Association of Hamstring Strain Injury With Hip Flexor Tightness Among Male Football Players: A Cross-Sectional Study
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Abstract
Background: Hamstring strain injury is a frequent and clinically important musculoskeletal problem among football players, often contributing to pain, functional limitation, recurrent injury, and time loss from sport. Restricted hip flexor flexibility may alter pelvic control and running mechanics, potentially increasing posterior-chain loading during sprinting and explosive football movements. Objective: To determine the frequency of hip flexor tightness and examine its association with hamstring strain injury indicators among male outfield football players. Methods: This cross-sectional observational study included 75 male football players aged 18–30 years from football clubs and academies in Lahore, Pakistan. Participants were selected through non-probability convenience sampling. Goalkeepers and players with current major hamstring or hip flexor injury, knee or hip osteoarthritis, patellofemoral pain syndrome, leg length discrepancy, or previous hip/knee surgery were excluded. Hip flexor tightness was assessed using the Thomas test, while hamstring-related clinical status was assessed using injury-history questioning, the Functional Assessment Scale for Acute Hamstring Injuries, and the Modified Bent-Knee Stretch Test. Data were analyzed using SPSS version 26, with chi-square testing used to examine associations. Results: The sample included 18 defenders, 31 midfielders, and 26 attackers. Thomas test positivity was observed in 61.3% of players, while Modified Bent-Knee Stretch Test positivity was observed in 70.7%. Hip flexor tightness was most frequent among defenders at 88.9%, followed by midfielders at 54.8% and attackers at 50.0%. Position-specific analysis showed a statistically significant association between hip flexor tightness and hamstring strain injury indicators among attackers (p = 0.008), while no significant association was observed among defenders (p = 0.908) or midfielders (p = 0.496). Conclusion: Hip flexor tightness and hamstring-related clinical positivity were common among male football players, but their association was significant only among attackers. Position-specific screening strategies may improve hamstring injury-prevention planning in football
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