Sports Physiotherapy: 3 Truths Behind Hamstring Strains

Hamstring Strain_ 3 Truths Behind Hamstring Strains



1. Current evidence related to the mechanism behind a hamstring strain, the importance of particular exercises that can decrease the risk of hamstring strains


2. Exercise programming for the individual returning from hamstring injury.


3. How a hamstring rehab program can be a great hamstring strain prevention program!

What Is A Hamstring Strain?




Hamstring strains are a common acute sports injury that sports physiotherapists encounter regularly in the clinic.

They are normally classified as proximal or distal strains, mostly involve eccentric muscle action and generally occur in either:

  • a sprinting-type activity (e.g. leg deceleration in terminal swing) or;
  • stretching type activity (i.e. picking up a ball)  


Hamstring strains are very common in sports that involve high levels of sprinting and agility such as AFL, soccer and athletics (i.e. sprinters). 


Though a majority of function may be restored when an individual returns to play, eccentric hamstring strength has shown to be inadequate and a contributing factor to the high hamstring strain recurrence rates (Askling, Saartok & Thorstensson 2006).


Truth 1: Exercises Can Decrease Recurrent Strains!



Fascicle length



A muscle fascicle is a bundle of skeletal muscle which increases in length after resistance training, usually eccentric training. There is a significant correlation between short (measured by fascicle length) and weak biceps femoris with hamstring injuries.


Prior hamstring injury and biceps femoris fascicle length is shown to have a strong relationship with each other (Alonso-Fernandez, Docampo-Blanco & Martinez-Fernandez 2017). With no previous hamstring injury, a relationship exists between shorter fascicle length and increased probability of hamstring injury (9cm associated with 38% likelihood, respectively).



With previous hamstring injury, the probability is significantly greater with a shortened fascicle length (9cm associated with 65% likelihood, respectively) (Opar 2016).


Though the non-modifiable risk factor of previous hamstring injury is set, we are able to use exercise to modulate the modifiable risk factor of fascicle length.


In this graph, it demonstrates the relationship between bicep femoris fascicle length and Nordic exercise strength.


With a weak/short biceps femoris had a 40% probability of hamstring strain compared to 3% probability with a strong/long biceps femoris.



Truth 2: Eccentric Exercises Are Awesome!




Contraction type


Muscle contraction types have an effect on fascicle length adaptation. After a 6-week concentric or eccentric only hamstring strengthening program, both eccentric and concentric exercise adaptations occur within 2-weeks of an exercise program. With concentric training, there is a change in fascicle length by -13.3% at 6 weeks.


The shortened fascicle adaptation is maintained after the strength training stimulus is removed (-12.2% at 10-weeks). Moreover, eccentric training has a similar but opposite effect on fascicle length, fascicles lengthen (14.1% at 6-weeks and 0.8% at 10-weeks) yet all adaptations are removed once the eccentric training stimulus is removed.


This highlights the importance of continuing eccentric hamstring exercise application as a preventative measure of recurrent hamstring strains (Timmins et al 2016).



Truth 3: Hamstring Strength Is Not Enough





During detraining periods, as previously discussed, once the eccentric training stimulus is removed, fascicle length adaptations are lost. However, though there is a loss in fascicle length, only small losses in strength adaptations associated with eccentric training are observed (Timmins et al 2016).


This is an interesting finding, as it may demonstrate why so many athletes will return to sport with adequate strength, but may reinjure in the future. It may be related to either the lack of eccentric strength work completed during their rehab or the cessation of eccentric exercises once they return to play.



What can we do about it?



The goals of a well-rounded hamstring rehab program is to cover these areas:


Concentric/Eccentric Long Length

  • Hip extension based exercises that keep you locked at the knee and bending forward at the hip
  • This is really important for footy players as the requirements of the game involve bending down and picking the ball from the ground

             Hamstring - Single Leg Bridge on Box        Hamstring - Single Leg Deadlift

                                  Single Leg Bridge on Step                                                                      Single Leg Deadlift


Concentric/Eccentric Moderate Length

  • Hamstring curls are great for this but also include your bridging based exercises
  • We can really work at developing strength and power with these exercises

      Hamstring - Seated Leg Curl         Hamstring - Hip Thrust

                                    Seated Hamstring Curl                                                                          Barbell Hip Thrust


Eccentric Only

  • The Nordic curl (as discussed above) are the perfect example of and eccentric only exercises
  • These are quite difficult, so there are many variations that allow someone to slowly progress to a full Nordic exercise. As stated, this process can take weeks to months, depending on the individual’s hamstring capacity

         Hamstring - Eccentric Hamstring Curls       Hamstring - Nordic Curl

                          Eccentric Hamstring Curl on Ball                                                                         Nordic Curl



  • We need the gluteals to work with the hamstrings
  • There are many exercises that can be done for glute strength. The key is to make it relevant to the sport and have a focus on control

             Hamstring - Hip Extension           Hamstring - Elevated Split Squat

                                      Cable Glute Extension                                                                      Rear-foot Elevated Split Squat



  • This involves a full body movement that incorporates a mixture of trunk rotations, upper body strength and single leg exercises

             Hamstring - Cable Wood Chops          Ankle - Drop Jump

                                        Cable Wood Chop                                                            Drop Jump from Height with Hurdle Jumps


Running Mechanics

  • A gradual running/sprinting program is vital for hamstring rehab and should be progressed over 3-6 weeks (depending on severity of this strain)

           Ankle - Sprint         Hamstring - Agility       

                                        Resisted Sprints                                                                                        Agility Work

Photos supplied by Physitrack


Now, if you have not covered all these areas in your previous hamstring rehab programming…it is likely that you have re-injured your hamstring at some point OR at increased risk of straining your hamstring.



Final Thoughts


What we see in the clinic quite often are athletes returning to their given sport too early after they have strained their hamstring. They usually think:


“My pain is gone, so it must be healed”

“I can lift heavy deadlifts, so my hamstring should be strong enough”

“It’s just a little sore, it should be right”


We need to ensure that we tick all the boxes before a safe return to sport and decrease the risk of re-injuring your hamstring.


Mark Walters
Mark Walters
Principal Physiotherapist (APA, DPT) B. Ex. Sci, D. Physio Mark thrives on helping people getting back to the activities they enjoy, and aims to do this with fun and engaging rehabilitation. He also has a passion for injury prevention and performance, as well as helping people age strong.