Stretching to prevent a hamstring injury is a common thought in the general population. Why? Well, stretching improves flexibility and reduces stiffness in muscles. So, stretching must help, right?
Not so quick.
Stretching to prevent a hamstring injury is a highly debated topic amongst researchers. In the last several years, the use of stretching to prevent a hamstring injury has been questioned.
Does it matter if you are trying to prevent a hamstring strain injury or proximal hamstring tendinopathy?
If you read my extensive article on a hamstring injury, then you know the two common types are hamstring strains and proximal hamstring tendinopathy.
Luckily for you, I will summarize the current evidence in regard to stretching to PREVENT both of these types in this article.
If you are interested in stretching your hamstring injury as a form of TREATMENT, you can read more on that here.
This article is all about prevention! In this article, you will learn:
Why stretching to prevent a hamstring injury may be beneficial
It has always been thought that stretching is beneficial in the prevention of injuries. After all, that is why every practice or game begins with a “warm up.”
It makes sense too.
If you can’t move your muscles as well, they will get injured if they are moved to ranges past their limits.
Furthermore, decreased hamstring flexibility has actually been shown to be a risk factor for developing a hamstring strain [1].
In terms of proximal hamstring tendinopathy, most of the evidence leans towards avoiding stretching. I will come back to this below.
Nevertheless, some think it makes sense to stretch to prevent a hamstring injury, particularly a strain. The thought being, stretching will increase the flexibility of the hamstrings so a strain never occurs.
Why stretching to prevent a hamstring injury may not be helpful
I just mentioned that decreased hamstring flexibility has been identified as a risk factor for developing hamstring strain. So why in the world would you not stretch?
Well, there have also been studies that show NO RELATIONSHIP between hamstring flexibility and risk for developing hamstring injuries [1] [2].
Welcome to the world of research!
It is not uncommon to have conflicting evidence, but I will touch on that later.
It is thought that increased flexibility may actually lead to proximal hamstring tendinopathy.
Those that have more hamstring flexibility also have more stress in their hamstring tendon, when stretched out to end range [3]. Thus, it is thought that increased flexibility can lead to increased compression as the hamstring tendon runs along the ischial tuberosity.
Click here to Learn more about proximal hamstring tendinopathy and hamstring strains.
Why the evidence is so conflicting
As frustrating as it may be, conflicting evidence can happen. That is because there is no perfect study. Every study has some sort of flaw or bias.
Researching and completing a study is HARD!
There is a reason not everyone chooses to get a PhD and/or become a researcher for their career.
Back to the reasons for the conflicting evidence on stretching to prevent a hamstring injury…
One reason for the conflicting evidence has to do with the lack of a “gold standard” for measuring hamstring flexibility.
If you read studies on hamstring flexibility, some will use a sit-and-reach test, while others will use a straight-leg raise or toe-touch test.
The issue with these methods is they may inaccurately measure hamstring flexibility [1].
For example, failing to stabilize the hip and lumbar spine would allow a person to demonstrate increased movement in their leg. This would then lead to skewed measurements.
In other words, a person may appear to have sufficient hamstring flexibility, when in fact they are compensating with their hip or back.
Another reason can be the lack of randomized control trials, or RCTs [2].
RCTs are often regarded as the best study design to truly assess the effect of a treatment. I will not bore you with the details of research designs, but just know more RCTs are needed to determine the use of stretching for hamstring injuries.
Closing Thoughts
I know I probably frustrated you with the failure to provide a clear answer in regard to the use of stretching to prevent a hamstring injury.
It is a hard pill to swallow, but not everything in Physical Therapy is crystal clear.
I am not saying stretching is not important. I definitely think it is important, specifically for warming up for practice or a game. But in terms of prevention of hamstrings, stretching may or may not be useful.
That being siad, what I do know is the Nordic Hamstring Curl does have good evidence backing its use in the prevention of a hamstring injury.
Resources
- [1] Opar DA, Williams MD, Shield AJ. Hamstring strain injuries: factors that lead to injury and re-injury. Sports Med. 2012;42(3):209-226. doi:10.2165/11594800-000000000-00000
- [2] Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40(2):67-81. doi:10.2519/jospt.2010.3047
- [3] Goom TS, Malliaras P, Reiman MP, Purdam CR. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management. J Orthop Sports Phys Ther. 2016;46(6):483-493. doi:10.2519/jospt.2016.5986
Aaron
Posted at 22:27h, 19 JuneWow I did not know a lot of this. I’ve been dealing with a hamstring injury for months and am to the point where I’m trying to prevent an hamstring injury and have always thought it was best to stretch and rest! Good stuff as always Apollo Rehab!
ebelt
Posted at 03:52h, 12 JulyThanks Aaron!