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Data-Driven Gradual Preseason Practice Acclimation Ramp Reduces Lower Extremity Strains in the National Football

Mackenzie M Herzog1, Kristin Y Shiue1, Rebecca Y Lee1

  • 1IQVIA, Durham, North Carolina, USA.

The American Journal of Sports Medicine
|April 4, 2026
PubMed
Summary

Implementing a gradual practice ramp in the National Football League (NFL) significantly reduced lower extremity (LEX) strains during training camp. This strategy, combined with load management education, decreased overall LEX strains by 35%.

Keywords:
NFLadductor strainepidemiologyfootballhamstring strainlower extremity strain

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Area of Science:

  • Sports Medicine
  • Epidemiology
  • Injury Prevention

Background:

  • Lower extremity (LEX) strains are common in the National Football League (NFL), with a high recurrence rate.
  • Nearly 20% of LEX strains occur during the critical training camp period at the start of preseason.

Purpose of the Study:

  • To analyze NFL training camp practice schedule strategies to identify factors linked to reduced injury incidence.
  • To develop and implement a league-wide strategy for lowering LEX strains and assess its effectiveness.

Main Methods:

  • Observational study analyzing injury and player tracking data from 2018-2023 NFL seasons.
  • Descriptive epidemiology approach to categorize and compare 5 distinct practice acclimation strategies.
  • Calculation of incidence rates for hamstring, quadriceps, adductor, and calf strains per club practice.

Main Results:

  • Gradual 15-minute ramp, <10-minute ramp, and high-low duration variation strategies showed lower training camp LEX strain rates.
  • A mandatory gradual practice acclimation ramp was implemented league-wide starting in the 2022 preseason.
  • Post-intervention, league-wide training camp LEX strain incidence dropped by 35% (288 in 2021 to 186 in 2023), and recurrent strains halved.

Conclusions:

  • A mandated gradual practice acclimation ramp, supported by load management education, effectively reduced LEX strains in the NFL.
  • The implemented strategy led to a substantial decrease in both initial and recurrent lower extremity injuries during training camp and the regular season.