injury Incidence, Prevalence and Severity in High-Level Male Youth Football: A Systematic Review. Sports Med. 2019 Dec;49(12):1879-1899. doi: 10.1007/s40279-019-01169-8.

  PMID: 31452129 BACKGROUND

• Owoeye OBA, VanderWey MJ, Pike I. Reducing Injuries in Soccer (Football): an Umbrella Review of Best Evidence Across the Epidemiological Framework for Prevention. Sports Med Open. 2020 Sep 21;6(1):46. doi: 10.1186/s40798-020-00274-7.

  PMID: 32955626 BACKGROUND

• Della Villa F, Buckthorpe M, Grassi A, Nabiuzzi A, Tosarelli F, Zaffagnini S, Della Villa S. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. Br J Sports Med. 2020 Dec;54(23):1423-1432. doi: 10.1136/bjsports-2019-101247. Epub 2020 Jun 19.

  PMID: 32561515 BACKGROUND

• Petersen J, Thorborg K, Nielsen MB, Budtz-Jorgensen E, Holmich P. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med. 2011 Nov;39(11):2296-303. doi: 10.1177/0363546511419277. Epub 2011 Aug 8.

  PMID: 21825112 BACKGROUND

• Huang YL, Jung J, Mulligan CMS, Oh J, Norcross MF. A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by Injury Prevention Programs: A Systematic Review of Randomized Controlled Trials and Cluster-Randomized Controlled Trials With Meta-analysis. Am J Sports Med. 2020 May;48(6):1505-1515. doi: 10.1177/0363546519870175. Epub 2019 Aug 30.

  PMID: 31469584 BACKGROUND

Central Study Contacts

Dr Anil John Principle Investigator, PhD

CONTACT

+919986033863; dranil@lincoln.edu.my

Gulab Kappattakath, Master of Physiotherapy

CONTACT

+971553841911; gulab.kappattakath@ehs.gov.ae

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Physiotherapist

Study Record Dates

• First Submitted: January 26, 2026
• First Posted: February 9, 2026
• Study Start: February 7, 2026
• Primary Completion (Estimated): February 7, 2027
• Study Completion (Estimated): April 23, 2027
• Last Updated: February 17, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

AE (1)