A Comprehensive

Guide to Preseason
Screening in Elite
Football
CONSIDERATIONS FOR PROGRAMMING & ISOMETRIC DATA
COLLECTION STRATEGY

EBOOK

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Why Profile Athletes in

the preseason?

Preseason offers an appropriate time to collect data on athletes that can

potentially identify risk factors of injuries associated with football. Deficiencies
and asymmetries found can be targeted with development conditioning
programs to mitigate that risk.

Athlete Management at the elite and sub-elite level aims to provide critical
information that allows stakeholders to:

• Identify areas of increased injury risk.

• Understand deficits in function that may limit athletic performance.
• Provide baseline data with respect to an athlete’s musculoskeletal health and
function .

These data sets are used to guide the prescription of training loads throughout
preseason and in season periods, and to support medical management plans in
order to maximise player availability and performance.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Designing Preseason
Profiling - Where to start?
Athlete Profiling requires an understanding Specific measures of hip strength for
of the demands of the sport, the most example, have not only been shown to be
common / costly injuries, the known associated with hip pathology and pain
modifiable risk factors for these injuries, (Mendis 2014, Diamond 2016, Markovic
and knowledge of the known modifiable 2020, De Lang 2022), and lower limb injury
measures shown to be associated with risk (Niemuth 2005) but also running
athletic performance relevant to the sport. performance (Dean et al 2005, Tottori 2018).
Therefore, for athletes involved in locomotor
sports, a comprehensive 3D hip strength
ATHLETE PROFILING REQUIRES profile is often included in preseason
AN UNDERSTANDING OF THE profiling as injury to the lower limb in
FOLLOWING SPORT-SPECIFIC general is a primary focus.
CONSIDERATIONS:

• The most common injuries. Hamstring injury remains the most costly
soft tissue injury in elite football, with rates
• The most costly injuries.
increasing significantly despite a clinical
• Known modifiable risk factors for these and research focus. Over the last 8 years the
injuries. proportion of injury cost due to hamstring
• Knowledge of the known modifiable strains has risen from 12 to 24%, with 18% of
measures shown to be associated with these being recurrences (Ekstrand 2023).
sport-specific athletic performance.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Designing Preseason
Profiling - Where to start?
Due to the multifactorial nature of into existing workflows, minimises demands
hamstring injury, there is no one single on athletes and MDT staff, and delivers
measure of muscular strength that can meaningful and actionable insight. Profiling
predict hamstring injury. However it is outcomes are then communicated to key
widely accepted that profiling posterior stakeholders, to support the management
thigh and hip strength can provide insight and prescription of training loads and
into strength deficits that may contribute to medical treatment plans; This should
hamstring injury risk and provide baselines contribute to an elite sporting environment
for assessment of strength training that mitigates injury risk and augments
outcomes over time. Moreover, monitoring general athletic development
health of the hamstring and other lower
limb musculature over the course of an
athletes pre-season and inseason has been
shown to assist clinical management of
athlete training loads in manner associated
with marked reductions in injury rates
(Wollin et al 2018, 2020).

Tests selected for profiling should be

valid, reliable, sufficiently sensitive, and
have a high level of clinical utility. In short,
collecting accurate data needs to be safe
and efficient. A well planned testing process
will ensure that profiling is easily integrated

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Isometric Strength Testing

as part of preseason
screening?
Deficits in Isometric strength are a known or eccentric bias tests. Moreover, as few
modifiable risk factor for injury and as 2 maximal isometric contractions have
impaired athletic performance. While been shown to reduce the muscle damage
Strength can be expressed and measured and DOMS associated with subsequent
in a variety of ways, Maximal Isometric eccentric exercise (Chen et al 2012). As such,
Strength testing has proven to be an the act of testing and regular monitoring
accurate, efficient and cost effective means Isometric Strength can provide a level
by which to regularly assess athletes during of protection against soft tissue injury
the preseason and in season. Moreover, beyond that provided by the flags and load
when performed regularly as part of an modifications that also result from analysis
athlete monitoring strategy, it has also been of the test data itself.
shown to be associated with reduced injury FInally, Isometric strength testing can be
incidence (Wollin et al 2018 and 2020). used to isolate and evaluate an athlete’s
It is also important to highlight that ability to produce force in a specific posture,
Isometric strength testing is well tolerated at a specific joint angle or muscle length.
by athletes. As Maximal Isometric Strength This is critical for sports such as sprinting,
Testing results in minimal to no delayed weightlifting, kayaking, swimming and
onset muscle soreness (DOMS), the risk of throwing, that require strength at specific
interruption to training or games due to joint angles / muscle lengths to maximise
test related muscle soreness is minimised performance and reduce injury risk.
relative to standard maximal isokinetic

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

“I had used different pieces of testing and

training technology at previous clubs, but after
trialling the KT360, I definitely realised the
benefits in its use and application.”

IBRAHIM KEREM
Head of Physiotherapy (women)
Manchester United FC

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Strength within the

Preseason Test Battery.
Other methods of assessment can be predictive value they may be clinically useful
used to supplement and / or support the when specific to an individual athlete’s
screening of Maximal Isometric muscle modifiable movement deficits and shown
strength. to be associated with the individuals injury
risk.

Detailed musculoskeletal assessment of the Standardised Hop, Jump and Landing tests
athlete by both medical and physiotherapy often used in the field have been shown to
/ athletic training staff is a critical part of be associated with lower limb injury risk.
preseason profiling that provides insight The value of these is markedly improved
into MSK health and function. Combining with the use of motion capture and force
these findings with measures of strength, plate data systems that provide insight into
power, proprioception and movement both the overall performance and quality
efficiency is currently considered the of hip, knee and ankle movement during
cornerstone of pre-seaon profiling in elite these tasks (e.g. Kotsifaki et al 2021).
sport. Combining strength with movement data
Objective assessment of movement (e.g. Maestroni et al 2020) provides greater
provides insight into areas of risk and insight into best practice athlete care pre
baseline data for future reference when and post injury.
monitoring for neuromuscular fatigue and /
or assessing readiness to return to play after
periods of rehabilitation. While functional
movement screens have shown no

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Recommendations for
Isometric Screening in
Football.
Muscle injury rates in football have been Identifying, understanding and modifying
well documented with the UEFA Elite muscle injury risk in football players requires
Club Injury Study currently in its 21st a multifactorial approach. While there is
season. A squad of 25 players can expect no single predictive strength test, profiling
about 15 muscle injuries per season and monitoring hamstring and hip strength
which accounts for 27% of the total injury measures associated with injury, movement
absence. (Ekstrand, Hägglund and Waldén assessment, athlete monitoring (off and on
2011) the field), and sound clinical reasoning are
widely accepted as best practice.

Ninety-two per cent of all muscle injuries Based on the known modifiable risk factors
affected the four major muscle groups for the most common injuries across
of the lower limbs: hamstrings (37%), football, the following recommendations
adductors (23%), quadriceps (19%) and calf are made for screening isometric strength
muscles (13%). Sixteen percent of muscle across the hip and anterior/posterior chains
injuries were re-injuries. of the lower limb in football populations.

During the last eight seasons, hamstring

injury rates have increased both in training
and match play, with the proportion of all
injury absence days caused by hamstring
injuries increased from 10% in 2001/02 to
20% in 2021/22 (Ekstrand et al 2022).

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Hip Profile (3D)

HIP ADDUCTION @ 30 HIP FLEXION @ 60
Hip Adductor / groin strength tested in a Hip Flexion strength tested at 60 degrees
functional position that ensures maximal flexion in a position bias toward optimising
recruitment of the adductor muscles most recruitment and torque generated by
commonly involved in groin strain and the psoas complex. Deficits in hip flexion
adductor tendinopathy, and the generation strength tested in mid to inner range are
of peak adductor force in the position most associated with hip joint labral pathology
likely to flag onset of adductor muscle in football populations. Training hip flexion
weakness prior to the onset of groin pain. strength has been shown to improve
running speed and efficiency / economy.

HIP ABDUCTION @ 30
Hip Abduction strength tested in a HIP EXTENSION @ 30
functional range specific to locomotor Hip extension tested with the hip at 30
activities. Deficiencies in Hip Abductor degrees is structured to be bias toward
strength have been associated with, and testing strength of the gluteus maximus
on occasions shown to be predictive of, muscle group. It is an indicator of the
increased lower limb injury risk, Hip pain capacity this muscle has to generate
and pathology, knee pain, ACL injury risk, horizontal force during bipedal locomotion
hop performance, achilles tendinopathy and when running in a straight line.
chronic ankle instability.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Hip Profile (3D)

HIP EXTERNAL ROTATION @ 90 Importantly, Hip external rotation deficits
Hip external rotation tested with the hip at and changes in the balance of hip external
90 degrees is designed to test an athletes rotation strength have been associated with
capacity for external rotation torque reduced hop performance, increased ACL
with the hip well flexed. This test is also injury risk, anterior knee pain, and closed
an expression of this rotational capacity chain balance function.
once external rotator muscles such as
the piriformis and posterior portion of
Total time for testing frontal plane capacity
gluteus medius are no longer contributing
of the hip (abduction and adduction) is
to external rotation torque given their
3 minutes. Total test time for testing a
transition in this more flexed hip range to
6 point bilateral 3D hip profile (Flexion,
being hip internal rotators.
Extension, abduction, adduction, ER90and
ER0) is approximately 20 minutes.
HIP EXTERNAL ROTATION @ 0
Hip external rotation tested with the hip
at 0 degrees of flexion is designed to test
an athletes capacity for external rotation
torque with the hip in a neutral position.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Posterior Chain.
Testing capacity of the posterior chain SEATED PLANTAR FLEXION
is commonly undertaken to understand (SOLEUS)
risk around hamstring, calf, hip and back Provides a soleus bias measure of ankle
injury. With regards to hamstring injury plantarflexion strength. By placing the
risk, there is need to target testing toward knee at a 90 degree angle the test is
the lateral hamstring complex (given this selective to the soleus in contrast to the
is injured 85% of the time), and to ensure standing ‘mid-thigh pull’ based test that
testing adequately assesses hip and knee provides a measure of combined soleus
components of the hamstring complex. and gastrocnemius strength across the
ankle joint. These tests have been shown
clinically to differentiate between soleus
KNEE FLEXION H45/K30
and gastroc injury types when pathologies
Provides an assessment of Isometric knee are confirmed by MRI to be localised to
flexion strength bias toward the knee in a the muscle or its associated intramuscular
position, and at a hamstring muscle length, tendon / aponeurosis.
at which hamstring injuries commonly
occur in locomotor sports.
Total test time for testing these 3 elements
of the posterior chain bilaterally is 8
HAMSTRING CLAW H45/K 15 minutes.
Provides a test of integrated hip and thigh
strength with the hamstring group acting
simultaneously across the hip and knee (in
synergy with other hip extensors and knee
flexors). The ‘claw-like’ action is specific to
the terminal swing / early stance phase of
running where many locator hamstring
running injuries occur.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Anterior Chain.
SEATED KNEE EXTENSION 60
Provides an indication of quadricep
muscle strength that can be used to assess
hamstring to quadricep strength ratio as an
indication of the balance of strength within
a limb. This ratio may provide insight into
the relative strength of an athletes posterior
and anterior chain and through this relative
injury risk.

When injury history or movement testing

warrants, additional long lever testing of
hip flexion from the neutral hip position can
provide greater insight into the athletes
capacity to generate combined hip flexor
and knee extensor torques specific to
kicking. So too can screening trunk flexion
and rotation strength.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

“The KT360 helps us in evaluating the post-

match state of the muscles and that way provides
us some additional measures for the decision-
making process regarding load management of
ARNE JASPERS
the players.”
Sport Scientist
Royal Belgian Football Association

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Preseason Profiling
Outcomes (KangaTech)
KangaTech allows an automated graphical The player demonstrated gross strength
view of an athlete’s strength profile in any deficits in all planes. These are most marked
body region via the KT Chart. The symmetry in the frontal (adduction and abduction)
of strength between limbs and the balance and transverse (ER90 and 0) planes. He
of strength within a limb across regions can is relatively strongest in hip flexion (50th
be understood. percentile).
Data can be normalised to lever length and
body weight, allowing effective comparisons
between individuals and subgroups within
the same team. Moreover, the KT database
allows the athlete to be compared to de-
identified normative KangaTech data sets
from the same or similar sports (e.g. AFL,
NBA, EPL, MLS, MLB).
The 3D hip strength of an elite football
player with a long history of recurrent
groin, hamstring, calf and low back injuries
is presented below (Figure 1). Data in this
case is normalised to lever length and body
weight and presented in a percentile plot
against AFL footballers.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Preseason Profiling
Outcomes (KangaTech)
These results can be used to determine
which isolated strength parameters may be
a priority for development and those that
simply need to be maintained. For example,
if hip Abduction and external rotation
strength are poor, these may be targeted 3
x per week with a combination of complex
/ functional and isolation based exercises.
Conversely, the plan for strength parameters
that are deemed to be sufficient may be to
simply maintain the athletes strength over
the course of a season. As such, training
frequency, intensity and volume may differ.
When strength development is targeted
but there is an associated MSK pathology
and pain when loading a musculotendinous
unit, practitioners may prescribe a
combination of gym based loading
exercises over the course of each week that
are likely to both modulate pain but also
address deficits in muscle strength, cross
sectional area, endurance and / or tendon Figure 1
pathology / pain concurrently.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Preseason Profiling
Outcomes (KangaTech)
The value of accurate and efficient profiling
analysed through the KT chart, supported
by repeat profiling and monitoring over the
course of an athletes season and career is
obvious.
Understanding the training history and
significant pathologies associated with this
athlete’s profile was important to improving
strength training outcomes. Review of
previous strength training history revealed
that these deficits existed despite traditional
strength training and rehabilitation streams
involving double leg triple extension,
multi-directional lunge, standing banded
and Copenhagen and slide board based
adductor loading. Isolated and integrated
isometric and isotonic exercise variations
targeted the hip Abductor, adductor,
external rotation and hip extension, were
progressed to measurable loads sufficient
to maximise strength adaptations. The
changes demonstrated in the follow up KT Figure 2
Chart over a 12 week preseason period are
shown in Figure 2.
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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Preseason Profiling
Outcomes (KangaTech)
The KT Historical graph (Figure 3) allows
changes in any strength parameter
to be monitored over time and for the
relationship between strength, pain and
load to be better understood. These data
are further supported by electronic PROMS
questionnaires (e.g. Visa-A questionnaire
for achilles tendinopathy) which allow pain,
function and disability to be concurrently
monitored with strength. It is common
for users to automate and rationalise the
collection of Visa and HAGOS questionnaire
results, for example, using KangaTech. Note
the unilateral reduction in R knee flexion
strength (red band) that was associated
with pain on testing that required medical
/ physiotherapy intervention V the bilateral
reduction in knee flexor strength (green
band) that was associated with increased
game loads of high speed running but not Figure 3
any pain on testing.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

Profiling Workflow.
3D Hip Profile

Standard KangaTech protocols for testing However, when profiling an entire list this
maximum voluntary isometric contraction requires more planning. The burden of this
(MVIC) have been designed to elicit maximal testing can be nullified by spreading the
recruitment of the target muscle group/s 6 point testing over a 3 week period with Hip Adduction Hip Abduction Hip Flexion
inorder to provide an accurate measure of athletes undertaking only 2 tests per week ( Neutral )
their peak torque in either mid range or a over the course of a 3 week period.
range specific to injury risk.
1 MIN 1 MIN 3 MIN
Testing can be performed as part of prep
These tests utilise positions that require to train or standard strength development
little skill / learning or stabilisation across sessions. In doing so processes leverage
segments when athletes apply high off the payers already being adequately
level force against a sufficiently stiff high warm to perform the tests effectively and
grade external frame. These increase the the degree to which testing interferes with
likelihood of reliability acquiring an MVIC standard workflows is minimised.
on each test and minimise the time to test.
Detailed athlete profiling of the hip and
Hip Extension Hip ER 90 Hip ER 0
posterior chain can take 25 - 30 minutes.
This time is minimised by planning the test
order to minimise athlete movement and
repositioning of the test unit. 3 MIN 3 MIN 3 MIN

When planning comprehensive profiling

for one or a small number of athletes,
TOTAL : 14 MIN
scheduling the time required is relatively
straight forward.

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A COMPREHENSIVE GUIDE TO PRESEASON SCREENING IN ELITE FOOTBALL

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