Preventing Hamstring Strains. How to Reduce Hamstring Injuries.
Hamstring strains are absolutely dreaded by track and field athletes alike. They are not only painful, but also have a lengthy recovery timeline, and a HUGE risk of injury re-occurrence.
Unfortunately, they are also one of the most common injuries we see in both athletes and weekend warriors alike.
And it is understandable to some degree. The hamstrings are one of the key prime movers of the lower limb, and as a result are under significant stress during a number (if not ALL) of athletic movements. Due to this they are arguably at greater risk of injury than many other muscle groups.
This is no excuse.
I can guarantee 90% of you are not doing enough to reduce your risk of developing a hamstring injury.
And there is A LOT we can do to prevent hamstring injury.
Anatomy of the Hamstring Muscle Group
The hamstrings actually consist of three separate muscles. Semitendinosus, Semimembranosus and Biceps Femoris.
Without going into too much detail, both the Semitendinosus and Semimembranosus originate on the medial aspect of the bottom of the pelvis (ischial tuberosity for the anatomy nerds out there), and attach on the medial aspect of the tibia.
The biceps femoris is actually divided into two parts, the short head and the long head, both of which originate at different points. The long head of biceps femoris originates on the lateral portion of the pelvis, while the short head originates at the top of the femur. Both muscles come together and attach to lateral portion of the tibia and the fibula.
The Function of the hamstring Muscle Group
The hamstrings are often considered a knee flexor. It allows us to flex the knee joint. While this is anatomically correct, it isn’t actually how they act during movement.
When we are running and sprinting the shank of the lower limb goes through a swing phase. This is when the knee extends in front of the body prior to taking the next step. During this movement the hamstrings are actually contracting eccentrically to slow the movement of the shank prior to touching the ground. This is integral to running function, as by keeping this movement under control we reduce the load that goes through the knee while simultaneously preparing ourselves to take the next step.
Additionally, the hamstrings also act to extend the hip joint. This means they play a role helping the glutes produce powerful hip extension, which we see during rapid acceleration, jumping, bounding and changing direction.
The hamstrings can also act to stabilise the knee and pelvis during movement. Most notably when the foot makes contact with the ground during a typically running gait cycle.
So we can see that there is a fair bit going on here. Most of which is NOT just knee flexion.
So how do hamstring strains occur?
The most likely occurrence of hamstring strain comes during that swing phase of gait (we mentioned it earlier) while we are sprinting. During this movement the hamstring is lengthening under A LOT of load.
A hamstring strain in this scenario is the combined result of fatigue accumulation and the over-lengthening of the hamstrings.
As the hamstrings get fatigued their capacity to manage load is reduced. This means that they lose their ability to control the forward movement of the shank during swing phase. As a result, during swing phase, the shank moves too quickly and too far in front of the body, causing the ‘over-stretching’ of the muscles, and a subsequent strain or tear in the muscle tissue.
It is important to note that while this type of injury is most common, hamstring strains can occur through other movements. A similar type of injury can occur through kicking motions, and during rapid deceleration and change of direction, again where the hamstrings are lengthening under significant load.
What makes us more likely to develop a hamstring injury, and what can we do to fix it?
So we have an understanding of what the hamstring muscles consist of, and how we can get hamstring injuries. But what about the things that predispose us to hamstring injuries, and what can we do to correct them.
In my experience, there are four key variables that we can work on to significantly reduce the risk of developing a hamstring injury.
Unilateral strength differences
This one makes sense if we think about it. If we exhibit significant strength differences in one limb compared to the other, there are going to be repercussions.
Firstly, in regards to hamstring strength specifically, the muscle of the weaker limb is going to fatigue much faster than that of the stronger limb. This fatigue is going to make ‘over-stretching’ much more likely, which can lead to injury.
Additionally, if one limb fatigues quickly, our movement mechanics are going to change significantly as a result. Poor and inefficient movement can lead to compensation patterns, excessive fatigue, and then injury. Interestingly, when we talk about fatigue and altered movement, it is not limited to just unilateral hamstring weakness. Unilateral weakness in the quadriceps and the glutes can also lead to altered movement of the pelvis, which significantly increases our risk for injury.
So how can we fix it?
This one is pretty simple to fix.
Do single leg work. And LOTS of it.
My first point of call would be single leg hip dominant exercises, such as single leg deadlift variations. These exercises not only provide an opportunity to build eccentric and concentric hamstring strength unilaterally, they also place a demand on the glutes (glute med in particular) to provide stability to the pelvis and hip. As a result, we get stronger hamstrings and increased hip stability. Both of which improve our ability to move at the hip, reducing our risk of injury.
Secondly, I would also include single leg squat variations, such as split squats and Bulgarian split squats. These exercises allow us to build unilateral strength of the quads and the glutes, while still improving our stability around the hip.
Poor pelvic positioning
Considering that the hamstrings attach directly to the pelvis, it makes sense that the position of the pelvis can influence the hamstrings.
If we are stuck in a permanent state of anterior pelvic tilt (APT), our hamstrings are always going to be in a lengthened position. This not only creates a sensation of tightness throughout the hamstring muscles, but also puts us in a position where ‘over-stretching’ happens much easier.
Anterior pelvic tilt occurs when we have weak glutes, hamstrings and abdominals, and tight quads and hip flexors. The weak muscles allow the pelvis to be pulled into a position of anterior tilt by the tight muscles.
Now fortunately, again this is something we can improve through smart training.
Firstly, we need to improve the strength of our hamstrings and glutes through hip extension exercises, and improve the strength of our abdominals through trunk stability exercises.
I would start looking towards deadlift variations as a way to directly increase hamstring and glute strength. The Romanian deadlift is a fantastic variation that somewhat isolated the movement at the hips, making the hip extensors really drive the movement. Additionally, improving glute and hamstring strength is going to improve their overall work capacity. This makes them less susceptible to fatigue, reducing injury risk even further!
To increase the strength of the abdominals, I would recommend the use of plank variations. In particular, the RKC plank, which is a variation where we stabilise the spine while in a position of posterior pelvic tilt. This allows us to work both the glutes and the abdominals to stabilise the spine and the pelvis, promoting pelvic movement away from APT. With this variation the key is to squeeze the glutes as hard as humanly possible. This moves the pelvis in to a posteriorly tilted position, which absolutely hammers the abdominals.
Secondly, trying o release the hip flexors and quadriceps could also go a long way to improving pelvic position. A standard hip flexor stretch is a great way to reduce the tension of the hip flexors, while foam rolling is an ideal way to reduce tension of the quadriceps. Both of these will help improve pelvic positioning, reducing injury risk.
Inhibited or down-regulated glutes
As mentioned initially, the hamstrings also act as a hip extensor during explosive movements. In an ideal world the hamstrings act as synergists to the glutes, which really drive the movement at the hips. But, unfortunately, we do not live in ideal world.
In modern society we spend a huge amount of time sitting down. When we sit, the glutes are in a lengthened position, and by spending too much time in this position they become tight, weak, and inhibited. As a result, 90% of the people I see have seriously inhibited glutes, and use their glutes properly!
If our glutes don’t work, the hamstrings then become the primary driver for explosive hip extension movements. This leads to excessive fatigue of the hamstrings, which then leads to injury.
This can be improved by performing low level glute activation exercises during your warmup as a way to activate and prepare the glutes for movement. Once they have been sufficiently activated, they are likely to work more during explosive movements, reducing the total work done by the hamstrings.
To found out more about glute activation exercises, check out this article.
Poor eccentric hamstring strength
Improving eccentric strength of the hamstrings can play a big role in reducing the risk of developing a hamstring strain.
As mentioned above, majority of hamstring injuries occur during the swing phase of running gait, when the hamstrings are undergoing an eccentric contraction. If we have weak hamstrings that cannot control the shank as it moves forward, we are more likely to ‘over-stretch’, and therefore more likely to get injured.
Again, we can improve eccentric hamstring strength through an increase in eccentric loading. It is worth noting that eccentric loading is extremely taxing on the muscles, and can lead to significant muscle damage, so taking it slow is the best way to approach this type of training.
I would start by introducing eccentric loading to hip dominant exercises. For example Romanian deadlifts with a 3 second lowering portion.
Once I felt comfortable that the individual had good eccentric strength and control I would progress to more taxing exercises such as Nordic curls and glute ham raises. These exercises really allow you to overload the eccentric portion of the lift, building that eccentric strength.
Putting it all together
So to summarise, we need to improve any unwanted postural deviations, improve unilateral strength, improve eccentric strength of the hamstrings specifically, and improve glute activation.
A sample lower body program aimed at reducing hamstring injury risk might look something like this:
Self-myofascial release and stretching
- Foam roll TFL, Quads
- Hip flexor stretch 2 x 15 s /side
Glute activation sequence
- Prone hip extension 2 x 12 /side
- Side lying hip abduction 2 x 12 / side
- Glute bridge 2 x 12
- X band walk 2 x 12 / side
- Single leg deadlift bodyweight 2 x 8 / side
- Bodyweight split squat 2 x 8 / side
- Goblet squat 2 x 10
- Deadlift (2 second eccentric) 5 x 4
- Single leg deadlift 3 x 8 / side
- Bulgarian Split squat 4 x 6 /side
- Romanian Deadlift (3 second eccentric) 4 x 6
- Nordic curl 4 x 6
- RKC plank 3 x 10seconds
- Pallof Press 3 x 12 / side
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