Why Hamstring Injuries Keep Coming Back: And How to Stop It

A previous hamstring injury is one of the strongest predictors of a future one. Reinjury rates of 14%-63% have been reported within the same season or two years after the original injury. The underlying reason is almost always returning to sport before strength, high-speed capacity, and sport-specific readiness have genuinely been restored.

Looking for what rehabilitation actually involves? Read: Hamstring Injury Treatment: What the Evidence Says

The Numbers

Studies report hamstring recurrence rates of 14%-63% in the same playing season or within two years of the original injury. Systematic reviews have consistently identified previous hamstring injury as one of the most significant predictors of a subsequent tear, with a 2 to 6 times higher rate of recurrence in athletes with prior injury. A prospective study of athletes in sprint and high-speed running events found an odds ratio of 2.85 for re-injury in those with prior hamstring injury.

Why Feeling Ready Is Not the Same as Being Ready

Pain reduces relatively early in recovery, often well before strength, explosive capacity, and tolerance for high-speed running have been restored. The athlete jogs without discomfort. Training feels manageable. They return to competition.

Then they sprint at full effort, or decelerate sharply, or change direction at pace, and it tears again.

The stages between pain resolution and genuine readiness are:

• Strength restoration - the injured hamstring must rebuild its capacity to produce force, including in the lengthened positions most relevant to sprinting.
• Progressive running exposure - from low-speed jogging through to submaximal and then maximal velocity work, systematically.
• Sport-specific demands - the actual patterns of acceleration, deceleration, change of direction, and repeated sprint effort must be replicated in training before they are encountered in competition.

Returning before any of these stages is complete is where recurrence risk concentrates.

What Reduces Recurrence Risk

Eccentric capacity - building the hamstring's ability to absorb force while lengthening, through exercises like the Nordic hamstring exercise, single-leg deadlifts, and progressive lengthened-position loading. Nordic hamstring exercise programmes have been consistently associated with reductions in hamstring injury incidence in athletes who adhere to them.

Progressive sprint exposure - perhaps the most commonly missed element. Gym-based strength is necessary but not sufficient. The athlete must systematically progress through submaximal to maximal running speeds before returning to competition.

Objective return-to-sport criteria - not a set number of weeks, but confirmed strength, running capacity, eccentric tolerance, and sport-specific readiness assessed against objective standards.

How IP Physio Approaches This

The aim is not simply to get you pain-free. It is to ensure the hamstring is prepared for the demands you are returning to.

We use hand-held dynamometry and ForceDecks force plates to assess bilateral strength and force production at key points throughout rehabilitation. Running analysis can identify changes in mechanics following injury that may be relevant when progressing back to high-speed running. Return-to-sport clearance is based on a multidimensional assessment covering strength, high-speed running capacity, eccentric tolerance, functional performance, psychological readiness, and training load tolerance, not a calendar.

Get in touch with us today if you have had multiple hamstring injuries and want to understand what needs to change.

References

• de Visser HM, Reijman M, Heijboer MP, Bos PK. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med. 2012;46(2):124-130. doi:10.1136/bjsports-2011-090317.
• Martin RL, et al. Hamstring strain injury in athletes: clinical practice guidelines. J Orthop Sports Phys Ther. 2022;52(3):CPG1-CPG44. doi:10.2519/jospt.2022.0301.
• Freckleton G, Pizzari T. Risk factors for hamstring muscle strain injury in sport. Br J Sports Med. 2013;47(6):351-358. doi:10.1136/bjsports-2011-090664.
• van der Horst N, et al. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players. Am J Sports Med. 2015;43(6):1316-1323. doi:10.1177/0363546515574057.