Choosing The Right Hamstring Exercises

The Hamstrings are a group of 3 muscles on the back of your thigh; biceps femoris, semimembranosus and semitendinosus. These 3 muscles are involved in flexing the knee extending the hip. Hamstring injuries are a common occurrence in runners and footballers (AFL, Soccer, Rugby League and Rugby Union). Here we outline the different types of hamstring injuries and some rationale as to which to use in your training programs.

Hamstring Injury

Hamstring muscle tears are the most common muscle injuries in male football players, and track and field athletes (1-5). They are associated with significant time loss (1) and also high re-occurrence rates (3). Thus, adequate prevention and rehabilitation processes are of major importance in these groups.

The predominant hamstring injury mechanisms in football and track and field occur during high-speed running and/or acceleration efforts (1, 2). In kicking sports they can also occur during movements with large joint excursions (i.e., stretching-type injury) such as high-kicking, split positions and glide tackling (6). Hamstring injuries in football most commonly involve the proximal muscle-tendon unit junction (MTJ) of the BFl, accounting for approximately 60–85% of all hamstrings injuries (60%). During a previous blog we have discussed how muscle injuries such as a hamstring injury is classified, with injuries with ‘c’ classifications more prone to longer recovery and higher risk of re-occurence (7). Key risk factors for hamstring injury include hamstring strength through range of movement (essentially being strong and flexible) and gradual exposure to high speed running (which has previously been discussed here). It is commonly advocated that hamstring strengthening and notably eccentric training be incorporated to reduce risk of hamstring injury (6, 8-10).

Anatomy

The Hamstring muscle group comprises three muscles; biceps femoris, semitendinosus and semimembranosus.

• Biceps Femoris – the largest of the hamstring muscle group,located to the outiced (laterally), it has two heads a short head and a long head. The long head originates from the ischial tuberosity and attaches into the outside of the tibia and fibula head (outside of the shin bone). Whilst the short head originates along the outside of the femur and attaches into the same location.

• Semimembranosus: Originates from the outer aspect of the ischial tuberosity and attaches into the medial aspect of the tibia. It sits slightly deeper to the longer thinner semitendinosus.

• Semitendinosus; Again originates from the ischial tuberosity and attaches via a long skinny tendon into the medial surface of the tibia.

Types Of Hamstring Exercises

Strength exercises incorporate one or more contraction types for a muscle group; isometric (muscle length stays the same), concentric (muscle length shortens) or eccentric (muscle lengthening). These three contraction types can be utilised through numerous different hamstring exercises, with often a focus on a lengthening or eccentric contraction (6,9).

Regardless of the type of muscle contraction, hamstring exercises can be broken up into 3 categories; knee dominant in which all or the majority of the movement occurs at the knee; hip dominant in which all or the majority of movement occurs at the hips; or integrated exercises which incorporate both movement at the knee and at the hip whilst loading the hamstrings. Some evidence suggests that knee dominant exercises such as a lying leg curl (or prone leg curl) elicits significantly greater activity in the distal portion of the hamstrings muscle (11, 12). Research from Bourne et al (2017) illustrated during eccentric contractions, hip-extension or hip dominant exercise more selectively activates the lateral hamstrings (biceps femoris) while knee flexion-oriented exercises (such as lying leg curls and Nordics) preferentially recruit the medial hamstrings (semimembranosus and semitendinosus). However, despite being the least selective activator of Biceps Femoris the highest readings for muscle loading was the Nordic Hamstring Exercise (see below). A key to having well rounded concentric and eccentric hamstring strength utilises both knee dominant, hip dominant and integrative hamstring exercises. Below are some examples of each.

1. Knee Dominant

• Lying Leg Curl (Prone Hamstring Curl)

• Nordic Hamstring Curl (Avoid flexion forward at the hip – keep long and tall)

• Hamstring Slides (These can be performed double or single leg; and as a eccentric contraction only or concentric and eccentric)

2. Hip Dominant

• Romanian Deadlift (Double leg, Staggered, Single Leg)

• Harop Curls

• Good Mornings (Double leg, Staggered, Single Leg)

• 45 degree Hip Extension

3.Integrated

• Modified Razors

• Razor Curl

Further information on hamstring strength for runners can be found here

 

Lewis Craig (APAM)
POGO Physiotherapist
Masters of Physiotherapy

Featured in the Top 50 Physical Therapy Blog

 

References

1. Woods C, Hawkins RD, Maltby S, Hulse M, Thomas A, Hodson A. The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of hamstring injuries. Br J Sports Med. 2004;38(1):36–41. Epub 2004/01/31. pmid:14751943; PubMed Central PMCID: PMC1724733.
2. Woods C, Hawkins RD, Hulse M, Hodson A. The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of preseason injuries. Br J Sports Med. 2002;36(6):436–41. Pmid:12453838
3. Malliaropoulos N, Isinkaye T, Tsitas K, et al. Reinjury after acute posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med 2011;39:304–
4. Malliaropoulos N, Papacostas E, Kiritsi O, et al. Posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med 2010;38:1813
5. Askling C, Saartok T, Thorstensson A. Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Br J Sports Med 2006;40:40–4.
6. Askling C, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013;47(15):953–9. Epub 2013/03/29. Pmid:23536466.
7. Pollock N, Patel A, Chakraverty J, et alTime to return to full training is delayed and recurrence rate is higher in intratendinous (‘c’) acute hamstring injury in elite track and field athletes: clinical application of the British Athletics Muscle Injury ClassificationBritish Journal of Sports Medicine 2016;50:305-310.
8. Askling C, Karlsson J, Thorstensson A. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scand J Med Sci Sports 2003;13:244–50.
9. Petersen J, Thorborg K, Nielsen MB, et al. Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. Am J Sports Med 2011;39:2296–303.
10. Brughelli M, Cronin J. Preventing hamstring injuries in sport. Strength Condit J 2008;1:55–64.
11. Schoenfeld, B. J., Contreras, B., Tiryaki-Sonmez, G., Wilson, J. M., Kolber, M. J., & Peterson, M. D. (2015). Regional differences in muscle activation during hamstrings exercise. The Journal of Strength & Conditioning Research, 29(1), 159-164.
12. Bourne MN, Williams MD, Opar DA, et alImpact of exercise selection on hamstring muscle activationBritish Journal of Sports Medicine 2017;51:1021-1028.