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Let’s talk about the ham

Dr Alex Eade (Osteopath)

No not the Christmas ham, but the hamstring muscle


Hamstring strains are a commonly sustained by those who play sports, especially those involving sprinting, kicking and high speed movement. Approximately one-third of hamstring strains will recur with the highest occurrence being within the first two weeks. This may result from a quick return to sport or a poor rehabilitation program. Re-injury means more time on the sidelines missing out. To reduce this from happening, I recommend a rehabilitation program that strengthens the hamstring at different muscle lengths. 


Our hamstring are the muscles at the back of our thighs and have three separate muscles. They help to move  the hip and the knee joint. The hamstrings run from the lower part of the pelvis to the back of the shin below the knee.



Bicep Femoris – most common

Hamstring strains are classified as grade 1-3 depending on the extent of the injury


Hamstring injury grades

Grade 1 

  • 2 – 3 weeks
  • Overstretching without without tearing of muscle or tendon fibres
  • Symptoms may not present until activity is over
  • Usually no loss of muscular strength
  • Increased tightness
  • Feeling of pain when sitting or walking upstairs
  • Weight Bearing activities may not be possible, walking might be possible and will have minimal swelling


Grade 2 

  • 4 – 6 weeks
  • Partial tear in the muscle
  • Strength and flexibility reduced
  • Pain immediate and severe
  • Pain on stretch and contraction
  • Limping
  • Pain straightening the knee


Grade 3 

  • Usually requires surgery, up to 12 weeks
  • Severe or complete rupture, may have a large lump of muscle where the tear is
  • Sudden sharp pain
  • Pain with walking
  • Grade 2 and 3 injuries cause bruising to appear


Management of hamstring injury

  • First 48 hours
    • RICER protocol for the next 2-3 days
    • Rest
    • Ice – 20 minutes every 2 hours
    • Compression – with a bandage
    • Elevation – reduce swelling 
    • Referral – Osteopath
  • Early mobilisation
    • Pain free knee extension

After 48 hours, time frame dependent on injury severity 

  • Stretching
    • Hamstrings
    • Antagonist muscles – Quadriceps, Iliopsoas
  • Strengthen
    • Hamstrings 
      • Concentric
      • Eccentric
    • Glutes and adductors
  • Manual therapy
    • Hamstring and other muscles around hip joint
    • Ankle, Knee, Hip, Lumbopelvic mobilisation
  • Cross-training bike
  • Running program


Rehabilitation goal

  • Primary goal of rehabilitation is to allow the athlete to return to sport at a level of performance before the injury and with minimal risk or recurrence of the injury
  • Need to address hamstring strength and any imbalance between them and the quadriceps
  • Need to cover the two joint muscle action with a variety of exercises
  • Hip extension strength at long muscle length – hip hinges eg RDL
  • Knee flexor strength at long muscle lengths – hamstring bridges
  • One final point to note, eccentric only exercise help lengthen skeletal muscle fibers


Mobility section

Bend knee hamstring stretch

  • Have foot up elevated
  • Have hips square
  • Come into a small knee bend
  • Hinge at the hip and not flexing through the spine
  • Aim: Stretch the belly of the hamstrings

Reps: hold for 20-25 sec


Supine “the extender” knee

  • Lying on your back
  • One leg straight down, other lifted up to chest
  • Actively extend leg at the knee, pumping foot up and down
  • Swap legs

Aim: Hamstring active stretch

Reps: 12


Squat rockback

  • On forearms and knees
  • Have knees out wider than hips
  • Rocking back pushing hips towards heels
  • Keep chest and head up

Aim: Loosen up hips, adductors stretch

Reps: 8


Spiderman Rocks

  • Get on all fours and then have one foot up next to your hand
  • From here shift your hips up and back in a rocking motion

Aim: Hip flexors, Hamstring stretch

Reps: 8 reps each side


Strength section 

Single heel slide

  • Lying down on your back
  • Can use just a sock on to slide
  • Injured leg outstretched
  • Slide heel towards the body

2 set x 8 reps


Standing leg curl

  • Standing on one leg
  • Lift heel to glutes, bending at the knee

2 set x 8 reps 


Hamstring bridge

  • Setting up like a traditional glute bridge
  • Move feet further from the body
  • Push through the foot, lifting hip up
  • Should feel activation more in Hamstring than Glutes

2 sets x 8 reps


Double heel slide

  • Lifting hips like a glute bridge
  • Can use socks to slide
  • Slowly slide out heels
  • Drop hips down at end range
  • Then slide heel back towards hips

2 sets x 6 reps


Slow staggered RDL

  • With one leg, place it in line with the heel of the other foot
  • Have weight through the front leg
  • Slowly hinge with that hip down for 3-5 sec
  • Aim: Eccentrically load hamstring, lengthen muscle belly

2 sets x 6-8 reps



Brukner, P. (2010). Clinical sports medicine. Sydney: McGraw-Hill.

Erickson, L., & Sherry, M. (2017). Rehabilitation and return to sport after hamstring strain injury. Journal Of Sport And Health Science, 6(3), 262-270. doi: 10.1016/j.jshs.2017.04.001

Hamstring Strain | Sports Medicine Australia. (2019). Retrieved 19 November 2019, from https://sma.org.au/resources-advice/injury-fact-sheets/hamstring-strain/

Muscles of the Posterior Thigh – Hamstrings – Damage – TeachMeAnatomy. (2019). Retrieved 19 November 2019, from https://teachmeanatomy.info/lower-limb/muscles/thigh/hamstrings/

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