fb

The hamstring muscle group is at the back of the thigh and consists of three muscles, namely biceps femoris, semimembranosus and semitendinosus. These three muscles cross over the hip and knee joint and have long tendons to facilitate a greater “spring” effect that improves athletic performance. The main functions of the hamstring include moving the hip backwards and bending the knee and is involved in walking and running. During these two activities there is a complex interplay between the hamstring and the quadriceps, the muscle in the front of the thigh¹.

Hamstring injuries can occur anywhere along the length of the muscle. Most hamstring injuries occur in sport where the person/athlete has to run at higher speeds, hurdle, kick or where high-speed movements are needed.¹ ³ In athletes, hamstring injuries are most common in the pre-season.³

What are the risk factors?

Some risk factors for hamstring injuries include the following:¹ ³

  • Greater training volume
  • Poor strength
  • Poor flexibility of the hamstring
  • Previous hamstring strain
  • Muscle fatigue
  • Older age
  • Problematic pelvic control
  • Reduced mobility of the sciatic nerve
  • Muscle imbalance compared with the other leg or an imbalance in the hamstring/quadriceps strength ratio.

Impact of hamstring injuries on tendons or muscles

When the tendon is affected, there can either be a tendinopathy (dysfunctional tendon) that develops or there can be a tear. When the muscle is involved, it is typically a strain or tear. There are various muscle injury classifications³ but regardless of the extent of the injury, most injuries will be managed conservatively with load reduction and physiotherapy. Surgery will only be required if there are complete ruptures.

The most important part of managing a tendinopathy is progressive strengthening. Initially the person may only do isometric contractions (contractions without movement), but they will then progress to slow progressive strengthening. Strengthening of the lower back and pelvic area is also important to provide appropriate stability. Activity modification will be needed to allow the tendon time to respond to treatment and Shockwave therapy may be a helpful adjunct treatment. For people returning to sport, sports-specific rehabilitation and explosive muscle training will also be needed.²

Hamstring injury stretching

Left leg isometric hamstring contraction⁴

Hamstring muscle injuries are similarly managed and, again, strengthening is the cornerstone of rehabilitation. Eccentric strengthening also appears to reduce the time to return to sport. There is no evidence that platelet injections assist with return to play or prevention of hamstring injuries and there is limited evidence for stretching, trunk exercises and neural mobilisation. Healing time varies between three weeks and four months, depending on the part of the hamstring that was injured, as well as the severity of the injury³.

Exercises to alleviate injury

Some basic hamstring exercises are shown below. Although basic, it is important to consult a physiotherapist before doing any strengthening for a hamstring injury to make sure the correct exercises are being done.

Using a chair to exercise hamstring injuries

Hamstring chair bridge⁶

Use of a pilates ball to assist with exercises for hamstring injuries

Hamstring ball curls⁵

References

1. Linklater JM, Hamilton B, Carmichael J, Orchard J, Wood DG. Hamstring injuries: anatomy, imaging, and intervention. InSeminars in musculoskeletal radiology 2010 Jun (Vol. 14, No. 02, pp. 131-161). © Thieme Medical Publishers.
2. Dizon P, Jeanfavre M, Leff G, Norton R. Comparison of conservative interventions for proximal hamstring tendinopathy: A systematic review and recommendations for rehabilitation. Sports. 2023 Feb 24;11(3):53.
3. Silvers-Granelli, H.J., Cohen, M., Espregueira-Mendes, J. and Mandelbaum, B., 2021. Hamstring muscle injury in the athlete: state of the art. Journal of ISAKOS, 6(3), pp.170-181.
4. https://www.youtube.com/watch?v=AVAXhy6pl7o
5. https://www.youtube.com/watch?v=R_ixoqCNuNE
6. https://www.youtube.com/watch?v=TZ7bcZwzLg0