Hamstring Strain (Pulled Hamstring)

A hamstring strain is a common injury involving a tear in one or more of the hamstring muscles.  A pulled hamstring can range from mild to very severe involving a complete tear of the muscle.

Pulled hamstring symptoms

One of the most obvious symptoms of a hamstring strain is a sudden sharp pain at the back of the leg during exercise, most probably during sprinting or high speed movements. Depending on how bad the injury is the athlete will usually have to stop immediately and further participation in training or sport difficult or impossible. Often the athlete will try to play on with a pulled hamstring but this is one injury where it just isn’t possible.

Palpating the hamstings

Pulled hamstrings are graded 1, 2 or 3 depending on severity.  Grade 1 consists of minor tears within the muscle. A grade 2 is a partial tear in the muscle and grade 3 is a severe or complete rupture of the muscle.

Grade 1 Hamstring strain

With a grade 1 hamstring strain the athlete may have tightness in back of the thigh but will be able to walk normally. They will be aware of some discomfort and unable to operate at full speed. There will be little swelling and trying to bend the knee against resistance is unlikely to reproduce much pain.

Grade 2 Hamstring strain

With a grade 2 hamstring strain the athletes gait will be affected and they will most likely be limping. Sudden twinges of pain during activity will be present. They may notice some swelling and pain will be reproduced when pressing in on the hamstring muscle as well as trying to bend the knee against resistance.

Grade 3 Hamstring strain

A grade 3 hamstring strain is a severe injury involving a tear to half or all of the muscle. The athlete may need crutches to walk and will feel severe pain and weakness in the muscle. Swelling will be noticeable immediately and bruising will usually appear within 24 hours.

Hamstring strain causes


The hamstring muscle group consists of three separate muscles; the semitendinosus, semimembranosus and biceps femoris. During sprinting the hamstring muscles work extremely hard to decelerate the tibia or shin bone as it swings out. It is in this phase just before the foot strikes the ground that the hamstrings become injured as the muscles are working hardest at the same time as approaching their maximum length.

A pulled hamstring rarely manifests as a result of contact. If you have taken an impact to the back of the leg it should be treated as a contusion until found to be otherwise. A strained or pulled hamstring as it is sometimes called is a tear in one or more of the hamstring muscles.

Problems with the lower back and pelvis may increase the likelihood of suffering a hamstrings strain and should always be considered, particularly for recurrent hamstring injuries.

Pulled hamstring treatment

Ice pack on hamstrings

It is vitally important that treatment for a hamstring strain starts immediately following injury. See hamstring strain rehab for a full hamstring strain rehab program for grade 1,2 and 3 hamstring strains.

What can the athlete do?

The most important phase for treatment is the first 48 hours post-injury. In this time the following can be carried out by the athlete themselves:

Apply Cold Therapy immediately for 10-15 minutes and repeat this every hour for the first day. After this, every 2-3 hours is sufficient. Use a compression bandage to minimize intra muscular bleeding and swelling. Rest as much as possible with the leg elevated.

Hamstring exerciss

Stretching exercises should be done but only when pain allows. It is likely that strengthening exercises will be possible before the leg is ready for stretching.

What can a Sports Injury Specialist do?

Advise on a full hamstring strain rehab program such as that developed for us by premiership football physiotherapist Neal Reynolds.

Use sports massage for hamstrings to speed up recovery. Sports massage is important in the treatment and rehab of hamstring muscle injuries as massage helps correct new muscle fiber realignment and minimizes scar tissue. In addition massage can increase the blood flow to the injured area.

Hamstring massage

Use ultrasound and other forms of electrotherapy are often used as part of pulled hamstring treatment to aid the healing process and reduce swelling. Provide mobility aids such as crutches particularly if the hamstring strain is severe. Resting it is important.

Provide an MRI scan to ascertain the amount of damage sustained. In severe ruptures surgery may be needed to repair the muscle damage.

Hamstring Strain Rehab Program

Premiership Physiotherapist Neal Reynolds has produced a step by step rehabilitation program based around healing or treatment, stretching, strengthening and maintaining aerobic fitness.

Aims of rehabilitation

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting rehabilitation. The aims of this pulled hamstring rehab program are to reduce pain and inflammation, improve flexibility and muscle condition, increase the load through the hamstring muscle gradually to a level where the athlete can return to full fitness training and match play.

Hamstring rehabilitation explained

The hamstring strain rehab program is based around four elements or strands. The athlete will progress at different rates depending on the severity of the injury and the athlete themselves. The program is based on what a full time professional footballer might do with all the time and resources available they need. Where the athlete starts along each stage will also depend on how old the injury is and how bad it is when beginning rehab.


Hamstring massage

This element is the treatment side of rehab and includes cold therapy or ice, electrotherapy such as ultrasound or laser, deep tissue sports massage and heat. Healing is split into three stages:

  • Phase 1 is the acute stage and can last 3 to 4 days.
  • Phase 2 is the sub acute stage lasting anything from 10 days to 2 weeks depending on severity.
  • Phase 3 is the final stage returning back to full fitness.
  • More on hamstring strain healing and treatment.


Janny hamstring stretch

Hamstring stretching begins with very gentle static stretches initially moving onto more dynamic sports specific stretches as the injury heals. Different stretches will target the muscle in different ways depending on exactly where the muscle tear is. Some hamstring strains are nearer the knee and others may be higher up in the muscle.

See stretching for hamstring strains for more details and specific exercises.


Partner hamstring strengthening

Hamstring muscle strengthening is thought of in terms of gradually increasing the load on the muscle. Strengthening exercises should always be done pain free. If it hurts then it isn’t helping. In the early stages of hamstring rehabilitation basic static exercises are done often using a therapist or partner to provide resistance. These will progress to more sports specific and demanding exercises as the muscle strengthens.

See hamstring strengthening exercises for more details and specific exercises.

Aerobic fitness

When an athlete is injured it is important to maintain fitness as much as possible for physical as well as physiological reasons. With a hamstring strain it will be impossible to run so our progressive program starts with arm bikes for athletes with severe muscle strains and builds up.

Later in the rehab program timed shuttle runs and sprints like professional footballer would be expected to be able to do are included. It is important to progress this far before returning to competitive matches or re-injury is likely.



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