Our hamstrings are the muscles which originate in our seatbones and travel down the back of the leg to the knee joint, attaching just below it. The hamstrings are involved in bending the knee, rotating a bent knee, extending and rotating the hip and tilting our pelvis backwards. They are a fundamental part of our gait cycle (whether walking or running), our pedal stroke, our swim kick and pretty much anything we do with our legs.
Hamstring injuries can be a major setback. Often characterised by sharp pain at the back of the thigh, they can range from minor strains to severe tears, sidelining us for weeks or even months. Understanding how to prevent and rehabilitate hamstring injuries, including the more chronic condition of hamstring tendinopathy, is crucial for being able to keep doing the activities we love.
Causes and Symptoms
Hamstring injuries typically occur due to overstretching or overloading the muscles during high-intensity activities such as running, jumping, or sudden changes in direction. Common symptoms include:
Sudden, sharp pain at the back of the thigh during activity
Swelling or bruising in the affected area
Muscle weakness or inability to bear weight on the leg
Stiffness and tenderness when touching the injured area
Hamstring Tendinopathy
Hamstring tendinopathy is a chronic condition that involves degeneration of the tendons where they attach to the ischial tuberosity (sit bones) at the base of the pelvis, often associated with overuse. Unlike acute hamstring strains, tendinopathy develops gradually, often feeling like glute pain initially, but can get worse until it feels like it’s hard to sit down. A step up in your training programme or an increase in strength/hill training can be enough for hamstring tendons to become unhappy. Symptoms of this include:
Deep, aching pain in the buttock or upper hamstring
Pain during or after physical activity or prolonged sitting
Stiffness and discomfort in the morning, after periods of inactivity or when stretching the hamstrings.
Tenderness at the ischial tuberosity
Prevention Strategies
Preventing hamstring injuries and tendinopathy involves a combination of proper warm-ups, strength training, flexibility exercises, and adequate rest. Here are some effective strategies:
Dynamic Warm-ups: Begin each workout with dynamic mobilisations like leg swings, high knees drills and “chicken scoops” (shown below) to increase blood flow and flexibility in the hamstrings.
Strength Training: Incorporate exercises such as single leg deadlifts, hamstring curls, and glute bridges into your routine. Stronger hamstrings can better handle the demands we place on them in physical activities.
Flexibility Exercises: Include static hamstring stretches in your routine to maintain muscle flexibility. This lying down one is a great choice as it effectively targets the hamstring while protecting your back.
Cross-Training: Engage in a variety of activities like swimming, cycling, or yoga to give your hamstrings a break from repetitive stress while maintaining overall fitness.
Proper Form: Focus on maintaining proper form during all exercises to reduce the strain on your hamstrings. While running this means maintaining a tall posture with a high cadence and engaging your core & glutes.
Rehabilitation Exercises
If you’ve suffered a hamstring injury or tendinopathy, rehabilitation is key to a full recovery. Follow a structured rehab program that includes:
Rest and Ice: In the initial stages, rest the injured leg and apply ice packs to reduce swelling and pain.
Strengthening: Gradually reintroduce strengthening exercises. Begin with low-intensity activities like isometric contractions (e.g., pushing your heel into the floor while seated) before progressing to more loading (eg a static hip bridge) and then to more dynamic exercises.
Eccentric Training: Eccentric exercises, such as the Nordic hamstring curl, are particularly effective. Kneel on a soft surface, have a partner hold your ankles, and slowly lower your torso towards the ground using your hamstrings to control the descent.
Gradual Return to Activity: Start with low-intensity exercises and gradually increase intensity and duration. Listen to your body and avoid pushing through pain.
Specific Exercises for Hamstring Tendinopathy
Early Stage: Minimal hip flexion
Start with 30seconds of sometric long leg bridging on two legs, progressing to 45seconds and then a one leg hold.
2. Progression as pain diminishes: exercises every other day. Focussing on working slowly and with good form.
Continue with stage 1 isometric exercises on the "off" days as this may help reduce pain.
Nordic hamstring curl: Attempt to keep a straight line between your knees, hips, and shoulders as you slowly lower to the floor or object in front of you. You'll then catch yourself with your hands and push back up to the starting position.
Banded supine leg curl: Slowly bend your knees, pulling your feet toward your buttocks. Only go as far as you can without feeling your pelvis or spine move. Then slowly return to the starting position.
3. Further progression when these exercises no longer precipitate pain: Eccentric loading (slow and controlled).
Bridge with Hamstring Curl: Lie on your back with your feet on a stability ball. Lift your hips to form a straight line from your shoulders to your knees, then curl the ball towards you with your heels.
Single-Leg Deadlifts: Stand on one leg with a slight bend in the knee. Keeping your back straight, hinge at the hips and lower your torso until it’s parallel to the floor, then return to the starting position.
Conclusion
Taking care of your hamstrings is essential for a long and injury-free active lifestyle. By incorporating preventive measures and following a structured rehabilitation program if injuries or tendinopathy occur, you can keep your hamstrings healthy and strong. Remember, it’s better to take a short break and recover fully than to risk a more severe injury by pushing through the pain.
For personalised advice or more information, please get in touch by calling Mary on 07909 551191, emailing on mary@marybrooking.co.uk or clicking on the link below.
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