Research Normative Data Report
Hamstring Strain Injury
Introduction
The purpose of the Research Based Norms Report is to collate normative data as reported in the literature.
It allows patients to be compared to the general population. These reports provide clinicians with an extra
tool for making decisions with regards to progression during hamstring rehabilitation and return to play
testing.
We aimed to identify and collect available normative data on muscle length (range of motion), strength, and
function across different populations and age groups in the presence of pathology, injury, or a
musculoskeletal condition. For Hamstring Rehabilitation, it largely concentrates on Performance Metrics.
Patient Reported Outcome Measures (PROMS) were also included.
The included studies focus on structural injury, mainly including Grade I and II injuries. We have not
included any operative studies or severe injuries (i.e. Grade III , Grade IV, and avulsion type injuries)
We have grouped the data into two distinctive periods during rehabilitation. This is largely determined by
the data reported in the literature
Two major considerations when reading this project:
The data presented are aggregated from numerous studies and are derived from each other.
Therefore, you may note that the difference in range of motion between the uninjured and injured
limbs may not be the same as the reported difference or deficit between injured and uninjured limbs.
We encourage you to see these as standalone outcomes, and not linked as the data supporting
these outcomes are from numerous independent sources.
Data on women are not available.
Although some studies did include female participants, it was not reported separately and represent
less than 1% of the data included in this report. The gender data gap is highlighted here, and we
actively aim to promote more data collected and reported on women athletes and players.
The underlying data has been rigorously reviewed to ensure the norms are accurate and reliable. Where
appropriate, we have aggregated the data around specific tests and their parameters. However, it’s
important to keep in mind a few limitations:
For most of the included studies, only average and standard deviations of aggregated data were
available. If median and interquartile range was reported, we present this data. Where appropriate,
median and interquartile ranges have been converted to mean and standard deviations.
1 Hamstring Strain Injury – Introduction
Differences between age and gender was not consistently reported.
Different technologies and hardware were used. While we do not feel this represents significant
differences, it is important to acknowledge that differences between these applications exist.
The data mainly reflects studies conducted in soccer (football).
We hope that these insights help you to improve your patients' health. Please consider VALD Normative
Data Reports for distribution and averages across different age groups in healthy populations.
Contents
Initial Assessment ................................... 3
Return to Play ............................................ 9
Week 1 ........................................................ 16
Week 13 ..................................................... 19
Week 26 ..................................................... 21
View included references at end of document
2
Hamstring Strain Injury – Introduction
Hamstring Strain Injury
Initial Assessment
3 Hamstring Strain Injury – Initial Assessment
Initial Assessment
Pain on Palpation
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Length of pain on palpation Injured 3 cm 8 cm 13 cm
Width of pain on palpation Injured 2 cm 4 cm 6 cm
Active Knee Extension Test Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Injured 46° 71° 96°
Range of motion
Uninjured 56° 79° 103°
Deficit compared to
Injured -1° 13° 27°
uninjured side
Difference between injured
Injured -5% 13% 32%
and uninjured side (%)
% of uninjured side Injured 54% 78% 102%
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Range of motion Injured 36° 54° 72°
Deficit compared to
Injured 5° 12° 19°
uninjured side
Difference between injured
Injured -2% 21% 44%
and uninjured side (%)
4 Hamstring Strain Injury – Initial Assessment
Maximal Hip Flexion Active Knee Extension (MHFAKE) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Injured 86° 103° 119°
Range of motion
Uninjured 68° 83° 98°
Difference between injured
Injured -3% 15% 28%
and uninjured side (%)
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Range of motion Injured 79° 93° 107°
Difference between injured
Injured -11% 18% 25%
and uninjured side (%)
Passive Knee Extension Test (PKET) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Injured 14° 34° 55°
Range of motion
Uninjured 17° 36° 56°
Deficit compared to
Injured -4° 2° 8°
uninjured side
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Deficit compared to
Injured -2° 6° 14°
uninjured side
5 Hamstring Strain Injury – Initial Assessment
Straight Leg Raise (SLR) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Injured 52° 68° 84°
Range of motion
Uninjured 70° 84° 99°
Difference between injured
Injured 2% 13% -27%
and uninjured side (%)
% of uninjured side Injured 71% 87% 104%
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Range of motion Injured 44° 62° 81°
Difference between injured
Injured -4% 16% 37%
and uninjured side (%)
Hand Held Dynamometer Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
0° knee flexion in prone
Deficit compared to
Injured 3N 28 N 53 N
uninjured side
% of uninjured side Injured 42% 68% 95%
15° knee flexion in prone
Injured 66 N 143 N 219 N
Force
Uninjured 183 N 243 N 302 N
Deficit compared to
Injured 24 N 100 N 176 N
uninjured side
6 Hamstring Strain Injury – Initial Assessment
Hand Held Dynamometer Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
15° knee flexion in prone
Difference between injured
Injured -4% 34% 64%
and uninjured side (%)
% of uninjured side Injured 26% 54% 83%
45° knee flexion in prone
Injured 85 N 144 N 204 N
Force
Uninjured 272 N 278 N 284 N
Difference between injured
Injured 22% 46% 71%
and uninjured side (%)
90° knee 90° hip flexion in prone
Injured 121 N 158 N 196 N
Force
Uninjured 323 N 330 N 337 N
Difference between injured
Injured -5% 22% 48%
and uninjured side (%)
90° knee flexion in prone
Injured 75 N 131 N 187 N
Force
Uninjured 159 N 194 N 229 N
Deficit compared to
Injured -12 N 40 N 92 N
uninjured side
Difference between injured
Injured -2% 29% 56%
and uninjured side (%)
% of uninjured side Injured 22% 46% 71%
7 Hamstring Strain Injury – Initial Assessment
Hand Held Dynamometer Available on DynaMo
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
15° knee flexion in prone
% of uninjured side Injured 4% 29% 54%
45° knee flexion in prone
Force Injured 108 N 163 N 217 N
% of uninjured side Injured -8% 27% 45%
90° knee 90° hip flexion in prone
Force Injured 125 N 167 N 209 N
% of uninjured side Injured 0% 16% 33%
90° knee flexion in prone
Force Injured 79 N 128 N 178 N
Difference between injured
Injured -15% 30% 45%
and uninjured side (%)
% of uninjured side Injured -6% 18% 42%
8 Hamstring Strain Injury – Initial Assessment
Hamstring Strain Injury
Return to Play
9 Hamstring Strain Injury – Return to Play
Return to Play
Hamstring Outcome Score (HaOS)
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Score Injured 76 88 100
Pain on Palpation
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Length of pain on palpation Injured -1 cm 0 cm 1 cm
Width of pain on palpation Injured -1 cm 0 cm 1 cm
Active Knee Extension Test (AKET) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Injured 64° 73° 83°
Range of motion
Uninjured 58° 68° 78°
Deficit compared to
Injured -3° 2° 7°
uninjured side
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Range of motion Injured 68° 76° 84°
10 Hamstring Strain Injury – Return to Play
Maximal Hip Flexion Active Knee Extension (MHFAKE) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Range of motion Injured 112° 118° 124°
% of uninjured side Injured 91% 99% 107%
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Range of motion Injured 107° 117° 127°
Passive Knee Extension Test (PKET) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Injured 6° 16° 24°
Range of motion
Uninjured 7° 17° 27°
Deficit compared to
Injured 3° 1° -5°
uninjured side
% of uninjured side Injured 96% 100% 105%
Straight Leg Raise (SLR) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Injured 70° 82° 93°
Range of motion
Uninjured 68° 82° 96°
% of uninjured side Injured 96% 100% 105%
11 Hamstring Strain Injury – Return to Play
Straight Leg Raise (SLR) Available on DynaMo
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Range of motion Injured 69° 80° 90°
Sprint Test Available on SmartSpeed
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
5m sprint time Injured 1.27s 1.36s 1.46s
10m sprint time Injured 1.99s 2.12s 2.24s
40-yard sprint time Injured 4.55s 4.7s 6.85s
Hand Held Dynamometer Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
15° knee flexion in prone
Deficit compared to
Injured -15N 1N 17N
uninjured side
45° knee flexion in prone
Force Injured 192 N 248 N 304 N
% of uninjured side Injured 78% 95% 111%
90° knee 90° hip flexion in prone
Force Injured 192 N 231 N 270 N
% of uninjured side Injured 84% 97% 111%
12 Hamstring Strain Injury – Return to Play
Hand Held Dynamometer Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
90° knee flexion in prone
Force Injured 147 N 174 N 200 N
Deficit compared to
Injured -13 N 2N 17 N
uninjured side
% of uninjured side Injured 78% 94% 110%
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
45° knee flexion in prone
Force Injured 202 N 255 N 307 N
90° knee 90° hip flexion in prone
Force Injured 176 N 242 N 307 N
90° knee flexion in prone
Force Injured 144 N 184 N 223 N
Nordic Hamstring Exercise Available on NordBord
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Injured 213 N 301 N 389 N
Peak force
Uninjured 212 N 316 N 420 N
Peak force imbalance Injured -11 N 3N 16 N
13 Hamstring Strain Injury – Return to Play
Nordic Hamstring Exercise Available on NordBord
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Injured 193 N 280 N 367 N
Average force
Uninjured 188 N 289 N 390 N
Average force imbalance Injured -14 N 1N 16 N
Isokinetic Dynamometer
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Knee Flexor Concentric Peak Torque @ 60°/s
Injured 84 Nm 110 Nm 137 Nm
Torque
Uninjured 96 Nm 124 Nm 153 Nm
Difference between injured
Injured 5% 18% 32%
and uninjured side (%)
Knee Flexor Concentric Peak Torque @ 180°/s
Torque Injured 59 Nm 87 Nm 115 Nm
Knee Flexor Concentric Peak Torque @ 300°/s
Injured 65 Nm 87 Nm 110 Nm
Torque
Uninjured 77 Nm 97 Nm 117 Nm
Difference between injured
Injured 10% 25% 41%
and uninjured side (%)
14 Hamstring Strain Injury – Return to Play
Isokinetic Dynamometer
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Knee Flexor Eccentric Peak Torque @ 60°/s
Injured 143 Nm 188 Nm 234 Nm
Torque
Uninjured 154 Nm 197 Nm 240 Nm
Difference between injured
Injured 6% 22% 38%
and uninjured side (%)
Knee Extensor Concentric Peak Torque@ 60°/s
Injured 187 Nm 229 Nm 271 Nm
Torque
Uninjured 183 Nm 231 Nm 278 Nm
Difference between injured
Injured 8% 22% 37%
and uninjured side (%)
Knee Extensor Concentric Peak Torque @ 300°/s
Injured 114 Nm 139 Nm 164 Nm
Torque
Uninjured 117 Nm 141 Nm 165 Nm
Difference between injured
Injured 8% 23% 37%
and uninjured side (%)
15 Hamstring Strain Injury – Return to Play
Hamstring Strain Injury
Week 1
16 Hamstring Strain Injury – Week 1
Week 1
Active Knee Extension Test (AKET) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Deficit compared to
Injured -7° 3° 13°
uninjured side
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Deficit compared to
Injured -2° 7° 16°
uninjured side
Passive Knee Extension Test (PKET) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Deficit compared to
Injured -3° 2° 7°
uninjured side
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Deficit compared to
Injured -1° 2° 5°
uninjured side
Hand Held Dynamometer Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
15° knee flexion in prone
Force Injured 107 N 128 N 149 N
90° knee flexion in prone
Force Injured 91 N 108 N 125 N
17 Hamstring Strain Injury – Week 1
Hand Held Dynamometer Available on DynaMo
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
15° knee flexion in prone
Difference between injured
Injured -7.5% 13% 33.5%
and uninjured side (%)
90° knee flexion in prone
Difference between injured
Injured -8.5% 9% 26.5%
and uninjured side (%)
18 Hamstring Strain Injury – Week 1
Hamstring Strain Injury
Week 13
19 Hamstring Strain Injury – Week 13
Week 13
Isokinetic Dynamometer
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Knee Flexor Concentric Peak Torque @ 60°/s
Injured 86 Nm 114 Nm 143 Nm
Torque
Uninjured 99 Nm 130 Nm 161 Nm
Knee Flexor Eccentric Peak Torque @ 60°/s
Injured 132 Nm 168 Nm 204 Nm
Torque
Uninjured 144 Nm 176 Nm 208 Nm
Knee Extensor Concentric Peak Torque @ 60°/s
Injured 187 Nm 225 Nm 263 Nm
Torque
Uninjured 181 Nm 229 Nm 278 Nm
Knee Extensor Eccentric Peak Torque @ 60°/s
Injured 208 Nm 267 Nm 326 Nm
Torque
Uninjured 191 Nm 259 Nm 327 Nm
20 Hamstring Strain Injury – Week 13
Hamstring Strain Injury
Week 26
21 Hamstring Strain Injury – Week 26
Week 26
Active Knee Extension Test (AKET) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Deficit compared to
Injured -6° -1° 4°
uninjured side
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Deficit compared to
Injured -4° 1° 6°
uninjured side
Passive Knee Extension Test (PKET) Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Deficit compared to
Injured -8° -2° 4°
uninjured side
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Deficit compared to
Injured -6° 0° 6°
uninjured side
Hand Held Dynamometer Available on DynaMo
20 – 30 years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
15° knee flexion in prone
Difference between injured
Injured -14% 2% 18%
and uninjured side (%)
90° knee flexion in prone
Difference between injured
Injured -12% 2% 16%
and uninjured side (%)
22 Hamstring Strain Injury – Week 26
Hand Held Dynamometer Available on DynaMo
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
15° knee flexion in prone
Difference between injured
Injured -13% 1% 15%
and uninjured side (%)
90° knee flexion in prone
Difference between injured
Injured -12% 1% 14%
and uninjured side (%)
Isokinetic Dynamometer
30+ years old
Metric Limb Standard deviation (-1) Average Standard deviation (+1)
Knee Flexor Concentric Peak Torque @ 60°/s
Injured 95 Nm 124 Nm 153 Nm
Torque
Uninjured 101 Nm 129 Nm 156 Nm
Knee Flexor Eccentric Peak Torque @ 60°/s
Injured 140 Nm 177 Nm 213 Nm
Torque
Uninjured 138 Nm 176 Nm 214 Nm
Knee Extensor Concentric Peak Torque @ 60°/s
Injured 179 Nm 226 Nm 274 Nm
Torque
Uninjured 182 Nm 230 Nm 278 Nm
Knee Extensor Eccentric Peak Torque @ 60°/s
Injured 226 Nm 276 Nm 325 Nm
Torque
Uninjured 204 Nm 272 Nm 340 Nm
23 Hamstring Strain Injury – Week 26
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Tol JL, Wangensteen A. Early versus delayed lengthening exercises for acute hamstring injury in male
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24 Hamstring Strain Injury – References
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25 Hamstring Strain Injury – References
