Hamstring Injuries

Hamstring Injuries

Hamstring injuries, tweaks, pulls, spasms, muscle pain, tendon pain…what difference is there? Actually, a lot! The hamstring muscles are at the back of your thigh and are often injured in runners. Especially those who have started quality session training such as hills and speed work.



Particularly when one is now trying to IMPROVE your running and now, BAM, an injury! Aaaah.

I would say that I am becoming an expert in this area. I literally detached my hamstring tendon from my bone and had an operation just over a week ago. Check out “cutting deep” with details about this surgery. I definitely have a lot of empathy!

Hamstring Injuries

Hamstring Anatomy

The Hamstrings are made up of three muscles: biceps femoris (on the outside), semimembranosus and semitendinosis. The long head biceps femoris and semitendinosus form the common proximal tendon (the one that I detached!). It attaches to your ischial bone (the bone that you sit on). Semimembranosus has a separate tendon attachment.

One of the main functions of the hamstrings in running is that it works eccentrically (like a breaking mechanism) just before foot strike (together with glut max). In otherwords, during terminal swing phase.

Hamstring Injuries

Causes and Culprits

Clinical Sports Medicine describes 2 types of hamstring injuries.

Type 1

During high speed running which is more common. This is mainly located to the long head of biceps femoris and usually involves the proximal (top) muscle tendon junction.

Type 2

Occurs during movement leading to extensive lengthening when the hip is flexed. For example, high kicking and slide tackle. It can occur at slow speeds. Typically located close to the ischial tuberosity (bum bone) and involves the free tendon semimembranosus.

Type 1 is more common in running injuries. This injury can often be caused by:

  • rapid increase in volume/ intervals
  • increase hill/ sprint
  • inappropriate mix of high and low intensity
  • return to sport after a break
  • introduction to hurdles
  • lunges
  • squats
  • plyometrics (bounding/ jumping/ ballistic exercises – high explosive)

Poor running technique with a combination of:

  • overstriding (foot lands in front of your head, looking from a side view)
  • forward lean body
  • anterior pelvic tilt (forward rotation of your pelvis/ large curve in your lower back)
  • excessive dorsiflexion (foot lifted up)

may also lead to hamstring strain/ injuries.

Hamstring Injuries

Specific Rehabilitation Guidelines

It is important to know that these are GUIDELINES.

Proximal hamstring tendonopathy

When the pain is underneath the buttock (ie the bone that you sit on), this is the proximal hamstring tendon area. Special care is needed not to OVERSTRETCH this tendon in the initial stages of rehabilitation. It WILL most likely get irritated.

  • Heavy slow resistance (HSR) recommended initially. Really important to MAINTAIN muscle and tendon length.
  • Nordic exercises
  • Gym ball kick – prone (on your stomach) or tantrums. These are high firing to improve speed of firing

An example of an exercise that would irritate this part of the hamstring: squats.

Bulk of hamstring

Take note how many of these exercises may irritate the PROXIMAL HAMSTRING.

  • Kettle bell swings (caution with proximal hamstring) end stage.
  • Sumo squat
  • Skipping with knees extended
  • Supine (on your back) leg curl
  • Jumping split squats – challenging. Provocative with hamstring insertion (proximal). Vertical aim rather than horizontal.
  • Sled pulls/ pushes – horizontal force – end stage hamstring and calf. Whole body work out.
  • Eccentric hamstrings bridge on skateboard – single leg progression.
  • Bounding – end stage
  • Chops – Extended legs (calf too) legs forward in extension and also working hamstring. Adapt with driving arms and legs, higher and quicker, straight leg bounding.

Running technique adaptations – increase cadence, run tall, push pelvis forward (esp for proximal hamstring).

The key to decreasing injury: FASCICLE LENGTH (of the muscle). This is the eccentric part of exercise.

Thanks to The Running Physio for some guidelines with this rehabilitation.

Hamstring Injuries

It is important, if the pain does not ease in a few days, to consult a physio for guidelines. You may need hands-on treatment as well as a full biomechanical assessment. Other factors to consider are referred pain from the back and hip. These need to be ruled out first especially with any nerve – type symptoms (tingling, pins and needles or numbness).

Take a look at my Hamstring Strapping Technique for one way to support the hamstring.