New Studies Show How to Prevent Hamstring Injuries

When U.S. national soccer team striker Jozy Altidore clutched his thigh and fell to the ground in the World Cup last month, physical therapist Holly Silvers thought once again of Russian hamstring exercises.

New York Red Bulls striker Thierry Henry injured his hamstring in an April 2012 game. Photo by Matthew D. Britt (edited).
New York Red Bulls striker Thierry Henry injured his hamstring in an April 2012 game. Photo by Matthew D. Britt (edited).

No less than three other members of the team  (Fabian Johnson, Matt Besler and Deandre Yedlin) reportedly suffered injuries to this muscle group in the back of the thigh during the World Cup. Silvers, who helped develop the FIFA11+ injury prevention program for soccer’s governing body, tells me most of these injures could be prevented. Besides the pain these players experienced, the injuries literally hamstrung the team in a series of tough matches.

And it’s not only soccer players who suffer these injuries. Four Major League Baseball players (Munenori Kawasaki, Alberto Callaspo, Chris Dickerson and Shane Victorino) are currently on the disabled list because of hamstring injuries, according to ESPN. In fact hamstring strains afflict participants in just about every sport that involves running.

New Studies

Two studies presented Sunday in Seattle at the American Orthpaedic Society for Sports Medicine (AOSSM) show just how effective a few simple exercises can be against this type of injury.

One was Silvers’ controlled study on the FIFA11+. Previously her group showed the program could cut overall injuries by about half in female soccer players, but data on specific individual injuries were mostly not significant. In this new study she and her colleagues showed, among other things, that the program cut hamstring injuries by more than two thirds among over 1700 male NCAA soccer players.

That study focused on healthy athletes. In a separate study on athletes who had already injured their hamstrings, 43 followed a hamstring strengthening program, and none of them reinjured these muscles over the next two years or so. Eight blew off the program, and four of these got hurt again.

The athletes in the second study originally hurt themselves playing American football, Gaelic football, running, softball lacrosse, field hockey, basketball, soccer, karate, or doing exercises like weight lifting. They were prescribed a regimen designed by PRO Sports Physical Therapy in Scarsdale and Lenox Hill Hospital in New York City.

The lead researcher at PRO Sports, Timothy Tyler, emphasized that the program strengthened muscles at “long lengths.” That is, the athletes straightened their legs all the way during the strengthening exercises. (The injured athletes didn’t start the strengthening right away; they went through a series of steps to prepare first.) It’s a little hard to come up with exercises that strengthen hamstrings at long lengths unless you have access to weight-lifting equipment, or at least elastic bands

Here’s one example posted by Blake Kassel of

By contrast the FIFA11+ program includes Nordic Hamstring exercises: you kneel with your body in a straight line from your head to you knees. Someone or something holds your ankles and you fall forward as slowly as possible, resisting the fall, until you can’t stay up. You catch yourself and start over.

Here’s a demonstration posted by High Performance Conditioning:

Silvers prefers the Russian variation in which you tip only until you are about to fall, then straighten to the starting position. Neither the Nordic nor the Russian requires equipment, and they can be done just about anywhere. (The videos on YouTube all seem to depict the Nordic version, even those labeled “Russian.”)

Although Tyler’s study achieved a higher success rate in a more vulnerable population, the results of these studies don’t prove one program is better than the other, because the patient groups and study designs were so different. But it’s encouraging to see that both appeared so effective. You can do either one and get good results.

The real question is how to get more people doing these exercises.

Silvers and her colleague, Bert Mandelbaum, invited 411 NCAA men’s teams to participate in the study by incorporating the FIFA program into their warmup routine, but only 61 agreed. Apparently too many strength and conditioning coaches think they can come up with something better on their own. The results show just how wrong they were.

I encourage everyone who plays running and jumping sports to add hamstring exercises like this to their routine — unless you want to end up like Jozy Altidore, watching rather than playing your favorite sport.

4 thoughts on “New Studies Show How to Prevent Hamstring Injuries”

    1. Perfect. I did it yesterday and my hamstrings were sore today. It’s a great exercise, but easy to overdo because you don’t feel it until afterwards — in my experience.

  1. Fabulous article. [and not to be rude, but I think there is a small typo in the one paragraph -5th paragraph, 2nd under New Studies, last sentence. It seems like it should say injuries not exercises. Only telling you because the article is so good and I want to refer people to it!]

    1. Thanks. And I do appreciate your pointing out the typo, which is now fixed. Not rude at all!

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