Hamstring injuries are among the most common non-contact injuries in sports. It is important to train hamstring muscles optimally in order to prevent these injuries from occurring. In this article, we’re going to show you how to strengthen your hamstrings, by covering our favorite hamstring exercises including nordic hamstring curl variations as well as swiss ball hamstring variations to prehab against hamstring strains!

 

How Do Hamstring Strains Occur?

The hamstrings are most commonly injured either during high-speed running and mainly involving the biceps femoris long head or during movements leading to extensive lengthening of the hamstrings (such as high kicking, sliding tackle, sagittal split) often involving the free proximal tendon of semimembranosus. That being said, both types of injuries involve the hamstrings being maximally stretched under high amounts of force.

All injuries occur when tissue capacity cannot meet the demands of the activity. In the case of hamstrings strains, they occur when the hamstrings do not have the adequate eccentric strength (tissue capacity) to control themselves while they’re going into a lengthened position (activity demand). For the hamstrings, this occurs when the hip is moving into flexion and the knee is moving into extension, which is the same position you would get into if you wanted to stretch your hamstrings!

 

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Nordic Hamstring Curl Variations

We’re big fans of the Nordic hamstring curl and have highlighted many variations of it in the past. However, this first one by Skadefri takes the cake. In comparison to the lat pull-down variation (2nd clip), this is a lot safer. You don’t need to worry about accidentally landing on your face and it doesn’t require you to find the most appropriate amount of resistance before beginning. In comparison to the pushup variation (3rd clip), this doesn’t require nearly the amount of upper extremity (chest/tricep) strength that many are lacking (think of your youth athletes). Furthermore, with this variation, you get a great added benefit of some core work. At the fully rolled out position, it’s essentially a plank on a swiss ball. Similar to the “stir the pot” exercise – without the stirring of course. If you’re more limited by core strength than hamstring strength while doing this variation, then you just discovered a big-time limitation aka a weak link that you need to fix with some prehab ASAP.

Researchers have determined through isokinetic testing (via high-tech research laboratory equipment) that a strength imbalance ratio of >20% between eccentric hamstring force production and concentric quadriceps force production resulted in a 4X increase in the risk of hamstring injury compared to a normal strength profile ratio (ie equal strength between the hamstrings and quadriceps)!

 

Watch This Youtube Episode. To Learn More About Nordic Hamstring Curls

 

Using Lat Machine

Many authors suggest that the hamstrings must be strong enough to eccentrically control and offset the strength of the concentric action of the quadriceps during the late terminal swing phase such as when you are performing a kick or doing hurdles. You have two big groups of muscles (hamstrings and quadriceps) on opposite sides of the knee joint. When one muscle (quadriceps) fires and begins moving the knee into extension, what’s going to stop the knee from going into hyperextension? Muscle-wise, that would be your hamstrings.

If your quadriceps are too strong—or hamstrings too weak, rather—when you forcefully move into extension, your hamstrings won’t be able to control the motion and will rip, resulting in a hamstring strain.   If you’re strong enough like Porto Ido here (see video clip below), the Nordic hamstring curl will be cake. If you’re like the rest of the mortals like me, try the second variation using your hands to help control the descent (eccentric part) and push yourself back up (concentric part).

 

Using a Partner

 

Eccentric Hamstring Strengthening Distally and Proximally

While the Nordic hamstring curl has been studied the most in terms of hamstring strain injury prevention, we believe that in order to truly bulletproof your body, you need to strengthen the hamstrings both distally and proximally. The Nordic hamstring curl occurs when the hip is in a slightly flexed/neutral position, with the knee moving eccentrically from a knee flexed to an extended position. Meaning the distal musculotendinous junction around the knee is primarily working eccentrically while the proximal musculotendinous junction is more or less working isometrically. In theory, this is great for prehab distal hamstring strain. But what about proximal hamstring strains?

In my opinion, to prehab against proximal hamstring strains, you need to eccentrically work the hamstrings in the opposite fashion – where the knee is fixed while the hip is moving from an extended to a flexed position. And that is where one of my favorite exercises comes in: The Romanian Deadlift and all of its variations.

 

Contralateral Offset Romanian Deadlifts + Across Body Reach

The contralateral offset hold further adds to the stability demands of the exercise (that’s already on one leg). By holding the weight in your opposite hand, you are adding a longer lever to the exercise aka it will take more muscle activity to stabilize and move the weight.

Remember, torque (muscle activity in this case) = lever arm (perpendicular distance from weight to axis of rotation) x applied force (weight of the kettlebell).

So we can increase muscle activity and make the exercise harder by either increasing the amount of weight we are holding in our hand (applied force) or by increasing how far away the weight is from our hip joint (lever arm).  Adding the contralateral reach with the weight also acts to further increase the lever arm. But what I really like about the reach is that you can significantly increase the amount of muscle stretch and eccentric load on the glutes. We are getting as much hip flexion, internal rotation, and adduction as we possibly can with this variation at the bottom, all being controlled eccentric by the glutes (and hamstrings). Simplified…but more eccentric muscle stretch = more conducive environment for hypertrophic gains and prehab!

READ: HOW TO MASTER THE SINGLE LEG RDL

 

Hamstring Strain Warm-Up

As we said, hamstring strain injuries are among the most common acute musculoskeletal injury in the United States. Even more concerning is that hamstring re-injury rates are extremely high, especially during the first 2 weeks after return to sport. In fact, over 1/3 of hamstring injuries will reoccur during this time. A dynamic warmup is essential for all athletes to prime their bodies for any activity, especially after recovering from a hamstring injury. This video demonstrates a collection of dynamic movements to adequately warm up the hamstrings, improve hip flexibility, and promote proximal stability.

 

Dynamic Hamstring Warmup

“Proximal stability promotes distal mobility.” This adage holds true for every body region and the hamstrings are no exception. Neuromuscular control of the lumbopelvic region is absolutely imperative to all lower extremity biomechanics, especially to optimal hamstring function during normal sporting activities. Improving the performance of the proprioceptive system at differing joint angles and body positions through technique-based exercises, balance drills, and plyometric exercises is key. A neuromuscular control program “aims to stimulate the proprioceptive pathways and the processing of such information, with planned and unplanned movements, and, through repetition and practice, alter the neuromuscular response and allow adaptive changes to occur.” A 2009 study by Cameron et al looked at the effects of the “HamSprint Drills” warm-up routine on lower limb neuromuscular control of Australian Rugby players.

 

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The Best Hamstring Exercises: Sprint Drills

They found that after 6 weeks of performing the HamSprint drills, the players in the intervention group significantly improved their kinesthetic body awareness and lower limb neuromuscular control in comparison to a usual warm up of stretching and running. The HamSprint Drills were all specifically tailored to the improvement of running technique, coordination, and hamstring function. They included movements like high knee marching, ankle pops, leg cycling, quick support drills, pawing, falling starts, 3-point starts, and squat jump and gos. Here, I demonstrate just a few of the HamSprint Drills.

LISTEN: HOW CAN WE DO BETTER WITH HAMSTRING INJURIES?

 

Perform Only The Eccentric Portion

The eccentric portion of the hamstring swissball curl is the most important when it comes to a hamstring strain [P]Rehab. Hamstring strains occur during the lengthening/eccentric portion of motion when sprinting or cutting, thus to optimally prehab against future hamstring strains training the eccentric portion is a must! You can slowly acclimate yourself or your clients to just the eccentric portion of the swissball hamstring curl performing implementing the entire thing.

Swissball Hamstring Curl Eccentrics

Sample Hamstring [P]rehab Program Exercise Video

Lie on your back and put both of your feet on the swissball. With your knees straight, perform a bridge by diffing your heels into the swissball to lift your hips up. Once up, slowly roll the swissball towards you by bending your knees. Once the swissball has rolled towards use, slowly roll it back out. Rolling it back out with control is the hardest and most important part! You can use your hands at your side if needed. You should feel your hamstrings working very hard to control the swissball movement. Do not let the swissball move from side to side. It should only be rolling forward and backward. Make sure to only extend at the hips, and not the lower back!

 

Closing Thoughts

After reading this article, you have learned the best hamstring exercises to prevent injury, including nordic hamstring curl variations and swissball exercises. The Nordic hamstring curl can be an effective exercise to incorporate into your programming to prehab your hamstrings against a future hamstring strain. Even adding 2 sets/week of 4-6 reps may be enough to effectively prehab your hamstrings as this Presland et al 2018 study demonstrated equal fascial length and eccentric strength following high and low volume nordic hamstring curls. Moreover, The swissball hamstring curl is an amazing knee flexion dominant hamstring exercise that allows for easy micro-progressions or micro-regressions to find a suitable level of difficulty. Give these variations a shot and let us know how it goes! So grab a partner, swissball, or lat pulldown machines as demonstrated in the videos above, and get to incorporating the Nordic hamstring curl (and Romanian deadlift) into your programming!

 

Build A Stronger Posterior Chain

What was your high school superlative? If the hamstrings had one it’d be most likely to be injured in the lower body. The good news is the hamstrings have reflected and want to change their ways to become the least likely to become injured. That happens with strength training geared at injury prevention!

 

References

1. Attar, W.s.a. Al, et al. “Effect of Injury Prevention Programs That Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis.” Journal of Science and Medicine in Sport, vol. 20, 2017, doi:10.1016/j.jsams.2017.01.124.
2. Attar, W.s.a. Al, et al. “Effect of Injury Prevention Programs That Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis.” Journal of Science and Medicine in Sport, vol. 20, 2017, doi:10.1016/j.jsams.2017.01.124.
3. Brukner, Peter. “Hamstring Injuries: Prevention and Treatment—an Update.” British Journal of Sports Medicine, vol. 49, no. 19, 2015, pp. 1241–1244., doi:10.1136/bjsports-2014-094427.
4. Cameron, Matthew L., et al. “Effect of the HamSprint Drills Training Programme on Lower Limb Neuromuscular Control in Australian Football Players.” Journal of Science and Medicine in Sport, vol. 12, no. 1, 2009, pp. 24–30., doi:10.1016/j.jsams.2007.09.003.
5. Presland, J., et al. “The Effect of High or Low Volume Nordic Hamstring Exercise Training on Eccentric Strength and Biceps Femoris Long Head Architectural Adaptations.” Journal of Science and Medicine in Sport, vol. 20, 2017, p. 12., doi:10.1016/j.jsams.2017.09.213.

 

About The Author

Michael Lau, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Product Officer

Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California. As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients. A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach-prehab-can reduce the risk of injuries and pain in the first place. He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and return to sport for the lower extremity athlete.

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.