Effects of Fatigue Induced by Sprinting on Biomechanics and Potential Hamstring Injury Risk

Introduction

As of today (January 2025), hamstring injuries are still considered one of the biggest injury dilemmas in sprint-based team sports such as football ¹, rugby sevens ², American football ³, Australian football ⁴, Gaelic football ⁵, and field-hockey ⁶. Furthermore, in track & field, the shorter 100–400-meter sprint events include the highest risk ⁷. In the sprint-based team sports most of the hamstring injuries seem to take place during sprinting, roughly 60-80% ^1,5. Although not reported in many studies, the less frequent injury scenarios outside of sprinting exist, too, such as overstretching actions (slide tackles, high kicks etc.), jumps, and specific COD maneuvers ^1,5. The main injury time point in sprinting leading to hamstring tears is proposed to be the late swing phase (also called terminal swing phase), although initial contact seems to be a close second ⁸. This is likely because the hamstrings muscle-tendon unit (MTU) experience the largest mechanical strain during the late swing in unison with the highest eccentric demands (considered a stretch shortening cycle) ^9,10 ​(Figure 1). 

Figure 1. Hip and Knee joint power (A) and hamstring MTU length (B) during maximal sprinting ​^9,10.

At this point it’s good to clarify that mechanical strain in synonymous to lengthening past optimal length  ¹¹. Interestingly, increased trunk lean during sprinting seems to increase hamstring mechanical strain during stance and not significantly the late swing phase ¹²​. This might to some degree explain why a recent study by Vermeulen et al., (2024) among football players found that a substantial portion of hamstring injuries involve some sort of contact with another player prior to injury, potentially influencing kinematics during the gait cycle. 

What these aforementioned sports seem to have in common is that they all involve – to different extents – the use of the entire linear sprint acceleration spectrum (so early acceleration, transition, possibly leading to maximal velocity). A relatively recent musculoskeletal study by Pandy et al. ¹⁴ also confirmed that hamstrings is a key muscle group involved in linear sprinting, including all phases of acceleration and maximal velocity. Thus, sports that include the use of all the different sprint phases will likely also utilise the hamstrings full potential to a frequent degree. In turn, the hamstrings would have a larger potential to run into a supply and demand issue. This is likely one of the largest reasons why hamstring injuries are not as large of a problem in sprint-based team sports played in smaller court/field dimensions, such as handball ¹⁵ and basketball ¹⁶  (although still a moderate problem), as they tend not to involve the entire linear sprint acceleration spectrum.  Furthermore, the most injured hamstring in sprint-based sports is predominantly the biceps femoris long head ¹. The reason for this seems to be highly connected to the fact that its muscle-tendon unit experiences the largest strain across all the acceleration steps compared to the other hamstring muscles ¹⁷. Furthermore, the hamstrings are mechanically strained more and faster during accelerative running compared to speed-matched constant speed running ¹⁸​. 

Supply and demand were mentioned, well the “demand” brings us to the potential for fatigue and something else these sports have in common. Fatigue can come in different forms, which we will clarify later. Thus, even the 100-m athletes can have potential for fatigue (chronic / residual); for example, from total training or competition volume. However, the 400-meter has been shown to have a higher hamstring injury risk compared to the 100-meter event ¹⁹, potentially explained by the event itself involving high levels of fatigue. Thus, sports involving the combination of accelerated sprinting towards maximal velocity and the potential for substantial fatigue seem to be highly challenging ²⁰. Fatigue likely increases the risk of most muscle strain scenarios, although this hasn’t been directly studied. The closest and largest team sport epidemiological study to connect the dots between fatigue hamstring injuries is by Ekstrand et al.¹, which included 2636 hamstring injuries from 3909 football players from 54 elite teams (in Europe) from 2001-2022 (21 seasons). Almost 50% of match hamstring injuries took place during the last 15 min of the first and second halves, which deviated significantly from the expected match distribution (Figure 2). 

Figure 2. Ekstrand et al. ¹ distribution of hamstring injuries in football during the first and second half. A) Distribution of hamstring injuries, B) distribution of Biceps Femoris LH, Semitendinosus, and Semimembranosus injuries. 

These findings are supported by previous studies in football and rugby ^21,22​. It is important to note that none of these studies actually controlled for fatigue by directly measuring it but based on numerous simulated match studies ^23–27, fatigue can be likely implied at end of each half, which will be addressed in the following sections. Furthermore, injury risk is made worse by congested match schedules, potentially biasing different fatigue mechanisms (central vs peripheral). 

Thus, I hope I have convinced you that fatigue is likely a contributing factor in many hamstring injury scenarios, and as the main injury mechanism is sprinting, we should be most interested in what exactly causes this. A good disclaimer for this article is that most studies revolve around football as its by far the most studied sport, but I will aim to extrapolate appropriately. 

How do we fatigue during stretch shortening tasks? 

Briefly, we will be focusing on motor performance fatigue which fundamentally refers to a reduction in maximal voluntary force production of the neuromuscular system, influenced by both peripheral (muscle) and central (central nervous system; CNS) factors of the athlete This then can lead to a cascade of events, such as changes in movement strategies, which in general is the minds effort to reduce the risk of injury ^28,29.  However, in high level sports it can be likely expected that the athlete can override this protective mechanism to different extents ²⁹. 

In this article we will follow a slightly modified framework presented by Komi et al.³⁰, who’s classic stretch-shortening cycle (SSC) fatigue review attempts to understand what might be going on when fatigue sets in during sprinting (Figure 3). 

Figure 3. Progression of SSC fatigue. Adapted from Komi et al.​ ³⁰. RFD: Rate of force development, MVC: Maximal voluntary contraction.

Fatigue can be fundamentally traced down to a loss in maximal voluntary contraction (MVC) and rate of force development (RFD) ^28,31. Interestingly, RFD has been shown to be potentially even more sensitive to muscle damage markers​ ³², which we will address later. To keep this article slightly more practical, we won’t speculate on whether peripheral or central fatigue causes the greatest reduction in RFD and MVC, but instead acknowledge that both mechanisms are likely involved in hamstring injuries, based on the only two studies that have explored them in a cohort of football players ^33,34. Figure 4 represents in general the timeline of what can be expected in SSC fatigue. Let’s dive into each progression of Figure 3.

1. Deteriorated muscle function 

Depending on the level of metabolic build-up and the intensity (force output) of the SSC exercise, there will be a different balance between central and peripheral fatigue ³⁵. Typically, the stretch reflex is compromised early and reduced neural input leads to a loss in maximal voluntary force³⁵. Muscle damage, which is typically measured indirectly via creatine kinase in the blood, also seems to have a direct relationship to inhibition early on, such as for the stretch reflex ³⁶. However, this relationship is potentially more pronounced in later stages of recovery, which we will address later (Figure 4). Furthermore, it seems that both isometric and eccentric muscle actions are considered of relatively equal value in assessing SSC fatigue, while concentric is less sensitive ³⁷.

Figure 4. Typical traces of fatigue seen in SSC studies from different variables. Adapted from Nicol et al’s studies ​^35,36. All measurements are done on the triceps surae and fatigue tested in hopping. EMG: electromyography, MVIC: maximal voluntary isometric contraction. 

Reduced tolerance for energy absorption and elastic energy potential 

As our focus is on muscle strain injuries and the possible influence of fatigue, one of the most fitting studies to start with is the classic study by Mair et al. ³⁸​, a highly cited study in muscle strain behavior during fatigue. They showed for the first time in rabbit specimens that fatiguing the extensor digitorum longus muscle did not change how much mechanical strain was required to tear the muscle; instead, the fatigued muscle required more strain to absorb the same amount of energy.

Figure 5. Muscle energy absorption capacity during a non-fatigued and fatigued state ​³⁸

To clarify, absorption of energy means in this case that the muscle is acting eccentrically, so it can resist an external force applied upon it. This corroborates results from human studies where decreases in voluntary activation at optimal MTU lengths seem to lead to increased fascicle lengthening ³⁹. This then may lead to further fatigue at longer lengths. Indeed, simulated match play studies show that the hamstrings capacity to resist eccentrically decreases substantially compared to concentric actions, with the largest decrease at longer lengths  ⁴⁰​. The hamstrings can also lengthen via hip flexion from two routes: either from the thigh flexing relative to the pelvis with the spine remaining still, or the pelvis rotating anteriorly towards the thigh via lumbar extension. As other muscles attach to the pelvis, anterior pelvic tilt can either happen due to the hamstrings being overpowered by antagonists ⁴¹, and/or the hamstrings changing their strategy for energy absorption by lengthening. Increased anterior pelvic tilt in a non-fatigued state has been associated with injury risk in football players both dynamically ⁴², and via static measures⁴³, but not in rugby players ⁴⁴. To date, no published studies have examined the relationship between sprint kinematics under fatigue and injury risk. 

The contact phase of maximal sprinting also involves energy absorption, as the first part of contact is a high braking force phase. This can be considered a second SSC cycle as the knee flexes during contact¹⁰. Faster athletes are able to produce higher initial forces at contact and thus resist higher deformation (i.e, increases in stiffness) ⁴⁵. This is partly due to being able to produce high levels of pre-activitation just before ground contact ⁴⁶. In fact, it has been shown during sprint fatigue, the more pre-activity reduces, the higher the drops in braking phase ground reaction forces (r = 0.77) ⁴⁶. Co-contraction timing is clearly important during sprinting to maximise both limb speed and stiffness ^47,48, which is likely affected by fatigue during sprinting ⁴⁹.

3. Increased work during push-off 

Because the SSC function is compromised, it seems that the body tries to derive more work from the muscle (vs the tendon) during the propulsive phase of contact. Unfortunately, there seems to be very little published ground reaction force (GRF) data on this, especially in sprinting. The only published data to my knowledge is from Nicol et al. ​⁵⁰, who had 8 marathon runners do maximal sprints and drop jumps (from 50 cm) on force plates pre-post a full marathon! They noticed that during a fatigued state, the braking forces were lower and created a bimodal GRF curve, while also push-off forces were lower, and contact times increased (Figure 6). 

Figure 6. GRF profiles of a sprint (A) and drop jump from 50 cm, completed pre- and post a full marathon ​⁵⁰.

Nicol et al.⁵¹ also did a second study on the same population where she reported changes in kinematics during submaximal running on a treadmill. They noticed that the marathon runners flexed their hip and knee at impact more, thus reducing stiffness, which would make sense based on the increased GRF bimodality seen in the sprint and the jump in Figure 6. Based on some unpublished GRF data from our research team’s publication in 2019, led by Pascal Edouard ⁵²​, and some unpublished kinematic data from our team’s study in 2022 led by Valentin Romero​ ⁵³, I created Figure 7. Here we can see one realistic hypothetical scenario of how the force trace and kinematics interact in team sport athletes.

Figure 7. GRF and kinematic changes during stance at maximal velocity from one participant during a non-fatigued state and a fatigued state from separate studies (thus, a hypothetical scenario). Data taken with permission ^52,53.

This longer contact and increased push-off would make sense based on repeated sprint studies showing that there is typically a larger drop in step frequency, while step length is less affected ^54,55. We also found this in our 2022 fatigue paper but did not report the data. As we can see from Figure 7, the kinematic figure depicts a typical “kick-back” mechanism, potentially contributing to increased anterior pelvic tilt ^56,57. 

What about delayed fatigue (+1-8 days)? In reality, we know that many athletes experience cumulative fatigue from congested game/event schedules or hard training blocks. Thus, they can be already slightly fatigued when starting the event. Figure 4 already shows delayed fatigue as a sort of second wave, especially the creatine kinase increase, which is associated with muscle damage and concomitant inflammation ⁵⁸. Thus, there seems to be a substantial delayed increase in inflammation a couple of days post eccentric/SSC stimuli, which is the reason why muscle soreness typically has the words “delayed onset” before them (DOMS). These inflammatory markers then likely cause a cascade of inhibitory signaling events and are highly associated with delayed recovery of important SSC properties, such as the stretch reflex ³⁵. In Figure 8, a comparison has been made for subject’s creatine kinase recovery from days 2 to day 4. Although it’s good to remind the reader that creatine kinase is not the direct cause, the authors found a nearly perfect correlation between the reduced % amount of creatine kinase and the % recovery of the gastrocnemius stretch reflex ³⁶. Thus, a faster reduction in inflammation is likely directly connected to the recovery of SSC properties.  

Figure 8. The relationship between creatine kinase recovery and gastrocnemius stretch reflex recovery from a fatiguing SSC task ​³⁶.

What is interesting is that different muscles seem to also have different recovery profiles after eccentric exercise leading to inflammation ⁵⁹, which is likely connected to their architecture (pennation angles, fascicle length to muscle length ratios), cross-sectional area, and fiber type ratio ^60–62​​. Indeed, the hamstrings seem to have on average a delayed recovery compared to the knee extensors ^59,62​, possibly mostly due to their lower pennation angles and size (and not necessarily fiber type on average​⁶³​), especially semitendinosus and biceps femoris ⁶⁴​. There are numerous studies that have focused on declines in specific metrics post repeated sprints and measure them on multiple days.  

In terms of papers focusing on hamstring fatigue, some of the most arguably interesting papers to date are from Carmona et al.’s group ^24,25​. Their first study on the topic, after performing a repeated sprint protocol 3 days in a row, evaluated maximal sprint mechanical output (force-velocity profile), accompanied with a high frequency IMU sensor on the pelvis to track anterior/posterior movement, muscle soreness, hamstring MVIC, and range of motion, among other things. Figure 9A shows the group averages per day per variable. 

Figure 9. Hamstring related performance changes post repeated sprints (A) and individual pelvic movement changes (B). Adapted from Carmona et al. ²⁴. MVIC: Maximal voluntary isometric contraction (90:20), ROM: Range of motion, F0: Maximal theoretical horizontal force, V0: Maximal theoretical horizontal velocity.

Group averages are already interesting by themselves, as it shows what metrics are in general sensitive to fatigue, some more invasive than others (perceived soreness, MVIC and maximal velocity). However, individual variability for fatigue response has been reported to be large in many studies ^24,25,40,65, which is shown in Figure 9B as one example from Carmona et al. ²⁴, with the changes in pelvic tilt and the reason why some tests didn’t reach significance on a group level. Thus, and as noted by the authors, recovery tests should be monitored at the level of the individual, which we will address in the training section. Furthermore, in their follow-up paper, for the first time, biceps femoris long head biopsies were taken 72 h post simulation match, looking at both damage and fiber type ²⁵. The most important result was that many of football players had visible signs of damage (some minor, some clearly larger). Providing a strong case to question the modern issues of congested match schedule culture ⁶⁶.
Whether fiber type is relevant for longer recovery is slightly unclear. Type-II fibers are likely more prone to damage due to their structure, more sensitive to fatigue, and have been argued to be a logical reason why RFD seems to be more sensitive than peak force to the level of fatigue ^25,32,65. However, speaking with the authors of Carmona et al. ²⁵, there seemed to be no correlation between the dominant fiber type of the athlete and how much damage was seen in the muscle post simulated match. Furthermore, indirect retrospective assessment of fiber typology in amateur football players (estimated by proton magnetic resonance spectroscopy for quantification of the semitendinosus muscle carnosine content) were not associated with a history of hamstring injuries ⁶⁷. Thus, at least for now, we just don’t know the full relevance of fibre type assessment, but RFD seems like a great option to include if you have the possibility ²⁶ (Figure 10). 

Figure 10. Differences in recovery of rate of force development (RFD) and maximal voluntary isometric contraction (MVIC) 24-72 h post simulated football match. adapted from Casio et al.’s data ²⁶. The highlighted grey area highlights the area where the significant differences were found. ** = p<0.01, *** p<0.001. 

What kinematic changes are seen during repeated sprinting that may influence the hamstrings? 

First, it must be acknowledged that no study has measured directly hamstring lengthening during maximal sprinting yet as of January 2025 (only submaximally ⁶⁸), not to mention repeated sprinting. Hamstring MTU lengthening is assumed based on kinematic data of the hip and knee. The assumption here is that fatigue typically causes changes at the hip and knee based on the SSC fatigue process described in the previous section. This is easily hypothesised by the fact that the hamstrings have been shown to drop in MVIC after repeated sprint events ^26,27,60,69, thus they likely will change their strategy to continue absorbing a similar amount of energy during gait (if the aim is to maintain similar speeds). Thus, the hamstring tissue could experience higher strain during the sprint swing phase. Furthermore, “kicking” more during toe-off would cause potentially anterior rotation of the pelvis, further straining the hamstrings. This cascade of events during fatigue would in theory increase injury risk. But what does the hamstring sprint fatigue literature say?  

There are five studies that have measured kinematics during repeated sprinting, four of which focused on group results ^23,27,49,60​, so we will address them first in Table 1.  

Table 1: Repeated sprint studies on hamstring kinematics.

So, the current summary is one study showing no change ⁴⁹, two studies showing decreased strain ^23,60​, although one of them did show increases in anterior pelvic tilt ²³, and one showing increased strain ²⁷. What is interesting is that the two most similar studies in their protocols, Small et al.  and Wilmes et al.^23,27, had opposite results (similar population, same fatigue protocol, same measurement outcome of combined angle). Furthermore, athletes with a previous hamstring injury have shown both reduced ⁷⁰​ and increased lengthening ⁷¹ ​during non-fatiguing sprinting. Thus, we are understandably confused. This brings us to our research teams study published in 2022 ⁵³. We asked the question if we should be looking at an individual level versus a group level. We recruited 51 football players, over twice the sample size of the studies in Table 1. They completed a repeated sprint protocol of 2 x (6 x 30 m, 30 second recovery). We measured simple 2D kinematics of initial contact at the 22.5-27.5 m marker. In our study we also considered the contralateral thighs behavior as we couldn’t assess the pelvis directly. Our results showed a 12.8 % drop in maximal velocity, with 5 distinct clusters (groups) of kinematic change. Simplified, 1 cluster represented the group that likely reduced hamstring strain, the other increased strain, and the rest of the clusters represented non-uniform strategies that had a net effect of no lengthening (i.e., knee extension increased but was compensated by reduced hip flexion or contralateral thigh angle or vice versa) (Figure 11). 

Figure 11. Three distinct groups of kinematic change during repeated sprints found by Romero et al. ⁵³.

It seems that fatigue induced by sprinting does not universally correlate with increased mechanical strain on the hamstrings. We also must acknowledge that even though the decreased strain on the hamstrings seems like a better protective mechanism, this might take place by shifting the load on other muscles, thus increasing the injury risk somewhere else. Then we need to acknowledge that this analysis only considers the sagittal plane. Tibial medial and lateral rotation have their role in biasing medial or lateral hamstrings ⁷², and so does pelvic drop movement, due to the minor hip adduction moment arm ⁷³. Thus, the response to fatigue should be treated on an individual, multi-planar level, and is likely dependent on a myriad of central and peripheral fatigue components, likely adjusted based on the athlete’s current co-ordination capabilities, cardiovascular levels and muscle structure of agonists, synergists and antagonists. But what is interesting is that fatigue does seem to correlate with the degree of change in kinematics, whether that is decreased or increased strain. Both Wilmes et al.²⁷ and Baumert et al.⁶⁰ reported drops in MVIC after repeated sprints and found significant correlations between changes in kinematics and changes in MVIC. Thus, we can potentially conclude that the first stage is to place strategies to avoid drops in MVIC/RFD as much as possible through different training/recovery means, and thereafter consider the potential shift in kinematic strategies on an individual basis. Furthermore, in our recently published blog, Adam Field highlights findings that resonate with the above discussion, where he identified significant alterations in sprint technique on an individual level occurring throughout the duration of 120 min simulated football match play using the S-MAS score.

Summary

Fatigue-Resilient Function: Maintaining MVC and RFD may help reduce maladaptive kinematic changes and mitigate injury risks.

Prevalence: Hamstring injuries are common in sprint-based team sports (e.g., football, rugby) and short-distance track events (100–400 meters).

Injury Context: Most injuries (60–80%) occur during sprinting, especially in the late swing phase, when hamstrings experience the greatest strain and eccentric demands. Increased trunk lean during contact and player contact can further influence injury risk.

Muscle Specificity: The biceps femoris long head is most frequently injured, possibly mostly due to its vulnerability to strain during accelerative sprinting.

Fatigue: A critical factor in injuries seems to be repeated sprints, and inadequate recovery between events. Increases in fatigue are most evident in reductions in MVIC and RFD.

Mechanical Impacts: Fatigue alters movement strategies, increasing strain and shifting workloads from tendons to muscles, which reduces stiffness and changes kinematics.

Recovery Challenges: Hamstrings recover slower than other muscle groups due to their structural properties, with peak soreness and inflammatory responses lasting 1–4 days.

Kinematic Variability: Studies show mixed results on hamstring length changes during fatigue, with both increased and decreased strain reported.

Kinematic Influences: While most research focuses on sagittal-plane movements (hip flexion and knee extension), transverse (tibial rotation) and frontal plane (pelvic drop) dynamics also impact hamstring strain.

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