Snapshot: Hamstring Strain

Snapshot - Hamstring Strain

Hamstring injuries are among the most common injuries in sports.

Commonplace in those sports that require sprinting, kicking, quick bursts of acceleration and deceleration, and change of direction. Very commonly seen in team sports.

Will cause missed playing or training time. 

Notorious for high rates of re‐injury. This could be due to consistently treating and fixing the injury itself but not looking for the true cause. 


The hamstrings are comprised of three muscles, located on the back of the thigh:

  • Biceps femoris
  • Semimembranosus
  • Semitendinosus

Important to note is that these are two‐joint muscles that both extend the hip and flex the knee, often at the same time.

Mechanism of Injury

There a generally two possible methods of injuring the hamstring; the muscle is either overstrained at high speed or overstretched at a slower speed.

However, the most common is seen with high speed sprinting. The muscle implicated here is the biceps femoris. This is the largest muscle and most frequently injured of the three muscles.

Less frequent are injuries that occur during slower movements such as dancing. This involves the hamstrings being placed in a highly stretched position. The muscle normally implicated here is the semimembranosus.  The area of pain with this injury tends to be higher up on the thigh. Often a less painful injury but historically takes longer to heal.

Risk Factors

It is generally accepted that those who have suffered one hamstring injury are at significant risk of re injury in the future. Muscle weakness and fatigue, poor flexibility and muscle imbalances can also be attributed to increase the risk of injury. However, it is important to look more closely for the true cause rather than the possible consequences listed above. It is important to ask why! Why are my hamstrings always fatiguing early in a workout? why are they always tight? why are my quadriceps so much stronger?

Hamstring dominance

The hamstring muscles assist the gluteal muscles with hip extension. However, weak, or underactive gluteal muscles can cause the hamstrings to play a bigger role. This can lead to a hamstring dominance. Over time this can lead to hamstring overuse and allows the glutes to get away with not functioning properly, as the hamstrings compensate.

Anterior pelvic tilt

The hamstring muscles start at the sitting bones in the hip. The biomechanics of hip therefore can play a huge role in the function of the hamstring muscles. Very commonly seen is what is called anterior pelvic tilt. This is where the pelvis sits in a tipped forward position. This can be on both sides or just one side. This causes the hamstrings on that side to be placed in a stretched or lengthened position. Subsequently it will be harder to activate and use this muscle and any activity which can cause tightness, weakness and therefore imbalance.

3 Tips to Avoid Injury

  1. Stretch / foam roll the hip flexors and quadriceps muscles (right)

When alignment and anterior pelvic tilt is the problem, then these muscles are no doubt going to be tight. The hamstrings are already likely in a stretched position, so actively stretching them further will not bring about the results your after. Go after the cause not the consequence.

  1. Glute activation and core stability training

The bridge (right) is an effective exercise that focuses on engagement of your gluteal and stomach muscles and focus on the mind-muscle connection that is likely ineffective right now.

  1. Hamstring strengthening

There’s little doubt that you probably need to strengthen your hamstrings. The question is how? Evidence suggests that eccentric exercise is the best type of strengthening to avoid hamstring injury. Nordic hamstring curls (right) are the gold standard of preventive hamstring exercises.

Written by: NICK ASHMAN, MScPhysiotherapy, CSCS, BSc (Hons) Applied Sports Science

Orthopedic Rehabilitation
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