A Comprehensive Hamstring Guide: From Rehab to Performance

What do you call a pig’s leash? A HAMSTRING

I don’t know what’s funnier - the joke or this Game of Thrones meme:

Now that I have your attention, let’s dive into this much-needed blog post.

I’ve been seeing a number of hamstring injuries in the clinic and on the field, so this blog will focus on what you can do to recover from a hamstring injury.

Disclaimer: This should not be used as medical advice. If you are dealing with an injury, please seek out a local Physical Therapist or healthcare provider.

So, let’s get started:

Anatomy of the Hamstrings:

The hamstrings are comprised of 4 different muscles (5 if you include the adductor magnus, but we’ll keep it simple here). These 4 muscles are:

• Biceps Femoris – Long Head
  • Origin: ischial tuberosity
  • Insertion: fibular head
• Biceps Femoris – Short Head
  • Origin: distal lateral portion of femur
  • Insertion: fibular head
• Semimembranosus
  • Origin: ischial tuberosity
  • Insertion: medial tibial condyle
• Semitendinosus
  • Origin: ischial tuberosity
  • Insertion: medial tibial condyle

All cross both hip and knee joints except for the short head of biceps femoris and are innervated by the tibial/fibular divisions of the sciatic nerve. These muscles work together to extend the hip and flex the knee.
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Mechanism of Injury:

If you watch any video with a hamstring strain, it typically occurs when an athlete is decelerating (slowing down). The muscle is being loaded while it is lengthening (eccentric loading) – which is where we tend to be the weakest.

Acute Stage:

When someone first strains their hamstring, there’s a few things you can do to help optimize the recovery process.

Follow the guidelines of POLICE:

• P: Protection
  • Remove any triggers that will continue to aggravate the hamstring
• OL: Optimal Loading
  • As early as possible, start to load the hamstring isometrically
• I: Ice
  • Ice can help with swelling and pain mitigation
• C: Compression
  • This can help to keep swelling to a minimum and make the area feel protected
• E: Elevation
  • Helps with swelling and lymphatic flow up the chain

Once you’ve put some of this in play, you can start to implement some soft tissue and mobility techniques. It’s important to note, loading is going to be the most important component in this process.


Soft Tissue and Joint Mobility

The goal here isn’t to release any adhesions or scar tissue. We’re just trying to decrease some sensitivity and pain to allow other movement opportunities and progressive loading.

Tack and Stretch

Standing Hip and Hamstring Mobility

Supine Hip and Hamstring Mobility

​Loading

This is where we build strength and resiliency in the hamstrings.

Here’s our loading progressions in a nutshell:

Isometric Loading 🡪 Isotonic Loading 🡪 Heavy Slow Resistance Training (high load/low velocity exercise) 🡪 Slow Stretch-Shortening Cycle 🡪 Fast Stretch-Shortening Cycle

Isometric Loading

Glute Bridge – Isometric Hold Variations
(Dosage: 3-5 sets x 15-45 second holds)


Isotonic Loading
(Dosage: 3-4 sets x 10-20 reps)

Glute Bridge
 
Straight Leg Glute Bridge

Band Pull Through
 
Hamstring Roll Out


Heavy Slow Resistance Training (high load/low velocity exercise)

Kickstand RDL
 
Nordic Hamstring Curl

Half-Kneeling Hamstring Slide



Slow Stretch-Shortening Cycle 🡪 Fast Stretch-Shortening Cycle

Band Step Down
 
Kettlebell Swing

Supine Band Kickdown

Standing Band Kickback – Slow
 
Standing Band Kickback – Fast

Single Leg Plyometrics

Hamstring Tantrum – Supine

Hamstring Tantrum – Prone Knee Bend



What’s the biggest risk factor for a hamstring injury you ask? A previous hamstring injury. Make sure to take the appropriate steps to get your hamstrings taken care of. You don’t want to be that person that looks like a sniper took them out.

Ready to come see us?

​If you’re dealing with an injury, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before.


Cheers,

Dr. Ravi Patel, PT, DPT, CSCS