Hamstring Injuries in Athletes: Evidence-Based Treatment

Justin W. Arner, MD; Michael P. McClincy, MD; James P. Bradley, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(23):868-877. 

In This Article

Injury Prevention

Hamstring strength training is an important aspect of injury prevention. Exercises focusing on improved eccentric knee flexion have been shown to decrease injury recurrence.[11] Further injury prevention may be possible through isolated targeting of specific hamstring muscles, with the long head of the biceps femoris and semimembranosus being more active during hip extension and the semitendinosus and short head of the biceps femoris preferentially assisting knee flexion. Eccentric exercises such as the Nordic hamstring exercise have been shown to reduce hamstring injuries by 50% to 70% in large athletic populations; however, its use is not widespread.[3,12,13] This is an eccentric exercise where the athlete kneels while his heels are held to the ground by an assistant and then the athlete leans forward allowing his knees to extend in a controlled manner until he or she is laying prone. Then, a hamstring curl is performed so the athlete's body is again in the kneeling position with his knees at 90° (Figure 2). The greater education of sports medicine health care teams and further evidence-based outcome studies are needed to determine when and how preventive measures can be successful.[11]

Figure 2.

Photographs showing Nordic hamstring exercise: an eccentric exercise where (A) the athlete kneels while his heels are held to the ground by an assistant, (B) then the athlete leans forward allowing his knees to extend in a controlled manner until he or she is laying prone. A hamstring curl is then performed so the athlete's body is again in the kneeling position with his knees at 90°.

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