The hamstrings are a large group of muscles that run the length of the back of your thigh. Their action is to bend the knee and extend the hip behind you. These muscle actions are very important for all sports and can be a huge determinant of performance.
A hamstring strain can be one of the more frustrating injuries to recover from. The recurrence rate for these muscle injuries can be alarmingly high indicating our lack of proficiency as a profession in handling these injuries. So how do we help minimize risk for these types of injuries?
One study looked at risk factors for a hamstring injury in a large group of 146 soccer players. They found significantly lower hamstring strength, decreased hamstring-to-quadricep ratio, and previous hamstring injury were linked to an increased risk for an acute hamstring injury. Other non-modifiable risk factors such as age, muscle fiber type, ethnicity, and even degree of anterior pelvic tilt have only been theorized up to this point without any definitive proof of their contribution.
Often times these injuries can occur from explosive exercises or movements such as sprinting or kicking. One study found that the mechanism of injury in 65 out of 69 confirmed hamstring strains across 2 seasons of Australian soccer was in fact due to running. It is believed to be such a high incidence of injury during high intensity running or sprinting because of the forces required to be absorbed at both the knee and the hip.
So now that the injury has occurred, how do we appropriately rehabilitate this injury and prevent future injury? There are multiple considerations when dealing with a hamstring strain. First, the patient’s pain and tolerance to range of motion can be very limited especially early after the injury. One study looked at pain-free vs. pain-threshold rehabilitation following an acute hamstring injury and found the return to sport time to be similar but found the pain-threshold rehabilitation group to have significantly higher isometric strength and fascicle length. This demonstrates that pushing patients into a tolerable amount of pain may be indicated due to the strength differences found. Another variable to consider is the different types of muscle contractions may be tolerated differently. Typically, isometrics are handled much better earlier on than more demanding concentric or eccentric contractions. The last variable to consider with hamstring rehabilitation is the incorporation of velocity specific contractions. We believe this is a key component that is missed in typical rehabilitation plans and a component that we love to focus on later in the rehabilitation process. We like to utilize increased velocity with plyometrics and other exercises such as tantrums to grade the exposure to increased velocity.
A good place to start with hamstring strains is to begin with knee flexion and hip extension isometrics. Utilizing different points in the ROM for the isometrics can really challenge the hamstrings and can be a good way to add variation. Once tolerance to isometrics has improved, we like to incorporate concentric and eccentric exercises as tolerated to maximize the force creation and tolerance to load. Variations that we like to utilize with our patients include bridge variations, RDL variations, hamstring curl variations, and eventually Nordic progressions. A study looked at the incorporation of Nordic hamstring curls and their role in helping to counteract the previously mentioned risk factors. This study found that the incorporation of Nordic hamstring exercises performed for 3 sets of 6-10 repetitions in each session performed twice a week did in fact counteract these risk factors.
We love to help individuals maintain their active lifestyles and stay in the gym. If you or somebody you know would benefit from our expertise surrounding hamstring strains, please do not hesitate to reach out to us.
- Ribeiro-Alvares JB, Marques VB, Vaz MA, Baroni BM. Four weeks of Nordic hamstring exercise reduce muscle injury risk factors in young adults. J Strength Cond Res. 2018;32(5):1254-1262.
- Opar DA, Williams MD, Shield AJ. Hamstring strain injuries: factors that lead to injury and re-injury: Factors that lead to injury and re-injury. Sports Med. 2012;42(3):209-226.
- Lee JWY, Mok K-M, Chan HCK, Yung PSH, Chan K-M. Eccentric hamstring strength deficit and poor hamstring-to-quadriceps ratio are risk factors for hamstring strain injury in football: A prospective study of 146 professional players. J Sci Med Sport. 2018;21(8):789-793.
- Hickey JT, Timmins RG, Maniar N, et al. Pain-free versus pain-threshold rehabilitation following acute hamstring strain injury: A randomized controlled trial. J Orthop Sports Phys Ther. 2020;50(2):91-103.