Hamstring Injuries in Sport: Understanding, Preventing, and Rehabilitating

Hamstring injuries are one of the most common and frustrating issues faced by athletes, particularly in sports involving sprinting, rapid acceleration, and sudden deceleration. As a physiotherapist working with different sports, I frequently see athletes struggling with these injuries due to inadequate strength, poor biomechanics, or incomplete recovery. In this blog, we’ll break down the anatomy, the role of the hamstrings in running & field-based sports, the importance of accurate diagnosis, and how targeted physiotherapy can help prevent and rehabilitate these injuries effectively.

Understanding the Hamstrings: More Than Just a Muscle Group

The hamstrings consist of three muscles at the back of the thigh:

• Biceps femoris (long and short head)

• Semitendinosus

• Semimembranosus

These muscles run from the pelvis (ischial tuberosity or ‘sit-bones) down to the shin bone, crossing both the hip and knee joints. This dual function makes them particularly vulnerable to injury, especially during high-speed running and sudden changes in direction or load.

The Hidden 4th Hamstring: The Role of the Groin Muscles

While the hamstrings are the primary focus, it’s important to acknowledge the adductor magnus, a groin muscle that often acts like a "fourth hamstring." It assists in hip extension and can compensate when the hamstrings are weak or fatigued. Addressing adductor function is crucial in hamstring rehab and injury prevention.

Hamstring Function in Running

The hamstrings play three key roles during the running cycle:

1. Hip Extension (Propulsion Phase): Alongside the glutes, the hamstrings powerfully extend the hip, driving the body forward during the push-off phase. Weakness in this function can lead to inefficiency and overloading of the hamstring tendons.

2. Knee Flexion (Swing Phase): As the leg swings forward, the hamstrings bend the knee, preparing for the next step. Weak or imbalanced hamstrings may struggle to control this motion, increasing injury risk.

3. Eccentric Control (Deceleration Phase): Just before the foot strikes the ground, the hamstrings work eccentrically (lengthening under tension) to slow down the forward-moving leg. This is the phase where most hamstring injuries occur, as the muscle is under maximum stretch while generating high forces.

Why Accurate Diagnosis Matters

Not all hamstring injuries are the same. A precise diagnosis—including the location and severity of the tear—guides the rehabilitation process. For example:

• Proximal (high) hamstring injuries near the pelvis often involve tendon damage and require a slower, more tendon-focused rehab.

• Mid-belly muscle strains tend to heal faster but need careful progression to prevent re-injury.

• Distal hamstring injuries closer to the knee can impact knee stability and sprinting mechanics.

Imaging (such as MRI or ultrasound) can help determine the extent of damage and guide rehab timelines.

Screening & Force Plate Testing: Preventing Injury Before It Happens

Hamstring strength isn’t just about brute force—it’s about balance, coordination, and control. Using force plate testing and biomechanical screening, like we do at Up N Adam Performance Training & Physiotherapy, we can identify key risk factors such as:

• Imbalances between left and right hamstrings

• Poor eccentric strength (ability to control lengthening under load)

• Asymmetries in force production during sprinting or jumping movements

By addressing these weaknesses before an injury occurs, athletes can reduce their risk of acute hamstring strains and chronic overuse injuries.

Physiotherapy Approach: Addressing the Root Cause

A well-structured hamstring rehab program includes:

• Accurate load management: Gradual loading of the injured tissue to promote optimal healing without overstressing the muscle.

• Eccentric strengthening: Exercises like Nordic hamstring curls and Romanian deadlifts train the hamstrings to handle high forces during the deceleration phase of running.

• Hip-dominant exercises: Strengthening the glutes and adductor magnus helps offload the hamstrings and improve propulsion.

• Neuromuscular control: Sprint drills, agility work, and run biomechanics analysis help athletes return to full function safely.

Conclusion

Hamstring injuries are complex but highly preventable with the right approach. Understanding their function, diagnosing the injury accurately, and implementing targeted strength and biomechanical training can significantly reduce re-injury rates.

Hamstring re-injury rates are very high in those athletes who:

1. don't complete their prescribed rehab journey or

2. who aren't adequately strength tested by their treating physiotherapist to prove that they are safe to return to their chosen sport.

If you’re struggling with hamstring issues or want to assess your risk, working with a physiotherapist experienced in hamstring rehabilitation can make all the difference. Prevention is always better than cure—so make sure your hamstrings are up to the challenge before they let you down!

This is Physiotherapist Hayd'n Baragry, signing off for now!

You can book an appointment with Darren or Newcastle Knights Physiotherapists Katie or Hayd'n at www.upnadamptphysio.com