A hamstring strain or ‘pulled hamstring’ is a tear to one of the hamstring muscles. Sudden sharp pain is felt at the back of the thigh which can range from mild to severe. Our step by step rehabilitation program takes you from injury to full fitness.
Hamstring strain symptoms
Symptoms of a hamstring strain usually consist of a sudden sharp pain at the back of the thigh, either whilst sprinting or performing a fast stretching movement such as a high kick. Hamstring strains are graded 1, 2 or 3 depending on how bad they are.
- A grade 1 hamstring strain is relatively mild. You may feel a twinge or tightness at the time of injury, with little or no swelling.
- A grade 2 is more severe.
- If you have a grade 2 strain you will feel a sudden sharp pain at the time of injury. Swelling is likely and you will be unable to continue playing or training.
Read more on hamstring strain diagnosis.
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; the semitendinosus, the semimembranosus and the biceps femoris. The muscles originate from the lower part of the pelvic bone (ischial tuberosity) and insert into the back of the tibia. When they contract, they bend the knee and help extend the hip (move the leg
What causes a hamstring strain?
Hamstring strains usually occur in two different ways. They are either sprinting related or stretch related for example in martial arts, gymnastics or dancing.
Sprint related hamstring strains
- During sprinting the hamstring muscles work extremely hard. In particular, at a point just before the foot strikes the ground they decelerate the tibia (shin) very quickly. It is at this point that the hamstring is most likely to tear.
- Sprint related hamstring injuries usually occur lower down the biceps femoris muscle. More specifically, where the muscle joins to the tendon. They often feel worse initially, but recover more quickly.
Stretch related hamstring strains
- Stretch related injuries usually occur higher up at the back of the thigh. Most commonly the in the tendon of the semimembranosus muscle.
- These injuries may take longer to heal because the blood supply to the tendon is not as good.
- Referred pain is caused by problems elsewhere such as the lower back and hip.
- These may increase the likelihood of suffering a hamstring strain and should always be considered, particularly if you suffer from recurrent hamstring strains.
Hamstring strain treatment & rehabilitation
Treatment is divided into immediate first aid, then longer-term treatment which begins after the initial acute stage of healing.
Stage 1 – Acute stage
The acute phase of hamstring strain rehabilitation usually lasts 3 to 4 days depending on how bad the injury is. Complete rest is advised, with no running or playing active sport allowed and as little walking as possible.
Apply the PRICE principles of protection, rest, ice, compression, and elevation. Apply cold therapy for 15 minutes every hour in the early stages, or at least 3 or 4 times per day. Ice should not be applied directly to the skin as it may cause ice burns. Instead, wrap in a wet tea towel. Commercially available cold packs and wraps that are just as effective. These can be reused and these also provide compression as well. The aim of the cold therapy is to stop any internal bleeding and reduce pain and swelling.
Use a compression bandage or thigh support to apply compression. This can be worn all the time during the acute stage to help reduce swelling and support the muscle. Elevate the limb as much as you can because this will help swelling and tissue fluids drain away.
The athlete is ready to move on to stage 2 when daily activities and normal walking are all pain-free. If this is not the case, then continue with rest, ice and compression.
Stage 2 – Subacute stage
Depending on the severity of the injury, the subacute stage can last from 1 to 10 days for a grade 1 hamstring strain, 2 to 3 weeks for a grade 2 hamstring strains and for a severe grade 3, it can last from 3 to 8 weeks or more and may require surgery.
At this stage, hot and cold packs can be alternated. The ideal ratio is to apply the heat pack for 2 minutes followed by 1 minute for the cold pack and then repeat this process 6 times giving a total of 18 minutes treatment twice a day. You can use a hot water bottle or commercial gel pack that can be heated in hot water or carefully in the microwave oven to apply heat to the limb. Always ensure that you regularly check the area to ensure that you do not cause a burn from either the heat pack or the cold pack.
A professional therapist may choose to use electrotherapy, such as ultrasound, laser or pulsed shortwave, to encourage healing during this stage. Ideally, this should be performed daily but this is not usually possible unless you are a professional sportsperson.
Stage 3 – Final stage
In the final stage of the healing process, deep tissue massage can be performed every 3 days, allowing for the longer recovery between sessions.
Performing foam roller exercises for the hamstrings can help to massage the muscle and this technique is called “myofascial release”. To perform this,
Heat packs can be applied for 20 minutes at a time, once a day, to help warm the muscle up and stimulate blood flow. This should be continued until you are back to full fitness and you have completed all the stages of the stretching, strengthening and aerobic fitness elements of hamstring strain rehabilitation.
It is important to maintain fitness whilst injured for both physical and psychological reasons. When pain allows, begin with the rowing machine, stationary cycle, arm only swimming and gradually moving on to jogging and half paced running and then eventually start short sprints and sports specific training.
Sports Massage or soft tissue massage or soft tissue massage can be used at this stage but the pressure must be very light and superficial, to begin with, but can gradually get deeper as the days/weeks pass. Massage can help to break down any scar tissue that has formed and can help to relax tight muscles and stimulate blood flow to the area and all of this aids the healing process and may increase flexibility. Light massage can be applied daily initially but later on, as the techniques become deeper, more recovery time between sessions may be required.
The athlete is ready to move onto the third and final stage of the rehabilitation process when jogging is pain-free for at least 5 minutes and you are performing dynamic stretching pain-free in the stretching exercise program.
Hamstring kinesiology taping
Kinesiology taping can be applied during the later stages of rehabilitation by encouraging activation of the muscle
Hamstring strain exercises
Both stretching and strengthening exercises are important. After the initial acute stage, very gentle static stretching exercises can begin as long as they are pain-free. As your injury heals, dynamic stretching which involves movement is introduced and eventually sports-specific drills.
Strengthening exercises also begin gently with isometric contractions and progress through to advanced hamstring exercises.
Read more on Hamstring exercises.
- Woods C, Hawkins RD, Maltby S et al. The Football Association Medical Research Programme: an audit of injuries in professional football – analysis of hamstring injuries. Br J Sports Med 2004;38(1):36-41
- Askling C, Thorstensson A. Hamstring muscle strain in sprinters. New Studies in Athletics 2008;23:67-79