Hamstring strains are one of the most frustrating injuries you can endure. Why? They linger. And worse, they often come back. If your favorite fantasy football player suffers a hamstring strain early in the season, you worry that it will stay with him and hamper his numbers all season long. If you strain your hamstring playing pickup basketball, you know that there is a lot of rehab & training between you and being able to sprint confidently again without worrying about that hamstring. These are some of the reasons prevention is so important. This article will discuss some key strategies and exercises to prevent hamstring strains.
What are your Hamstrings?
The hamstrings are a group of muscles on the back of your thigh stretching from your hip across your knee. They are made up of the:
- Biceps Femoris
- Semimembranosus
- Semitendinosus
Many people know that the hamstrings bend your knee, but they are also involved in extending your hip. This combination of movements (hip extension and knee flexion) is particularly important during sprinting. More specifically, the eccentric control of these motions is crucial during sprinting as your hamstrings work double time to control your leg as it goes into hip flexion and knee extension. It is then asked to rapidly transition from controlling these motions to actively creating their opposite motions for the next stride.
The Biceps Femoris is the most commonly injured portion of the hamstring and it is crucial in making this transition – being asked to fire rapidly from a lengthened position. To learn more about what a hamstring muscle strain is, dive into the blog below then jump right back here!
READ: HAMSTRING STRAINS
The knowledge that hamstring injuries most often occur this way informed our strategies for preventing them. Let’s dive into some crucial exercises to make sure those hamstring are strong to take on any movement thrown at them!
The Magic of Eccentric Strengthening
Typically, when you think of working out, you think of contracting your muscles i.e. shortening them. This is what we call a concentric exercise – loading a muscle while shortening it. In contrast, an eccentric exercise is loading a muscle while lengthening it. Exercises often have both a concentric and an eccentric portion. If we think of a biceps curl as an example: bending your elbow up shortens your biceps and is thus a concentric exercise, returning the weight to the starting position of having your arm straight is the eccentric portion. Exercises that have an exclusively eccentric focus allow us to utilize more resistance and thus generate more force since we do not need to overcome the resistance and shorten our muscle but rather can use a high level of force that we control as the muscle lengthens.
LEARN MORE ABOUT OUR HAMSTRING REHAB PROGRAM
Hamstring strains can be so nagging, we get It! That’s why we have designed the Hamstring Rehab and Hamstring Prehab programs through our app. Follow along as we take you step by step through the rehab process. Say goodbye to that hamstring strain for good!
Eccentric hamstring strength exercises are the foundation of preventing hamstring strains and there is one exercise that is the king: The Nordic Hamstring Curl.
The Nordic Hamstring Curl:
The research is unequivocal: if you want to prevent hamstring strains the Nordic Hamstring Curl MUST be a part of your weekly routine. The American Physical Therapy Association’s Clinical Practice Guidelines on hamstring strains cites only 1 exercise as a level A recommendation in its prevention of hamstring strains and that is the Nordic Hamstring Curl.
One meta-analysis of 15 different papers found that performing this exercise consistently reduced hamstring strains by an astonishing 51%.
The Nordic Hamstring Curl works because it exposes your hamstrings to high eccentric loads, allowing them to be strengthened in a lengthening position. More specifically, they train your hamstring to work in the position it is most often strained as we stated above.
READ: NORDIC HAMSTRING CURL VARIATIONS TO PREHAB AGAINST HAMSTRING STRAINS
While no one exercise is cited as often as the Nordic Hamstring Curl: eccentric strength exercises of all sorts are the cornerstones of successful prevention programs. One study showed that a strength imbalance of > 20% when comparing eccentric hamstring force production to concentric quadriceps force production led to a fourfold increase in hamstring injury risk. The authors suggested this was due to the hamstrings struggling to eccentrically control the concentric action of your quad as it straightens your leg during activities like running.
While weaker quads are certainly not a solution you’d want, stronger hamstrings are!
What About Flexibility?
Many people stretch their hamstrings passively before they start playing a sport. Think of the guy bending over and touching his toes on the sideline of a basketball game. Studies have not shown this to be effective in reducing the risk of injuries. In contrast, players with increased quadriceps flexibility were shown to have lower risks of hamstring strains – thus indicating there may be some benefits from quad stretching over time, although not necessarily just before an activity.
Warming Up & Preparing to Play
More important than static stretching is a proper warmup. Sprinting is a high-level activity and your muscles need to be prepared to work at those high levels of loads and in those stretched positions. Gradually increasing the speed and intensity of your workout before sprinting is an excellent way to prepare your body to play or sprint without injuring your hamstring.
READ: HOW TO WARM UP YOUR HAMSTRINGS
In addition to this neuromuscular control exercises have been suggested as potentially helpful in preventing hamstring strains. Drills such as:
- Quick-support running drills
- Forward-falling running drills
- High knee marching
- Explosive starts and cuts
The focus of these drills is on postural control and power development. Even more specifically: training the way you play has been shown to decrease the risk of hamstring strains. Many athletes who participate in short-interval sprinting sports like soccer, football, and basketball spend a lot of time training their aerobic system with longer jogs and runs. A study in Australian Rules looked at football players who transitioned their training program to be more sport-specific, focusing on increased high-intensity anaerobic interval training significantly, reduced their incidence of hamstring strains.
Closing Thoughts:
An ounce of prevention is worth a pound of cure. The best way to deal with hamstring strains is to avoid them in the first place. The gold standard for doing that is eccentric strengthening exercises of your hamstrings, most specifically the Nordic Hamstring Curl. Performing this multiple times a week can reduce your risk of injury by 51%! Stretching your quads may also have a positive impact but stretching your hamstrings is unlikely to make a difference.
LEARN MORE ABOUT OUR HAMSTRING REHAB PROGRAM
Finally, training for your specific sport: working on the intensity and energy system that is required and focusing on the specific types of neuromuscular control you need to be successful will also reduce your risk of injury and keep you playing longer.
References:
- Hamstring Strain Injury in Athletes: A Summary of Clinical Practice Guideline Recommendations: Using the Evidence to Guide Physical Therapist Practice. J Orthop Sports Phys Ther. 2022;52(3):127-128. doi:10.2519/jospt.2022.0501
- van Dyk N, Behan FP, Whiteley R Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes British Journal of Sports Medicine 2019;53:1362-1370.
- Croisier J-L, Ganteaume S, Binet J, Genty M, Ferret J-M. Strength Imbalances and Prevention of Hamstring Injury in Professional Soccer Players: A Prospective Study. The American Journal of Sports Medicine. 2008;36(8):1469-1475. doi:10.1177/036354650831676
- Arnason A, Andersen TE, Holme I, Engebretsen L, Bahr R. Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports. 2008;18(1):40-48. doi:10.1111/j.1600-0838.2006.00634.x
- Gabbe BJ, Finch CF, Bennell KL, et al Risk factors for hamstring injuries in community level Australian football British Journal of Sports Medicine 2005;39:106-110.
- Verrall GM, Slavotinek JP, Barnes PG. The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules football players. Br J Sports Med. 2005;39(6):363-368. doi:10.1136/bjsm.2005.018697
- Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40(2):67-81. doi:10.2519/jospt.2010.3047
About the Author
Tommy Mandala, PT, DPT, SCS, OCS, CSCS
[P]rehab Writer & Content Creator
Tommy Mandala is a Doctor of Physical Therapy, Board Certified Clinical Specialist in Sports & Orthopedics, and Certified Strength and Conditioning Specialist in New York City. He is the founder of ALL IN ACL, a digital coaching platform dedicated exclusively to helping ACLers return to the life they had before their injury with full confidence in their knee. Prior to that, he worked in the sports clinic at Hospital for Special Surgery, the #1 Orthopedic Hospital in the country. While there, he had the opportunity to hone his skills as an ACL specialist working closely with world renowned surgeons and evaluating patients from all over the world. He completed his sports residency training at the University of Delaware where he had opportunities to work with many of their Division I sports teams as well as the Philadelphia 76’ers NBA G-league affiliate, the Delaware Blue Coats. He also trained at Champion Sports Medicine in Birmingham, Alabama where he had the opportunity to learn from researchers in the American Sports Medicine Institute. Currently, Tommy works exclusively with ACLers through his digital coaching model. While many of these clients are athletes, Tommy works with ACLers of all different abilities helping them to build the strength they need to overcome this unique injury. One of his favorite aspects of his job is taking active clients who have never been a “gym person” before and showing them the amazing things that happen when they learn to strength train.
Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.
About the author : Tommy Mandala PT, DPT, SCS, OCS, CSCS
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