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Injury Prevention 101: Hamstrings

In this article I discuss what causes hamstring injuries and give you some practical tips and exercises to prevent them. It’s a summary of the fith session in the Injury Prevention series which I presented live in the Sports Injury Support group. You can watch the videos of the presentations in the group if you search for #injuryprevention. The other topics include position sense, core stability, glute med, glute max, quadriceps and calves.

In this article:

  • What the hamstrings does

  • What causes hamstring injuries?

  • Flexibility exercises should target more than just the hamstrings

  • Hamstring strengthening exercises

  • Download exercises as PDF


What the hamstrings does


The hamstrings are made up of 4 muscles that run down the back of your thigh. They attach at your sit-bone (ischial tuberocity) on the lower part of your pelvis and then split so that 2 of them attach on the inside of your knee and the other 2 on the outside.


Their main function is to bend your knee (knee flexion) and help with hip extension (taking your leg back).


What causes hamstring injuries?


Weakness: If there’s a big difference between muscle strength in your right and left legs, it can lead to hamstring strains in the weaker leg. That’s one of the reasons why it’s important to do exercises where you train one leg at a time (e.g. single leg Romanian deadlift) as you won’t notice any differences if you only use double leg exercises.


Poor lumbo-pelvic control or core stability: Lumbo-pelvic control refers to your ability to keep your pelvis level and stable while you move. Excessive forwards and backwards tilting can contribute to hamstring strains, because the hamstrings attach to the sit-bone on the pelvis.  You can find an example of basic exercises to improve your lumbo-pelvic control in this article about core stability.


Fatigue: When you’re tired your nervous system struggles to control your muscles properly and your muscle fibres become weaker which makes it a lot easier to strain them.


Referred pain from the lower back and gluteals: Not all injuries that feel or present like a hamstring strain are always what they seem. Referred pain from the lower back or glutes can feel very similar to a hamstring tear. An experienced sports physiotherapist should be able to tell you if your injury may be more than just a simple hamstring strain.


Tight hamstrings: This is a controversial subject as there are several studies that show that tight hamstrings does not necessarily predispose you to injury while others have found that it does. In practice I tend to always address both strength and flexibility. As explained above the lower back and gluteals may also influence your hamstrings, therefore I always include mobility work for all of these areas.


Tight hip flexors: Research has shown that tight hip flexors can inhibit your glutes. The glutes are your main hip extensor muscles. If they are switched off, your hamstrings will have to work a lot harder which can lead to strains.


Lack of position sense: Position Sense is the ability of the brain to know exactly where your limbs are in space and time. If your position sense is affected, it leads to poorer control which in turn can lead to all sorts of injuries including hamstring strains.


Flexibility exercises should target more than just the hamstrings


Your nervous system (brain, spinal cord, nerves) is continuous from your brain to the tips of your fingers and toes. It is designed to slide freely past bones and through or between muscles. If it gets stuck somewhere along the line (e.g. due to tight muscles holding on to it), it causes the nerve to stretch rather than slide.


Nerves don’t like being stretched and this can manifest in a wide variety of symptoms including a feeling of persistant muscle tightness or twinges or even tingling when you place your leg or arm in certain positions. It is important to understand that this is actually extremely common and can usually be fixed with a few simple mobility exercises.


If you're one of those people who struggle with extremely tight hamstrings despite stretching them religiously, you may very well have a sciatic nerve that’s not free to slide. If this is the case the brain won’t allow your hamstrings to fully extend as it is trying to protect the nerve from being stretched. In practice, I often find that these people regain normal hamstring length by just working on the mobility of their lower backs and glutes.


As mentioned above, tight hip flexors can also cause trouble, so it’s best to include a stretch for them as well.


Please note: The exercises in this article may not be appropriate for you. Please consult your healthcare or fitness provider before doing any of them. You can also consult me via Skype if you wanted a bespoke treatment plan.


Figure four stretch

Purpose: To improve the flexibility around your pelvis and lower back and help your sciatic nerve to slide more freely.

Starting position: Supine with both knees bent up.

Movement: Place the outside of your left ankle just above your right knee. Take hold of your right thigh with both your hands and pull it towards your chest. You should have a pillow under your head if you struggle to keep your neck in a good position.

You should feel the stretch in the left buttock/thigh/back depending on which part is the tightest.

Aim: Hold the glute stretch for 30 seconds and repeat on the opposite side. Repeat 3 times.

Piriformis stretch

Purpose: To improve the flexibility around your pelvis and lower back and help your sciatic nerve to slide more freely.

Starting Position: Supine with both knees bent up.

Movement: Cross your right leg over your left leg. Place your right hand on your right knee and your left hand on your shin. Pull with both hands at the same time so that your knee moves diagonally towards your left shoulder. You should feel a stretch in your right buttock.

Check that: You also pull with the hand that is on the shin – this twists the hip and increases the stretch. Make sure your knee moves across your body.

Aim: Hold the stretch for 30 seconds and repeat on the opposite side. Repeat 3 times.

Hamstring stretch

Purpose: To improve hamstring flexibility

Starting position: Sit on the floor with one leg extended in front and with the other foot resting on your inner upper thigh. If your hamstrings are very tight, you may find that sitting on a pillow that lifts you up a bit helps.

Movement: Slide your hands down your leg. You will likely not be able to reach your foot and that is OK. Just go to the point where you can still KEEP YOUR KNEE STRAIGHT. It should be a gentle stretch. Your body should be aligned nicely with the leg straight forward and the hips and shoulders squared.

Check that: You do not force the movement and that you knee stays straight.

Aim: Hold the stretch for 30 seconds and repeat on the opposite side. Repeat 3 times

Hip flexor stretch

The main hip flexor muscles are the iliopsoas and rectus femoris. You should stretch both of these.

Purpose: You will activate your glute max much better if your hip flexors aren’t tight.

Starting position: Half kneel with your one knee on a pillow and your other leg out in front of you. Hold on to something for balance if needed.

Movement: A. Push your hip forward, but at the same time tilt your pelvis backwards. This is important – if you allow your pelvis to tilt forward, the stretch will not be as effective. This will mainly stretch the iliopsoas muscle, but if you’re very tight you may have to spend time on this part first and then add in part B.

B. Once you can easily achieve part A, maintain that position and grab hold of your foot. You may have to loop a belt or towel around your foot if you are very stiff.

Check that: Your pelvis remains tilted backwards throughout the stretch. Remember, strong sustained stretches switches muscles off, so these should be followed by dynamic movements if you're doing them shortly before doing sport.

Aim: Hold the stretch for 30sec and repeat 3 times on each leg.

Hamstring strengthening exercises


I always prefer exercises that are easy to do at home. My favourite 2 hamstring strengthening exercises are the single leg deadlift and the bridge and it’s various progressions.


Single leg deadlift

Why I like it: It’s not only a very good exercise that strengthens the hamstrings and glutes, but it also helps to develop your balance and position sense. So you’re getting a very good return for your effort!

Starting position: Balance on one leg with your knee slightly bent.

Movement: Tighten your stomach muscles and slowly hinge forward from your hips and lift your other leg straight out to the back. Your back should NOT bend. Try to get your body and hind leg in a straight line.

Check that: Your supporting knee stays slightly bent.

Aim: Hold the position for 10 seconds. Build up to repeating 10 times on each leg.

You can progress this exercise by holding a weight in your hands.

Double leg bridge – feet up

This exercise is similar to the bridge that we used in the previous article to strengthen the glutes, but you can target your hamstrings by moving bottom further away from the chair.

Starting position: Lie on your back with your heels on a chair. Make sure that your bottom is far enough away from the chair so that your knees are bent at about 15 degrees when you reach the top. The straighter your knees, the more it becomes a hamstring exercise and that’s our goal for now. If, however, you find that your hamstrings want to cramp, you may have to move your bottom closer to the chair to start with.

Movement: Activate your pelvic floor and deep abdominals by squeezing as if you don’t want to wee or fart. Keep them activated and lift your bottom into the air so that your body forms a straight line. Once at the top, you should squeeze your buttocks and make sure that you don’t feel any strain in your lower back. If you do feel strain in your lower back, make sure that you are squeezing your stomach and glutes and not trying to just arch your back.

Check that: You don’t feel any strain in your lower back. If your hamstrings cramp, move your bottom closer to the chair.

Aim: Hold the position for 10sec. Rest 10 sec. Repeat 10 times. Build up to 4 reps of 30sec holds.


Progress to: Single leg bridge

Starting position: Lie on your back and place one heel on the top of a chair and keep the other foot in the air.

Movement: With the knee resting on the chair slightly bent, lift your bottom off the floor until your body forms a straight line. Tighten up your stomach muscles and your glutes. Your pelvis must stay in a straight line. Do not allow the one side to drop to the floor. Then slowly lower yourself back down.

Check that: You do not put too much pressure on your neck and that you do not over-extend your back by trying to lift your hips too high. It may be an indication that you are forcing the movement too much if your back hurts afterwards. If you find that your hamstrings cramp – shift your bottom closer to your feet.

Aim: Build up to 3 sets of 15 reps on each leg

Progress to: Double leg ball curls

Starting position: Lie on your back with your heels on a big ball and knees bent to 90 degrees.

Movement: Lift your bottom off the floor so that your body forms a straight line. Engage your stomach muscles and squeeze your glutes. Now slowly roll the ball away from your body by straightening your legs out. Then slowly roll the ball back towards your bottom.

Check that: Your bottom stays at the same level in the air.

Aim: Build up to 3 sets of 15 reps.

Download the exercises as PDF

Let me know if you have any questions. You can consult me via Skype for an online diagnosis of your injury and a treatment programme tailored to your needs. I’ve also created a free Facebook group where you can ask questions about your injuries and get injury prevention advice.

Best wishes

Maryke

Sports Physiotherapist


References:

  1. Ackermann, Paul, et al. "Neuronal pathways in tendon healing and tendinopathy: update." (2016).

  2. Brukner P. Hamstring injuries: prevention and treatment—an update. British Journal of Sports Medicine 2015;49(19):1241-44. doi: 10.1136/bjsports-2014-094427

  3. Cameron, Matt, Roger Adams, and Christopher Maher. "Motor control and strength as predictors of hamstring injury in elite players of Australian football." Physical Therapy in Sport 4.4 (2003): 159-166.

  4. Mills M, Frank B, Goto S, et al. Effect of restricted hip flexor muscle length on hip extensor muscle activity and lower extremity biomechanics in college‐aged female soccer players. International journal of sports physical therapy 2015;10(7):946.

  5. Shield AJ, Murphy S. Preventing hamstring injuries – Part 1: Is there really an eccentric action of the hamstrings in high speed running and does it matter? Sport Performance & Science Reports 2018(April 25) https://sportperfsci.com/preventing-hamstring-injuries-part-1-is-there-really-an-eccentric-action-of-the-hamstrings-in-high-speed-running-and-does-it-matter/

  6. Van Hooren B, Bosch F. Preventing hamstring injuries - Part 2: There is possibly an isometric action of the hamstrings in high-speed running and it does matter. Sport Performance & Science Reports 2018(April 25) https://sportperfsci.com/preventing-hamstring-injuries-part-2-there-is-possibly-an-isometric-action-of-the-hamstrings-in-high-speed-running-and-it-does-matter/

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