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How I Prevent, Treat, and Rehabilitate Hamstring Injuries

Bert R. Mandelbaum, MD, DHL (Hon)


October 26, 2016

In This Article

Important but Much-Ignored Muscles

I take every chance I get to recommend that athletes exercise their hamstrings in a very comprehensive way. As a sports medicine specialist, it's one of the most important and impactful directions I can give. And yet it very often goes ignored.

Athletes injure their hamstrings at a greater rate than most other body parts. In baseball, hamstring injuries are the second most common injury causing missed days.[1]

But hamstring injuries are even more common in football and soccer. Two thirds put the player on the sideline for more than 24 hours, and 6.3% take the player out for 3 weeks or more.[2]

In one study, athletes of all sports in the National Collegiate Athletic Association (NCAA) sustained three hamstring injuries for every 10,000 practices or games.[2]

The injuries occur when the hamstrings cannot balance the force generated by the quadriceps. The hamstrings are the little sisters that have to run with the quads.

Over and over in athletes such as soccer star Jozy Altidore, the US Men's National Team forward, I've seen huge quadriceps that simply overpower the hamstring. It's no surprise that Altidore had to be carried off the field with a torn hamstring at the start of the US-Ghana soccer game in the 2014 World Cup.

The same is too often true in sprinters like Usain Bolt, who tore his hamstring in July; the amount of torque developed by the quads simply overwhelms the hamstrings.

Mechanics of Hamstring Injuries

Imagine pushing a rolling pin with a hand on each handle. If you push much harder with one hand than the other, the rolling pin will make a circle instead of rolling in a straight line.

That's the principle with the hamstring and quadriceps, except that the muscle doesn't make a circle—it tears.

Most often, the weak point is the muscle tendon junction, so that's where you'll find the damage. The most common hamstrings to be injured are the biceps femoris, the semitendinosus, and the semimembranosus, in that order.

The damage occurs as a result of eccentric strain. To prevent these injuries, athletes must strengthen their hamstrings with eccentric exercises. The most effective exercises I know for this purpose are the Russian and Nordic hamstring exercises.


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