A hamstring strain, commonly known as a pulled hamstring, occurs when one or more of the hamstring muscles at the back of the thigh are overstretched or torn. Hamstring injuries are common in sprinting, football, rugby, running, and explosive sports which involve sudden acceleration or stretching movements. Here we explain the symptoms, causes, treatment, rehabilitation, and return-to-sport process for hamstring strains.
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Medically reviewed by Dr Chaminda Goonetilleke, 10th Jan. 2022
Hamstring strain symptoms
Hamstring strain symptoms often begin with a sudden, sharp pain at the back of the thigh during sprinting, accelerating, or fast stretching movements.
Hamstring strains are graded 1, 2, or 3 depending on the severity of the injury:
- A grade 1 hamstring strain is mild. You may feel a sudden tightness or twinge at the back of the thigh, with little or no swelling. Walking is usually possible, although sprinting and explosive movements may be uncomfortable.
- A grade 2 hamstring strain is more severe and involves a greater number of damaged muscle fibres. Symptoms usually include sudden, sharp pain, swelling, weakness, and difficulty continuing an activity or training.
- A grade 3 hamstring strain is a severe injury involving a partial or complete muscle tear. Significant pain, swelling, bruising, and loss of function are common. In more severe cases, walking may be difficult.
More on hamstring strain diagnosis.
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Causes
Hamstring strains usually occur in two ways. They are either sprint-related or stretch-related, commonly during activities such as sprinting, martial arts, gymnastics, or dancing.
Sprint-related hamstring strains
During sprinting, the hamstring muscles work extremely hard. Just before the foot strikes the ground, the hamstrings rapidly decelerate the tibia (shin bone). This is the point at which the hamstring muscle is most vulnerable to tearing.
Sprint-related hamstring injuries usually occur lower down in the biceps femoris muscle, most commonly where the muscle joins the tendon. These injuries often feel more severe initially but typically recover more quickly.
Stretch-related hamstring strains
Stretch-related hamstring injuries usually occur higher up at the back of the thigh and most commonly involve the tendon of the semimembranosus muscle.
These injuries may take longer to heal because the blood supply to the tendon is more limited.
Referred pain
Pain at the back of the thigh is not always due to a hamstring strain. Problems affecting the lower back, hip, or sciatic nerve may produce similar symptoms.
Conditions involving the sciatic nerve may also increase the risk of developing recurrent hamstring strains. This should be considered, particularly if symptoms keep returning.
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Hamstring strain treatment
Treatment for a hamstring strain consists of immediate first aid followed by a structured rehabilitation programme.
The acute phase of rehabilitation usually lasts 3 to 4 days, depending on the severity of the injury. During this stage, apply the PRICE principles: protection, rest, ice, compression, and elevation.
Protection
Protect the muscle from further injury by stopping exercise or leaving the field of play as soon as possible.
Rest
Rest from any activity that causes pain, both immediately after the injury and during the early stages of healing.
Ice/cold therapy for torn hamstrings
Apply cold therapy with compression for 15 minutes every hour during the early stages of injury, or at least 3 to 4 times per day.
Do not apply ice directly to the skin, as this may cause ice burns. Instead, wrap the ice in a wet towel or use a commercially available cold therapy wrap.
Compression
Wear a compression bandage or thigh support during the acute stage to help reduce swelling and support the injured muscle.
Later in rehabilitation, a thigh support may help retain heat and improve blood flow to the area, which can aid healing.
Elevation
Elevate the leg as much as possible to help reduce swelling and encourage excess fluid to drain away.
Full Hamstring strain rehabilitation program
Hamstring strain recovery time
Recovery time depends on the severity of the injury and how early rehabilitation begins.
- Mild grade 1 hamstring strains may recover within 1 to 3 weeks.
- Moderate grade 2 injuries often take 4 to 8 weeks.
- Severe grade 3 hamstring tears may take several months to recover and occasionally require surgery.
Returning to sprinting or sport too early increases the risk of reinjury. A structured rehabilitation programme is important to restore flexibility, strength, running mechanics, and confidence.
Exercises & Rehabilitation
Rehabilitation exercises are essential following a hamstring strain. A structured programme helps restore flexibility, strength, running mechanics, and confidence while reducing the risk of reinjury.
During the early stages of rehabilitation, exercises should remain pain-free and focus on restoring gentle muscle activation and movement.
As symptoms improve, rehabilitation progresses through several stages:
- Early-stage isometric exercises to restore muscle activation
- Gentle mobility and stretching exercises
- Progressive hamstring strengthening exercises
- Eccentric strengthening exercises to improve load tolerance
- Running drills and sprint progressions
- Sports-specific rehabilitation and return-to-play exercises
Dynamic stretching and explosive movements should only be introduced once strength and flexibility have improved sufficiently.
Progressing rehabilitation too quickly is one of the main reasons hamstring strains return. Our step-by-step hamstring rehabilitation programme uses criteria-based progressions to help ensure each stage is completed safely before moving to the next.
More on Hamstring strain exercises
Returning to running after a hamstring strain
Returning to running too early after a hamstring strain significantly increases the risk of reinjury. Running and sprinting place high loads through the hamstring muscles, particularly during acceleration and high-speed movements.
Before returning to running, you should be able to walk pain-free and complete early strengthening exercises without symptoms increasing.
Rehabilitation usually progresses gradually through several stages:
- Walking
- Light jogging
- Moderate-paced running
- Acceleration drills
- Sprint progressions
- Sports-specific running drills
Speed, distance, and intensity should all increase gradually. Any increase in pain, tightness, or loss of confidence may indicate that the hamstring is not yet ready for higher loads.
Sports Massage for pulled hamstrings
Once the acute phase is over massage may be beneficial. Initially, it must be very light to avoid damaging the muscle. As healing progresses, massage techniques can gradually become deeper and more targeted. Massage as part of hamstring strain treatment can:
- Help to flush away tissue fluids and swelling.
- Soften and align new scar tissue that has formed.
- Relax tight muscles which have gone into spasm.
- Stimulate blood flow to the area which aids the healing process.
Learn hamstring massage techniques.
Hamstring kinesiology taping
Kinesiology taping may help during the later stages of hamstring rehabilitation by improving muscle awareness and supporting movement during exercise and sport.
Learn Kinesiology taping for hamstrings.
What is a pulled hamstring?
A hamstring strain (pulled hamstring) is a tear to any one or more of the hamstring muscles at the back of the thigh.
The hamstring muscle group consists of three separate muscles:
- Semitendinosus
- Semimembranosus
- Biceps femoris.
The muscles originate from the lower part of the pelvic bone (ischial tuberosity) and insert into the back of the shin bone (tibia). When they contract, they bend (flex) the knee and help extend the hip (move the leg backwards).
Read more on Hamstring muscles.
Hamstring strain references & research
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