Hamstring injury – NHS

A hamstring injury is a strain or tear to the tendons or large muscles at the back of the thigh.

It’s a common injury in athletes and can happen in different severities. The 3 grades of hamstring injury are:

• grade 1 – a mild muscle pull or strain
• grade 2 – a partial muscle tear
• grade 3 – a complete muscle tear

The length of time it takes to recover from a hamstring strain or tear will depend on how severe the injury is.

A minor muscle pull or strain (grade 1) may take a few days to heal, whereas it could take weeks or months to recover from a muscle tear (grade 2 or 3).

The hamstrings

The hamstrings are tendons (strong bands of tissue) at the back of the thighs that attach the large thigh muscle to the bone.

The term “hamstring” also refers to the group of 3 muscles that run along the back of your thigh, from your hip to just below your knee.

The hamstring muscles are not used much while standing or walking, but they’re very active during activities that involve bending the knee, such as running, jumping and climbing.

What causes hamstring injuries?

A hamstring injury often happens during sudden, powerful movements, such as sprinting, lunging or jumping that overstretch your tendons or muscles. The injury can also happen gradually during slower movements.

Recurring injury is common in athletes and sportsmen, as you’re more likely to injure your hamstring if you’ve injured it before.

Regularly doing stretching and strengthening exercises, and warming up before exercise, may help reduce the risk of injuring your hamstring.

How do I know if I’ve injured my hamstring?

Mild hamstring strains (grade 1) will usually cause sudden pain and tenderness at the back of your thigh. It may be painful to move your leg, but the strength of the muscle should not be affected.

Partial hamstring tears (grade 2) are usually more painful and tender. There may also be some swelling and bruising at the back of your thigh and you may have lost some strength in your leg.

Severe hamstring tears (grade 3) will usually be very painful, tender, swollen and bruised, making it difficult to walk and stand. There may have been a “popping” sensation at the time of the injury and you’ll be unable to use the affected leg.

When to see a GP

Most hamstring injuries can be cared for at home.

See a GP if you have any concerns about your injury, particularly if you think it’s a severe injury, it’s not healing, or your symptoms are getting worse.

The GP can also advise you about when you can return to your normal activities and what exercises you should do to aid your recovery in the meantime. They may also refer you for a scan or to a physiotherapist for specialist treatment in some cases.

Rest and recovery from a hamstring injury

Recovering from a hamstring injury may take days, weeks or months, depending on how severe it is.

A completely torn hamstring may take several months to heal and you’ll be unable to resume training or play sport during this time.

Initial treatment

During the first 2 or 3 days, you should care for your injury using RICE therapy:

• Rest – rest your leg as much as possible.
• Ice – apply cold packs (a bag of frozen peas wrapped in a tea towel will also work) to your hamstring for up to 20 minutes every 2 to 3 hours during the day. Do not apply ice directly to your skin.
• Compression – compress or bandage the thigh to limit any swelling and movement that could cause further damage. You can use a simple elastic bandage or elasticated tubular bandage available from a pharmacy.
• Elevation – keep your leg raised and supported on a pillow as much as possible, to help reduce any swelling.

Regular painkillers, such as paracetamol or a non-steroidal anti-inflammatory drug (NSAID) cream or gel, may also help relieve the pain.

Short-term use of oral NSAIDs, such as ibuprofen tablets, can also help reduce swelling and inflammation. However, these are not suitable for everyone. Check the leaflet that comes with your medicine to see if you can take it.

The GP may recommend you wear a knee splint for a brief time. This will help stop your leg moving to help it heal.

Gentle exercises and stretches

Returning to strenuous exercise too quickly could make your injury worse, but avoiding exercise for too long can cause your hamstring muscles to shrink and scar tissue to form around the tear.

To avoid this, you should start doing gentle hamstring stretches after a few days, when the pain has started to subside.

This should be followed by a programme of gentle exercise, such as walking and cycling, and hamstring strengthening exercises.

The GP can give you further advice and, if necessary, refer you to a physiotherapist for a suitable exercise programme.

To avoid injuring yourself again, you should only return to a full level of activity when your hamstring muscles are strong enough. Your physiotherapist or GP will be able to advise you about this.

Many people need to avoid sports for at least a few weeks, but the length of time you need off will depend on the severity of your injury.

Page last reviewed: 03 November 2021
Next review due: 03 November 2024

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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Treatment of sprained thigh muscles in Moscow

Among the injuries that occur in athletes, the most common is sprained thigh muscles. It is mainly the posterior thigh muscle group that suffers, since it is in this place that the ligaments and muscles are least adapted to intense loads. Any sudden movements can cause damage to the muscle fibers of the back of the thigh, since the ligaments do not have sufficient elasticity. Less often, but still there are stretching of the muscles of the anterior and lateral groups.

Causes of thigh muscle strain

Hip muscle injury occurs when:

• performing technically difficult exercises by an untrained person;
• ignoring stretching before intense sports activities;
• making sudden movements with the leg;
• blows and other mechanical injuries in sports and at home;
• negligence – falling, sharp straightening of the limb.

You can avoid muscle strain during sports by doing a good warm-up. It allows you to achieve warming up of the ligaments and muscles, increasing their elasticity. Those who are not involved in professional sports are advised to use comfortable, appropriately sized shoes in everyday life, to avoid performing heavy and overwhelming exercises in the absence of proper physical fitness.

Factors that increase the likelihood of hip strain:

1. Age. In adulthood and old age, the ligaments lose their elasticity, so the risks of muscle injuries are much higher than in young people. After the first episode of muscle strain, this injury often occurs again.
2. Past injuries of the muscles and tendons of the thigh. Often, connective tissue forms at the site of the rupture – in other words, a scar. Such fabric is easily torn, which may well occur during strenuous activity or during a fall.
3. Poor warm-up. Athletes know that before the main training block, it is important to warm up the muscles and ligaments. Warming up protects against injuries and sprains, increases the effectiveness of training.
4. Poor nutrition. The lack of protein, vitamins and microelements makes muscles and other tissues less strong: even with minor injuries, they can be easily damaged. Recovery in this situation takes longer, since along with the main treatment of muscle strain, nutrition must be adjusted.
5. Osteoporosis. Calcium is washed out of the bones, which makes the bones, as well as tendons and ligaments, less durable. The tissues become brittle: with an awkward movement or stretching of the ligament, the thigh muscles can be completely torn.

Signs indicating thigh muscle strain

The first clinical manifestation of thigh muscle strain is pain. The pain sharply increases when the patient tries to take a sitting position, because of the discomfort, the mobility of the entire limb is limited. The intensity of pain, as well as the presence of other signs of muscle damage, depends on the degree of damage to it.

There are three degrees of thigh muscle strain:

1. The first degree is characterized only by pain, there are no other signs of thigh muscle tear. Motor activity is weakened. The condition returns to normal after a couple of days, subject to rest and other therapeutic measures.
2. In the second stage, a partial rupture of muscle tissue occurs. In addition to pain, there is already swelling of the soft tissues; on examination, subcutaneous hematomas are also determined. Recovery here requires more time – it takes up to two weeks.
3. The third stage – the pain syndrome is combined with limited mobility, severe edema and hematoma. When you try to make movements in the affected limb, a characteristic crack occurs, which indicates a rupture of the fibers, a violation of their integrity. Body temperature reaches subfebrile numbers. Movements in the knee and hip joint cause increased pain. The terms of treatment and rehabilitation can reach two to three months.

After an injury, it is important to quickly differentiate a muscle strain from a complete rupture. It is also necessary to make sure that there is no rupture of the ligament or muscle tendon, fracture of the bone, knee or hip joint. If the pain syndrome does not subside within a day, then you should definitely contact a medical institution for examination and an accurate diagnosis. The doctor will prescribe adequate therapy, which will help in a short time to cope with the stretching of the thigh muscles and the accompanying complications of this condition. In a clinic or emergency room, radiography, magnetic resonance imaging, or ultrasound examination of soft tissues can be performed.

Hip sprain treatment

Hip sprain therapy begins with creating conditions for complete rest of the injured leg. Bed rest should be observed, if necessary, use a splint and the help of loved ones. Immediately after injury, it is recommended to apply cold to the area of ​​\u200b\u200bthe injured limb – such a compress will relieve swelling and reduce hematoma. Cold helps prevent the development of aseptic inflammation in the affected muscles, ligaments and tendons.

Special compression underwear helps against swelling and congestion in the veins – it can be purchased at the pharmacy. Underwear should be used for 2-3 months with interruptions to prevent re-injury, reduce the duration of treatment and rehabilitation.

In case of acute pain, it is advisable to use painkillers. They are prescribed in a short course of no more than five days in a row, since most painkillers have side effects. They negatively affect the gastric mucosa, so people with gastritis and ulcers should definitely take additional funds to prevent exacerbations – for example, omeprazole. It is allowed to take antispasmodics – the most popular representative of this class of drugs is drotaverine (no-shpa). Muscle relaxants are used to relieve muscle tension – one of their representatives is mydocalm. With tendinitis or myositis, anti-inflammatory drugs are used – diclofenac, ibuprofen: they not only relieve inflammation, but also relieve pain. When prescribing drugs, the doctor must take into account possible contraindications, age and concomitant diseases.

Rehabilitation period

Treatment does not end with one medication. Following the main therapy, the recovery period begins – it is no less important for maintaining the same motor activity and preventing delayed complications. Rehabilitation in time takes from two to three weeks to six months: a lot depends on the degree of injury, the individual characteristics of the body – age, concomitant diseases, regenerative capabilities, etc.

In the process of rehabilitation, it is important to create a stable connection between individual muscle fibers, the integrity of which was broken as a result of an injury. Immediately after the pain syndrome has passed, it is necessary to begin physiotherapy exercises. Moderate physical activity does not allow connective tissue to form at the site of injury. Such scar tissue is formed precisely when movements are limited for a long time, which cannot be done with injuries during the rehabilitation period. Physiotherapy exercises are also needed to strengthen muscles that have weakened during treatment, because the limb should have been at rest. It also helps prevent re-injury to the thigh muscles.

At the rehabilitation stage, physiotherapeutic procedures are used – ultrasound, magnetotherapy and other methods. All of them have a mild effect on the body, have practically no contraindications, so they can be prescribed even for the elderly and children. Massage helps to improve blood circulation in the thigh muscles, as a result of which the process of tissue regeneration is accelerated.

Combined with physiotherapy, therapeutic massage and acupuncture, regular exercise helps to completely eliminate the effects of injury. The main thing is not to rush in the transition from treatment to rehabilitation, for a quality recovery of the tissues of the body, time is needed.

Material verified by an expert

Mikhailov Valery Borisovich

Manual therapist, vertebrologist, neurologist

Work experience – 25 years

Sprain of the posterior muscles of the thigh symptoms and treatment in Moscow

torn muscles – one of the most serious injuries of the leg . Since these muscles pass through two key articular joints at once, their stretching can be accompanied not only by a temporary loss of hip function, but also by adjacent inflammatory processes in the tendons, cartilaginous tissues, and menisci.

In total, three groups of muscles are concentrated in the thigh – back, on the front of the thigh and internal, which are responsible for bringing the legs together / apart. More often, stretching is observed with external muscles, damage to internal ones is one of the most dangerous, possibly with sharp dilutions of the hips without preliminary warming up.

Sequelae of injury

Stretching appears either immediately or after some time. The main signal is pain in the thigh, spilling over the entire limb or concentrated in the affected muscles.

1. If the sprain is severe, up to a tear – partial or complete – then a click / pop will be heard / felt in the muscles.
2. If the vessels are torn during stretching, then – subcutaneous bruising, from red to purple.
3. Since the sprain is more common in the transition of muscles to the tendon, the most sensitive area of ​​the thigh will be the joint area.

Verification of the injury zone

Since the pain syndrome during sprain in the hips is very severe and significantly reduces the quality of life, it is recommended to seek help as soon as possible. An orthopedic doctor deals with stretching issues, she is also a traumatologist. During the appointment, such a specialist will:

• survey about activities that lead to sprains;
• muscle examination;
• will ask you to bend/spread your legs/hips.

Diagnosis is often limited to such hip manipulations. But in some cases, with severe swelling, redness, and hemorrhage under the skin, ultrasound, MRI, CT, and X-ray of the thigh may be prescribed to eliminate the risk of severe muscle damage. The first three manipulations will help determine the degree of injury to the thigh fibers, the last will eliminate the possibility of ruptures and damage to bone tissue.

What needs to be done to recover?

When sprained, urgent help is needed, without waiting for a doctor, the patient can already do some important actions:

• immediately stop muscle movements;
• bandage to reduce swelling and prevent bruising;
• place the thigh in an elevated position;
• apply cold to affected muscles;
• take pain medication.

Maximum rest will be required for the first 1-2 weeks after a sprain. Bed rest is desirable, lameness should be excluded or supportive devices should be used when walking. To avoid the development of inflammation, the doctor may recommend anti-inflammatory muscle therapy. With severe pain, anesthetic injections into the sprained area are possible.

The treatment is to support the muscles and provide the conditions for a rapid natural recovery of functions. What is prescribed for:

• physiotherapy;
• relaxation programs;
• massage;
• special exercises (often with a load on the thigh placed in water).