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Why hamstring eccentrics are hamstring essentials
  1. Kristian Thorborg1,2
  1. 1Arthroscopic Centre Amager, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
  2. 2Department of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
  1. Correspondence to Kristian Thorborg, Arthroscopic Centre Amager, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark; kristianthorborg{at}

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There is no dispute that acute hamstring injury is a major sports injury,1,,6 particularly in football codes2 3 5 6 and other sports that demand high-speed running.1 The purpose of this editorial is to provide the reader with evidence-based tips for optimising hamstring injury prevention.

THE return-to-SPORT hustle

Gambling early return against recurrence

Early return to sport (≤3 weeks) is often proposed for hamstring injuries,7 even though basic research clearly shows that ongoing muscle regeneration still occurs,8 and the risk of recurrence is dramatically increased at this point.7 Recurrence includes possible additional injury and non-optimal healing of the hamstring muscle-tendinous complex.9 Such an injury can cause an athlete severe hamstring problems up to a year.6 10

Therefore, to manage hamstring injuries properly, it is important to address one of the main problems – the extremely high recurrence rate5 6 7 – which includes everything from exacerbation to re-injury.11 The acute hamstring injury and its recovery can be difficult for most lay people (including athletes and coaches) to comprehend, as jogging and moderate-paced running is often possible early after the injury – suggesting that full recovery is close. However, because the eccentric capacity (the ability to dissipate forces through lengthening contractions) of the hamstring muscle-tendinous complex is not challenged until the introduction of high-paced running,12 13 full recovery can still be weeks/months away.

My own experience is that athletes, coaches and medical personnel are often overoptimistic in their evaluation of when the athlete should return after a hamstring injury. The classic example is the principle often applied in soccer, where a player is deemed ready to play if he can fully participate in the last training session the day or two before a game. This is not a good criterion for return to sport …

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