Hamstring Strains: Rehab and injury prevention

Hamstrings:semimembranous, semitendinous, bicep femoris

Let’s start from the beginning:

What are the Hamstrings?

The hamstrings are a group of three muscles that are located at the back of your thigh. The names of the individual muscles are: Semimembranous, Semitendinous and Bicep Femoris. The job of these muscles is to bring your knee towards your bum. It is common to get hamstring injuries in sports that require a lot of sprinting or jumping but it is also common in other sports like dancing and waterskiing. (Garrett, 1996) Around 12-16% of professional football will experience hamstring injuries.

Unfortunately the hamstrings are notorious in having a slower healing and a high rate of re-injury of 12-31%. (Heiser et al, 1984)

What are the risks of getting Hamstring problems:

• Fatigue
• Muscular imbalance between the hamstring and quadriceps
• Weakness in the Hamstring
• Lack of flexibility
• Previous injury to the hamstrings causing scar tissue to develop.

Muscular Imbalance and weakness:

It is important to notice if there is a difference in strength between you quadriceps and your hamstrings, (the muscles at the front and back of your thigh). If you see a therapist they should check this for you alternatively grab a friend. You may already have an idea if the front or back of your thigh is much stronger but its best to check with someone objectively. All you have to do is lie down and then get your friend to resist your movement. So keeping your leg straight you want to push down against them for your hamstrings and push up against them for your quadriceps. It’s important to check both sides to see if there is a difference, one will mostly be a bit stronger that’s alright you will have one more dominant leg. Once you have identified if there is an imbalance you will need to make sure your rehab and strengthening plan reflects this but more about that later.


How to test your hamstring strength

Lack of Flexibility:

Flexibility and the ability to adapt in a muscle is not something to be overlooked especially if you are doing activities where you are changing direction a lot of the time. One major factor in picking up a strain or tear in the hamstrings is when you take a sudden change of movement so the muscle ability to react to sudden change is very important. It will also help to allow the hamstrings but also the other muscles in the surrounding area to work together. In your rehab program you will want to focus on stretches and drills that will increase flexibility some of these will include: side shuffling drills with a step or ladder, high knees, but kicks and deep lunges. This exercises will all work to strengthen and stretch out the hamstrings as well as work with the surround muscles like the hip flexors which are central to your running mechanics. Witvrouw et al proved that through testing the flexibility of the hamstrings you could evaluate the risk of developing an injury.

Previous Injury:

If you have had a previous injury in the hamstrings depending on the severity and the healing and rehab that you received at the time there may be a legacy of this in your muscles. When you damage a muscle it will try and repair and rebuild itself. As this occur you can develop scar tissue which is a more fibrous band in the muscle similar when people say there muscles are tight and knotted. If you have some scar tissue it can limit the flexibility and ability for the muscle adapt to a change of movement. Therefore it will limit the function, strength and the movement you will have in that muscle group. It also may cause the other muscles around it to have to work harder to compensate and could affect the co-ordination of the muscles. (Peterson & Hölmich,2005)


You maybe shocked to hear but research by Woods et al reported that of all hamstring injuries in football matches 62% of injuries occurred due to fatigue! (Woods et al, 2004) It wont surprise you that most of the injuries occurred in the second half of the footballers matches. The main mechanism behind why when your tired your muscles are more likely to pick up injury is as they are less likely to be able to absorb the energy than before and therefore have to overstretch or work.

To avoid this it is important that you make sure you have a good warm up before you do any exercise. I know it can be annoying especially when you are stretched for time but it crucial so don’t skip it out!! A study by Safran et al even provided a good warm up could prevent be the key to preventing a muscle strain injury.


While I have including some advice on the initial rehab of the injury your longer term plan should be trying to increase and maintain the flexibility and strength within the muscles.


Rest, Ice, Compress and Elevation: The chances are this is not something that you haven’t been told before. This is the first point of call for an injury it’s not necessarily want you should be doing months into your rehab plan but this is a good pace to start. Rest, if you are experiencing pain then it’s you body telling you to take a break and relax, so listen to it!! Due to the hamstrings being a relatively larger muscle place the ice wrapped in a towel for around 8 mins on and then take it off wait for your muscle to return to normal temperature and then repeat. I am sure this is not the first time you have been told to ice your hamstrings but do you know why ice? I theory is to minimise the inflammation in the muscles as well as control any minor haemorrhaging you may have from the healing process as well as obviously reducing the pain. (Drezner, 2003)


Taking a non-steroidal anti-inflammatory such as ibuprofen is university accepted as a protocol for the initial injury to a muscle strain or tear. It is also recommended that it is only used in the short term for around 3-7 days it is not recommended for longer than that or to rely on them for every niggle that you pick up. (Clanton & Coupe, 1998)


As I have already mentioned above according to the research one of the main risks to reinjuring a muscle strain particular in the lower extremity is inflexibility in the muscles. The research also states that number of repeats of stretches isn’t always that important but you must hold the stretch for at least 15-30 seconds each for it to be affective. I know it can be boring but don’t slack off! You also want to stretch the muscle till you feel a pull but not to the point where you have any pain.


I am going to suggest to do the exercises for a minute each and repeat three times but if you want to adapt this then that’s fine go with what feels best. As for weights again I’ll let you decide but make sure you can do the exercises with the best form the amount of weight is not that important.

Side shuffle:

This is a drill to work on your agility and proprioception that you would need when you are changing direction. Due to the side stepping nature of the drill it is a way of working the hamstring without directly affecting it. Therefore you can do this exercise earlier on in your rehab program it is recommended to do it:  Three times for 1 minute.


Deep lunges:

– you can add weights if you wish
From a standing start you want to put on foot forward so that your knee and hips are at 90 degrees and your back is straight. You want to put to move your weight from your back foot to your front foot.

Lunge exercise

Single Leg deadlift:

This is when you stand on one leg with you knee slightly bent and slowly bend down keeping your back in a straight position. You want your back leg to remain in a neutral position slightly bent as you bend forwards and then return to the starting position.

Single leg roman deadlift
Single leg deadlift

Single leg bridge:

This is a really great exercise and is a personal favourite of mine. You start by lying on the ground with your knees bent at 90 degrees with your feet flat on the ground. It is best to do it on one leg at a time so lift on leg of the ground and place it on the opposite knee. Then simply lift you hips off the ground till your knees, hips and shoulders are all in a straight line. You can adapt this exercise but placing you legs on a chair, step or ball to make it harder for yourself but always start simple and build it up.

Single leg glue bridge
Single leg glute bridge:

Nordic Hamstring exercise:

You will need a friend for the exercise or someway to keep your ankles in place. You want to kneel on the ground while you ankles are held. Then all you do is simply move your body forwards while trying to keep your posture straight. You want to lower your body as much as possible.

nordic hamstring curl
Nordic Hamstring Curl:

Foam rolling:

Foam rolling can be a great way to stretch and work into those tight muscles especially if you have had a previous injury before. The theory is that the foam roller will work into the fibrous knots or scar tissue that may have build up in your muscles. This exercise comes with a warning foam rolling can be very painful and its important that you NEVER go back a 6/10. You need to work on the muscle for at least 2 minutes so don’t stop!!

Cross Training:

As for Cross Training, cycling is important not just for strengthening but it will also help to maintain your cardiovascular fitness. It will help to strengthen and develop your hamstring and quads as most of the drive in cycling will come from those muscles. As the technique is different to running and jumping and therefore you’ll strengthen the muscles in a slightly different area which will also help to create more balanced muscle groups.


(Garrett, 1996) , Witvrouw et al , (Peterson & Hölmich,2005) , (Woods et al, 2004), (Drezner, 2003), (Clanton & Coupe, 1998) , (Heiser et al, 1984)

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