Part 1: Understanding Soft Tissue Injuries – The Elevate Philosophy on Stress, Capacity and Performance

Soft tissue injuries are one of the most common and frustrating issues faced by athletes and coaches alike. Hamstrings, quadriceps and calves don’t just derail short-term availability – when poorly managed, they can trap athletes in a cycle of re-injury, lost confidence and compromised performance.

At Elevate, we believe that breaking this cycle starts with understanding why soft tissue injuries occur in the first place. Rather than viewing them as random or inevitable, we approach them through a clear performance lens built around the relationship between stress and capacity. This philosophy underpins everything we do within our REBUILD system.

In this first part of our two-part series, we’ll explore the Elevate philosophy on soft tissue injuries, why they occur, and why balancing stress and capacity is the foundation of effective rehab and long-term resilience.

Why Soft Tissue Injuries Occur

At their most basic level, soft tissue injuries occur when the load placed on a muscle exceeds its ability to tolerate that load. When we consider what “load” is in the context of soft tissue injuries, we’re talking about a mechanical stress that is applied to a system, in this case, a muscle.

This relationship can be thought of as a simple set of scales. On one side, we have the stress that is applied to the tissue and on the other side we have the capacity of the tissue to tolerate that stress.

When stress outweighs capacity, the muscle breaks and an injury occurs.

What this means for us as coaches is that we have a duty to understand (a) how to manipulate the stress a muscle experiences during training (b) how we can develop the capacity of our athletes to withstand greater amounts of stress without injuring. 

Importantly, this isn’t just about lifting heavier weights or running faster. Stress is multi-dimensional, and muscles don’t fail only because forces are “too big”. They often fail because forces are applied too quickly, too often i.e. under fatigue, or in positions and/or directions the athlete isn’t prepared for.

Understanding Stress: More Than Just Force

When we talk about load or stress, we’re referring to a mechanical force placed on the body. In the context of soft tissue injuries, three key types of stress are particularly relevant:

• Tension = Pulling force causing elongation
• Shear = Parallel forces causing sliding 
• Torsion = Twisting force causing rotation

Regardless of type, all these stresses result in deformation of the tissue – specifically, lengthening. When a muscle lengthens under load, it experiences strain.

Whilst muscles are capable of handling strain, i.e. they actively contract to resist excessive lengthening and protect their fibres, problems arise when the applied stress overwhelms this protective capacity, leading to excessive strain and, ultimately, tissue damage.

Speed Changes Everything

When we look at the equation for stress i.e. stress = force / cross-sectional area, force is a key component. When considering force, we typically focus on two things…

• The magnitude or size of the force applied
• The rate at which that force is applied

Due to their viscoelastic nature, skeletal muscle behaves differently at different speeds. As the rate of loading increases, muscle tissue becomes stiffer. While this stiffness allows muscles to transmit force efficiently, it also reduces their tolerance to stretch or deformation.

A useful analogy for this is a car seatbelt:

• Pull it slowly, and it extends smoothly
• Pull it quickly, and it stiffens and locks
• Apply enough force at high speed, and the seatbelt will break

This is why the majority of muscle injuries occur during rapid, high-velocity actions. Research conducted within football-playing populations consistently shows that hamstring injuries commonly occur when sprinting (Ekstrand et al., 2023), while quadriceps injuries commonly occur during high-speed kicking or running actions (Aiello et al., 2023). Even in calf injuries, it’s often the accumulation of repeated accelerations and decelerations that eventually pushes tissues beyond their limit (Soler et al., 2024).

The takeaway is simple: injuries are rarely about slow, controlled movements. They happen when tissues are asked to tolerate fast, forceful lengthening without adequate preparation.

Not All Muscles Are Stressed Equally

Muscle groups like the hamstrings and quadriceps are made up of multiple muscles, each with different roles and stress profiles.

For example:

• The rectus femoris crosses both the hip and knee and is heavily involved in kicking, making it vulnerable during high-velocity hip flexion and knee extension
• The vastus muscles primarily control knee extension and are heavily stressed during deceleration and change of direction
• The biceps femoris (lateral hamstring) is commonly injured during sprinting
• The medial hamstrings (semitendinosus and semimembranosus) are more exposed during large stretch-based actions

Understanding these differences matters. If rehab loading doesn’t reflect the specific demands that caused the injury, athletes are left underprepared – even if they feel “strong” in generic tests.

Capacity: The Other Side of the Equation

Stress is unavoidable in sport. Therefore, improving capacity is our greatest tool for reducing soft tissue injury risk.

Capacity is not determined by a single quality. It’s a combination of multiple interrelated factors:

1. Strength

Stronger muscles can generate greater active force, helping them resist deformation and excessive strain.

2. Rate of Force Development

Because injuries occur at speed, muscles must be able to activate and produce force quickly – not just maximally.

3. Coordination and Movement Quality

Movement matters. Efficient strategies distribute forces more evenly across the system, reducing overload at vulnerable tissues.

A simple example is lumbopelvic position during running. As the pelvis anteriorly tilts, this causes the hamstrings to lengthen (Mendiguchia et al., 2024), therefore athletes who demonstrate this pattern during running may be at a greater risk of suffering a strain. Conversely, improving an athlete’s ability to control this positioning may help to reduce their injury risk.

4. Muscle Architecture

Research has demonstrated that targeted eccentric loading can influence muscle structure, via increases in muscle fascicle length (Ribeiro-Alvares et al., 2018), which has been postulated to make tissue more resilient to strain (Andrews et al., 2025).

5. Fatigue Resistance

Acute fatigue can considerably reduce muscle force production, reducing the capacity to resist strain and, therefore, increasing the risk of a muscle injuring.

As well as this, the accumulated “micro-damage” associated with repeated muscle actions, combined with insufficient recovery, may also affect muscle function and increase injury risk. This is particularly relevant for the calf muscles in sports involving running as they experience significant load, even at lower speeds (Dorn et al., 2012).

In summary, capacity is multi-faceted and dynamic. It can improve or degrade depending on how training stress is applied and managed.

The Cost of Getting Rehab Wrong

Repeat injuries are rarely a result of bad luck – they’re often the result of incomplete or poorly structured rehab.

Common mistakes include:

• Doing too little for too long in the early phases of rehab
• Only focusing on developing strength
• Accepting pain or poor movement strategies i.e. compensations
• Rushing progression without clear criteria
• Treating the injured muscle in isolation rather than addressing the whole system

These mistakes will likely result in rehab that (a) doesn’t effectively prepare athletes for the increasing demands of returning to dynamic tasks, such as running (b) fails to restore athletes to their full capacity meaning they return under-prepared and under-confident, potentially leading to poor performance and/or re-injury.

The Elevate Philosophy

At Elevate, our philosophy is simple:

Soft tissue injuries are a capacity problem, exposed by stress.

We can’t – and shouldn’t – remove stress from sport. Instead, we need to prepare athletes to tolerate it.

That means:

• Loading early, but intelligently
• Developing a wide range of physical qualities other than just isolated strength
• Respecting healing timelines without being overly conservative
• Addressing movement, coordination and synergists
• Progressing based on competency, not the calendar

In Part 2 of this series, we’ll break down exactly how this philosophy comes to life through our REBUILD system – and how we apply it in practice to guide athletes from injury back to game-ready performance.

Want to Learn More?

Check out our full soft tissue injury workshop video here: Workshop

Our Soft Tissue Series programmes are now available to purchase here: Programmes

References:

1. Ekstrand, J., Bengtsson, H., Waldén, M., Davison, M., Khan, K. M., & Hägglund, M. (2023). Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22. British Journal of Sports Medicine, 57(5), 292-298.
2. Aiello, F., Impellizzeri, F. M., Brown, S. J., Serner, A., & McCall, A. (2023). Injury-inciting activities in male and female football players: a systematic review. Sports Medicine, 53(1), 151-176.
3. Soler, A., Agulló, F., Hernández-Davó, J., Raya-González, J., Del Coso, J., González-Ródenas, J., & Moreno-Pérez, V. (2025). Influence of the external workload on calf muscle strain injuries in professional football players: a pilot study. Sports Health, 17(1), 175-182.
4. Mendiguchia, J., Garrues, M. A., Schilders, E., Myer, G. D., & Dalmau‐Pastor, M. (2024). Anterior pelvic tilt increases hamstring strain and is a key factor to target for injury prevention and rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy, 32(3), 573-582. 
5. Ribeiro-Alvares, J. B., Marques, V. B., Vaz, M. A., & Baroni, B. M. (2018). Four weeks of Nordic hamstring exercise reduce muscle injury risk factors in young adults. The Journal of Strength & Conditioning Research, 32(5), 1254-1262.
6. Andrews, M. H., Shield, A. J., Lichtwark, G. A., & Pincheira, P. A. (2025). Hamstring Injury Mechanisms and Eccentric Training-Induced Muscle Adaptations: Current Insights and Future Directions. Sports Medicine, 55(10), 2429-2443.
7. Dorn, T. W., Schache, A. G., & Pandy, M. G. (2012). Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. Journal of Experimental Biology, 215(11), 1944-1956.

About Us

At Elevate: Speed & Rehab, we specialise in Performance Rehab for athletes dealing with ACL, hamstring, calf, ankle, hip & groin injuries; helping you reduce recovery time and get back performing at your best, and beyond. Whether you’re an athlete looking for expert sports rehabilitation, or a coach or physio wanting to develop your practice, we’ve got you covered. Find out more by clicking here