Given the relatively high prevalence of hamstring re-injury, it is important to consider preventative measures prior to and following hamstring strains.2,9,14,15,33

Eccentric hamstring strengthening, with a slow lengthening phase of contraction, has been shown to prevent new and recurrent hamstring injuries in soccer players.13,22,23,25,26 There is evidence that incorporation of eccentric exercises into preseason and in-season training may decrease the occurrence of hamstring injuries and prevent recurrent hamstring injuries.13,22,23,25,26 However, eccentric exercises can be quite painful, so a gradual increase in intensity and duration of these exercises is recommended in order to avoid excessive muscle soreness and increase compliance.23,25,26

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Given the relative risk factors for hamstring injury and re-injury, it's prudent for athletes to develop a balanced conditioning program that incorporates:

  • Flexibility
  • Eccentric strength training
  • Neuromuscular control (balance and coordination)

A conditioning program with these elements may help prevent initial and recurrent hamstring strains. Further research into potential benefits and longitudinal effects of eccentric training are ongoing.

Conclusion

Hamstring injuries are extremely common occurrences in all levels and types of athletic activity. Acute hamstring strains and tendon injuries can be severely debilitating for anyone. Proper and prompt management of these injuries can improve outcomes, speed return to play, and decrease re-injury rate. Eccentric exercises offer a promising way to treat and prevent recurrent injuries and further research into potential benefits and longitudinal effects are ongoing. Proximal hamstring avulsion-type injuries warrant advanced imaging and possible surgical fixation. It is important to individualize treatments and consult with a physician or qualified clinician for each patient, each injury, and each sport.

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