Over the past few months, we have had numerous patients come in with various types of hamstring injuries. Ranging from the odd tweak whilst kicking a football in preparation for the new season, to overuse injuries due to training for the upcoming marathon season. The trouble with any hamstring injury is the high risk of recurrence due to a range of intrinsic factors including motor control and strength, soft tissue extensibility, pelvic control and postural alignment.


The “hamstrings” are comprised of three, sometimes four, muscle groups. They originate at the bottom edge of the pelvis and attach to behind and below the knee joint. This attachment site allows the hamstrings to function across two joints (hip & knee); they have the ability to extend the hip and flex the knee.


As with any muscular and tendon structure within the body, injury can occur when the load transmitted through the structure exceeds the load capacity of the structure. This overload can occur with one very large force or repeated small forces. Injury can occur in one of three places: (i) the insertion of the tendon onto the bone, (ii) the junction between the muscle and tendon, and (iii) through the belly of the muscle. The severity of injury can range from a small micro-tear of a few fibres of the muscle or tendon, to a complete rupture of the muscle or tendon.


Occasionally the stress placed on the tendon can result in an avulsion fracture (where the tendon pulls part off the bone where it attaches) and this often creates an interesting dilemma, whether to treat the injury as a fracture or a muscle strain. We frequently state to our patients that we believe most muscle and tendon injuries occur from a relative weakness of the structure and not from inflexibility. The flexibility can affect the load bearing but injury recovery and prevention requires strengthening in a functional range, functional load and functional type of muscle contraction.


Petersen et al (2011) investigated the effect of Nordic hamstring exercises in the prevention of hamstring injuries. The Nordic hamstring exercise is a partner exercises, where the athlete starts in a kneeling position, with their torso from the knees upwards held rigid and straight. The training partner applies pressure to the athlete’s lower legs to ensure that the feet stay in contact with the ground throughout the movement. The athlete then attempts to resist a forward-falling motion using their hamstring muscles to maximise loading in the eccentric phase. The athletes are required to brake the forward fall for as long as possible using their hamstrings.


Take Home Messages:

  1. Hamstring injuries are common and occur from a range of intrinsic factors that can be identified in order to prevent these injuries from occurring;
  2. Hamstring strengthening programs should include dynamic stability, trunk stability and specific hamstring strengthening;
  3. Hamstring strengthening programs are beneficial in reducing the potential for injury to occur and should be performed regularly in any individual training for a running, cycling or dynamic competition (a 10-week program is outlined below).


Week Sessions Nordic Hamstring Ab Crunchies Star Balance Hamstring Bridge
1 1 2×5 2×10 3x30s 2×8
2 2 2×6 2×15 3x30s 2×10
3 3 3×6-8 3×10 3x45s 3×10
4 3 3×8-10 3×15 3x45s 3×12
5 – 10 3 3x 12-10-8 3×20 3x60s 3×15-20



Petersen, J., Thorborg K Fau – Nielsen, M. B., Nielsen Mb Fau – Budtz-Jorgensen, E., Budtz-Jorgensen E Fau – Holmich, P., & Holmich, P. (2011). Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. (1552-3365 (Electronic)).

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Larry is a highly skilled physiotherapist who specialises in treating back and neck pain, postural issues and scoliosis. He is certified in Schroth and SEAS methods and through the Egoscue University. Larry has a background in elite gymnastics and springboard diving and also has many years experience in endurance running and triathlons. His specialist knowledge and techniques have seen him appointed as a gymnastics coach and physiotherapist at both the Olympics Games and Special Olympics.

His passion and driving philosophy is about achieving the best outcomes for his patients utilising an amalgam of the latest techniques and theories while recognising there may sometimes be a need for invasive procedures. Where deemed appropriate Larry will then refer to a specialist. To further his holistic understanding and approach, Larry is currently undertaking a Ph.D. in Spinal Deformity and regularly attends and speaks at international conferences and courses and clinics.

Fun fact: Larry is learning how to surf - so be careful next time you go to the beach! Qualifications: B.Sc (Physiotherapy); M.Sc. (Exercise Physiology); Advanced Certificates in Schroth (BSPTS) and Egoscue (PAS) and SEAS Larry is Level II certified (advanced) in the conservative treatment of Scoliosis based on the Schroth method. The training was conducted by Dr Manuel Rigo of the Barcelona School at Scoliosis Rehab Inc in Wisconsin. He has completed his SEAS scoliosis treatment training at ISICO in Milan. Larry has also spent time working with Dr Rigo in the Barcelona clinic. Larry also has advanced certificates in shoulder treatment, posture alignment therapy and acupuncture.