Hamstring strains are both common and painful. They strike athletes of all sorts — including runners, skaters, and football, soccer, and basketball players.

Hamstring strains occur when the hamstring is lengthened to greater than optimal lengths, especially in the hip flexion and knee extension positions. It has a high probability of occurrence and often accounts for 12% to 15% of all sports injuries. It occurs in sports that require: – sprinting – kicking – accelerating – changing direction.

Evidence-based treatment:

– Day 0: Start PROM and isometric contractions

The goal is to avoid immobilization, thereby promoting myofibroblast regeneration and maintaining fiber alignment at the site of injury.

Day 3: Start sub-maximal isotonic exercises.

The aim is to limit scar formation and avoid re-injury of the fibers.

– Day 10: Start eccentrics

The goal is to prevent atrophy during fiber regeneration.

Caution! Early isometric training, just maintain the available mobility, but don’t stretch!

– 5 sets of 45 seconds at 70% MVIC

 – For initial stages, hip should be in minimal amounts of hip flexion

 – May be completed multiple times per day

Isometric Examples

Isometric Examples

 – Either eccentric (ECC) loading or heavy slow resistance (HSR)

– May continue stage 1 exercises on off days – 8–15 RM, 3–4 sets every other day

 – 70–90 degrees of hip flexion

 – HS activation is shown to be higher when the exercise targets knee flexion at higher degrees of hip flexion

– May begin to phase out tempo – Performed every other day

– Only required for those who are returning to sport (RTS) 

– Power/elastic stimulus – May limit hip flexion early – 2 times per week – Be very careful with hills and sprinting

As hamstring strains can be nasty injuries, athletes should work hard to avoid them. After all, healing a hamstring strain is much harder than preventing it. Here are some tips:

Warm up before and stretch after physical activity.

Boost the intensity of your physical activity slowly — no more than a 10% increase a week.

Stop exercising if you feel pain in the back of your thigh.

Stretch and strengthen hamstrings as a preventive measure.