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Causes of a hamstring strain: Hamstring Muscle Injuries – OrthoInfo

Hamstring Muscle Injuries – OrthoInfo

Hamstring muscle injuries — such as a “pulled hamstring” — occur frequently in athletes. They are especially common in athletes who participate in sports that require sprinting, such as track, soccer, and basketball.

A pulled hamstring or strain is an injury to one or more of the muscles at the back of the thigh. Most hamstring injuries respond well to simple, nonsurgical treatments.

The hamstring muscles run down the back of the thigh. There are three hamstring muscles:

  • Semitendinosus
  • Semimembranosus
  • Biceps femoris

They start at the bottom of the pelvis at a place called the ischial tuberosity. They cross the knee joint and end at the lower leg. Hamstring muscle fibers join with the tough, connective tissue of the hamstring tendons near the points where the tendons attach to bones.

The hamstring muscle group helps you extend your leg straight back and bend your knee.

Normal hamstring anatomy. The three hamstring muscles start at the bottom of the pelvis and end near the top of the lower leg.

A hamstring strain can be a pull, a partial tear, or a complete tear.

Muscle strains are graded according to their severity. A grade 1 strain is mild and usually heals readily; a grade 3 strain is a complete tear of the muscle that may take months to heal.

Most hamstring injuries occur in the thick, central part of the muscle (the muscle belly) or where the muscle fibers join tendon fibers.

In the most severe hamstring injuries, the tendon tears completely away from the bone. It may even pull a piece of bone away with it. This is called an avulsion injury.

A severe hamstring injury where the tendon has been torn from the bone.

Muscle Overload

Muscle overload is the main cause of hamstring muscle strain. This can happen when the muscle is stretched beyond its capacity or challenged with a sudden load.

Hamstring muscle strains often occur when the muscle lengthens as it contracts, or shortens. Although it sounds contradictory, this happens when you extend a muscle while it is weighted, or loaded. This is called an “eccentric contraction.”

During sprinting, the hamstring muscles contract eccentrically as the back leg is straightened and the toes are used to push off and move forward. The hamstring muscles are not only lengthened at this point in the stride, but they are also loaded — with body weight as well as the force required for forward motion.

Like strains, hamstring tendon avulsions are also caused by large, sudden loads.

During sprinting, the hamstring muscles are lengthened and loaded as the back leg pushes off to propel the runner forward.

Courtesy Thinkstock © 2015

Risk Factors

Several factors can make it more likely you will have a muscle strain, including:

Muscle tightness. Tight muscles are vulnerable to strain. Athletes should follow a year-round program of daily stretching exercises.

Muscle imbalance. When one muscle group is much stronger than its opposing muscle group, the imbalance can lead to a strain. This frequently happens with the hamstring muscles. The quadriceps muscles at the front of the thigh are usually more powerful. During high-speed activities, the hamstring may become fatigued faster than the quadriceps. This fatigue can lead to a strain.

Poor conditioning. If your muscles are weak, they are less able to cope with the stress of exercise and are more likely to be injured.

Muscle fatigue. Fatigue reduces the energy-absorbing capabilities of muscle, making them more susceptible to injury.

Choice of activity. Anyone can experience hamstring strain, but those especially at risk are:

  • Athletes who participate in sports like football, soccer, basketball
  • Runners or sprinters
  • Dancers
  • Older athletes whose exercise program is primarily walking
  • Adolescent athletes who are still growing

Hamstring strains occur more often in adolescents because bones and muscles do not grow at the same rate. During a growth spurt, a child’s bones may grow faster than the muscles. The growing bone pulls the muscle tight. A sudden jump, stretch, or impact can tear the muscle away from its connection to the bone.

If you strain your hamstring while sprinting in full stride, you will notice a sudden, sharp pain in the back of your thigh. It will cause you to come to a quick stop, and either hop on your good leg or fall.

Additional symptoms may include:

  • Swelling during the first few hours after injury
  • Bruising or discoloration of the back of your leg below the knee over the first few days
  • Weakness in your hamstring that can persist for weeks

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Patient History and Physical Examination

People with hamstring strains often see a doctor because of a sudden pain in the back of the thigh that occurred when exercising.

During the physical examination, your doctor will ask about the injury and check your thigh for tenderness or bruising. He or she will palpate, or press, the back of your thigh to see if there is pain, weakness, swelling, or a more severe muscle injury.

In this severe tear of the hamstring tendon away from the bone, the muscle has balled up at the back of the thigh.

Reproduced from Frank RN, Walton DM, Erickson B, Nho SJ, Bush-Joseph CA, Verma NN: Acute proximal hamstring rupture: surgical technique. Orthopaedic Knowledge Online Journal 2014. Accessed July 2015.

Imaging Tests

Imaging tests that may help your doctor confirm your diagnosis include:

X-rays. An X-ray can show your doctor whether you have a hamstring tendon avulsion. This is when the injured tendon has pulled away a small piece of bone.

Magnetic Resonance Imaging (MRI). This study can create better images of soft tissues like the hamstring muscles. It can help your doctor determine the degree of your injury.

Treatment of hamstring strains will vary depending on the type of injury you have, its severity, and your own needs and expectations.

The goal of any treatment — nonsurgical or surgical — is to help you return to all the activities you enjoy. Following your doctor’s treatment plan will restore your abilities faster, and help you prevent further problems in the future.

Nonsurgical Treatment

Most hamstring strains heal very well with simple, nonsurgical treatment.

RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.

  • Rest. Take a break from the activity that caused the strain. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
  • Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
  • Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
  • Elevation. To reduce swelling, recline and put your leg up higher than your heart while resting.

Immobilization. Your doctor may recommend you wear a knee splint for a brief time. This will keep your leg in a neutral position to help it heal.

Physical therapy. Once the initial pain and swelling has settled down, physical therapy can begin. Specific exercises can restore range of motion and strength.

A therapy program focuses first on flexibility. Gentle stretches will improve your range of motion. As healing progresses, strengthening exercises will gradually be added to your program. Your doctor will discuss with you when it is safe to return to sports activity.

Surgical Treatment

Surgery is most often performed for tendon avulsion injuries, where the tendon has pulled completely away from the bone. Tears from the pelvis (proximal tendon avulsions) are more common than tears from the shinbone (distal tendon avulsions).

Surgery is not commonly performed for tears within the muscle belly.

Procedure. To repair a tendon avulsion, your surgeon must pull the hamstring tendon back into place and remove any scar tissue. Then the tendon is reattached to the bone using small devices called anchors.

Rehabilitation. After surgery, you will need to keep weight off of your leg to protect the repair. In addition to using crutches, you may need a brace that keeps your hamstring in a relaxed position. How long you will need these aids will depend on the type of injury you have.

Your physical therapy program will begin with gentle stretches to improve flexibility and range of motion. Strengthening exercises will gradually be added to your plan.

Rehabilitation for a proximal hamstring reattachment typically takes at least 6 months, due to the severity of the injury. Distal hamstring reattachments require approximately 3 months of rehabilitation before returning to athletic activities. Your doctor will tell you when it is safe to return to sports.

Most people who injure their hamstrings will recover full function after completing a rehabilitation plan. Early treatment with a plan that includes the RICE protocol and physical therapy has been shown to result in better function and quicker return to sports.

To prevent reinjuring your hamstring, be sure to follow your doctor’s treatment plan. Return to sports only after your doctor has given you the go-ahead. Reinjuring your hamstring increases your risk of permanent damage. This can result in a chronic condition.

Platelet-rich plasma (PRP) is currently being investigated for its effectiveness in speeding the healing of hamstring muscle injuries. PRP is a preparation developed from a patient’s own blood. It contains a high concentration of proteins called growth factors that are very important in the healing of injuries.

Many treatment centers across the country are incorporating PRP injections into the nonsurgical treatment regimen for some hamstring muscle injuries. However, this method is still under investigation and more research is necessary to prove PRP’s effectiveness.

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Five Painful Causes of Hamstring Injuries

At Tenet Healthcare, we want to provide you with tips for healthy living to ensure you live a long, pain-free life.

Enjoying a morning run or playing sports in the park seems innocent enough. However, a pulled hamstring muscle can ruin your day, causing pain to your leg and your knee. A pulled hamstring is an injury to one or more of the muscles at the back of the thigh. Although predominantly common in athletes, if you’re an active person who likes the outdoors, read on to stay prepared and prevent injury.

What is your hamstring?

The hamstring starts at the bottom of the pelvis and lines the back of the knee joint and ends at the lower leg. Hamstring muscle fibers join with the tough, connective tissue of the hamstring tendons near the points where the tendons attach to bones.

How do hamstring muscles get injured?

A hamstring strain can be a pull, a partial tear, or a complete tear. Muscle strains are graded according to their severity. A mild strain usually heals readily, while the more severe hamstring injuries may result in an avulsion injury, requiring immediate care.

Five common causes of hamstring injuries:

  1. Muscle overload – happens when the muscle is stretched beyond its capacity and is strained with a sudden load.
  2. Hamstring muscle strains – when you extend a muscle while it is weighted, such as at the gym.
  3. Muscle tightness – skipping out on daily stretching exercises can leave your muscles tight and more susceptible to injury.
  4. Muscle imbalance – during high-speed activities, the hamstring may become fatigued and can lead to a strain.
  5. Poor conditioning – weak muscles are less able to cope with the stress of exercise and are more likely to be injured.

What are the symptoms of hamstring injuries?

If you strain your hamstring, you may notice a sudden, sharp pain in the back of your thigh. It will cause you to come to a quick stop. Additional symptoms may include:

  • Swelling
  • Bruising or discoloration of the back of your leg below the knee
  • Weakness in your hamstring

How are hamstrings related to knee pain?

The hamstring muscle group helps you extend your leg straight and bend your knee. Because they are so closely intertwined, mobility in your knees can also be compromised when you are suffering from a hamstring injury.

What you can do to prevent injury

Prevention is the best cure, and although accidents might still happen, these important tips can help you avoid hamstring injuries:

  • Regular, consistent exercise.
  • Stretching before and after a rigorous sports activity.
  • Bending your knees when carrying and being careful with heavy load.

How to treat hamstring injuries

The first goal of treatment is to prevent injuries from becoming worse. If you or someone you know is suffering from a mild hamstring injury, following these home management strategies will do wonders:

  • Get ample rest, ice your injury regularly, keep light pressure on it (such as with a compression sleeve), and keep your injured leg elevated. These will help reduce pain, inflammation, and swelling. Remember R-I-C-E: rest, ice, compression, elevation.
  • Gently massage the afflicted area to ease pain and muscle tension.
  • Move around a bit to get the blood flowing and speed up the healing process. Sitting for long periods of time and being sedentary slows down the recovery process.
  • Take anti-inflammatory medications to help manage pain and swelling.
  • Do gentle stretching exercises to encourage blood flow to the tendon.

When to See a Doctor for Sports Injuries

Don’t delay seeking medical help when you have an emergency. Go to the doctor right away if your injury causes extreme swelling, bruising, or pain.

American Academy of Orthopedic Surgeons
Medical News Today

Various treatments for a hamstring strain or tear – Drink-Drink


  • Symptoms of a hamstring injury
  • Causes of a hamstring injury
    • Risk factors for hamstring injury:
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    • Hamstring Injury Diagnosis
      • Hamstring Injury Grade I
      • Hamstring injury Grade II
      • Hamstring injury Grade III
    • Treatment of hamstring injury
      • Non-surgical treatment
      • Surgical treatment
    • Prevention of hamstring injury

    knee tendon such as sprains and tears are common in sports that require either a lot of running or strong acceleration and deceleration. The hamstrings are made up of a group of muscles and tendons that run along the back of the leg from the base of the pelvis to the lower leg. While their main role is to flex the knee, the hamstrings also contribute to the rotation of the calf.

    A hamstring strain refers to an injury in which a muscle or tendon is stretched or torn. Less severe deformities are often referred to as a “stretched hamstring”. A hamstring tear, also known as a tear, suggests a more serious injury.

    Some hamstring injuries are mild and resolve with rest and over-the-counter pain relievers. Others are more severe and may require surgery and extensive rehabilitation.

    Symptoms of a hamstring injury

    An acute hamstring injury usually causes sudden sharp pain in the back of the thigh that can stop you halfway. In some cases, you may hear an audible “pop” or feel your leg pull out from under you. A chronic hamstring injury can occur if an untreated tear or sprain worsens over time.

    After an injury, you will often be unable to painlessly extend your knee more than 30 to 40 degrees. Acute injuries are almost always accompanied by spasm, tightness and soreness, developing either immediately or after a few hours. In the event of a tear, you can often feel or see an indentation at the site of the tear. Swelling and severe bruising usually follow.

    Causes of hamstring injury

    Most hamstring injuries occur when the muscles are overworked. These include the biceps femoris, semitendinosus, and semimembranosus muscles. Muscle overload occurs when a muscle is either stretched beyond its limits or is subjected to sudden excessive weight loading.

    Most sprains occur when the hamstrings lengthen and contract at the same time (known as eccentric contraction). One such example is the sprint, during which the back leg is straightened out and you move forward on bent toes.

    Other injuries occur when the hamstring is overstressed when lifting weights with a sudden release of energy. One such example is powerlifting.

    Risk factors for hamstring injury:

    • Differences in leg length
    • Imbalance between quadriceps (front of thigh) and hamstring muscles.
    • Incorrect or no warm-up before exercise
    • Muscle fatigue during activity
    • Poor flexibility
    • Poor muscle strength
    • Exceeding current limits
    • Tight hip flexors
    • Weak glutes (buttocks)

    Diagnosis of hamstring injury

    Hamstring injuries can usually be diagnosed by the location and intensity of pain, as well as traffic restrictions. Most of them tend to occur either in the middle of the back of the thigh or directly under the gluteal muscle, near the point where the tendon joins the bone.

    Imaging is not required in most cases to confirm the diagnosis. However, severe injuries may require evaluation with magnetic resonance imaging (MRI), which is the gold standard for visualizing soft tissue injuries. On the other hand, ultrasound can provide a qualitative assessment of injury by viewing muscles and tendons in real time. X-rays, although useful, can sometimes miss smaller tears.

    Hamstring injury can be classified as Grade I, Grade II, or Grade III based on assessment.

    Grade I hamstring injury

    • Ability to flex the knee
    • Slight noticeable swelling
    • Muscle stiffness, tenderness and tightness
    • Normal gait and range of motion, albeit with discomfort

    Second degree hamstring injury

    • Affected gait
    • Limited range of motion
    • Muscle pain, sharp tingling and tightness
    • Noticeable swelling or bruising
    • Pain on touch and bending the knee

    Grade III hamstring injury

    • Difficulty walking unaided
    • Marked swelling and bruising
    • Pain at rest, aggravated by movement

    Treatment of hamstring injuries

    Treatment hamstring injury depends on the severity of the symptoms. All but the most severe can usually be treated without surgery. Those involving tendon avulsion, in which the tendon is completely detached from the bone, require surgery and an extensive rehabilitation program.

    Non-surgical treatment

    Most acute hamstring injuries can be treated at home using the RICE protocol, which includes:

    • R : Rest, often with crutches to keep weight off the leg.
    • I : Use of a cold compress with ice to reduce pain and inflammation.
    • C : Compression with a compression bandage to reduce swelling, prevent tissue bleeding, and prevent further expansion of the tear.
    • E : Elevate the leg over the heart to drain blood away from the leg, thereby reducing pain and swelling.

    More severe injuries may require immobilization with a knee brace to keep the leg in a neutral position. Pain can be treated with either an analgesic such as Tylenol (acetaminophen) or a non-steroidal anti-inflammatory drug (NSAID) such as Advil (ibuprofen) or Aleve (naproxen).

    Once the injury has stabilized and pain and swelling subsided, physical therapy can begin, using light stretches to restore range of motion and strengthening exercises to increase muscle mass and support.


    Hamstring tears invariably require surgery to reattach the tear. Avulsions most often occur near the pelvis (proximal tendon tear), although they can also occur closer to the tibia (distal tendon tear).

    If an acute tear occurs, the surgeon usually waits 72 hours to allow the flexed muscles to “relax”. Delaying beyond this point is usually not recommended as the muscle may begin to emaciate (atrophy) and form extensive scarring (fibrosis).

    During repair of a torn tendon, the surgeon returns the hamstring muscles to their original position and cuts away any scar tissue at the torn end. The tendon is then reattached to the bone with staples and/or sutures. If the muscle itself is torn, sutures will be used to reconnect the ends without excessively shortening the length.

    After surgery, you will need to use crutches and a brace to keep your leg in a neutral position. After complete healing, physiotherapy and rehabilitation begin, which last from 3 to 6 months. Every effort will be made to control pain with regular application of ice packs and over-the-counter pain relievers. Stronger NSAIDs may be prescribed if necessary.

    Hamstring Injury Prevention

    Because hamstring injuries commonly occur during sports and athletics, the usual precautions should be taken prior to exercise. Top prevention tips include:

    • Add retro running (backward running) to your workout to help balance your glutes and hamstrings while strengthening the muscles around your knee.
    • Approach squats and other exercises that engage your glutes and hip flexors with caution, starting slowly and gradually increasing in depth.
    • Follow the 10% rule, in which you increase the intensity, distance, or duration of your workout by no more than 10% each week to avoid overexertion.
    • Stretch after your workout the same way you stretch before. It is important to remember that during strength training, muscles tend to contract. If stretching is avoided, these muscles can eventually lock into this half-flexed position.
    • Pre-workout warm-up with eccentric hamstring stretch.

    Knee ligament tear – symptoms and treatment

    Every day we take thousands of steps, go up and down stairs, squat, play sports. The special structure of the knee joint, including the presence of ligaments, makes it possible to perform these movements freely and without pain. The knee ligaments (there are four in total: two cruciate and two external) ensure the correct position of the joint and its stability. The anterior and posterior cruciate ligaments hold the knee forward and backward. When moving to the side, the joint is fixed by the internal and external lateral ligaments (medial and lateral). By themselves, these structures are very strong, however, physical overload, injuries and diseases of the joints can cause damage to the knee ligaments.

    Damage to the ligaments of the knee joint

    Specialists identify several degrees of damage to the knee joint.

    1. Partial ligament tear, which is often called sprain
    2. Incomplete knee ligament tear is a knee ligament tear when only part of the fibers is damaged
    3. Complete knee tear ligaments

    The most commonly affected is the anterior cruciate bundle. This damage occurs during active sports (skiing, playing football). Often, a knee ligament tear occurs with a sharp change in movement, an unsuccessful landing after a jump, a fall, when the tibia abruptly mixes inward.

    Damage to the medial lateral ligament of the knee is also common. The mechanism of injury is very similar to an anterior cruciate ligament injury.

    Tears of the external lateral ligament and injuries of the posterior cruciate ligament are uncommon. Such injuries are usually caused by road accidents or very severe injuries in sports.

    Knee ligament rupture symptoms and signs of manifestation

    Symptoms vary depending on which ligament is injured. But there are several manifestations that are characteristic of damage to all ligaments of the knee joint.

    • During the injury, a characteristic sound is heard – a click, crackling, crackling of a torn ligament
    • Severe sharp pain in the knee joint
    • Swelling of the knee with hemorrhage
    • Restriction of mobility
    • Instability in the joint.

    All these manifestations indicate problems with the knee ligaments. In this case, it is urgent to be examined, determine the degree of damage to the ligaments and decide on treatment. It is impossible to make a diagnosis on your own – after knee injuries, our patients often attributed everything to a banal sprain, which turned into a more serious injury and entailed unpleasant consequences. Therefore, if you are injured, consult a doctor.

    How to treat a ligament tear in the knee

    For less complex injuries, it is possible to get by with only conservative therapy. But when there is complete or partial damage to the ligaments of the knee joint, there has been a complete rupture or separation of the ligament from the attachment site, surgery is needed. Arthroscopic surgery is performed in our clinic for such indications.

    Knee ligament surgery for rupture

    The ligamentous apparatus of the knee joint is restored with the help of a surgical intervention – arthroscopy of the knee joint. This low-traumatic technique allows effective treatment of knee ligaments through small punctures.

    The Orthopedic Clinic also performs ligament plasty using the patient’s own tendon. To do this, access to the joint is made through incisions of several millimeters, with the help of special navigation systems, new holes are made to fix the graft in the bone. First, a hole is created in the thigh, then a hole is made in the tibia using the navigator. Often, the patient’s own tendon is used as a graft to repair the ligament.

    The graft is sutured in a special way: inserted into pre-drilled channels in the femur and tibia and fixed in them. On the tibia, the graft is fixed with a self-absorbable screw (it does not need to be removed again). After some time, the ligament takes root and fills the space of the damaged knee joint complex.

    Rehabilitation after knee ligament rupture

    In order to return the joy of movement to patients, our clinic uses an integrated approach. That is, by contacting the orthopedics clinic, the patient receives all the necessary assistance: from consultation to postoperative recovery.

    A successful knee reconstruction surgery will bring excellent results only in tandem with professional rehabilitation. The main goal of rehabilitation measures is the development of the joint, the restoration of functions and movements in the knee. And it is very important that the rehabilitation treatment is carried out correctly. Therefore, after the operation, our qualified rehabilitation specialist takes care of each patient. An experienced specialist conducts an examination and decides when and how to strengthen muscles and joints in each case so that recovery is as fast as possible.

    How to develop a knee after a ligament rupture?

    Many patients who are going to have a knee ligament injury are wondering how to develop their knee after surgery. Today there are a huge number of exercises that increase muscle tone and resume movement in the joint. However, in this case, one cannot rely only on one’s own strength and proceed to the development of the joint without consulting a specialist. After all, each case is individual and arrogance in the delicate matter of rehabilitation can only do harm. In the postoperative period, under the supervision of a specialist in the orthopedics clinic, patients perform static exercises, knee extension exercises, maintain strength in the calf muscles, quadriceps muscle, and train to walk on crutches. At this time, it is necessary to use a brace, do not overload the operated leg and listen to the recommendations of doctors.

    Do the ligaments of the knee joint fuse?

    If it is a minor injury to the knee ligaments, conservative therapy is sufficient to restore. If the injury to the knee ligaments has led to a rupture, the torn ligament fibers do not grow together. Torn ligaments in the knee are a 100% indication for arthroscopic surgery.

    How long does a knee ligament tear heal?

    Recovery after a knee ligament tear takes an average of 3 to 6 months. The terms of rehabilitation depend on how long ago the injury occurred, on the degree of damage, the age of the patient, and the general condition of his body.