An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury


Strength training is a valuable component of hamstring strain injury prevention programmes; however, in recent years a significant body of work has emerged to suggest that the acute responses and chronic adaptations to training with different exercises are heterogeneous. Unfortunately, these research findings do not appear to have uniformly influenced clinical guidelines for exercise selection in hamstring injury prevention or rehabilitation programmes. The purpose of this review was to provide the practitioner with an evidence-base from which to prescribe strengthening exercises to mitigate the risk of hamstring injury. Several studies have established that eccentric knee flexor conditioning reduces the risk of hamstring strain injury when compliance is adequate. The benefits of this type of training are likely to be at least partly mediated by increases in biceps femoris long head fascicle length and improvements in eccentric knee flexor strength. Therefore, selecting exercises with a proven benefit on these variables should form the basis of effective injury prevention protocols. In addition, a growing body of work suggests that the patterns of hamstring muscle activation diverge significantly between different exercises. Typically, relatively higher levels of biceps femoris long head and semimembranosus activity have been observed during hip extension-oriented movements, whereas preferential semitendinosus and biceps femoris short head activation have been reported during knee flexion-oriented movements. These findings may have implications for targeting specific muscles in injury prevention programmes. An evidence-based approach to strength training for the prevention of hamstring strain injury should consider the impact of exercise selection on muscle activation, and the effect of training interventions on hamstring muscle architecture, morphology and function. Most importantly, practitioners should consider the effect of a strength training programme on known or proposed risk factors for hamstring injury.

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Correspondence to Matthew N. Bourne.

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Conflict of interest

Anthony Shield and David Opar are listed as co-inventors on a patent filed for a field test of eccentric hamstring strength (PCT/AU2012/001041.2012), as well as being minority shareholders in a company responsible for commercialising the device. Matthew Bourne, Ryan Timmins, Tania Pizzari, Joshua Ruddy, Casey Sims and Morgan Williams declare that they have no conflicts of interest relevant to the content of this review.

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Bourne, M.N., Timmins, R.G., Opar, D.A. et al. An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury. Sports Med 48, 251–267 (2018).

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