Hamstring strains are extremely common in the athletic performance population especially during running events.
The reason why hamstring strains are very common and the typical “pulled a hammy” when running fast occurs is because these muscles attach across two joints.
They originate on the ischial tuberosity, otherwise known as your “butt bone” and insert across the knee at the tibia and fibula.
Anatomy of the hamstring musculature, demonstrating origin and insertion to appreciate the multipoint function.
The hamstrings comprise of 3 major muscles:
The first two reside on the inside of the back of the thigh while the short and long head of the bicep femoris is located on the outside of the thigh.
The semimembranosus and semitendinosus flex the leg at the knee and when the knee is bent, rotate the tibia medially.
The biceps femoris flexes the knee and rotates the tibia laterally.
All the muscles help to extend the hip and trunk.
Eccentric means that as the hamstring lengthens, so as the leg moves forward, the tissue is also contracting to control how fast the leg moves forward.
Picture a rubber band being pulled and the hamstrings basically control the rate of how fast the rubber band stretches.
Hamstrings also work isometrically as they will contract and hold the position of the leg against force.
Deficiency in isolated hamstring eccentric and isometric strength has been contributed to strains or tears.
A strain is an over stretching of the muscle tissue where tearing of the muscle fibers occurs due to the inability to control against the forces being acted upon it.
A grade 1 strain is a minimal amount of tissue where a grade 3 is a massive amount of tissue.
Severe injury can result in an avulsion tear where the tendon that attaches the hamstrings to the ischial tuberosity, pulls off of the bone.
Avulsions are very rare at the insertion point at the knee as most of the forces occurring are distally at the knee and being resisted higher up in the muscle tissue.
Generally, individuals are stronger in their hamstrings distally more than proximally.
Strains are painful and the progression back into exercise needs to be modified and controlled.
This IS NOT the type of pain to push through.
The pain is a message that the tissue cannot tolerate the loads being applied at the time.
Working through high pain movements and positions is not a proper learning environment for the neuromuscular system and often compensation will occur to avoid the pain.
A recent study just compared pain threshold vs. non-painful exercise in rehabilitation of hamstring strains.
The following are some basic exercises that can be done as preventative of injury to the hamstrings as well as rehabilitating after a strain.
As always, severe injury, resulting in pain or dysfunction without progress, should always be evaluated by a medical professional.
Limited active straight leg raise.
The ability to perform an active straight leg raise to 85-90 degrees perpendicular to the ground is important as it demonstrates good mobility of the posterior chain and hip.
To correct a deficient active straight leg raise there is a technique used to help the neuromuscular systems learn to reduce the tension in the tissue and improve the leg raise.
Start position of the active straight leg raise neuromuscular retraining technique and end position demonstrated with control of the pelvis and positioning of the legs.
The goal is to allow the one leg to stretch while controlling your core and executing a repeated leg raise on the other side.
You are retraining your neuromuscular programming for proper control and function of the pelvis and hamstrings.
Repeat 10 times on each leg or continue until you see improvement in your active straight leg raise.
The ability to touch the toes demonstrates full mobility of the posterior chain and lumbar spine in a functional position. Lifting items from the floor requires this movement to be functional to avoid compensation.
The inability to reach the toes is generally due to tension in the hamstrings.
The toe touch progression retrains the neuromuscular system to reduce tension in the hamstrings while using core control to flex forward and stand tall.
The foam roll helps to apply more stretch to the posterior chain as well as challenge the center of gravity for balance for neuromuscular control throughout the range.
With the foam roller under the thigh, assume the position as shown above.
Hamstring supine isometric. Controlling the pelvis while pulling the heel into the ground.
Assume the hook lying position as shown.
Lying on your stomach, loop both heels into a band.
Start by lying on your back with your feet propped up onto a stool or small box.
Lying on your back with a foam roll under the back of the knee, pull one leg up to your chest as shown above.
If you have furniture sliders or VAL sliders, start by lying on your back with your feet on the sliders.
Using a pole or dowel, position it behind your back with contact points being the back of your head, between your shoulder blades and tailbone.
Once you have the hip hinge movement down, add resistance.
There are some more advanced posterior chain and hamstring loading exercises out there, specifically the Nordic hamstring curl, gluteal/hamstring drop in the GHD machine and single leg loading movements.
The exercises described here are good options to help stimulate the tissue in a controlled manner to promote healing and restore function.
Often these movements are deficient in many individuals and these basics need to be practiced before progressing to more advanced exercises. These are a good place to start when experiencing a hamstring injury or if you want to work the basics for hamstring function.
As improvement is seen and the positions are functional and non-painful, progression to more advanced exercises is then appropriate.
About The Author:
Michael St. George PT, DPT has been practicing for 10 years primarily in the outpatient and orthopedic setting. He works for a physical therapist owned private practice based in the greater Philadelphia area and surrounding suburbs. Mike is certified through Functional Movement Systems for FMS, SFMA and FCS which consist of screens and testing used to measure movement quality and performance. Mike also has experience with working with numerous surgeons and physicians from the Rothman institute. Currently he works primarily with ACL, meniscus and post surgical recovery and sports injuries, return to sport testing and performance, running evaluation and re training and hand and upper extremity conditions.
Hickey, J., Timmins, R., Maniar, N., et al. (2020) Pain-Free Versus Pain Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy. Vol 50 (2) 91-103