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The Most Extensive Examination of Hamstring Injuries in American Football

Dr. Elliott’s groundbreaking research on NFL hamstring injuries has recently been published by the American Journal of Sports Medicine. Here is a link to the abstract.

We posted about the importance of the study a few months ago, and how we hope the research and findings from this exhaustive study will serve to reduce hamstring muscle strains in sports where hamstring injuries are common, and address more of the underlying issues surrounding injury prevention.

At P3, we believe teams need to do more to assess each individual athlete’s injury predispositions. Certain athletes are predisposed to specific injuries. For example, athletes with a posterior tilt of the hips, that tend to reach their feet out in front when they run, and have poor eccentric adaptations, are at a high risk of having hamstring problems. Often times these predispositions go unnoticed or unaccounted for.

While certain athletes are more predisposed to hamstring injuries than others, Dr.  Elliott’s study demonstrates that the risk of hamstring injuries for all football athletes if neural de-conditioning and relative muscle weaknesses take place during the off-season. In fact, over half of NFL hamstring injuries during the ten year study took place during the pre-season before teams had played any official games. Unfortunately most teams do no take in to account the de-conditioning that takes place during the off-season, and go full speed from the start, instead of implementing progressive increases in sprinting intensity and volume.

During Dr. Elliott’s time as head of injury prevention and performance with the New England Patriots, he placed a heavy emphasis on training nervous system activation of hamstrings through eccentric adaptations. An athlete who is eccentrically adapted is able to forcefully contact the ground and use the elastic properties of their body to execute movement, and thus able to sprint full speed without the risk of injury. If an athlete is stable and has safe mechanics, high intensity plyometrics which activate both the trunk and lower body are an excellent way of improving eccentric adaptations.

Dr. Elliott’s proactive injury prevention program with the New England Patriots leading up to their Super Bowl run effectively identified “at risk” players and significantly decreased morbidity from hamstring muscle strains.

- The four years leading up to the intervention, the Patriots had a mean of 21.5 Hamstring Muscle Strains (HMS) per year

- Post intervention, the Patriots incurred only two HMS.

- Of these injuries, one was experienced by a player identified as “highest risk” and the other was experienced by a player who was picked up after camp, thus not part of the intervention.

Although the program with the New England Patriots was extremely successful in decreasing injuries, saving millions of dollars, and improving performance, science-based interventions have been extremely rare in professional sports. We hope that this study and our current work with athletes at P3, as well as with professional sports teams in baseball and basketball, will serve as impetus for change.

For more analysis on Dr. Elliott’s recently published study, read this article from Reuters Health. For more information on the Peak Performance Project and the Santa Barbara, California facility, visit


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