The Magical Exercise For Preventing Lower Body Injury
Takeaway Points:
While the hamstrings have been claimed to be the most important muscle for squat and deadlift performance, this is mostly an exaggeration.
That said, the hamstrings do have an important role in the performance of runners and sprinters.
Hamstrings injuries are among the most common lower body injuries for sports involving running. Interestingly, they can be almost entirely prevented by eccentric-only training for the hamstrings.
Non-runners can also benefit from the use of these exercises.
The Nordic hamstring curl is generally the most recommended exercise for this purpose, although eccentric versions of some hip exercises will also work well.
The importance of the hamstrings.
A few years back, I was told that the hamstrings are the single most important muscle when it comes to squatting and deadlifting in powerlifting. At the time, I accepted that piece of information, mostly because I didn’t know any better and it was coming from a source I trusted. On top of that, it’s a pretty common recommendation we hear in powerlifting: in order to improve strength in our lower body lifts, we need to focus primarily on the hamstrings and the posterior chain. Later, however, I came to question that information.
More recently, Greg Nuckols wrote up his excellent guides on why the hamstrings are generally overrated for squat performance. Luckily, however, since he points out that it’s more optimal to focus on glute development, that doesn’t throw too much of a wrench into most people’s training. After all, many posterior chain exercises involve working the hamstrings, the glutes, and the lower back all together, making it easy to get in work for the glutes anyway.
While it may not be the magic bullet for your lower body training in general, there’s another piece of the puzzle that I want to share: that in some cases, hamstring training is the magic bullet for preventing lower body injury.
Lower body injuries are some of the most common injuries in sports involving running, and hamstring injuries are the “most prevalent” non-contact injury in sports involving running, including football. This is particularly devastating since one of the biggest factors in injury chance is whether or not you’ve injured the same area previously - you’re then likely to reinjure yourself, and reinjuries are likely to be more devastating than the original injury. This sets off a chain reaction that gets worse and worse.
(A bit more on injuries can be found in my recent post on how we get injured.)
This is also devastating because it seems that the hamstrings have a large factor in terms of sprint and running performance. For example, in the infographic below, Chris Beardsley lays out how as running speed increases, the amount of force which needs to be absorbed by the hamstrings also increases. In his page on the hamstrings, we see that there’s a crucial relationship between hamstrings strength and running performance.
230 Likes, 12 Comments - Chris Beardsley (@chrisabeardsley) on Instagram: "For many years, researchers and coaches have thought of the sprinting movement as like a bouncing..."
So how can we avoid injuring our hamstrings?
It turns out that there’s a surprisingly simple solution: eccentric (lowering) hamstrings exercises.
A lot of research has been done into eccentric training for the hamstrings. A 2015 review found that the use of eccentric hamstrings exercises seems to reduce the injury rate for athletes to a whopping one third of the rate for those not doing the exercises. This is huge - very rarely do we find such a large causal link.
The study needed to control for the fact that many of the subjects simply weren’t doing the exercises and thus weren’t seeing the benefits, thus leading to the amusing title: “Eccentric training for prevention of hamstring injuries may depend on intervention compliance: a systematic review and meta-analysis.” When these slackers were controlled for, the value of eccentric training became readily apparent.
It’s also important to realize that it may not just be the strength of your hamstrings that matters. After all, many athletes theoretically have strong hamstrings simply from the normal amount of weight training that they do, and if this were the case then they likely wouldn’t see any additional benefit from adding eccentric hamstrings exercises to their routine. Instead, it seems that eccentric training is highly effective simply because it helps rebalance the strength ratio between your concentric (raising) and eccentric strength, preferentially improving eccentric strength without training concentric strength.
Who will benefit from this kind of training?
If you are someone who runs, whether recreationally or competitively, whether as part of a field sport or as an endurance event, the use of eccentric hamstrings exercises is a no-brainer.
If you have suffered a lower body injury previously, whether from competitive sports or from lifting, eccentric hamstrings training is effective in reducing the risk of reinjury. Since you’re at a higher risk for reinjury, and since reinjury can be more severe than the original injury, this can very easily impact your ability to train and get more jacked. Thus, you’ll definitely want to implement eccentric hamstrings exercises to keep yourself steadily improving as you get older and accumulate more training hours.
If you’re someone who regularly trains with heavy lifts, you should be aware that there’s definitely going to be a gap in your training. Both the squat and the bench press involve eccentric lowering phases, followed by a reversal and concentric raising phase after hitting proper depth. However, neither of these are exercises that place a great deal of emphasis on the hamstrings, so the hamstrings are likely to go under-trained on the eccentric end. The deadlift, which will serve as the primary posterior-chain-heavy exercise for most powerlifters, features a concentric raising phase, but doesn’t feature a necessary eccentric, lowering phase.
Most powerlifters lift the deadlift to the waist - completing the lift - but don’t bother to control it on the way down, or only minimally exert a small amount of force to control it on the way down and prevent themselves from fully dropping the bar. As you get stronger and the weights get heavier, this problem can only exaggerate itself as the ratio between your concentric and eccentric strength gets further and further off. I can certainly say that with some of my clients, attempting to exert greater control of the bar during the eccentric phase of the movement after a long period of simply dropping the bar has caused muscle strains and other issues.
This isn’t to say that I think that every rep of your deadlift should focus on a large amount of eccentric action to slow the bar during its descent. As you get stronger, that weight gets pretty heavy, and while many are simply naturally a bit stronger eccentrically, the concentric strength can certainly greatly overshoot the eccentric strength in a deadlift. Eccentric-only exercises tend to induce more muscular damage and therefore more soreness - especially if you’re not accustomed to them - than concentric-only exercises. When paired with a strong deadlifter doing eccentrics on heavy deadlifts, this is a recipe for totally messing up your recovery. On lighter warmup sets or assistance work, however, I would definitely recommend exerting more control over the bar during the eccentric phase for this reason.
Fourthly, it’s also possible (though this is entirely my conjecture) that eccentric training may have an impact on injury rates in other areas. For powerlifters, the most common injury sites are the shoulder and the lower back.
Since the bench press (and potentially the strict press) are the primary training methods that powerlifters use for upper body training, it’s possible that placing a slightly greater emphasis on the eccentric phase of the bench press, or doing more eccentric-focused sets as accessory work, may help reduce injury rates. This seems likely to be relevant information because, let’s be honest, most of us are pretty lazy about the eccentric phase of our bench press. When it comes to the overhead press, control of the eccentric phase may be virtually non-existent if you’re used to letting the bar do a minimally-controlled fall back to the shoulders while getting the head out of the way. However, it may be prudent to do eccentrics for the shoulder press via dumbbells instead, since it’s harder to drop them on your head. This is similar to the extreme stretching method I explored in another post.
You still need to be careful - eccentrics still cause more muscle damage than traditional concentrics, so you can't throw them into your program carelessly.
When it comes to protecting the low back, chances are that it’s a bit more complicated than simply adding some eccentric lifts in (the spine is complex), but it’s still possible that some eccentric, low back focused eccentric versions of exercises such as hyperextensions, reverse hyperextensions, good mornings, and RDL’s may help.
It’s possible that eccentric training may be a key piece in the puzzle of what causes injury, or it’s possible that this relationship is unique to the hamstrings. I think it would be interesting to see more research on the impact of eccentric training on injury rates in a variety of sports, not just those involving a great deal of running.
If you’re looking to train the hamstrings eccentrically, what exercises are most useful?
For many of the studies that researched the topic, the exercise of the choice is the Nordic hamstring curl. In this eccentric version of the hamstring curl, you place your knees on a pad of some sort, anchor your feet behind you (or have a partner hold your ankles) and then perform a controlled fall to the floor, engaging your hamstrings to keep it as slow as possible and maintaining a solid straight line position from knees to head. By placing your hands in front of yourself (and probably a mat, as well) you can then catch yourself before you hit the floor (think the knee pushup position) and then sit back to reset the rep easily and repeat. This exercise should be done only for a few reps per set, with the focus being on increasing the control of each rep rather than just adding more and more poor quality reps. I typically recommend 3x5 with many of my clients.
Here's Bret Contreras covering many of the ways that you can setup a Nordic hamstring curl:
While the Nordic hamstring curl is the eccentric exercise of choice due to its ease of use, it’s far from the only option. Controlled leg curls or lying leg curls will also work well, as will slow eccentric versions of other posterior chain exercises, including RDL’s, good mornings, and light deadlifts. Eccentric-focused squat variants are unlikely to be particularly useful due to their lack of focus on the relevant hamstrings. If you’re using exercises which don’t specifically target the hamstrings, the use of visualization to focus on the hamstrings may be helpful.
It’s unlikely that doing super-high intensity eccentrics will be helpful, and I don’t tend to recommend the old school practice of doing eccentrics with greater than 100% of your max, in part simply because this is hella inconvenient if you don’t have a training partner to help reset the weight with each rep, and in part because there’s a lot that can go wrong when you’re working with weights that heavy.
Instead, I would recommend working within more of an assistance or “hypertrophy” range, 6-15 reps per set with a moderately heavy weight, a slow, controlled eccentric phase, and a faster, less emphasized concentric phase. Such exercises need not be frequent, and can probably be performed just 1-2 times per week for 1-3 sets each time. You may want to work this into any existing injury prevention routine or cooldown that you’re using for the sake of simplicity. I personally do 3x5 on Nordic ham curls once a week.
Bulletproofing your hamstrings may not be necessary for everyone, but it’s sure to be massively helpful for some. For this reason, dedicated hamstrings training is still a useful tool in any exerciser’s toolbox. There’s also minimal downside - dedicated hamstrings exercises will still provide size growth and have some carryover to other lower body strength, in addition to checking all your boxes on injury prevention.
Besides, who doesn’t want to get some badass hamstrings like these?
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