Protective Effect of Lower Limb Strength on Lower Limb Injuries Within International Sixes Lacrosse Players: A Nine-Month Prospective Study

Abstract Ripley, NJ, Collier, M, Fahey, JT, and Comfort, P. Protective effect of lower limb strength on lower limb injuries within international sixes lacrosse players: A nine-month prospective study. J Strength Cond Res XX(X): 000–000, 2026—The aim of this study was to prospectively determine whether lower limb strength, assessed through the isometric mid-thigh pull (IMTP), offers a protective effect to future lower limb injury in international men's sixes lacrosse players. Nineteen elite nonprofessional men's sixes lacrosse players from the British Men's Lacrosse team (25.4 ± 4.1 years, 1.8 ± 0.1 m, 88.9 ± 6.8 kg) performed 3 trials of the IMTP at the start of a 9-month competitive period, with injuries and injury mechanisms recorded by the lead physiotherapist. Noncontact injury and overload injuries were ran as dependent variables in 2 separate Bayesian logistic regressions where IMTP relative net peak force was the independent variable, with odds ratio (ORs) and 95% confidence intervals (95% CIs) calculated to determine the risk of the injury outcome. Receiver operating characteristic (ROC) analysis was used to determine a threshold for relative net peak force and future injury risk. Relative net peak force had a protective effect for noncontact injuries (OR = 0.33 95% CI = 0.28–0.38) and overload injuries (OR = 0.67 95% CI = 0.49–0.86), with a strong–very strong level of evidence, based on the Bayes factor. Receiver operating characteristic curves indicated relative net peak force values of 31.3 and 28.7 N/kg resulted in the highest combined sensitivity and specificity for future noncontact injury and overload injuries. Practitioners should prioritize the development of lower limb strength, aiming for a minimum relative net peak force of 31.3 N/kg to reduce the risk of future lower limb injuries.