What is a hamstring injury?
The hamstring consists of a group of three muscles and their tendons on the back of the thigh. When these muscles or tendons stretch beyond the normal range of motion, the hamstring can strain or tear, causing instant—and sharp—pain. This is often called a pulled hamstring.
The hamstring muscles and tendons behind the thigh connect to the knee and hip joints. Running, jumping, and lunging rely on the hamstring. Pulled hamstrings happen often in sports with lots of sprinting and sudden starting and stopping.
Rest is typically considered the best treatment for a hamstring injury. If not allowed to heal properly, the hamstring could easily be reinjured.
Grades of hamstring injuries
Hamstring injuries fall into one of three grades of severity:
- Grade 1: A minor hamstring strain
- Grade 2: A partial hamstring tear
- Grade 3: A fully torn hamstring
What are hamstring injury symptoms?
Immediate pain is one sign of a pulled hamstring. The more severe the injury, generally the higher the level of pain. A hamstring popping sensation can accompany sudden hamstring tears. Along with hamstring pain that radiates from the injured area, other pulled hamstring symptoms include:
- Swelling on the back of the thigh
- Tenderness to the touch
- Hamstring bruising
- Leg weakness and restricted mobility
- Muscle stiffness or spasms
Request an appointment with a Mass General Brigham Sports Medicine specialist to learn more.
What are the causes of hamstring injuries?
Stretching the hamstring beyond the normal range of motion can cause a hamstring injury. Extreme movement during sports can be a factor but so can limited muscle flexibility.
Hamstring injuries are common in soccer, basketball, football, tennis, or any other sport with a high level of immediate bursts of sprinting and sudden changes of direction. These motions stress the hamstrings and could stretch them too much, increasing the risk of injury.
A tight, non-flexible hamstring muscle decreases the muscle's range of motion and increases the chance of the muscle stretching too far during athletic activities, causing a pulled hamstring.
Further risk factors for a hamstring injury include:
- Returning to activity before a hamstring injury has fully healed
- A muscle imbalance when the quadriceps are much stronger than the hamstring
- Fatigue that leaves hamstring muscles vulnerable
- Not warming up before activity or being out of shape for the chosen activity
- A hard impact to the muscle
How to diagnose a pulled hamstring
A provider diagnoses a hamstring injury with a physical examination and uses imaging technology to check the grade of injury.
A physical examination is typically enough to diagnose a hamstring injury and often includes:
- Questions about the injury and the location of the pain
- An examination of tenderness, swelling, and bruising
- Range of motion and strength tests
In cases of a physical exam, a provider is looking to determine the location of pain and hamstring strength. A magnetic resonance imaging (MRI) scan can provide detailed information on the extent of the tear, especially in more extreme injuries.
Hamstring injury treatment
Taking the stress off a pulled hamstring is a critical first step in any hamstring injury treatment. Resting and limiting activities that involve bending and flexing the leg are also important. Crutches might be recommended to ease the weight put on the hamstring.
Additional treatment for a hamstring injury includes:
- Limiting activities to reduce the stress put on the hamstring
- Icing the hamstring to reduce swelling
- Compressing the injured area to help limit swelling
- Taking anti-inflammatory medication to decrease pain and swelling
- Strengthening and stretching the hamstring with physical therapy
Surgery for a hamstring injury is rare and only recommended when the muscle completely pulls free from the bone or when the tear is extreme.
The recovery process from an injured hamstring could take anywhere from a few days for a Grade 1 injury to multiple months for a Grade 3 torn hamstring. Following a period of rest, athletes can ease back into exercise, modifying activities to reduce stress on the hamstring and limit the risk of reinjury.
Simple exercises help keep the hamstring from stiffening or developing scars. As the hamstring continues to heal, increasing exercise with low-stress activities, such as walking or cycling, helps rebuild strength. Once fully healed, a regular strength and flexibility routine keeps the hamstring in proper shape.
Preventing hamstring injuries
Preventing hamstring injuries in athletes requires:
- A routine of strengthening exercises
- Flexibility exercises to increase hamstring mobility
- Proper warm-up and cool-down before and after activity
- Proper conditioning to ease into new exercises
Find helpful tips on how to prevent sports injuries from the Mass General Sports Medicine Team.
FAQs
While a hamstring injury typically doesn't require surgery, athletes need to treat it properly with rest, ice, activity modification, and proper exercises to heal fully.
Walking can be a good reentry exercise for a hamstring injury following a period of rest. Walking is a low-stress exercise for the hamstring, but it must be done without pain to have benefit.
Providers recommend icing a pulled hamstring in the days following the injury. Heat helps loosen muscles once the initial injury period has passed.
Massaging a strained hamstring can help both during and after recovery. A massage flushes fluid, helps decrease scar tissue, loosens and stretches muscles, and stimulates blood flow needed for recovery.
