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  • Jessie Mayo

The Hamstring - don't be hamstrung

Updated: Sep 6, 2023

The hamstrings are a group of three muscles on the back of your thigh. Hamstring injuries are one of the most common injuries in sport. They are a powerful group of muscles that help extend the hip and flex the knee. There is the big biceps femoris muscle on the outside and there are two muscles on the inside - semi-membranosus and semi-tendinosus.

The hamstring muscles are two joint muscles, meaning they cross over the hip as well as the knee. They run from the pelvis, behind the hip, behind the knee and attach below the knee. They are powerful prime moving muscles but they are also highly susceptible to injury.

Hamstring strains occur in two ways; high speed contraction (e.g. taking off for a sprint) or slowly overstretching. The high speed running injuries occur during sprinting such as Usain Bolt, or in team sports, such as football. The overstretch type injuries more commonly occur in dancing or gymnastics, but are not isolated to these sports. The mechanism in these two types is different, as well as which muscle is injured. This means the rehabilitation focus and the time to return to sport also differs.

Here we will focus on the high speed running type hamstring injuries. Hamstring injuries in high speed running are one of the most common musculoskeletal injuries. There is a lot of research into the risk factors of hamstring injuries, because it is far better to prevent injuries from occurring than to rehabilitate them. Though there are many plausible risk factors for hamstring injuries, there are two that have the strongest evidence. Strength and length.

The longer and stronger your hamstring muscles are, the less likely you are to injure them. Longer fascicle (muscle fibre) length leads to a more load tolerant tissue. And it goes without saying, the strong your muscle is, the better it is at withstanding load. Whilst we can test how strong you are, unfortunately the tests are not accurate enough to help predict who will and who will not injure their hamstring. It's not all bad news though. The Nordic hamstring curl is here to save the day.

The Nordic hamstring curl is an eccentric hamstring exercise. Doing this exercise will decrease your risk of injury. This exercise works your whole hamstring group, with supramax eccentric overload with only body weight. Nordics not only help prevent hamstring strains, they also improve performance in sprinting and change of direction. Learning how to perform this exercise properly and how to integrate it into your weekly training is the next step.

Another important part of hamstring injury prevention and injury rehabilitation is running. Hamstring strains occur during high speed running, so we need to run and run fast. We need to expose our muscles to the forces and speeds they will do in a game or competition regularly throughout their training cycle to get them conditioned appropriately. Often in training, the actions mimic match play however have limited exposure to the running intensity that is seen in the game. Exposure to 90-100% of max speed improves muscle-tendon unit work and muscle force. As with anything, it is not as easy as just adding high speed running to your current program. High speed running is the risky activity, so it needs to be incorporated appropriately, ensuring there is good baseline conditioning and running volume.

Hamstring injury prevention and injury rehabilitation are much the same. They both need to be complete, holistic programs that look to performance. Buckthorpe et al (2018) suggested a five point strategy.

1. Strength - improving the capacity of the hamstring muscles will help improve its ability to withstand the forces that commonly injure them. As discussed above - Nordic hamstring curls drastically reduce injury rates. In addition to this people need specific exercises to address their individual needs and varied movement patterns.

2. Training balance - monitoring and managing the load placed on the person.

3. Lumbo-pelvic stability - optimising recruitment of the core muscles to create a stable base for the legs to create power.

4. Conditioning - sufficient cardiovascular fitness is protective of the hamstrings as the player is more able to cope with the demands without the detrimental effects of fatigue such as compromised biomechanics and neuromuscular fatigue.

5. Movement quality - improving the fundamental movement patterns with varied directions and speeds allows for optimal utilisation of muscle strength.

Tick all of these boxes with your rehabilitation/prevention program and you're heading in the right direction.

One thing to be aware of with hamstring pain is that pain in the hamstring area may be due to injury away from the hamstring. The sciatic nerve is a big nerve and runs down the back of the leg along the hamstring muscle group. An injury from the low back and anywhere along the course of the sciatic nerve can present as hamstring pain. It is important to see a Physiotherapist to ensure you receive the correct management.

The Movement Workshop can assist in assessing, correctly diagnosing, and treating your hamstring injury. Book a consult today for further assistance.

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