This week, senior Victory physio Sophie Apps (a specialist in treating lower limb injuries) tells us all about hamstring injuries.
Where and what are my hamstrings?
The start “ham” derives from the Old English word ‘ham’ or ‘hom’ which is the back of the crease of the knee, from a Germanic base where it previously meant “crooked”. The ‘-string’ refers to the tendons, and so we have the name the hamstrings.
The hamstring group consists of three muscles – called biceps femoris, semimembranosus and semitendinosus. These are the muscles running from the back of your legs down from your glutes to the back of your knee. All muscles have origins and insertions, where their tendons attach muscle to bone.
The hamstring origin occurs at your ischial tuberosity (sit bone), where the semitendinosus and biceps femoris muscles blend together and share a common origin at the ischial tuberosity (sit bone) called the conjoint tendon. The semimembranosus tendon has a separate origin just to the outside of the conjoint tendon origin.
The hamstring muscles then insert onto the outside part of the tibia, the head of fibula and the inside part of the tibia.
What do hamstrings do?
Because the hamstrings cover two joints (the hip and the knee) they have two actions. Semitendinosus and semimembranosus extend your hip when you are stable, and they also bend your knee and medially (inwardly) rotate the lower leg when the knee is bent.
What causes hamstring injuries?
Hamstring injuries are unfortunately something I see frequently in clinic. All too many of use our front thigh (quads) a heck of a lot more than we use the muscles at the back of the thigh (hamstrings) leading to a huge amount of imbalance.
As you run, your quadriceps lengthen whilst your hamstring simultaneously shorten – and vice versa as you take the next steps. It’s important to realise that the two muscle groups work together; and that if there is an imbalance, then generally we work harder through the muscle that is stronger (it takes less effort, duh!). This has a knock-on effect over time, which means we use our quads more and more, and our hamstrings less and less so they become degenerate and in poor condition. Then when we really need them (to sprint across a road, or to lift our legs up when swimming) too much is asked of them and can lead to a strain on the main muscle (the muscle belly) or the tendon attaching from the bone to the muscle belly, causing tears and soft tissue damage.
Similarly, if we don’t use our glutes to control our hips and pelvis properly, then the hamstrings will often try to compensate – which they’re not designed to do, and which once more puts us at risk of injury if we move too fast or too hard (see the recent Lazy Bum Epidemic blog series for more details!)
The hamstring tendons themselves are also important, as tendon injuries are actually more common than muscle injuries – whether that’s the tendon at the top of the hamstring that attaches to the ischial tuberosity, or the tendon at the insertion into the tibia or fibula. When you injure a tendon, it’s because the tendon’s elastic limit has been pushed too far, causing inflammation within the tendon. This causes difficulty with movement as it cannot stretch and contract the hamstring muscle as before, which then leads to pain.
How can I protect myself against Hamstring Injuries?
Simple! Get them strong and keep them flexible – and work on the balance between hamstrings and glutes!
Most people forget about the muscles at the back of our thigh (maybe because we simply can’t see them!) and so, we then don’t train them, or stretch them enough.
The following are some ideas to help optimise, and then maintain the length of your hamstrings and exercises to keep them strong.
Endurance is a crucial factor, and so consistency and commitment to the cause is key. ‘’If you don’t use it you lose it!’’ to build endurance in your muscles it takes time and studies have shown that completing specific exercises for 3 times per week, over a period of approximately 8 weeks is how long it takes to develop endurance in your muscles.
There are a few ways to do this, but my favourite for stretching the top of the hamstring is a stance where your feet are crossed over and flat on the floor, and then gently reach down to touch your toes. This way you bias one hamstring slightly more with a stretch, and then stand back up again, switch over feet and try and touch your toes – or as far as you can.
It’s important to remember a stretch should feel like just that it’s not about torturing yourself but feeling like there is increased tension on your muscles and hold this tension for 30 seconds. Don’t bounce or rock at the end of a stretch – it won’t stretch you out any more, but actually puts more load on the tendons and may actually increase your risk of injury.
To stretch the bottom end of the hamstrings, by the knees, place your foot flat on a chair with your knee bent, and hug your knee so that your chest is on your thigh. Then gradually take your weight onto your back foot, straightening out your knee, until it is as straight as you can get it with your chest still on your thigh. Again, hold the tension for around 30 seconds.
There are a few different levels of difficulty with hamstring exercises but the simplest one is a hamstring curl using just your body weight. Lying on your tummy, bend your knee so your heel goes as close to your bottom as possible, then lower it down to the floor but don’t actually touch the floor. Slowly bring it back up to try and touch your bottom again. Repeat this for 30 seconds on your left leg, then for 30 seconds on your right leg, at a fairly fast pace. You can increase the level of resistance with a band or with weight as you get stronger. Have a look at this video for guidance.
When you walk or run, the glutes (which are the stabilisers of the hip and pelvis) should activate before the hamstrings. But when your muscle balance is out of whack, this often doesn’t happen. So, to rebalance the glutes and hamstrings, try lying on your tummy. Start by contracting alternate glutes, and then add a straight leg lift – the sequence should be: switch on your glute, then switch on your hamstrings to lift your leg, then lower the leg, then relax the glutes! This video explains more fully.
Isolated hamstring exercises
To see the true power of what your muscles can do, you need to use them in isolation, and as we are a bipedal creature we don’t do this with our lower body very often! You can simply do one leg at a time when doing hamstring curls and make a note of any differences felt in the left side vs the right, but more challenging is a single leg hamstring deadlift.
As we have shown in this video, the important thing to remember is not to use much (or any!) weight at all, and to keep the movement slow to maintain the control.
Your hips need to be at the same level, and your standing knee needs to be straight– remember where the hamstrings come from and go to? If we twist or tilt, then the forces acting on those three hamstring muscles will be uneven. Don’t worry if you can’t reach the ground: plenty of practice will allow the hamstrings to stretch and as a result you will be able to travel further.
Try and complete 12 x reps on each side and really feel the hamstring loading as you dip down as far as you can, keep the level of control the same for when you are coming back up to standing level.
A bit more
To make your hamstrings work in their true function when we run (length and contracting) you can try a catch. This is simply a hamstring curl as above lying on your tummy, and as you let your leg drop down to the floor (straightening it) you stop the leg dead, before the foot reaches the floor. Have a look at this video. This movement forces the muscles to act as a break and ‘catch’ the leg before it hits the floor. It may take practice, but is a good exercise to add to the other ones listed here.
A little bit more
Once you can manage something more challenging, then deadlifts are a great way to get those hammies kicking in – see this video. Many people are scared of this exercise for fear of damaging their lower spine. In reality it all comes down to correct technique and weight distribution… but you really need individual coaching to make sure you get that right!
Do you have, or are you at risk of, a hamstring injury? If so, call us on 0207 175 0150 and book a 90-minute assessment with Sophie, so that she can help to work out what’s going wrong for you, and the best way to help you overcome it and avoid further injuries in the future.