Eccentric Hamstring Training, the Knee Angle at Peak Torque and Hamstring Architecture: A Systematic Review and an MRI Training and Detraining Study

Physical therapists and physical therapist assistants who prescribe or carry out hamstring strengthening for athletes and active adults, in injury prevention programs and in return-to-sport rehabilitation. Physical therapist assistants deliver and progress the eccentric program under the direction and supervision of the physical therapist, who performs the examination, sets the plan of care, and decides what is tested and when the program changes.

Licensed physical therapists and physical therapist assistants in outpatient orthopedics, sports rehabilitation, collegiate and professional athletics, and performance settings. Athletic trainers, strength and conditioning professionals and students in these fields may also find the material useful.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

Kemp O, Jeanfavre M, Leff G, Juan J. Knee Flexion Angle at Peak Torque Changes Following Eccentric Hamstring Resistance Training in Adults: A Systematic Review. JOSPT Open. 2026:1-41. doi:10.2519/josptopen.2026.0205

Pai S A, Andrews MH, Gurchiek RD, Pincheira PA, Barbieri M, Friedrich T, Kogan F, Gold GE, Mazzoli V, Lichtwark GA, Delp SL, Chaudhari AS. Hamstring muscle architecture and microstructure changes following Nordic hamstring exercise training and detraining. J Sport Health Sci. 2025;14:101070. doi:10.1016/j.jshs.2025.101070

Both papers are used as published. Where they describe different things, or where one reports something the other did not measure, the course names the paper that reported it rather than blending the two.

After completing this course, you will be able to:

1. Describe the direction, the consistency and the certainty of the change in knee flexion angle at peak torque reported after eccentric hamstring resistance training in the JOSPT Open systematic review, including the two exercises associated with the largest shifts.
2. Name the hamstring muscle volume, fiber length, fiber angle and microstructure changes measured with magnetic resonance imaging after nine weeks of Nordic hamstring exercise and after three weeks of detraining in the Journal of Sport and Health Science study, including which muscles responded most.
3. Explain how the reported shift in peak-torque angle and the reported change in fiber length sit alongside one another, and state the limits each paper placed on its own findings when discussing dosing and maintenance of eccentric hamstring training.

1. Start Here: How This Course Works
2. Part One: Knee Flexion Angle at Peak Torque After Eccentric Hamstring Training
3. Who Was Studied and What the Review Set Out to Answer
4. How the Studies Were Found, Appraised and Graded
5. Where Peak Torque Moved: Results by Testing Position and Contraction Type
6. Exercises, Dose and What the Review Authors Concluded
7. Part Two: Hamstring Architecture and Microstructure After Nordic Training and Detraining
8. The Volunteers and the Nine-Week Nordic Program
9. What the Scans Measured: Volume, Fiber Length, Fiber Angle and Water Diffusion
10. Muscle by Muscle: What Changed After Nine Weeks of Training
11. What Three Weeks Without the Exercise Took Away and What It Left
12. Bringing It Together
13. Where the Two Papers Point the Same Way
14. Where They Diverge and Which Paper Found What
15. What the Evidence Supports for Dosing and Maintaining Eccentric Work
16. What Is Still Unanswered About Peak-Torque Angle as a Clinical Target
17. Key Takeaways
18. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 1.0 contact hour (60 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. Kemp O, Jeanfavre M, Leff G, Juan J. Knee Flexion Angle at Peak Torque Changes Following Eccentric Hamstring Resistance Training in Adults: A Systematic Review. JOSPT Open. 2026:1-41. doi:10.2519/josptopen.2026.0205
2. Pai S A, Andrews MH, Gurchiek RD, Pincheira PA, Barbieri M, Friedrich T, Kogan F, Gold GE, Mazzoli V, Lichtwark GA, Delp SL, Chaudhari AS. Hamstring muscle architecture and microstructure changes following Nordic hamstring exercise training and detraining. J Sport Health Sci. 2025;14:101070. doi:10.1016/j.jshs.2025.101070