In my last post, I broke down why traditional hamstring training is backward. Here’s the gist:

The biceps femoris is overworked: most hamstring exercises dump all the load on this small muscle, setting it up for injuries.

Tibial rotation gets overlooked: coaches and practitioners rarely address shin rotation, but it’s key to balanced knee mechanics and load distribution.

Powerhouse muscles stay unused: big players like the semimembranosus and pes anserine group are designed for knee flexion and tibial rotation, but popular exercises ignore them.

The peroneals need training for shin IR: no one trains these, yet they’re crucial for internally rotating the fibula and tibia during dorsiflexion.

Knee external rotation isn’t natural: once in a while, it’s fine. It’s useful in many contexts. But when it’s the only way people bend their knees, shit happens. Also, zero animals habitually bend their knees with shin external rotation—so why do we?

Traditional hamstring exercises focus on the wrong things and skip over the movement patterns that the human body clearly adapted for. Fixing this takes more than just switching up reps scheme and periodization.

(From: Bramah, Christopher, Jurdan Mendiguchia, Thomas Dos’ Santos, and Jean-Benoȋt Morin. "Exploring the role of sprint biomechanics in hamstring strain injuries: a current opinion on existing concepts and evidence." Sports Medicine 54, no. 4 (2024): 783-793.)

Part 1 was about one of the biggest unknown culprits of hamstring injuries. In this post, we’re discussing one of the biggest known culprits of hamstring injuries is a forward-tilted pelvis. Whether it’s the pelvis itself or the entire trunk tilting forward, like Naruto, this posture throws off alignment in a big way. By the way, I’ve never seen a baseball player not run like an anime character. Ever noticed that? It’s no coincidence that more and more ballplayers are getting hamstrung. (3)

Guess which one is a baseball player? (They’re running about the same speed, I can promise you that. And they’re both on flat surfaces, despite what the camera angle shows on the left.)

Here’s what that forward lean, or anterior pelvic tilt, does: it cranks up the strain on your hamstrings, pushing them to operate in positions that double their load. We’re trying to make modern athletes move like they’re built for four legs instead of two.

Fascinatingly, this anteriorly tilted pelvis approximates the pelvic position of our four-legged ancient ancestors. Quadrupeds (four-legged animals) have a 1:1 hamstring-to-quad ratio, their quads are the same size as their hamstrings. But humans? We're quad-dominant, with a 2:1 ratio. That forward tilt lengthens the hamstrings and strains them beyond what they’re built for—in fact, evolution suggests that an anteriorly tilted pelvis requires a hamstring twice the size our DNA is programmed for.

Changing someone’s pelvis position while they sprint requires more than glute bridges and other posterior pelvic tilting exercises. Athletes need:

Awareness of their pelvic position and the ability to move it, and only it. They should be able to move it at 3 percent intensity and 100 percent without sacrificing accuracy.
Muscular endurance and strength in human positions—meaning they can keep the positions in the fourth quarter. The endurance part means not training by the "Bigger, Faster, Stronger" creed, but grinding out sets of twenty to thirty.
Speed tolerance for these positions, working up from controlled movements to faster ones without jumping straight into plyometrics.
Finally, and crucially, integration into sport contexts. Just doing gym work is rarely enough to change movement in sport. This brings us back to point number one: athletes need an awareness of these changes and desire to make them during practice so that they can focus on the game in games.

I’ve elaborated on this entire process in a blog series called Creating Lasting Adaptations in Movement and Skill. Here’s part one.

Posterior Pelvic Tilt

So, we know that anterior pelvic tilt is problematic for hamstrings(3). But in the weight room, unfounded fears and popular ideas keep everyone anteriorly tilted. Yet again, we’re complicit. I find more reason than not. In the weight room and physical therapy clinic, there are way more cues for an anteriorly tilted pelvis and lumbar extension than the opposite.

Brands with the word “university” in their name (to lend themselves some credibility, it seems) are terrified of a little lumbar flexion. Practitioners and coaches around the world prohibit posterior pelvic tilt. And the few that promote it do so at such low intensities that it never transfers to the field of play.

We in this sports, rehab, training, and fitness industry have some big cognitive dissonance and hypocrisy. People are afraid to round their backs. But American football, Australian Rules Football, and rugby players sprint and then round their backs into turtle shells to protect the ball as they collide with another behemoth. And yet, are staff afraid to load their spines in flexion or posteriorly tilt their pelvis in a slow and controlled manner with weight?

I’ve made my point. Now, let me tell you about a two-time MVP player.

Two-Time MVP

Then there’s the problem with observation—it's scarce. I mean this in the Sherlockian sense, “You see, but you do not observe.” The problem is a stellar opportunity. Here’s what I mean.

I worked with one pro athlete who had a history of hamstring injuries. He was an MVP-caliber player, literally. He won it—twice. We agreed to keep our work quiet, so I’ll call him Wade Wilson. He had some of the highest Nord-Board scores on the team, and his score implied strong hamstrings. Yet disaster kept striking at the backs of his thighs. Wade tore his biceps femoris multiple times. He repeated the same rehab and strength protocol on each return.

Let me put that in even plainer terms: the best guy in the league kept getting sidelined by biceps femoris injuries. This continued for years despite doing all the popular hamstring exercises. He repeated the same rehab and strength protocol despite its repeated failure. A legion of “elite” staff surrounded him, staring, counting reps, Newtons, and miles, and yet no one observed what his biceps femoris did.

When Wade showed me what remedies he tried to prevent being hamstrung again, he did the same things he did after his first tear, as if they’d work this time around. (Did his staff chalk up his injuries to bad luck, or what? I don’t understand how they thought repeating the same protocol was reasonable.)

Wade’s programming was the following (with a constant anterior pelvic tilt): Nordic hamstring curls up the wahzoo, single-leg glute bridges for days, and so many RDLs that Romania granted him honorary citizenship. While he bridged his buttocks, his hip and shin were externally rotated. During his Nordics, his kneecap pointed downward into the pad, but his tibia and fibula were externally rotated to their end range. In other words, he kept training the fuck out of his biceps femoris at shortened lengths, and it repeatedly didn’t work. And no one noticed.

Once he found me, I asked him to rotate his shins inward during his hamstring exercises, and he could barely hold himself up. He went from hero to zero, but it immediately “just felt better,” he recounted. Then he snapped, “Why the fuck hasn’t anyone mentioned that before?! I’ve been doing them wrong for fourteen years!”

Now, over two years later, as I write this, he has had no more hamstring injuries.

I told you the story of one player, but this story has repeated itself for anyone who asked me for help with recurring hamstring injuries. It’s not a big number of athletes, but enough for me to feel confident writing this post.

Training Shin Internal Rotation…

What if we focused the the semimembranosus more? Not by asking people to volitionally contract muscles, “Squeeze your semimebranosus!” Never. But by creating exercises that move bones in ways that bias the biggest hamstring of the lot. Exercises that demand the tibia to internally rotate with knee flexion (concentric contraction), and and/or others to adduct, flex, and extend the hip. And then, crucially, observing how their bones on the field of play.

What if we had more variable types of squats instead of treating squats with knees and feet turned out as if it were the eleventh commandment? What if we did more things on one leg? Training on one leg should encourage hip adduction, not by bringing the knee under the midline but by shifting the pelvis over the stance leg, so there’s a slight eversion of the ankle. (See image below.)

What if we trained tibial internal rotation with knee flexion? Not only during rehab, but especially during strength and sprint sessions. I would feel irresponsible training the semimembranosus through various movements in the gym but permitting athletes to still bend their knees with shin ER while running.

I said this in part 1, but it deserves repeating: Some of those different movements, categorically, should be hip adduction. Instances where the pelvis shifts over the knee and the ankle everts. Again, this isn’t the knee moving toward the midline, but the midline moving over the knee.

Have you ever trained tibial IR? Chances are slim. It’s an uncommon movement. If you have, ensure your inner hamstring is doing a lot of the work. You’ll see exercise lists down below.

I don’t want to make it seem like tibial IR is the end-all-be-all to curing the world of hamstring injuries because it isn’t. The pelvis position matters, too, and it’s not about keeping it in one spot. That’s what’s already happening; it’s about restoring innate variability of pelvis positions and balancing out the muscle work around the legs instead of relying on the same exercises day in and day out.

Variable and Useful Ways to Train Hamstrings:

(These 7 videos are available only in The Evolved Coach Community)

What else is in TECC?

✅ AMA Wednesdays – Your questions, my answers, searchable forever.

✅ Free resources – Actual, useful ones. No fluff.

✅ A network of sharp, like-minded pros.

✅ Early access to every program & problem-solving guide I make.

Speed:

If…IF you (or your client) are ready for training these movements with speed, accuracy and progressions are key. Watch this Loom.

Conclusion

Look, the biceps femoris is the most injured hamstring. It’s smaller and overtrained to the point where hamstring tears should be expected. Especially in soccer players, who train knees-out-feet-out in the weight room, and then the sport requires knees-out-feet-out to pass and kick. The movements required to play are ones that bias the biceps femoris. No wonder it tears.

Athletes tear their biceps femoris, and their coaches and physical therapists never change their movement or training plans. Athletes return to sport, bending their knees and turning their feet out like they always have, but they have one thing different: they have hope. “But I’ve done my hamstring exercises!” as if the title alone is enough. Of course so many athletes reinjure themselves: their rehab or strength and speed training never addressed the cause.

Few people notice the facts I’ve written in this series. Therefore, these ideas have great potential for prevention.

There are other factors that matter, too, like running mechanics and speed tolerance. But this isn’t the post for those. I wrote about speed tolerance here.

Hamstring tears are a solvable problem, and the common solutions offered are just scratching the surface. We must learn from our failures instead of repeating them to find more effective solutions.

If you want to understand how to sustainably change movement, like tibial rotation, read my four-part series, Creating Lasting Adaptations in Movement and Skill.

If you really want to learn more, check out my courses.

This is a solvable problem…

— AE

CITATIONS

Ekstrand, Jan, Håkan Bengtsson, Markus Waldén, Michael Davison, Karim M. Khan, and Martin Hägglund. "Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22." British Journal of Sports Medicine 57, no. 5 (2023): 292-298.

https://bjsm.bmj.com/content/57/5/292

Hogervorst, Tom, and Evie E. Vereecke. "Evolution of the human hip. Part 1: the osseous framework." Journal of hip preservation surgery 1, no. 2 (2014): 39-45.
Bramah, Christopher, Jurdan Mendiguchia, Thomas Dos’ Santos, and Jean-Benoȋt Morin. "Exploring the role of sprint biomechanics in hamstring strain injuries: a current opinion on existing concepts and evidence." Sports Medicine 54, no. 4 (2024): 783-793.