Pain in hamstrings

Eccentric Training of Hamstring Injuries

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Pain in hamstrings

Eccentric Training of Hamstring Injuries

by chiropractor Michael Parham Dargoshayan at The chiropractor clinic in Sentrum - Ålesund (

hamstring Injuryr can be an extremely painful experience. Unfortunately, it is also referred to as one of the most common injuries among athletes who perform at the amateur and top levels. The occurrence of hamstring injuries occurs most frequently in sports that require maximum acceleration, running, kicking and fast turns (eg football and athletics). This article will explain how you can try to prevent or prevent a hamstring injury.


Anatomical overview of the musculature in the back of the thigh (both in surface and depth)


Photo: Nights


What is a hamstring?

Hamstring is a common denominator for a group of muscles that go along the posterior thigh. The simplest function of the muscle is to be able to bend the foot at the knee joint. When a hamstring injury occurs, one or more muscle fibers may overload (stretch) or a tear (injury) or rupture may occur. Biceps femoris is the most commonly reported of the total three muscle fibers in terms of stretching or injury of the hamstring muscles.

hamstring muscles

Why do you get hamstring injuries?

The causal mechanism is related to a combination between rapid eccentric contraction and active muscular contraction another place at the tendon attachment.

Look at what two people hold on each side end of a rope and they each pull their ends with equal strength. Suddenly, one person decides to create some slack in the rope and then quickly pull the rope with great force against himself again. This can cause the person on the opposite side to lose the rope out of their hands. He who loses the rope should simulate the tendon. This is where a hamstring injury usually occurs.

tug of war

How does a hamstring injury feel?

Mild hamstring injuries do not have to hurt. But the worst types can be so painful that it can be difficult to stand upright.


Symptoms of hamstring injury:

  • Acute and intense pain during an activity. May be in the form of a "clicking" / "popping" sound or feeling that something has "cracked".
  • Pain in the back thigh muscle and lower seat region as you walk, straighten the foot at the knee joint or when you bend forward with straight legs.
  • Soreness along the thighs
  • Swelling, bruising and / or a red rash along the posterior thigh.

A correct diagnosis of a hoarding injury is made by a primary contact for the musculoskeletal system (eg doctor, chiropractor, orthopedist). Here you will be asked questions regarding how the symptoms occurred as well as a thorough examination. You will be referred to imaging if this is considered appropriate.

Diagnostic ultrasound of adductor avulsion injury - Photo Wiki

- A diagnostic ultrasound examination (as shown above) or MRI may be necessary to diagnose the injury - but not in all cases.


What do you do when an acute hamstring injury occurs?

Find a safe place you can relieve the thigh, ice down the injury area for 15-20 minutes and create a compression along the thigh. Many people tend to put an ice pack on the injury area while creating compression with a band around the thigh. Lie on your back and lift your foot up 20-30 degrees to help further reduce swelling. You can also take anti-inflammatory drugs (ibux, ibuprofen, voltaren) as long as you do not have allergies or medical contraindications to anti-inflammatory drugs. Do not prescribe anything without talking to your GP. In the worst cases, the muscle may be completely torn off and you may need surgery.


When can I return to sports?

The average time lost from competition and training is 18 days, but this can vary from person to person. It turns out that when you return to training you can still struggle with the pain and symptoms for weeks and months after your injury. There is a 12-31% probability of relapse after your first hamstring injury. The biggest risk lies in the first two weeks after returning to your sport.


Grieg and Siegler conducted a study that concluded that eccentric strength in hoarding decreases with increased loading time. They studied football players and found that a football player was most likely to suffer a hamstring injury after playing the first half or right after the second half of the football game. With this, decisions are made that there may be a link between reduced eccentric strength in hoarding and likelihood of injury.

Athletics track

What eccentric exercises prevent / prevent hamstring injuries?

There are many ways to train the hoarding eccentrically. In particular, one exercise is a repetition of the result 1. Increased eccentric strength and 2. reduced risk of relapse.  This exercise is also known as ”Nordic hoarding ”.


NB Do not do the exercise if you have a recent injury. You should be able to carry both feet without creating symptoms in the rear thigh / seat region. Low intensity workouts such as fast walking, jogging and or light strength training should be painless before you begin.


The 3 phases of rehabilitation

The rehabilitation of hoarding injuries using eccentric exercises can be divided into 3 phases. The first phase the focus should be on controlling pain, swelling and inflammation. In addition, you should be able to manage painless concentric contraction of the muscle before you start with an eccentric contraction. This means that you should be able to lift the heel towards the buttocks without and with moderate resistance.

IFase 2 you should be able to do exercises such as - walking lunges, multi-directional step ups, stiff leg dead lifts, split squats and good mornings ”virtually painless (see illustrations later in the article). This is not an absolute list of exercises, but a guide on how to test yourself even if you are ready for phase 3.

3 Phase. Here you can start with Nordic hamstring the exercise (Fig. 6). Start the exercise with the use of an elastic band and then without, but only when you do the exercise with knit painlessly.


Execution of Nordic hamstring - use up to 5-7 seconds on the way down to the floor, push yourself to the starting position. Run 1-4 repetitions in succession, 15-25 seconds pause, then a new round. Feel free to run 2-5 laps as you do. Eventually you can also manage to lift yourself off the ground without having to push yourself up. This takes time and patience.


Do this exercise 2-3 times a week. Remember, you must be warm. Never start your workout with this exercise. This reduces the risk of injury.


Fig.1 "Walking lunges"

walking lunges

Fig. 2 "Step ups"

Step ups

Fig 3. "Stiff dead lifts"

Dead stiff lift

Fig 4. "Split squats" / Bulgarian outcome

split squats

Fig 5. Good mornings

good morning exercise

Fig. 6 "Nordic hamstring without elastic"

Nordic hamstring exercise

Fig 7. "Nordic hamstring w / elastic"

An alternative is also to do the so-called "assisted Nordic hoarding" exercise, where you use elastic to reduce the weight in the exercise.


"Eccentric Training for Hoarding Injuries"

By Michael Parham Dargoshayan (B.sci, M.Chiro, DC, MNKF)

Clinic owner at The chiropractor clinic in Sentrum - Ålesund (


Many thanks to the talented and charismatic Michael who has written this article for us. Michael Parham is a state-authorized primary contact for musculoskeletal disorders with six years of university education from Macquarie University, Sydney, Australia. Through his studies, he has also worked as an anatomy and physiology teacher at the University of Sydney.


His focus areas are muscle and skeletal disorders, dizziness / vertigo (crystal sick), headaches and sports injuries. He was also the chief chiropractor for patients referred from the emergency room.


Michael has previously worked at Sunnfjord Medical Center in teams of 13 GPs, radiologists, physiotherapists, ophthalmologists and rheumatologists, as well as the chief chiropractor for acute injuries referred from the emergency room.



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