Received: 17 January 2019 

|  Revised: 22 March 2019 

|
  Accepted: 4 April 2019

DOI: 10.1111/sms.13437

REVIEW ARTICLE

Late swing or early stance? A narrative review of hamstring

injury mechanisms during high‐speed running

Claire J. B. Kenneally‐Dabrowski1,2   | Nicholas A. T. Brown2,3  | Adrian K. M. Lai4  |

Diana Perriman 1,5,6
  | Wayne Spratford 3,7
  | Benjamin G. Serpell 3,8

1
ANU Medical School, Australian National
University, Canberra, Australian Capital
Hamstring injuries are highly prevalent in many running‐based sports, and
Territory, Australia predominantly affect the long head of biceps femoris. Re‐injury rates are also high
2
Australian Institute of Sport, Canberra, and together lead to considerable time lost from sport. However, the mechanisms
Australian Capital Territory, Australia
for hamstring injury during high‐speed running are still not fully understood.
3
Faculty of Health, University of
Therefore, the aim of this review was to summarize the current literature describing
Canberra Research Institute for Sport and
Exercise, University of Canberra, Canberra, hamstring musculotendon mechanics and electromyography activity during
Australian Capital Territory, Australia high‐speed running, and how they may relate to injury risk. The large eccentric
4
Department of Biomedical Physiology contraction, characterized by peak musculotendon strain and negative work during
and Kinesiology, Simon Fraser University,
Burnaby, British Columbia, Canada late swing phase is widely suggested to be potentially injurious. However, it is also
5
Trauma and Orthopaedic Research argued that high hamstring loads resulting from large joint torques and ground
Unit, Canberra Hospital, Canberra, reaction forces during early stance may cause injury. While direct evidence is still
Australian Capital Territory, Australia
6
lacking, the majority of the literature suggests that the most likely timing of injury
Discipline of Physiotherapy, Faculty of
Health, University of Canberra, Canberra,
is the late swing phase. Future research should aim to prospectively examine the
Australian Capital Territory, Australia relationship between hamstring musculotendon dynamics and hamstring injury.
7
Discipline of Sport and Exercise Science,
Faculty of Health, University of Canberra, KEYWORDS
Canberra, Australian Capital Territory, athletic injuries, biceps femoris long head, literature review, musculo‐skeletal modeling, musculotendon
Australia function
8
Brumbies Rugby, Canberra, Australian
Capital Territory, Australia

Correspondence
Claire J. B. Kenneally‐Dabrowski,
Movement Science Department, Australian
Institute of Sport, Leverrier St, Bruce,
Canberra, ACT, Australia.
Email: claire.kenneally-dabrowski@
ausport.gov.au

Funding information
Australian Government Research Training
Program

Scand J Med Sci Sports. 2019;29:1083–1091. wileyonlinelibrary.com/journal/sms © 2019 John Wiley & Sons A/S.     1083 |
Published by John Wiley & Sons Ltd
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1084       KENNEALLY‐DABROWSKI et al.
1  |   IN TRO D U C T ION
Hamstring injuries are one of the most common and debilitat-
ing injuries in many running‐based sports, including the foot-
ball codes and track sprinting.1-3 High rates of initial injury
coupled with frequent recurrence1-4 lead to significant peri-
ods of convalescence.2,4 The resulting player unavailability
in team sports negatively impacts team performance,5 while
individual performance may also remain diminished upon re-
turn to play.6
It is well established that hamstring injuries most com-
monly occur during high‐speed running.2,7,8 While the ham-
string complex is comprised of four muscles (biceps femoris
long head, biceps femoris short head, semimembranosus, and
semitendinosus), injuries primarily affect the biceps femoris
long head muscle (BFlh) at the proximal musculo‐tendinous
junction.9,10 In professional soccer, 57%‐72% of all hamstring
injuries occurred during high‐speed running, and in nearly all
of these injuries (up to 94%), the primary injury site was the
BFlh.2,11,12 Therefore, the focus of the majority of research,
and by extension, this review, is the BFlh musculotendon
complex. The BFlh is positioned laterally within the ham-
string complex and is bi‐articular, crossing both the hip and
knee joints and therefore contributing to hip extension and
knee flexion.13
Several studies have attempted to determine the mech-
anisms of BFlh injury during running through anatomical
studies,13-16 or kinematic and kinetic analyses of running.17-19
However, although it is the subject of significant speculation,
the exact mechanisms for hamstring injury during high‐speed
running have still not yet been definitively established. It has
been suggested that anatomical risk factors for BFlh injury
may include the morphology of the aponeuroses15,16 as well
as it's synergistic relationship and common proximal tendon
with semitendinosus.13 However, it is potentially the function
of the hamstring musculotendon complex during high‐speed
running that may provide the most insight into injury mech-
anisms. Advances in musculo‐skeletal modeling techniques
over the past decade have facilitated several investigations
into hamstring musculotendon mechanics during high‐
speed running. These modeling studies have indicated that
the mechanism of injury may relate to the timing of peaks
in musculotendon variables such as length and force.17,19-
24
These peaks occur in distinct phases of the gait cycle in
response to the task demands. Two distinct arguments have
been proposed for the timing of injury and pose the ques-
tion: Do hamstring injuries occur during late swing or early
stance?
Therefore, the objective of this review is to provide an
overview of:
• Musculotendon mechanics and muscle excitation of the
BFlh during high‐speed running.
• How these musculotendon mechanics and muscle exci-
tation may relate to the potential for injury during the late
swing or early stance phases of high‐speed running.
2  |  LITERATURE SEARCH
The databases Scopus, Web of Science, and PubMed were
searched using combinations of the following terms, ham-
string, inj*, sprint*, run*, EMG, activ*, kinematic*, kinetic*.
The reference lists of articles retrieved were also manually
searched for any relevant articles that were not identified
electronically.
3  |   HIP AND KNEE KINEM AT I C S
DURING HIGH‐ SPEED RUNNING
In this paper, the gait cycle will be discussed starting at toe‐
off, as this approach is more conducive to the discussion of
hamstring function at the late swing and early stance phases
where the interest in hamstring injury risk is greatest. Hip
and knee angles are discussed as relative angles between the
trunk and thigh, and thigh and shank, respectively. Further,
all kinematic and kinetic data presented in the following
two sections of this review refer to overground sprinting
data only.
As depicted in Figure 1, each stride commences with
early swing phase. Early swing phase begins at toe‐off after
which the hip transitions from maximum extension (ap-
proximately 195°) into flexion, and the knee flexes.25,26 At
the transition to mid‐swing, the knee reaches peak flexion
(approximately 40°) and the hip continues to flex,25,26 be-
fore beginning to extend rapidly, reaching a peak extension
velocity of 1195°/s.25 Late swing commences as the hip
reaches peak flexion (approximately 100°) and then starts
to extend in preparation for foot strike.25,26 The knee extends
until the shank is decelerated, at which point the knee starts
to flex just prior to foot strike. Early stance begins at foot
strike, where the hip extends while the knee flexes. Mid‐
stance defines the transition from knee flexion to extension,
and the hip continues to extend. Following this point, late
stance commences and the knee continues to extend until
just prior to toe‐off, where it starts to flex. The hip continues
to extend throughout late stance, nearing peak hip extension
at toe‐off.25,27
4  |   HIP AND KNEE KINETICS
DURING HIGH‐ SPEED RUNNING
Throughout the first half of swing phase, the hip produces a
large flexion moment, reported to peak at 4.3 N·m·kg, while
KENNEALLY‐DABROWSKI et al.
F I G U R E 1   The sprinting gait cycle. (A) Early swing (B) Mid‐swing (C) Late swing (D) Early stance/ foot strike (E) Mid‐stance (F) Late
stance/ toe‐off25,26
the knee produces an extension moment of smaller magni-
tude (1.0 N·m·kg).17,28 In the second half of swing, the hip
produces a large extension moment (4.2 N·m·kg) while the
knee displays a smaller flexion moment (1.8  N·m·kg).17,28
During swing, net joint torques are primarily a result of mus-
cle torques (generated from muscle contractions) and motion‐
dependent torque (arising from the mechanical interaction of
segments, eg, the angular acceleration of the shank).29,30
In contrast, during stance, the net joint torques primar-
ily result from muscle torques and external forces (result-
ing from ground reaction forces).29,30 During the beginning
of the stance phase, the hip exhibits extensor dominance,
reaching peak extension torque at approximately 4.1 N·m·kg,
before changing to a flexion moment toward the latter half
of stance.17,31,32 The reported knee moments during stance
vary much more between studies, which may be attributed to
different filtering techniques utilized.33,34 Schache et al17,28
described an extension moment for the first half of stance,
with a peak torque of 3.6 N·m·kg, before a flexion moment
is produced toward late stance. However, other studies have
reported a much more variable knee moment, sometimes
switching several times from extension to flexion dominance
throughout stance, although some researchers have argued
that this may be an artifact of data processing.31
5  |   M U S C L E E XC ITAT ION O F
THE BF LH DU R ING HIGH‐SP E ED
RU N N ING
Surface electromyography (EMG) has been used to define
EMG amplitude (ie, muscle excitation)35 of the lateral ham-
strings (BFlh and biceps femoris short head) during both over-
ground36-38 and treadmill19,39 high‐speed running. Muscle
excitation is evident throughout the whole gait cycle; how-
ever, muscle excitation is low through the early and middle
phases of swing.19,36,37 Two large peaks in excitation are ob-
served during late swing and early stance.19,36,37,39 The exact
magnitudes of these peaks have not been clearly reported
in the literature; however, when normalized to maximum
  
|
   1085
excitation within a stride, hamstring EMG has been reported
as being of similar magnitude during late swing and early
stance.37,39,40 When normalized to excitation during a maxi-
mum voluntary isometric contraction (MVIC), BFlh excita-
tion during late swing and early stance is reported to exceed
100% MVIC.38 It is not unusual to observe excitation levels in
excess of 100% MVIC when using this normalization method
during high‐velocity tasks such as sprinting.41 In comparison
with the rest of the gait cycle, the magnitude of excitation
in late swing has been reported as two to three times greater
than during early swing and late stance,36 and the excitation
during early stance is significantly greater than during late
stance.37 In addition, studies of strength training exercises
have demonstrated differences in proximal to distal regional
excitation of the hamstring muscles during exercises such as
the Nordic hamstring exercise, stiff‐leg deadlift, bent‐knee
bridge, prone leg curl, and sliding leg curl.42-45 While differ-
ences in regional muscle excitation have not yet been inves-
tigated during high‐speed running, it is likely that this could
provide further insight into muscle function and potential in-
jury mechanisms, as injuries often primarily affect one region
(the proximal musculo‐tendinous junction).46
6  |  M USCULOTENDON
M ECHANICS OF THE BFLH DU R I NG
HIGH‐ SPEED RUNNING
Musculo‐skeletal modeling studies have provided valuable in-
sight into the mechanics of the BFlh musculotendon complex
during high‐speed running. Predictions of functional variables
such as musculotendon length and force changes throughout the
gait cycle provide information that is unable to be derived directly
from human subjects. While there are still many limitations as-
sociated with musculo‐skeletal modeling such as anatomical
assumptions and approximations, and varying levels of model
complexity and subject‐specificity, the limitations are reason-
able if findings are interpreted in context of these limitations.47,48
Therefore, these studies are imperative to furthering understand-
ing of BFlh musculotendon function. However, to date, there have
 |
1086       KENNEALLY‐DABROWSKI et al.

T A B L E 1   Summary of literature describing BFlh musculotendon stretch and force during high‐speed running

Study details BFlh MT stretch BFlh MT force

Peak MT force Peak MT force

Peak MT stretcha during swing during stance

Running Timing of peak (% Timing of peak Timing of peak

Authors (y) Cohort Running mode speed (m/s) gait cycle) (% gait cycle) (% gait cycle)
Thelen et al 1 adult male Treadmill 9.3 ~60 mmb 17.6 N·kg‐1 ‐
(2005)49 ~90% ~85%b
Nagano et al 8 male track and field Overground 9.5 (0.2) 1.2 (0.0) 10.5 (0.7) N·kg−1 ~3 N·kg−1b
(2014)52 athletes (sub‐elite) 82.8 (1.9) % 80.3 (3.0) % ~5%b
Schache et al 7 experienced sprint- Overground 8.9 (0.7) 1.1 (0.0) 26.4 (5.2) N·kg−1 4.6 (1.0) N·kg−1
(2012)17 ers (5 M, 2 F) 86.4 (1.71) % 82.9 (1.0) % 0.0 (1.3) %
Chumanov et 12 adults (9 M, 3 F) Treadmill 8.0 (M), 1.1 (0.0) 13.2 (1.5) N·kg−1 11.6 (1.9) N·kg−1
al (2011)19 7.1 (F) ~90% 85%‐95%c ~10%b
Thelen et al 14 athletes (9 M, 5 F) Treadmill 9.4 (0.6; M), 1.1 (0.0) ‐ ‐
(2005) 18 8.1 (0.8; F) 89.6 (3.7) %
Chumanov et 19 athletes (14 M, Treadmill 9.1 (0.6; M), 51.2 (4.4) 21.4 (5.4) N·kg−1  
al (2007)50 5 F) 8.2 (0.8; F) mm ~ 90% 85%‐95%c
Wan et al 20 college students Overground 8.0 (0.49; 1.1 (0.1) ‐ ‐
(2017)22 (10 M, 10 F) M), ~90%b
6.9 (0.43; F)
Note: Data are presented as the mean (SD) where possible. Reported timings of peaks within gait cycle (% of gait cycle) reflect stance followed by swing, where the
transition from stance to swing occurred at 16.1%‐26.8% (range).
Abbreviations: F, female; M, male; MT, musculotendon.
a
Normalized to length during upright posture/ optimum length or change in length (mm) from upright posture.
b
Estimated from a graph.
c
As described by authors, peak occurred within reported range.

been limited musculo‐skeletal modeling studies of overground
running,17,36 as most have collected data on a treadmill.18,19,49,50
Data from treadmill running have limited applicability since it in-
duces kinematic and kinetic adaptations in an athlete's sprinting
mechanics.51 Furthermore, while some have used recreational or
sub‐elite athletic populations,17,18,36 there is a distinct lack of lit-
erature pertaining to athletic populations such as elite level sprint-
ers and football players, for whom hamstring injury mechanics
are most relevant. A summary of reported peak musculotendon
stretch and force for running can be found in Table 1.
7  |   M U S C ULOT E N D ON L E NGTH
CH A NG ES
The hamstring muscles undergo a stretch‐shortening cycle
throughout high‐speed running.49,52 In the first part of swing
phase the BFlh shortens,17,19,49 as the knee flexes and the hip
moves from extension into flexion.18,49 The hip continues
to flex until terminal swing, while the knee starts to extend
throughout the second half of swing,18,19,49 causing the BFlh
to rapidly lengthen.17-19,49 Several studies have reported peak
lengthening velocity at the transition from knee flexion to ex-
tension,17,18 and a second, smaller peak in lengthening velocity
has been described closer to terminal swing.17 During termi-
nal swing, the BFlh reaches peak length and strain at approxi-
mately 112% of upright standing muscle length.17-19,22,52 Just
prior to foot strike, the BFlh starts to shorten as the hip ex-
tends and the knee flexes in preparation for foot strike.17-19,49
The hip continues to extend throughout stance, and the knee
flexes for the first half, before starting to extend.18,49 Most
studies suggest that the BFlh shortens throughout stance.17,19
However, two studies36,53 have reported an eccentric (length-
ening) contraction of the hamstrings during late stance. The
extension of the hip places the hamstrings in a shortened posi-
tion, and while the knee does extend after mid‐stance, the ham-
string sagittal plane moment arms at the hip are greater than
at the knee.18,54 Therefore, it is argued that for knee extension
to cause lengthening of the hamstring muscles, the velocity of
knee extension would have to substantially exceed the velocity
of hip extension.19 Although it seems likely that in most cases,
the BFlh will shorten throughout late stance, it may be possible
that the length change is dependent on the degree of hip and
knee extension exhibited by an individual athlete.
While this information provides valuable insight into
BFlh function during running, a limitation of the majority of
this work is that it considers only the length changes of the
musculo‐tendinous unit as a whole. Relative lengthening and
KENNEALLY‐DABROWSKI et al.
velocity contributions from the muscle and tendon components
have not been discussed in the majority of current research.
Recently, Hooren and Bosch55,56 have challenged the view that
changes in the whole musculo‐tendinous unit may reflect mus-
cle fascicle behavior. They propose that the muscle fascicles of
the BFlh may not act eccentrically in the late swing phase of
high‐speed running. Rather, that the tendinous element facili-
tates lengthening and the fascicles remain closer to isometric.
However, it should be noted that this proposal is based on evi-
dence from other lower limb muscles57,58 and animal studies,59
and at this time, there is no direct evidence for this theory in
the human hamstring muscles during running. Quasi‐isometric
fascicle behavior has been previously observed during high‐
speed running at the ankle plantar‐flexor complex and also in
the vastus lateralis.57,58 While we cannot assume that this fas-
cicle behavior applies also to the hamstrings during running, it
may suggest that these phenomena are plausible. Further, both
Chumanov et al50 and Thelen et al49 have differentiated BFlh
muscle and tendon contributions to lengthening using mus-
culo‐skeletal modeling, and predicted small discrepancies in
lengthening patterns between the two elements. In fact, Thelen
et al49 noted that the stretch of the muscle component slows
once the muscle is excited at late swing, and that tendon stretch
is primarily responsible for negative work done during termi-
nal swing. Hence, these modeling studies suggest that length
and velocity changes in the muscle fibers of the BFlh could be
decoupled from the whole musculotendon complex, although
more focussed research is needed to clarify this relationship.
8  |  M U S C U LOT E N D O N FO RC E
The BFlh produces very little force throughout the first half of
swing phase, after which a large peak in musculo‐tendinous
force occurs. During late swing, the reported peak musculo‐
tendinous force is between 10.5 and 26.4  N·kg−1.17,50,52 This
typically decreases prior to foot contact before a second smaller
peak is observed in early stance (3‐ 11.6 N·kg−1).17,52 However,
it has also been proposed that the BFlh musculotendon force
during early stance may have been underestimated due to over‐
filtering, causing erroneously low hip and knee torques.29,34 It is
argued that in early stance, ground reaction forces cause a large
extension torque at the knee and a flexion torque at the hip.
Consequently, the hamstrings would be under very high load, in
order to produce large flexion torque at the knee, and extension
torque at the hip, to counter the large passive forces.29,34
9  |   T H E P OT E N T IA L FO R IN J URY
DU R ING LAT E SWING P H A S E
The occurrence of peak musculotendon force, high muscle
excitation, negative work, and peak musculotendon length
  
|
   1087
during terminal swing, have all been suggested to contrib-
ute to the increased risk of injury in the late swing phase of
high‐speed running.17,19,20,36 Chumanov et al19 observed that
peak stretch and negative work occurred exclusively dur-
ing the swing phase of high‐speed treadmill running. Large
loads were evident during both late swing and early stance;
however, peak musculotendon force of the BFlh increased
significantly with increasing running velocity only in the late
swing phase. When combined with increasing negative work,
the authors concluded that the large inertial loads placed on
the hamstrings during the late swing phase suggest an in-
creased likelihood of injury during late swing, rather than
early stance.
Researchers proposing an isometric function of the ham-
string fascicles at late swing also suggest that this large force
at late swing may be important in hamstring injury occur-
rence.55,56 The authors propose that forces at late swing may
become too high for fascicles to remain isometric and there-
fore cause an eccentric contraction and concomitant vulnera-
bility to injury.55,56 However, this mechanism is speculative,
as there is not currently any data to support this theory in the
hamstring muscles during running.
The extensive strain experienced by the BFlh in late
swing is also commonly suggested as a contributor to, or
even the primary cause for injury.17,19,21,60 Schache et al17
suggested that it is the greater strain experienced by the
BFlh compared to the other hamstring muscles, that makes
it more susceptible to injury. The strain experienced by the
BFlh was 2.2% and 3.3% greater than for semimembrano-
sus and semitendinosus, respectively, while peak musculo-
tendon force and negative work were comparatively less for
the BFlh. The relatively longer hip extension moment arm
of the BFlh compared to other hamstring muscles causes
this greater lengthening and strain when the hip is flexed
in the late swing phase.18 Therefore, the peak strain ex-
perienced by BFlh during terminal swing seems to be the
parameter that distinguishes it from the other hamstring
muscles and therefore may be the most relevant parameter
for understanding why the BFlh in particular is vulnerable
to injury during high‐speed running.
The relationship between the level of muscle excitation
and injury risk has been explored in animal studies. Yu et al36
suggested that the high levels of muscle excitation observed
during late swing exacerbate the susceptibility to strain in-
jury. This proposal was based upon a study of the mouse
extensor digitorum longus muscle, which demonstrated that
when a muscle is maximally activated, the amount of strain
needed to cause a muscle strain injury is decreased.61 This
indicates that the high levels of both excitation and muscle
strain during late swing are both conditions which are likely
to increase the risk of hamstring strain injury.
Other researchers have drawn on evidence from animal
models to support the argument that the conditions during late
 |
1088       KENNEALLY‐DABROWSKI et al.
swing are conducive to injury.61,62 Early research on the rabbit
extensor digitorum longus muscle during active and passive
lengthening first suggested that strain injury was the result
of reaching a critical strain, rather than exceeding a critical
force.63 Notably, in this study, failure always occurred at the
musculo‐tendinous junction, which suggests that these ex-
periments successfully mimicked real injury occurrence. In a
study of the rabbit tibialis anterior, Lieber and Friden62 mea-
sured the contractile properties of the muscle (as an indicator
of muscle damage) after eccentric contractions at various lev-
els of force and strain. The results suggested that muscle dam-
age is not a function of muscle force, but rather the amount
of muscle strain is the best indicator of injury. Moreover, the
study of the mouse extensor digitorum longus muscle also
demonstrated that the amount of negative work done by the
muscle was the best predictor of injury magnitude, as indi-
cated by force deficits following active or passive stretching
of the muscle.61 These principles support the proposition that
the mechanics of the BFlh during late swing are likely to be
the cause of BFlh injury during high‐speed running.
Two incidences where injury to the BFlh has occurred
during studies of high‐speed running further support late swing
as the likely phase for injury occurrence.21,23,24 While the first
kinematic deviations to indicate injury occurred during stance,
once neuromuscular latencies were accounted for, both studies
concluded that the late swing phase was the most likely time of
injury occurrence.21,23 In the running trials prior to the injury
occurrence, the BFlh of the subsequently injured leg demon-
strated greater peak length and force in late swing phase, com-
pared to the contralateral muscle, as well as a greater vertical
ground reaction force and loading rate for the subsequently
injured leg.23,24 Following the injury, the BFlh exhibited intol-
erance to eccentric contraction, performed less negative work
and had a reduced peak lengthening velocity.24 Despite having
kinematic and kinetic data during an injury occurrence, these
studies have not provided conclusive evidence that the injury
occurred during late swing. While the information provided is
no doubt unique and valuable, the arguments for the timing of
injury are still speculative, due to the uncertainty of predict-
ing neuromuscular latency.23 This highlights the complexity of
predicting injury timing, and therefore, further work is needed
to conclusively determine the timing of injury.
Finally, only one to date study has prospectively exam-
ined the relationship between running mechanics and subse-
quent hamstring injury. Schuermans et al64 determined that
subsequently injured soccer athletes displayed kinematic
differences during high‐speed running that were only ob-
served during the swing phase. Subsequently injured athletes
displayed greater anterior pelvic tilt during mid‐swing and
greater lateral flexion of the thorax during the late swing
phase. No kinematic differences were found between sub-
sequently injured and uninjured athletes during the stance
phase. The same authors also found differences in muscle
excitation between subsequently injured and uninjured soc-
cer athletes, that were again constrained to the swing phase.65
During mid‐swing, injured athletes showed significantly
lower muscle excitation of the trunk, and lower gluteal exci-
tation during late swing. Again, no differences were observed
between injured and non‐injured athletes during stance.
These findings support the contention that the late swing
phase is the high risk period for hamstring injury occurrence
during high‐speed running.
10  |   THE POTENTIAL FOR
INJURY DURING EARLY STANCE
Fewer researchers have suggested that BFlh injury risk
is greater during the early stance phase of high‐speed run-
ning.32,66 Early research proposed that the greatest knee flex-
ion and hip extension moments occur during early stance
phase, leading to very high loads on the hamstring muscles
and increased injury risk.32 One of the strongest voices in
support of increased risk of injury during stance phase rather
than swing has been Orchard.66 He has reasoned that strong
opposing forces resulting from ground reaction forces during
stance are likely to increase the risk of hamstring injury.
Orchard66 also observed that muscle strains do not typically
occur during open chain activities. For example, while divers
experience great stretch and high angular velocities when per-
forming a pike, they do not typically succumb to injury. This
observation was used to reinforce the point that injuries are
more likely to occur when forces are high, rather than when
the muscle experiences great strain. However, this theory lacks
experimental evidence to support this anecdotal observation.
Some researchers suggest that injury risk is increased
during both phases of high‐speed running. A recent opinion
paper by Liu et al34 supported Orchard's arguments, stating
that the hamstrings would be under high load in early stance,
due to ground reaction forces causing large joint moments.
They argued that the lower estimates of muscle forces during
early stance reported in musculo‐skeletal modeling studies
are due to over‐filtering of data, and that the hamstrings
would be vulnerable to injury in early stance due to this force
peak. However, Liu and colleagues suggest that both early
stance and late swing are potentially hazardous times for
injury during high‐speed running. They characterized these
two phases as one “swing‐stance transition” phase and advo-
cated for a more general principle, whereby the BFlh is more
prone to injury when the muscle has to counter large passive
forces. In late swing, the muscle torque is high, to counteract
a large motion‐dependent torque created by the angular accel-
eration of the shank. Therefore, they propose that the inertial
loads at late swing and external ground reaction force loads
in early stance both have the potential to cause injury to the
BFlh during high‐speed running.
KENNEALLY‐DABROWSKI et al.
11   |  F U T U R E D IR E C T ION S
This review has identified several gaps in the current
knowledge of hamstring mechanics during sprinting and
how they may relate to the timing of hamstring injury.
Firstly, there is a paucity of studies examining athletic
populations such as football players and sprinters, espe-
cially at the elite level. Secondly, there may be further
insights gained from exploring regional excitation of the
hamstrings during high‐speed running. Third, there is also
a need to examine relative lengthening and velocity con-
tributions of both the muscle and tendon when perform-
ing musculo‐skeletal modeling analyses. This is important
for distinguishing muscle and tendon contributions to peak
strain and force during the late swing phase and will assist
in refining injury prevention strategies. For example, there
is growing support for the importance of injury prevention
exercises that result in lengthening of muscle fascicles.67-69
Understanding the relative contribution of muscle fasci-
cles to overall strain of the musculotendon complex would
serve to validate and inform this training principle. Finally,
there is a distinct lack of prospective studies examining the
relationship between running mechanics and hamstring in-
jury occurrence. Schuermans et al64 provided the first ever
prospective link between running mechanics and hamstring
injury, using a strong study design which should be repli-
cated in other cohorts such as sprinters and other football
codes. Further, this work could be improved in future in-
vestigations by also examining kinetic variables, such as
joint moments and powers. Indeed, it would be a natural
progression to also conduct prospective musculo‐skeletal
modeling studies examining the relationship between ham-
string musculotendon dynamics and hamstring injury. This
would allow the identification of musculotendon dynam-
ics, and the gait cycle phase, that are associated with ham-
string injury.
12   |   P E R S PE C T IV E S
The timing of hamstring injury during high‐speed running
has been a topic of debate for many years. While we still lack
direct evidence, the majority of the literature suggests that the
most likely timing of injury is the late swing phase. Future re-
search should focus on prospectively examining the relation-
ship between running mechanics, hamstring musculotendon
function, and hamstring injury in athletic populations.
ACKNOWLEDGEMENTS
This research is supported by an Australian Government
Research Training Program (RTP) Scholarship.
  
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ORCID
Claire J. B. Kenneally‐Dabrowski  https://orcid.
org/0000-0001-5433-5082
Wayne Spratford  https://orcid.org/0000-0002-6207-8829
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How to cite this article: Kenneally‐Dabrowski CJB,
Brown NAT, Lai AKM, Perriman D, Spratford W,
Serpell BG. Late swing or early stance? A narrative
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