Fall sports are here, and with them come many of the same injuries we see every year. While each sport has unique demands, injury patterns remain surprisingly consistent. Pause for a second…what are the top injuries that come to mind? If strains, sprains, and head injuries made that list, you’re onto something.
You might think that the types of injuries would change dramatically as you move from high school to college to eventually professional sports, but the same patterns are seen. According to epidemiological studies from the Orthopedic Journal of Sports Medicine and the CDC many of the same injury patterns persist or continue to increase. In football, knee, ankle, and hamstring injuries remain common, while concussions continue to be a major concern. In soccer, ligament injuries, concussions, and muscle strains are among the most common diagnoses. Because of the frequency with muscle strains in various sports, we will take a closer look at some of these reasons for this injury, including loading mistakes, sprinting progressions, and what we can do to optimize the return to play timeline to decrease time lost. In the process to enjoying sports, it is key to stay healthy, and we must have clear and practical tips for both educating and empowering the people we work with.
Why do we see such a high rate of hamstring strains?
During the 2025 Major League Soccer (MLS) and National Women’s Soccer League (NWSL) seasons, thigh muscle injuries accounted for approximately 25% and 61% of all muscle injuries, respectively. Many times in the rehab and performance world there is a significant focus placed on strength and sprinting mechanics. These components have their place, but it doesn’t tell the full story. Leading researchers continue to find that screening for hamstring injury risk factors, do not improve identification of future injury when looking at eccentric strength, asymmetries, and biomechanics.
What is clear is that if your athlete is not being exposed to speeds after a certain time and then they run at a fast intensity, it places them at an increased risk for muscle strain. A key cornerstone to having healthy athletes, that can often go overlooked, is understanding the training age of the athletes and what their preparation looks like going into a season. Is this a freshman playing his first year of high school football, or is it a four-year varsity starter entering his senior season? Those athletes should not necessarily be exposed to the exact same training stimulus, simply because they are on the same team. Or an athlete who has spent the summer playing pickleball and videogames getting asked to run a multiple 40-yard sprints, train twice a day, and repeat the next day, will be at an exponentially higher risk of injury. Then coaches and medical staff are surprised when there are multiple hamstring and quad injuries during preseason. We are taking tissues that have not been adequately challenged for several months and asking them to perform one of the most demanding actions the human body can perform: maximal sprinting.
The problem is not that sprinting is bad. In fact, when sprinting is dosed correctly, it can be one of the most beneficial tools we have for both injury mitigation and high performance. The problem is when athletes are asked to sprint without an adequate progression to prepare them.
This is where a sprinting progression can make a major difference. Instead of immediately asking athletes to perform repeated 40-yard maximal sprints, we should gradually expose them to the demands of sprinting. Start with shorter distances and controlled exposures, over time progressing the distance and intensity. Over several weeks, athletes can build toward sprinting greater than 40 yards and performing repeated high-speed efforts.
Example of a Preseason Progression to Sprinting:
| Sprint Volume | Frequency | |
| Week 1 | 4-6 reps of 20-25 yd sprints | 1-2x’s/week |
| Week 2 | 4-6 reps of 25-30 yd sprints | 1-2x’s/week |
| Week 3 | 4-6 reps of 30-35 yd sprints | 1-2x’s/week |
| Week 4 | 4-6 reps of 35-40 yd sprints | 1-2x’s/week |
The goal is not to eliminate sprinting. The goal is to prepare athletes to sprint.
The same concept applies to almost every other physical demand in sport. If an athlete has not been jumping consistently, don’t immediately introduce hundreds of jumps. Sports medicine professionals can provide coaches education regarding exercise dosing, plyometric volume progression, and incorporate plyometrics as part of the injury prevention program (IPP) warm-up or a separate program allowing for varying intensities with a variety of plyometric activities prescribed based on athletic ability. For example, front-back or side-to-side jumps over different obstacles (towel roll, cone, or football) depending on the athletic ability. This is a great opportunity to collaborate with coaches and understand what their training culture entails. Injury prevention should not just happen inside the medical room, this is how we move from a tertiary approach of prevention toward a more proactive, primary approach.
An injury occurred…now what?
Even after taking careful consideration and using the perfect progression, injuries still happen and we need to be ready to respond.
One mistake I see frequently is being overly cautious in the beginning and then overly aggressive at the end. An athlete gets injured and is protected for too long. Both parties are afraid to move it, load it, and challenge it. Then, three weeks before the athlete is supposed to return, everyone realizes they are behind. Now the athlete is frustrated because they are still in pain. The coach is confused because their player is not progressing. The medical staff is stressed because a deadline is approaching. Suddenly, everyone is trying to compress weeks of rehabilitation into a few days.
For many musculoskeletal and ligamentous injuries one of the best things we can do is begin appropriate movement and loading early. For every day you don’t load tissue it adds 3 days on the back end to return to play. So, if you offload for a week you are ultimately adding 3 weeks on the back end. This does not mean that every injury should be aggressively loaded immediately. It means that we should understand the injury, understand the tissue, and provide an appropriate stimulus.
Example of loading a Grade 2 Bicep Femoris hamstring strain:
| 24-48 hours | o Knee Biased: Bilateral eccentric sliders Unilateral eccentric sliders
o Hip Biased: Bilateral hip thrustUnilateral loaded hip thrust o Function: Regain normal symmetrical walking gait |
| 2-6 days | o Knee Biased: Loaded unilateral sliders Nordic variations
o Hip Biased: Bilateral back extension on Glut-Ham Developer (GHD)Unilateral GHD o Function: steady state jogging, resisted low velocity accelerations <20meters |
| 7-14 days | o Knee Biased: Maintenance/variations of sliders and Nordic variations
o Hip Biased: Maintenance of Unilateral GHD exercises o Function: Progress from accelerations to top speed entries (reach >90% of max speed) |
*Athletes may progress when they are able to complete full range of motion with pain rated <4/10.
The principle is simple: protect what needs to be protected and load injured tissue appropriately to augment healing and strength
What Should We Remember?
As fall sports begin, there are several practical lessons for coaches and sports medicine professionals working with athletes:
- Know where each athlete is starting. Training age and recent exposure matters.
- Prepare athletes for the demands of their sport. Sprinting does not follow a linear load. There are exponential jumps in muscle demands as you increase speed.
- Load tissues early on. For every day you don’t load tissue it adds 3 days on the back end to return to play
The goal of sports medicine is not to eliminate injuries. Our goal should be to better prepare athletes for the demands of their sport. As sports medical providers, we also have an opportunity to prevent injuries with established strategies and improve preparation. Injuries will always be part of sports, but if we share our expertise, then we may be able to change these injury statistics for the better.
References:
- Lawrence, David W., Michael G. Hutchison, and Paul Comper. “Descriptive epidemiology of musculoskeletal injuries and concussions in the National Football League, 2012-2014.”Orthopaedic journal of sports medicine 5 (2015): 2325967115583653.
- National Safety Council. “Sports and Recreational Injuries.” Injury Facts, National Safety Council, https://injuryfacts.nsc.org/home-and-community/safety-topics/sports-and-recreational-injuries/
- Olson, David, et al. “Injuries in professional football: current concepts.”Current sports medicine reports 6 (2013): 381-390.
- Welton, K. Linnea, et al. “Injury recurrence among high school athletes in the United States: a decade of patterns and trends, 2005-2006 through 2015-2016.” Orthopaedic journal of sports medicine1 (2018): 2325967117745788..
- 2025 NWSL Injured List Tracker: Reason.” Spotrac, https://www.spotrac.com/nwsl/injured/_/year/2025/view/reason.
- Opar, David A., et al. “Is Pre-season Eccentric Strength Testing During the Nordic Hamstring Exercise Associated with Future Hamstring Strain Injury? A Systematic Review and Meta-analysis: DA Opar et al.” Sports Medicine9 (2021): 1935-1945.
- Bayer, Monika L., S. Peter Magnusson, and Michael Kjaer. “Early versus delayed rehabilitation after acute muscle injury.”New England Journal of Medicine 13 (2017): 1300-1301.
- Rehab Can’t Wait for the Clinic: Early Movement and Loading Is Critical to Post-Surgery Rehab.” Sportsmith, https://www.sportsmith.co/articles/rehab-cant-wait-for-the-clinic-early-movement-and-loading-is-critical-to-post-surgery-rehab/
