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

This is a review article just out yesterday by Matthew Bourne and colleagues, most of whom are from the hamstring injury group headed by Dr Anthony Shield. The title is pretty self-explanatory.

First online: 07 Nov 2017

Open-access: NO

Journal: Sports Medicine

The hamstring injury group in Australia has produced a tonne of great work in the field of hamstring rehab. Kudos to them. Basically this review article aims to provide the clinician with an evidence-base in terms of choosing strengthening exercises for hamstring injury prevention. Unfortunately I do not have access to the full article, but it would really be an interesting read. Until now we all know that the nordic hamstring exercise has very strong evidence in hamstring injury prevention, however the downside was that the protocol used in those studies were quite time-consuming according to the top teams in europe, the adherence to the protocol was pretty low as a result.

I am not sure if it was Ryan Timmins or Jack Hickey recently shared findings of their study which investigated the effects of a low volume nordic exercise protocol in comparison with a high volume one, and they found that a low volume protocol produced comparable results to the high volume protocol in terms of fascicle length and eccentric strength. It should be noted that both protocols started with a two week period of moderate to high volume nordics in the beginning, then followed by either a high or low volume maintenance protocol.

The hamstring injury group also produced a lot of great research comparing hip-oriented and knee-oriented strengthening exercise for example the hip extension exercise vs the nordic exercise. I think this review is great because this will help clinicians in their clinical reasoning skills, why each exercise is chosen and how it is tailored to the needs of the individual in front of them. We always hear how we should not just follow a recipe when it comes to rehab, but how each treatment should be tailored to the athlete presented to us. So this will definitely help us towards that goal.


“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.

Please click the link below to access the article:

Bourne, M. et al (2017) An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury. Sports Medicine.

*I just saw Dr Anthony Shield tweeting this link below for full-access of the paper, but it’s view-only, that’s good enough for me. Kudos to the authors for sharing it! Please click the link below for the full-text article:

Click here for full-access shared by the authors



One thought on “An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury

  1. Pingback: Top Resources of the Week (5 – 11th Nov) | Physio Research to Practice

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