Sports Medicine

, Volume 43, Issue 12, pp 1207–1215 | Cite as

Conceptual Framework for Strengthening Exercises to Prevent Hamstring Strains

  • Kenny GuexEmail author
  • Grégoire P. Millet
Current Opinion


High-speed running accounts for the majority of hamstring strains in many sports. The terminal swing phase is believed to be the most hazardous as the hamstrings are undergoing an active lengthening contraction in a long muscle length position. Prevention-based strength training mainly focuses on eccentric exercises. However, it appears crucial to integrate other parameters than the contraction type. Therefore, the aim of this study is to present a conceptual framework based on six key parameters (contraction type, load, range of motion, angular velocity, uni-/bilateral exercises, kinetic chain) for the hamstring’s strength exercise for strain prevention. Based on the biomechanical parameters of sprinting, it is proposed to use high-load eccentric contractions. The movement should be performed at a slow to moderate angular velocity and focused at the knee joint, while the hip is kept in a large flexion position in order to reach a greater elongation stress of the hamstrings than in the terminal swing phase. In this way, we believe that, during sprinting, athletes would be better trained to brake the knee extension effectively in the whole range of motion without overstretch of the hamstrings. Finally, based on its functional application, unilateral open kinetic chain should be preferred.



The authors would like to thank Mrs. Weibel-Pache for her contribution during the preparation of this manuscript. No funding was used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.


  1. 1.
    Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011;45(7):553–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Woods C, Hawkins RD, Maltby S, Hulse M, Thomas A, Hodson A, et al. The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of hamstring injuries. Br J Sports Med. 2004;38(1):36–41.CrossRefPubMedGoogle Scholar
  3. 3.
    Brooks JH, Fuller CW, Kemp SP, Reddin DB. Epidemiology of injuries in English professional rugby union: part 1 match injuries. Br J Sports Med. 2005;39(10):757–66.CrossRefPubMedGoogle Scholar
  4. 4.
    Brooks JH, Fuller CW, Kemp SP, Reddin DB. Epidemiology of injuries in English professional rugby union: part 2 training injuries. Br J Sports Med. 2005;39(10):767–75.CrossRefPubMedGoogle Scholar
  5. 5.
    Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997-2000. Br J Sports Med. 2002;36(1):39–44.CrossRefPubMedGoogle Scholar
  6. 6.
    Elliott MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med. 2011;39(4):843–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Murphy JC, O’Malley E, Gissane C, Blake C. Incidence of injury in Gaelic football: a 4-year prospective study. Am J Sports Med. 2012;40(9):2113–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Alonso JM, Tscholl PM, Engebretsen L, Mountjoy M, Dvorak J, Junge A. Occurrence of injuries and illnesses during the 2009 IAAF World Athletics Championships. Br J Sports Med. 2010;44(15):1100–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Malliaropoulos N, Papacostas E, Kiritsi O, Papalada A, Gougoulias N, Maffulli N. Posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med. 2010;38(9):1813–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Bennell KL, Crossley K. Musculoskeletal injuries in track and field: incidence, distribution and risk factors. Aust J Sci Med Sport. 1996;28(3):69–75.PubMedGoogle Scholar
  11. 11.
    Agre JC. Hamstring injuries. Proposed aetiological factors, prevention, and treatment. Sports Med. 1985;2(1):21–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Brooks JH, Fuller CW, Kemp SP, Reddin DB. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med. 2006;34(8):1297–306.CrossRefPubMedGoogle Scholar
  13. 13.
    Verrall GM, Slavotinek JP, Barnes PG. The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules football players. Br J Sports Med. 2005;39(6):363–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Novacheck TF. The biomechanics of running. Gait Posture. 1998;7(1):77–95.CrossRefPubMedGoogle Scholar
  15. 15.
    Mann RA, Hagy J. Biomechanics of walking, running, and sprinting. Am J Sports Med. 1980;8(5):345–50.CrossRefPubMedGoogle Scholar
  16. 16.
    Chumanov ES, Schache AG, Heiderscheit BC, Thelen DG. Hamstrings are most susceptible to injury during the late swing phase of sprinting. Br J Sports Med. 2012;46(2):90.CrossRefPubMedGoogle Scholar
  17. 17.
    Orchard JW. Hamstrings are most susceptible to injury during the early stance phase of sprinting. Br J Sports Med. 2012;46(2):88–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Chumanov ES, Heiderscheit BC, Thelen DG. Hamstring musculotendon dynamics during stance and swing phases of high-speed running. Med Sci Sports Exerc. 2011;43(3):525–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Schache AG, Dorn TW, Blanch PD, Brown NA, Pandy MG. Mechanics of the human hamstring muscles during sprinting. Med Sci Sports Exerc. 2012;44(4):647–58.CrossRefPubMedGoogle Scholar
  20. 20.
    Heiderscheit BC, Hoerth DM, Chumanov ES, Swanson SC, Thelen BJ, Thelen DG. Identifying the time of occurrence of a hamstring strain injury during treadmill running: a case study. Clin Biomech (Bristol, Avon). 2005;20(10):1072–8.CrossRefGoogle Scholar
  21. 21.
    Schache AG, Wrigley TV, Baker R, Pandy MG. Biomechanical response to hamstring muscle strain injury. Gait Posture. 2009;29(2):332–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Thelen DG, Chumanov ES, Best TM, Swanson SC, Heiderscheit BC. Simulation of biceps femoris musculotendon mechanics during the swing phase of sprinting. Med Sci Sports Exerc. 2005;37(11):1931–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Petersen J, Holmich P. Evidence based prevention of hamstring injuries in sport. Br J Sports Med. 2005;39(6):319–23.CrossRefPubMedGoogle Scholar
  24. 24.
    Wood SA, Morgan DL, Proske U. Effects of repeated eccentric contractions on structure and mechanical properties of toad sartorius muscle. Am J Physiol. 1993;265(3 Pt 1):C792–800.PubMedGoogle Scholar
  25. 25.
    Lieber RL, Woodburn TM, Friden J. Muscle damage induced by eccentric contractions of 25% strain. J Appl Physiol. 1991;70(6):2498–507.PubMedGoogle Scholar
  26. 26.
    Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med. 2007;35(2):197–206.CrossRefPubMedGoogle Scholar
  27. 27.
    Koulouris G, Connell D. Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol. 2003;32(10):582–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Verrall GM, Slavotinek JP, Barnes PG, Fon GT, Spriggins AJ. Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging. Br J Sports Med. 2001;35(6):435–9 (discussion 40).CrossRefPubMedGoogle Scholar
  29. 29.
    Orchard J, Marsden J, Lord S, Garlick D. Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. Am J Sports Med. 1997;25(1):81–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Yamamoto T. Relationship between hamstring strains and leg muscle strength. A follow-up study of collegiate track and field athletes. J Sports Med Phys Fitness. 1993;33(2):194–9.PubMedGoogle Scholar
  31. 31.
    Jonhagen S, Nemeth G, Eriksson E. Hamstring injuries in sprinters. The role of concentric and eccentric hamstring muscle strength and flexibility. Am J Sports Med. 1994;22(2):262–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Zakas A. Bilateral isokinetic peak torque of quadriceps and hamstring muscles in professional soccer players with dominance on one or both two sides. J Sports Med Phys Fitness. 2006;46(1):28–35.PubMedGoogle Scholar
  33. 33.
    Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med. 2008;36(8):1469–75.CrossRefPubMedGoogle Scholar
  34. 34.
    Brockett CL, Morgan DL, Proske U. Predicting hamstring strain injury in elite athletes. Med Sci Sports Exerc. 2004;36(3):379–87.CrossRefPubMedGoogle Scholar
  35. 35.
    Proske U, Morgan DL, Brockett CL, Percival P. Identifying athletes at risk of hamstring strains and how to protect them. Clin Exp Pharmacol Physiol. 2004;31(8):546–50.CrossRefPubMedGoogle Scholar
  36. 36.
    Brughelli M, Cronin J. Altering the length-tension relationship with eccentric exercise : implications for performance and injury. Sports Med. 2007;37(9):807–26.CrossRefPubMedGoogle Scholar
  37. 37.
    Arnason A, Andersen TE, Holme I, Engebretsen L, Bahr R. Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports. 2008;18(1):40–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Askling C, Karlsson J, Thorstensson A. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scand J Med Sci Sports. 2003;13(4):244–50.CrossRefPubMedGoogle Scholar
  39. 39.
    Gabbe BJ, Branson R, Bennell KL. A pilot randomised controlled trial of eccentric exercise to prevent hamstring injuries in community-level Australian Football. J Sci Med Sport. 2006;9(1–2):103–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Petersen J, Thorborg K, Nielsen MB, Budtz-Jorgensen E, Holmich P. Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. Am J Sports Med. 2011;39(11):2296–303.CrossRefPubMedGoogle Scholar
  41. 41.
    Potier TG, Alexander CM, Seynnes OR. Effects of eccentric strength training on biceps femoris muscle architecture and knee joint range of movement. Eur J Appl Physiol. 2009;105(6):939–44.CrossRefPubMedGoogle Scholar
  42. 42.
    Mjolsnes R, Arnason A, Osthagen T, Raastad T, Bahr R. A 10-week randomized trial comparing eccentric vs. concentric hamstring strength training in well-trained soccer players. Scand J Med Sci Sports. 2004;14(5):311–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Kilgallon M, Donnelly AE, Shafat A. Progressive resistance training temporarily alters hamstring torque-angle relationship. Scand J Med Sci Sports. 2007;17(1):18–24.PubMedGoogle Scholar
  44. 44.
    Brockett CL, Morgan DL, Proske U. Human hamstring muscles adapt to eccentric exercise by changing optimum length. Med Sci Sports Exerc. 2001;33(5):783–90.CrossRefPubMedGoogle Scholar
  45. 45.
    Clark R, Bryant A, Culgan JP, Hartley B. The effects of eccentric hamstring strength training on dynamic jumping performance and isokinetic strength parameters: a pilot study on the implications for the prevention of hamstring injuries. Phys Ther Sport. 2005;6(2):67–73.CrossRefGoogle Scholar
  46. 46.
    Iga J, Fruer CS, Deighan M, Croix MD, James DV. ‘Nordic’ hamstrings exercise—engagement characteristics and training responses. Int J Sports Med. 2012;33(12):1000–4.CrossRefPubMedGoogle Scholar
  47. 47.
    Tomberlin JP, Basford JR, Schwen EE, Orte PA, Scott SC, Laughman RK, et al. Comparative study of isokinetic eccentric and concentric quadriceps training. J Orthop Sports Phys Ther. 1991;14(1):31–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Seger JY, Arvidsson B, Thorstensson A. Specific effects of eccentric and concentric training on muscle strength and morphology in humans. Eur J Appl Physiol Occup Physiol. 1998;79(1):49–57.CrossRefPubMedGoogle Scholar
  49. 49.
    Brughelli M, Mendiguchia J, Nosaka K, Idoate F, Arcos AL, Cronin J. Effects of eccentric exercise on optimum length of the knee flexors and extensors during the preseason in professional soccer players. Phys Ther Sport. 2010;11(2):50–5.CrossRefPubMedGoogle Scholar
  50. 50.
    Morgan DL, Proske U. Popping sarcomere hypothesis explains stretch-induced muscle damage. Clin Exp Pharmacol Physiol. 2004;31(8):541–5.CrossRefPubMedGoogle Scholar
  51. 51.
    Whitehead NP, Morgan DL, Gregory JE, Proske U. Rises in whole muscle passive tension of mammalian muscle after eccentric contractions at different lengths. J Appl Physiol. 2003;95(3):1224–34.PubMedGoogle Scholar
  52. 52.
    Morgan DL. New insights into the behavior of muscle during active lengthening. Biophys J. 1990;57(2):209–21.CrossRefPubMedGoogle Scholar
  53. 53.
    Blazevich AJ, Cannavan D, Coleman DR, Horne S. Influence of concentric and eccentric resistance training on architectural adaptation in human quadriceps muscles. J Appl Physiol. 2007;103(5):1565–75.CrossRefPubMedGoogle Scholar
  54. 54.
    Seynnes OR, de Boer M, Narici MV. Early skeletal muscle hypertrophy and architectural changes in response to high-intensity resistance training. J Appl Physiol. 2007;102(1):368–73.CrossRefPubMedGoogle Scholar
  55. 55.
    Garrett WE Jr, Safran MR, Seaber AV, Glisson RR, Ribbeck BM. Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure. Am J Sports Med. 1987;15(5):448–54.CrossRefPubMedGoogle Scholar
  56. 56.
    Sale DG. Neural adaptation to resistance training. Med Sci Sports Exerc. 1988;20(5 Suppl):S135–45.CrossRefPubMedGoogle Scholar
  57. 57.
    Moritani T, deVries HA. Neural factors versus hypertrophy in the time course of muscle strength gain. Am J Phys Med. 1979;58(3):115–30.PubMedGoogle Scholar
  58. 58.
    Carroll TJ, Abernethy PJ, Logan PA, Barber M, McEniery MT. Resistance training frequency: strength and myosin heavy chain responses to two and three bouts per week. Eur J Appl Physiol Occup Physiol. 1998;78(3):270–5.CrossRefPubMedGoogle Scholar
  59. 59.
    McDonagh MJ, Davies CT. Adaptive response of mammalian skeletal muscle to exercise with high loads. Eur J Appl Physiol Occup Physiol. 1984;52(2):139–55.CrossRefPubMedGoogle Scholar
  60. 60.
    Hakkinen K, Alen M, Komi PV. Changes in isometric force- and relaxation-time, electromyographic and muscle fibre characteristics of human skeletal muscle during strength training and detraining. Acta Physiol Scand. 1985;125(4):573–85.CrossRefPubMedGoogle Scholar
  61. 61.
    Campos GE, Luecke TJ, Wendeln HK, Toma K, Hagerman FC, Murray TF, et al. Muscular adaptations in response to three different resistance-training regimens: specificity of repetition maximum training zones. Eur J Appl Physiol. 2002;88(1–2):50–60.CrossRefPubMedGoogle Scholar
  62. 62.
    American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009; 41(3):687–708.Google Scholar
  63. 63.
    Hollander DB, Kraemer RR, Kilpatrick MW, Ramadan ZG, Reeves GV, Francois M, et al. Maximal eccentric and concentric strength discrepancies between young men and women for dynamic resistance exercise. J Strength Cond Res. 2007;21(1):34–40.CrossRefPubMedGoogle Scholar
  64. 64.
    Kaminski TW, Wabbersen CV, Murphy RM. Concentric versus enhanced eccentric hamstring strength training: clinical implications. J Athl Train. 1998;33(3):216–21.PubMedGoogle Scholar
  65. 65.
    Guex K, Degache F, Gremion G, Millet GP. Effect of hip flexion angle on hamstring optimum length after a single set of concentric contractions. J Sports Sci. Epub 2013 Apr 30. doi 10.1080/02640414.2013.786186Google Scholar
  66. 66.
    Guex K, Gojanovic B, Millet GP. Influence of hip-flexion angle on hamstrings isokinetic activity in sprinters. J Athl Train. 2012;47(4):390–5.PubMedGoogle Scholar
  67. 67.
    Thelen DG, Chumanov ES, Hoerth DM, Best TM, Swanson SC, Li L, et al. Hamstring muscle kinematics during treadmill sprinting. Med Sci Sports Exerc. 2005;37(1):108–14.CrossRefPubMedGoogle Scholar
  68. 68.
    Chleboun GS, France AR, Crill MT, Braddock HK, Howell JN. In vivo measurement of fascicle length and pennation angle of the human biceps femoris muscle. Cells Tissues Organs. 2001;169(4):401–9.CrossRefPubMedGoogle Scholar
  69. 69.
    Visser JJ, Hoogkamer JE, Bobbert MF, Huijing PA. Length and moment arm of human leg muscles as a function of knee and hip-joint angles. Eur J Appl Physiol Occup Physiol. 1990;61(5–6):453–60.CrossRefPubMedGoogle Scholar
  70. 70.
    Malliaropoulos N, Mendiguchia J, Pehlivanidis H, Papadopoulou S, Valle X, Malliaras P, et al. Hamstring exercises for track and field athletes: injury and exercise biomechanics, and possible implications for exercise selection and primary prevention. Br J Sports Med. 2012;46(12):846–51.CrossRefPubMedGoogle Scholar
  71. 71.
    Brughelli M, Cronin J. Preventing hamstring injuries in sport. Strength Cond J. 2008;30(1):55–64.CrossRefGoogle Scholar
  72. 72.
    Oliver GD, Dougherty CP. The razor curl: a functional approach to hamstring training. J Strength Cond Res. 2009;23(2):401–5.CrossRefPubMedGoogle Scholar
  73. 73.
    Schmitt B, Tim T, McHugh M. Hamstring injury rehabilitation and prevention of reinjury using lengthened state eccentric training: a new concept. Int J Sports Phys Ther. 2012;7(3):333–41.PubMedGoogle Scholar
  74. 74.
    Kivi DM, Maraj BK, Gervais P. A kinematic analysis of high-speed treadmill sprinting over a range of velocities. Med Sci Sports Exerc. 2002;34(4):662–6.CrossRefPubMedGoogle Scholar
  75. 75.
    Yu B, Queen RM, Abbey AN, Liu Y, Moorman CT, Garrett WE. Hamstring muscle kinematics and activation during overground sprinting. J Biomech. 2008;41(15):3121–6.CrossRefPubMedGoogle Scholar
  76. 76.
    Mizuno T, Matsumoto M, Umemura Y. Decrements in stiffness are restored within 10 min. Int J Sports Med. 2013;34(6):484–90.PubMedGoogle Scholar
  77. 77.
    Paddon-Jones D, Leveritt M, Lonergan A, Abernethy P. Adaptation to chronic eccentric exercise in humans: the influence of contraction velocity. Eur J Appl Physiol. 2001;85(5):466–71.CrossRefPubMedGoogle Scholar
  78. 78.
    Schache AG, Blanch P, Rath D, Wrigley T, Bennell K. Three-dimensional angular kinematics of the lumbar spine and pelvis during running. Hum Mov Sci. 2002;21(2):273–93.CrossRefPubMedGoogle Scholar
  79. 79.
    Steindler A. Kinesiology of the human body under normal and pathological conditions. Springfield: Charles C Thomas; 1955.Google Scholar
  80. 80.
    Lutz GE, Palmitier RA, An KN, Chao EY. Comparison of tibiofemoral joint forces during open-kinetic-chain and closed-kinetic-chain exercises. J Bone Joint Surg Am. 1993;75(5):732–9.PubMedGoogle Scholar
  81. 81.
    Mayer F, Schlumberger A, van Cingel R, Henrotin Y, Laube W, Schmidtbleicher D. Training and testing in open versus closed kinetic chain. Isokinet Exerc Sci. 2003;11(4):181–7.Google Scholar
  82. 82.
    Cameron ML, Adams RD, Maher CG, Misson D. Effect of the HamSprint Drills training programme on lower limb neuromuscular control in Australian football players. J Sci Med Sport. 2009;12(1):24–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  1. 1.Department of Physiotherapy, School of Health SciencesUniversity of Applied Sciences Western SwitzerlandLausanneSwitzerland
  2. 2.Department of Physiology, Faculty of Biology and Medicine, ISSUL Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland

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