Exercise Rehabilitation, Strength & Conditioning

Part 4 of the hamstring muscle injury management program


Eccentric strengthening should form an essential part of any hamstring rehabilitation program and should include both hip and knee dominant hamstring exercises. There is a substantial weight of evidence that indicates that the terminal swing phase represents the highest risk phase of the gait cycle during high speed running. We know that the hamstrings are most active and eccentrically (or lengthened under force) as the knee is extending. This suggests that eccentric training, ideally at lengthened ranges, is the most indicated form of exercise in the rehabilitation and prevention of hamstring muscle injury.

Recent evidence demonstrated ‘spectacularly good’ results in reducing both injury and recurrence rates in footballers with an eccentric Nordic hamstring exercises. New injuries and recurrences were reduced by 60% and 85%, respectively. The only draw back with type this exercise is that a critical volume of exercise needs to be reached before its effects are realised. However, once this volume is reached the effects were highly substantial. The authors of this particular study suggest that the shift in optimum length may be the mechanism by which such favourable effects were achieved.

The Nordic hamstring exercise also has its criticisms including being bilateral and thus potentially promoting existing asymmetries and that it is a single joint exercise, whereas biceps femoris which is the most commonly injured hamstring muscle is biarticular. It is also typically performed at slow velocity and at relatively short muscle lengths until subjects have improved sufficiently to be able to lower themselves to the ground. However, it has been shown to significantly and immediately shift optimum length and when performed in sufficient volume also dramatically reduce injury rates.

So what other exercises should be performed?

A thorough hamstring exercise rehabilitation program should include a range of such exercises that encourage manual eccentrics in various positions:

  • box drops landing in squat or lunge
  • reverse plank with alternating legs
  • eccentric single and stiff leg dead lifts
  • exercise ball leg curls
  • hamstring catapults
  • sprinter eccentric leg curls
  • loaded hip bridges.
  • hip bridge bent knee to straight leg

It should not be forgotten that progression should not be just in terms of resistance and volume but also in velocity, muscle length at contraction and multiple joint motion.

At Sydney Sports Chiropractor we specialise in body based methods as well as prescribing eccentric hamstring exercises to encourage optimal rehabilitation from troublesome hamstring injury and re-injury. Call us today on 02 80655896 or send us an online enquiry here.

Brukner P, Nealon A, Morgan C, Burgess D, Dunn A. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. British Journal of Sports Medicine 2013: 0; 1-12

One thought on “Part 4 of the hamstring muscle injury management program

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