Pure Physio Blog

Are You At Risk Of A Hamstring Injury?

Published on
23 Dec 2015

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Hamstring injuries are common in the active population with the recurrence rate as high as 1 in 4. There has therefore been a lot of research into hamstring injuries and the risk factors contributing to them. Here’s some of the factors that recent research has found to increase risk of hamstring strain/injury.

Are you at risk of a hamstring injury?

The hamstring muscles are four powerful strap muscles that attach behind our pelvis, traverse down the back of our thigh to attach just behind our knee. Any one of these four muscles may be affected.

Hamstring pain isn’t always a hamstring strain. Your lower back, hip joint and sciatic nerve can all refer pain to the area. Problems in these regions can also cause weakness in the hamstring muscle, which leads to a strain. If these areas are not identified and addressed you will likely run into trouble as you try to return to day-to-day activity or a sport.

Hamstring injuries are really common in the active population, especially in sports like AFL and soccer. They are the most common injury in the AFL with players missing 20 games per season per club because of them.There is also a really high recurrence rate, with 1 in 4 players re-injuring.

There has therefore been a lot of research into hamstring injuries and the risk factors contributing to them. Here’s some of the factors that recent research has found to increase risk of hamstring strain/injury.

Hamstring Injury Risk Factors


It’s pretty well known that as we get older, we are more prone to injury. However, it might not be known that the risk of muscle strains actually increases pretty early on in life. Anyone over the age of 26 has a much higher risk of hamstring injury. At the elite level in the AFL, it was found that players over 23 years old had a doubled chance of hamstring strain than the younger athletes.


Deficiencies in muscle strength can lead to hamstring strains – especially if one hamstring is a lot weaker than the other. Any asymmetry will put uneven loading and force on each leg and can lead to either hamstring tearing.

It’s not only weakness in the hamstrings themselves that can lead to hamstring injury – the studies also found that being over dominant through quads was a risk factor. We see a lot of active clients who do quads heavy strength training in the gym. Some people will also do squats/lunge exercises that are supposed to target the glutes as well but due to technique faults and simply having already over-active quads, it produces further quad dominance and weakness through glutes and hamstrings.

It’s important to balance out the muscle strength with lower limb training to avoid injury, particularly hamstring strains.


Decreased range of motion in the joints and flexibility of particular leg muscles can increase the likelihood of hamstring injury. It’s obvious that having tightness in the hamstring will lead to a tear if it’s suddenly overstretched – if one hamstring is significantly tighter than the other side, it actually doubles the risk of tearing the tighter side.

Aside from the hamstrings themselves, a lot of athletes don’t realise that it’s also detrimental to be tight in the front of the hip and thigh. Tightness of the hip flexors and quadriceps was found to have a big impact on the biomechanics of the leg movement and lead to hamstring overload. We see a lot of desk based workers who spend many hours sitting at a desk which leads to shortening of the quads and hip flexors, so it’s important that anyone wanting to be active outside of work knows how to release these areas.

Previous injury

Some injuries can predispose athletes to hamstring strain. Previous hamstring injury is one of the biggest risk factors – if you’ve done it once, it’s pretty likely you’ll do it again, especially if you don’t do the appropriate rehabilitation. Previous calf or quad injury also increases the probability of having a hamstring injury due to subsequent overload. Rehab also becomes extra important after knee injuries that require ACL Reconstruction surgery – a relatively common injury in change of direction sports – after which, a player is 1.75x more likely to have a hamstring injury.

If you return to sport or high intensity activity before giving the muscle adequate chance to heal or do not complete a thorough rehabilitation program you are at an especially high risk of re-injury. Research has shown that a specific program of core and lower limb strengthening/coordination exercises can reduce the number of hamstring injuries per football team per season.  These programs are now standard practice in elite sporting clubs. As such, the physios at Pure Physio recommend all sportspeople, but especially those at high risk learn and are consistent with these exercises for the rest of their careers.

Diagnosing hamstring injuries

If you have been diagnosed with a hamstring injury, your physiotherapist will identify which hamstring muscle is involved and where within the muscle the injury is (ie muscle belly vs tendon or the area that combines the two).  This, along with a grading (how severe the strain is), will guide how long you will be out of action for, as well as dictate the rehabilitation process.

Once a diagnosis is made, the rehabilitation process can commence with a specific and tailored plan for the individual based on the degree of injury, and the sporting or lifestyle goals. Initially manual therapy is indicated to restore normal movement and reduce pain.  A structured rehab program is also commenced in early stage injury, designed to regain normal muscle activation and function, as well as muscle length.  Then it progresses to restore power, endurance and control.  All components are essential in regaining normal function and preventing recurrent injury.  From here a specific return to run/sport program needs to be prescribed.

It might be a bit daunting to discover that you have a really high risk of straining your hamstring if you have a few of the above risk factors but the good news is that the research is showing the risks can actually be decreased by building adequate strength in the hamstring. Studies have found that specific strengthening exercises can be performed to effect fascicle (bundle of muscle fibres) length, which can offset the non-modifiable risk factors such as age and previous injury.


Manage the risks associated with hamstring injuries by educating yourself on the specific techniques of strengthening exercises and follow the advice of your physiotherapist when unsure. If you have suffered from a previous hamstring injury or would like further information on how to prevent one, feel free to visit us in our clinics for more advice.

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