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Health & Exercise Forum

Don't Let a Hamstring Injury Become Your Achilles' Heel: Part 1 of 2

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Feb 27, 2012

Dr. Mackarey's Health & Exercise ForumGuest Columnist: Janet Caputo, PT, DPT, OCS

Tim Lavelle practiced long and hard to attain a position on the University of Scranton men’s basketball team.  Local long-distance runner Christopher Krall trained diligently for the Chevron Houston Marathon.  But despite their careful and persistent training, both sustained hamstring injuries early in the preseason.  How? Why?

Hamstring injuries occur when these muscles are stretched too far or when caught off-guard during a sudden change in speed or direction. Sprinting and other fast or twisting motions with the legs are the major causes of hamstring injuries. Hamstring injuries occur most often in sports that require running, jumping, and kicking, especially when sudden changes in speed and direction are required.

Research has identified several reasons that some athletes experience a re-injury to their hamstrings. First, a previous hamstring strain puts athletes at risk of re-injury. A strain can mean that either the muscle has been torn (i.e. moderate [grade II] hamstring strain) or that the muscle was overstretched and fibers were torn, which would have caused pain, swelling, and bruising (black and blue). Athletes are also at risk of re-injury if they have ever torn a large portion of the hamstring muscle or if they have had ACL (anterior cruciate ligament) reconstruction performed on the same side. Finally, athletes who have previously participated in a rehabilitation program that focused on stretching and strengthening of the injured hamstring without addressing neuromuscular training are also at risk of re-injury.

Although athletes cannot control the grade of a previous hamstring tear, the amount of muscle that their tear had involved, or whether they have had an ACL reconstruction, they can control the type of rehabilitation that they receive following a hamstring injury. It is important for athletes to realize that the right rehabilitation program may prevent their hamstring injury from becoming their Achilles’ heel (their great weakness)!

Scientific studies have discovered that rehabilitation programs focusing on stability (core and lower extremity), agility, and eccentric control are more effective in preventing hamstring re-injury than programs focusing on stretching and strengthening. This is because stability programs help develop the neuromuscular control that allows the body to respond to changes in surface or direction—these programs help the body “learn” how to monitor joint position, movement, direction, amplitude, and speed of movement. Agility programs develop coordination, power, balance, and speed.

Eccentric and neuromuscular training is critical because most hamstring injuries occur when the hamstring is contracting eccentrically (i.e. contracting and lengthening). A recent study revealed that eccentric training reduced hamstring injury by 60% and re-injury by 85%.

The following exercises will target the essential stability training requirements for recovery after hamstring injury.

Stability Exercies

Hamstring Curl

Lie on your back on the floor with your heels on a stability ball. Place arms over your chest and lift your hips so that you are straight from your heels to your shoulders. Tighten your tummy and slowly pull your heels towards your buttocks. Then, slowly return to the straight-legged position while you maintain a neutral low-back position. Repeat. (Beginner athletes should perform this exercise 10 times, intermediate 20 times, and advanced 30 times.)

Bent Leg Raise

Lie on your back on the floor with your feet flat on a stability ball. Place your arms on the floor, straight out from your sides, making a T-shape. Tighten your tummy. Push down with your feet while slowly lifting your hips toward the ceiling. Slowly lift your right leg up and then lower it back to the ball. Then, slowly lift your left leg up and then lower it back to the ball. Repeat this sequence. (Beginner athletes should perform this exercise 6 times, intermediate 10 times, and advanced 15 times.)


With a stability ball behind you, place your uninvolved foot on ball (the one without a hamstring injury). Place your hands on your hips and tighten your tummy. Slowly, bend your standing-leg knee and lower yourself until your thigh is horizontal, parallel to the ground. Slowly raise yourself back up to the starting position. Repeat. (Beginner athletes should perform this exercise 10 times, intermediate 10 times, and advanced 15 times.)


Guest Columnist: Janet Caputo, PT, DPT, OCS specializes in orthopedic and neurological rehabilitation as clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC.

Photos: Jennifer Hnatko.

Model: John T. Bedford, DPT.

Read “Health & Exercise Forum” – Every Monday in the Scranton Times-Tribune.  Next week, read Part 2 on exercises for hamstring injury rehab. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate clinical professor of medicine at The Commonwealth Medical College.