Throughout my career as a trainer, I’ve seen my fair share of people (both male and female) with knee injuries. There are many different approaches to attack and address these issues. Sometimes surgery is needed, physical therapy is the most common type of approach you will see, some people will even go to a massage therapist, and many other health care providers. Whatever approach you’ve seen, been through, or heard about, in my professional experience most approaches have one variable in common, they hardly ever address the hamstrings.
Don’t get me wrong there are many muscle groups that can affect and contribute to the health of your knee joint (quadriceps, gluteal, adductors). However, the point that I’m trying to make is that you you have three hamstring muscles and their attachment points are below your knee. They all have the same origin (Ischial tuberosity of the pelvis), and then as they get closer to your knee they break off two attach on the medial side (Semitendinosus, Semimembranosus) of your knee, and one that attaches on your lateral side (Biceps femoris).
Now that you’ve gotten a quick anatomy lesson, about three years ago a light bulb turned on for me and I started to think (which was pretty scary by the way). Out of my own curiosity, I started to research and I learned two key things that would change my approach to the way I program and train hamstrings. One, the hamstrings affect both the hip and the knee, simply put it has two ends, and you should use exercises that train both simultaneously. Two, the hamstrings are overlooked because they’re antagonists to the quadriceps; meaning, they assist the quadriceps with movements like squats and lunges. With that being said though, poor function in an agonist (quadriceps) may actually be problems with the antagonist (hamstrings). Not to mention the fact that the hamstrings aren’t mirror muscles like your quads, so nobody ever thinks to help or check them out. However, what often happens when an individual has knee pain is that we think the main muscle group that affects it is weak, and with the knees it’s obviously the quadriceps. I on the other hand have a different mindset, and in my experience the quads are not weak, they’re overworking. They’re doing three times the amount of work because your hamstrings along with your glutes (which are important as well) are not helping them out, specifically with movements that require a lot of deceleration.
We’re taught in school that the hamstrings are secondary hip extensors, and primary knee flexors. In some cases this this true, however, when it comes to movements where you have to cut and change direction, jump and land, or throw a ball, and actual fundamental human movement this couldn’t be further from the truth. I’m here to tell you that the hamstring primary job is to prevent anterior tibial displacement, and to assist the glutes in decelerating hip flexion. Simply put they keep your tibia from gliding to far ahead of your femur, and in conjunction with your glutes keep your femur from sinking to far below your knee joint. This shear force can cause many patella tendon issues, and many other knee pathologies. Also, the semitendinosus assists in deceleration of tibial internal rotation which is a mechanism for ACL injuries.