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  1. Josh Heerey1,
  2. Christina Le2,
  3. Brady Desmond Green3,
  4. Ronan Kearney4
  1. 1La Trobe University Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
  2. 2Glen Sather Sports Medicine Clinic, Edmonton, Alberta, Canada
  3. 3Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia
  4. 4Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Dr Ronan Kearney, Royal College of Surgeons in Ireland, Dublin 2, Ireland; ronankearney{at}rcsi.ie

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An evidence-based framework for strengthening exercises to prevent hamstring injury

Sports Med 2018;48:251

Problem: Hamstring injuries—with a view to mitigating injury risk. Hamstring injuries are multifactorial but it is hypothesised that targeted exercise interventions cause specific adaptations that may contribute to a more injury-resistant musculotendinous unit. There is a need to develop an evidence-based framework to preventing hamstring injuries.

Characteristics of hamstring muscle activation are one key consideration impacting exercise selection. The pattern and magnitude of activation of each muscle (biceps femoris, semitendinosus, semimembranosus) are heterogeneous among exercises. Generally, knee flexion-dominant exercises seem to be more effective for semitendinosus activation, such as the Nordic and leg curl. Hip extension-dominant exercises seem to be more effective for biceps femoris long head and semimembranosus activation, such as the stiff-legged deadlift. Parameters of hamstring muscle activation do have limitations and should not be the single consideration for exercise selection.

Another key consideration for exercise selection are the architectural adaptations induced by the exercise. Fascicle length may be one important architectural attribute in the context of hamstring injury risk. Biceps femoris long head fascicle length increases in response to eccentrically biased exercises. It may also be advantageous to induce …

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