We're finishing up our month of hamstring info, with a bit of a fact check on how you stop hamstring strains from coming back after you get one. First off, these are what we KNOW are risk factors for hamstring strain:

• Previous Injury
• Fatigue (Muscle or Whole Body)
• Age
• Sudden Increase in Training

These factors are practically the same for most muscle strains. To sum it up: you always gradually increase your training and playing time. You need to be even more careful if you've already had an injury, are above 35 years old, and it's beginning or late in the season. Next, it's essential to put strengthening exercises into your training plan (regardless of sport). Ideas include:

• Straight Leg Deadlift
• Nordic Hamstring Curls
• Reverse Lunges with Gliders

A Regimen with these can cut strain rates by almost 50% (VanderHorst, 2015). Closer to summer I will demo these in another series. It is not enough just to stretch the hamstring out, this will not prevent reoccurrence alone. Finally how do you know you're ready yo get back to run? Some go-to tests when I advise patients are:

• Running up a flight of stairs
• Quickly do a Straight Leg Raise
• Full Week of Practice with No Soreness

These are just guidelines I've used from experience, there are a tonne of ways you can measure return to activity.

As I talked about last week, your pelvic position plays a huge role in how your hamstrings feel. With a neutral pelvis there is balance between your hip flexors and hamstrings. Any tightness here is ok to be stretched out. 

But when we see an anteriorly tilted pelvis (like the picture below) it changes the game. The short hip flexors pull the front of the pelvis down. This by default causes the back of the pelvis where the hamstrings attach to be pulled up. It gives the hamstrings the sensation of being tight without even moving!

So that sensation of tightness, may not be true tightness at all! Stretching the hamstrings further won't make a difference. You have to slack from the other side (loosen the hip flexors, or tilt the pelvis back), to settle the hamstrings back to normal length.

This is a game changer for rehab! If you can't normalize that pelvis or get hip extension...the hamstrings will always take on more load when running, kicking, etc.

Before we even get into testing flexibility, the question is: does it matter? The simple answer is yes, but as I'll explain it depends on what you need that flexibility for. To test it:

• Lie Flat on the Ground
• Start with both legs straight
• Raise your testing leg in the air
• Your testing knees should be bent 5-15 degrees
• Keep your pelvis neutral, opposite leg on the ground

A good level of flexibility is hitting around 90 degrees straight in the air. But I find it alright if someone gets to 80 degrees depending on their sport and activity.

But when I do this test what I really look for is on the opposite die. When the leg goes up , what's the pelvis doing? If there's a lot of tilting and bending happening, this is more my concern. It means in a functional task like a soccer kick or sprint you're probably compensating and don't have TRUE flexibility of that hamstring.

For movement geeks it means you have poor extension or tight hip flexors on the opposite side. It can also mean poor hip mobility on the same side.

Hamstring 'inflexibility' is related to injury (Clarke, 2008). But it depends on WHY inflexibility is happening. You can't just stretch your hamstrings forever, you have to address core stability issues, other muscle balances as well.

​Do this simple test yourself, do you have good active hamstring flexibility?

So you just played a pick-up game of soccer for an hour. You go for that final break-away and BAM it feels like you've been hit in the leg with a hammer. This story is all too common, likely you've just experienced a hamstring strain. An injury to one of the thigh muscles, and one of the most common strains in the body.

How does this happen? When you're running at high speeds there's a lot more demand to the muscles of the hip (compared to jogging). The hamstrings run from the back of your pelvis to below your knees. So when your hip is driving your leg forward, the hamstrings act as the breaks to slow down the leg in the last part of 'swing phase'. This breaking action is called 'eccentric contraction' of the muscle

The most force goes through the muscle with this eccentric load. It's why you see these injuries happen on TV with no contact to the athlete. Examples:

• Sprinters at the end of a race
• Baseball players reaching for first base
• Soccer players following through on kicks

These injuries are commonly mismanaged and a lot of times rest doesn't help the muscle. In fact 1/3 of these injuries reoccur within 2 weeks of return to sport! (Heider 2010). We'll get into some hamstring anatomy in the next post.