May the (horizontal) force be with you : the role of ankle function and horizontal force production on hamstring injury risk and rehabilitation

Abstract

Hamstring injuries remain one of the most prevalent and challenging issues in field-based sports such as football, with injury rates showing no signs of decline despite extensive research efforts. The underlying mechanisms and risk factors associated with hamstring injury have been well established, including previous injury, age, strength, range of motion, and function. Recent evidence also highlights the role of sprint running mechanics as a key risk factor. Most preventative and rehabilitation strategies have focused on the hamstring muscle itself, emphasising eccentric strength, flexibility and symmetry between limbs. Primarily, these programmes address hamstring strength and flexibility in isolation. Failure to address the complexity of lower limb function in high-speed movements, where multiple joints and muscle groups interact dynamically, could lead to a higher risk of injury or incomplete rehabilitation. The interconnected nature of the kinetic chain suggests that a narrow focus on the hamstrings might overlook critical contributors to injury risk, as established by previous research investigating broader kinetic chain approaches. It has long been accepted that distal structures, such as the ankle joint, may influence proximal biomechanics through altered range of motion, force transmission and movement efficiency. We propose a possible mechanism by which these deficiencies or restrictions may lead to compensatory mechanics that increase hamstring strain.