Hamstring strain – aftercare Information | Mount Sinai

Pulled hamstring muscle; Sprain – hamstring

More About a Hamstring Strain

There are 3 levels of hamstring strains:

• Grade 1 — mild muscle strain or pull
• Grade 2 — partial muscle tear
• Grade 3 — complete muscle tear

Recovery time depends on the grade of the injury. A minor grade 1 injury can heal in a few days, while a grade 3 injury could take much longer to heal or need surgery. You may need surgery if the tear is near your buttock and the tendon is retracted.

What to Expect

You can expect swelling, tenderness, and pain after a hamstring strain. Walking may be painful.

To help your hamstring muscle heal, you may need:

• Crutches if you cannot put any weight on your leg
• A special bandage wrapped around your thigh (compression bandage)

Symptoms, such as pain and soreness, may last:

• Two to five days for a grade 1 injury
• Up to a few weeks or a month for grade 2 or 3 injuries

If the injury is very close to the buttock or knee or there is a lot of bruising:

• It may mean the hamstring was pulled off the bone.
• You will likely be referred to a sports medicine or bone (orthopedic) doctor.
• You may need surgery to reattach the hamstring tendon.

Symptom Relief

Follow these steps for the first few days or weeks after your injury:

• Rest. Stop any physical activity that causes pain. Keep your leg as still as possible. You may need crutches when you have to move.
• Ice. Put ice on your hamstring for about 20 minutes, 2 to 3 times a day. Do not apply ice directly to your skin.
• Compression. A compression bandage or wrap can reduce swelling and ease pain.
• Elevation. When sitting, keep your leg raised slightly to reduce swelling.

For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol). You can buy these pain medicines at the store.

• Talk with your health care provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
• Do not take more than the amount recommended on the bottle or by your provider.

Getting Active Again

When your pain has decreased enough, you can begin light stretching and light physical activity. Make sure your provider knows.

Slowly increase your physical activity, such as walking. Follow the exercises your provider gave you. As your hamstring heals and gets stronger, you can add more stretches and exercises.

Take care not to push yourself too hard or too fast. A hamstring strain can recur, or your hamstring may tear.

Talk to your provider before returning to work or any physical activity. Returning to normal activity too early can cause reinjury.

Follow-up

Follow up with your provider 1 to 2 weeks after your injury. Based on your injury, your provider may want to see you more than once during the healing process.

When to Call the Doctor

Call your provider if:

• You have sudden numbness or tingling.
• You notice a sudden increase in pain or swelling.
• Your injury does not seem to be healing as expected.

Cianca J, Mimbella P. Hamstring strain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 68.

Hammond KE, Kneer LM. Hamstring injuries. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller’s Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 86.

Reider B, Davies GJ, Provencher MT. Muscle strains about the hip and thigh. In: Reider B, Davies GJ, Provencher MT, eds. Orthopaedic Rehabilitation of the Athlete. Philadelphia, PA: Elsevier Saunders; 2015:chap 24.

Switzer JA, Bovard RS, Quinn RH. Wilderness orthopedics. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach’s Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 22.

Last reviewed on: 6/8/2022

Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

4 Signs of a Hamstring Tear: Joshua D. Harris, MD: Orthopaedic Surgery

4 Signs of a Hamstring Tear: Joshua D. Harris, MD: Orthopaedic Surgery

Hamstring tears are among the most common types of sports injuries in the United States, accounting for millions of injuries and doctor visits every year. Of course, you don’t have to be an athlete to tear your hamstring. Tears also become more common as we age, and our hamstring muscles and tendons become weaker and less flexible.

As a leading orthopedic surgeon in Houston, Texas, Joshua Harris, MD, treats hamstring tears and related injuries using a patient-centered approach focused on restoring pain-free mobility, helping each patient reach their unique activity goals. In this post, he reviews the four most common signs of a hamstring injury so that you can get treatment as soon as possible.

Hamstring tears: The basics

Your hamstrings comprise three muscles:

• the biceps femoris
• the semitendinosus
• the semimembranosus

Hamstring tears that affect all three muscles are called complete tears, while tears that affect one or two are referred to as partial tears.

The hamstring muscles extend from under your buttocks down to just below your knee. Hamstring muscles join the bones via the hamstring tendons. Together, the muscles and tendons help your knees flex and bend, promoting mobility and balance.

Most hamstring tears happen when the muscles are overstretched and overloaded. Lots of factors make hamstring tears more likely, including:

• Muscle tightness
• Muscle weakness
• Older age
• Younger age, when muscles are still developing
• Poor conditioning or improper training
• Muscle strength imbalance

Tears are also more common among athletes who put a lot of repetitive strain on their legs, like dancers, sprinters, and those who play football, basketball, or soccer.

Four signs of a hamstring tear

Learning to recognize the most common signs of a hamstring tear is crucial for making sure you seek medical help right away to prevent the injury from getting worse. These are the four most common signs to look for.

Sharp pain

Hamstring tears are typically accompanied by sharp, acute pain in the back of the thigh or underneath the buttocks near the muscle attachment. Often, this pain is preceded by a “snapping” or “popping” sound at the moment of injury.

Swelling and bruising

Hamstring tears cause significant tissue damage, so it’s not surprising most people also experience some swelling and bruising. Swelling can become apparent within a few hours of the injury, while it might take a couple of days for bruises to appear.

Leg weakness

Your hamstrings are responsible for the movements of your hips and knees when you walk, run, squat, or bend. Most people who have a torn hamstring find their leg feels weak during any of these movements.

Problems bearing weight

In addition to weakness when moving or bending your leg, hamstring tears can make it difficult or impossible to bear weight on the leg. Many people report their leg feels like it will buckle or give way when attempting to put weight on it. Weight-bearing can also cause significant pain.

Treating hamstring tears

Hamstring tear treatment depends on several factors, including the extent of the tear and the physical condition and goals of the patient. Partial and full hamstring tears won’t heal on their own, which means that surgery is the recommended route to repairing the tear and restoring normal function in nearly every instance. 

Dr. Harris is skilled in endoscopic surgeries using small incisions and traditional “open” surgery with large incisions to provide more access to the injury site. The approach he uses depends on the extent of the tear and other factors. After surgery, you’ll undergo a period of physical therapy to restore function and strength in your leg.

If you think you’ve torn your hamstring or you have symptoms of a hamstring injury, call or book an appointment online and let Dr. Harris develop a treatment program aimed at helping you get back on your feet.

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Does your hamstring hurt? Hamstring Stretch Poses

Tight hamstrings?

For most of us, tight hamstrings are not a life sentence. By incorporating certain lifestyle changes along with some yoga hamstring stretching exercises, you will be on the right path to hamstring elasticity, eliminating knee pain.

In this article we will look at:

• What are hamstrings
• How to know if your hamstrings are tight
• Causes of strain and injury of the hamstrings
• Risks associated with strained hamstrings
• And 3 Hamstring Stretches to Relax Tight Muscles

Ready to relax? Let’s dive into it!

The hamstrings are actually tendons (or strong bands of tissue) located at the back of the thighs. Their role is to attach the large thigh muscle to the bone.

However, the term “hamstring” also refers to the group of three hamstrings that run along the back of the thigh, from the thigh to just below the knee.

What are hamstrings?

Hamstrings are a group of muscles that cross the hip and knee joints and are responsible for walking, running, jumping and many other physical activities. The hamstrings flex the knee joint and extend the hip back to provide movement. The hamstrings, located at the back of the legs, oppose the quadriceps. Since the hamstrings originate in the sitting bones, they naturally stretch when sitting. However, prolonged sitting can affect their performance and lead to embarrassment.

Hamstring Anatomy

The hamstrings attach to the bone at the ischial tuberosity (better known as the sit bones). This area is located at one end of the rough line, a ridge along the femur (thigh) bone. The hamstring tendons also surround the space behind the knee.

There are three main muscles that make up the hamstring muscle group. The biceps femoris is a large, long muscle located at the back of the thigh that includes both the long head and the short head. The semitendinosus muscle is located in the back and medial (inner) part of the thigh, and the semimembranosus muscle is the most medial of the hamstring muscles. Here’s a closer look at the hamstring muscle group.

Biceps femoris

The long head and short head of the biceps femoris are two muscles that work together to rotate the thigh outward at the hip joint and extend the leg backward. They make a major contribution to hip extension, but they also flex and laterally rotate the knee at the joint. The biceps femoris muscle is attached to the main part of the lateral part of the tibia (lower leg) and is innervated by the sciatic nerve.

Biceps femoris long head: The most lateral hamstring, long head or “superficial” biceps femoris inserts on the lateral side of the fibula (lower leg) and originates on the inside of the sit bones.
Short head of the biceps femoris: The short head of the biceps femoris originates at three locations on the femur that are closer to the knee than to the thigh.

Some experts do not consider the short head of the biceps femoris muscle to be part of the hamstring muscle group because it is the only muscle in the group that does not cross two joints.

Semitendinosus

Like the biceps femoris, the semitendinosus is a large, long muscle of the hamstring. It starts on the inside of the back of the thigh near the biceps femoris on the inside of the sit bones. It also crosses the knee and connects to the inside of the top of the tibia. It also attaches to the fascia of the leg. The semitendinosus extends the hip posteriorly and provides medial rotation (that is, turning the lower limb inward) of the hip and knee joint.

Semimembranosus

The medialmost muscle, the semimembranosus, inserts on the inside of the tibia. Like the semitendinosus, the semimembranosus is a broad muscle, albeit more hidden.

It originates in the sitting bones, like other muscles in the hamstring group. However, it mounts higher. It also connects to the inside of the upper tibia (the knee joint). The semimembranosus extends the hip joint and flexes and medially rotates the knee toward the midline.

How do you know if your hamstrings are tight?

If you have tight hamstrings, you probably know about it. Most likely, you feel soreness or stiffness in the back of your thighs, and when you tie your shoelaces or pull something down, you feel tension, heaviness, or discomfort.

Causes of hamstring tension?

So, you have a tight hamstring. But why do you have tight hamstrings?

There are several reasons why your hamstrings may be tight.

Let’s look at 8 main reasons:

• Too much chair sitting. When you sit in a chair, your knees remain bent, which means that your hamstrings remain in a shortened, contracted position. That’s why it can be helpful to change positions or get up for a brisk walk every 15 minutes or so when sitting for long periods of time.
• Overuse – common among athletes. Heavy physical activity on the legs, such as running or cycling, can strain the hamstrings.
• Muscular compensation. Your hamstrings may overcompensate for another weak muscle. – Weak glutes or tight hip flexors are often the cause of overexertion of the hamstrings.
• Trauma. An injured hamstring may be tight. The body often tenses the muscles to prevent further damage.
• Lower back problems. Injuries to the lower back can put pressure on the sciatic nerve. Your sciatic nerve runs down your spine and legs, and pressure on the spinal nerve can cause leg muscles to tighten.
• Muscle weakness. Perhaps your hamstring is weak. Often in this case, your nervous system can tense your muscles for stability.
• Genetics. You may have naturally tight hamstrings. Some hamstrings are shorter than others. In general, the hamstrings are more tense in men than in women.
• Don’t stretch after your workout. A good way to get your muscles to contract is to stretch them after a workout. Just 10 minutes should be enough.

Hamstring injuries

Overuse hamstring injuries are common, especially in sports such as football, football, basketball and tennis, where running is combined with quick starts and stops. The long head of the biceps femoris is especially prone to injury in these sports, probably because it exerts the most force compared to the other hamstring muscles.

Hamstring strains and tears are also quite common.2 And they can become more severe if there is significant bruising behind the thigh. Repetitive stress injuries from running or walking are also a common cause of hamstring pain and injury.

Stretch marks and bruises

The onset of injury to the hamstring muscle group is often sudden and is usually identified as a sprain (sprain or tear) or contusion (contusion). Strains range from mild to severe and include the following traits.

Mild sprains are associated with minimal muscle damage and heal quickly. They can be treated with rest and over-the-counter pain medications.
Moderate stress causes partial muscle tear and loss of function.
Severe deformities lead to complete tissue rupture and lead to short-term or long-term functional disability.

Contusions are caused by an external force coming into contact with the hamstring muscles, such as in many contact sports. Bruised symptoms include:5

• Muscle pain
• Swelling
• Bruising and discoloration
• Limited range of motion
• Hardness

If pain from a hamstring injury doesn’t go away within a few days or interferes with normal walking and daily activities, see your doctor for diagnosis and treatment.

What are the risks associated with tight hamstrings?

Tight hamstrings are bad enough on their own, but addressing the problem early can save you further controversy, as tight hamstrings can lead to a number of side effects, including:

• Opens you up to more knee injuries. When your muscles are tight, you risk tearing them if you move in a way that stretches your muscles at speed.
• Pain in the knees, back and feet. Tight hamstrings can cause the pelvis to tilt backward, flatten the lower back, and cause pain in the knee, back, or feet.
• Poor posture. Tight hamstrings can be the cause of your bad posture!

Strengthening exercises

Walking, running, climbing and descending stairs help to strengthen the functional fitness of the hamstring muscle group. Hamstring exercises can be beneficial for everyone, but they can be especially beneficial for people who run or cycle, both of which target the quadriceps. It is important to balance quad development with cross training that includes sufficient strength and hamstring conditioning.

Various isolated and compound hamstring exercises can also be used in rehabilitation or bodybuilding settings. Exercises that include knee flexion and hip extension are commonly used to develop the hamstrings. Here are a few basic moves to try.

Basic Bridges : This simple exercise isolates and strengthens the hamstrings and glutes. Plant your feet on the floor and engage your glutes to tighten your hamstrings and lift your hips.

Single Leg Bridges : Similar to Basic Bridges, Single Leg Bridges target the hamstrings and glutes with the added task of lifting the legs to increase core stability. Support the lift of the hips and pelvis using the strength of the glutes and hamstrings, not the back muscles.
Leg Curl: Also known as hamstring curl, these exercises are commonly performed on machines to strengthen the hamstring and calf muscles. They can also be done with an exercise ball, lying on your back with your heels on the ball, and then rolling the ball towards you, bending your knees and lifting your hips.

Squat : This classic exercise can be done with or without weights to work the hamstrings, glutes and quads. Keep your back straight and your head straight as you reach the back of the seat to lower yourself into a squat.

Walking Lunges : This stability exercise strengthens the hamstrings, quads, glutes, calves and core muscles while testing your balance. Keep your torso straight and straight as you step forward and backward.

When is hamstring stretching useless in yoga?

A good yoga hamstring stretch may or may not be exactly what your tight hamstrings need. It all depends on the root cause.

For example, if your hamstrings are tight due to muscle weakness, stretching them will only make them weaker. If your hamstrings are weak, you’d better focus on strengthening them rather than stretching them.

Take a look at some of the strengthening yoga poses here.

3 best yoga hamstring stretch

In addition to preventing long periods of sitting and correcting any injury or imbalance you may have in your body, stretching is a great way to lengthen and relieve stubbornly tight hamstrings.

No. 1: Standing forward bend (Uttanasana)

Let gravity do all the work in that front crease. You will feel a fantastic stretch not only in your hamstrings, but in your entire back.

How to do it:

1. Start at the top of the mat in Mountain Pose (Tadasana) with your arms at your sides.
2. Gently bend your knees and, as you exhale, bend at the hips to bend your torso down over your thighbones.
3. Place your hands on the mat. They can lie comfortably on the ground, as well as hang freely. Don’t force yourself into an uncomfortable position just to touch the mat. Respect where you are in your practice today.
4. Inhale and lengthen the spine. Exhale, straighten your legs and lift your kneecaps up your thighs.
5. Find the length at the neck and pull the crown down towards the ground.

Tips, Tricks & Options:

• Bend your knees. If the stretch in your hamstrings feels too much, go ahead and bend your knees.
• Clasp your elbows. Grasp each elbow with the opposite hand and let your head hang freely, freeing your neck. -Swinging from side to side will allow you to stretch the entire back and hamstrings well.
• Spread your knees. Leg variety, bending one knee at a time, can seem really good here. -This dynamic forward bend variation will warm up your hamstrings. Spread your legs apart for a few seconds before lowering into a more static forward bend.

#2: Half Split Pose (Ardha Hanumanasana)

This yoga hamstring stretch is intense, but don’t be put off by the words splits!

Don’t force it, watch your breathing, and if at any point you feel pain, come out of the pose.

How to do it:

1. Begin in a low lunge position with the right foot forward with the right knee over the right ankle and the left knee on the mat.
2. Move your hips back. Straighten your front leg, but don’t block it (keep it microflexed). Bend your back leg.
3. Bend your right leg towards your face and place your hands on the mat in the space under your shoulders.
4. Engage the quadriceps muscle of the front leg by pulling the patella up. Lengthen your torso and engage your abs.
5. For deeper stretching. Breathe.
6. Release and repeat the pose on the other side.

Tips, Tricks & Options :

• Bringing your hands to the mat can be very difficult, especially if your hamstrings are tight. -The good news is that you can deepen your incline using yoga blocks. And if you don’t have yoga blocks, a thick book or two is equally good.
• Avoid rounding or bending the spine in a half split. Try to bend at the hips and lead with your chest. This may mean that you are in a more upright position. It’s all good.
• If you feel your back knee is pushing too hard, fold your yoga mat or roll up a blanket for extra cushioning and support.
• Make sure your thighs stay parallel in this pose. The thigh on the side of the front leg tends to slide forward. Keep this in mind and move your hip back.

No. 3: Reclined Hand to Big Toe Pose (Supta Padangushthasana)

How to do it:

1. Start lying on your back.
2. Holding the long end of the strap in the right hand, extending the arm towards the leg. Keep the belt taut.
3. Until you feel a stretch in your hamstring.
4. Make sure your hips are straight and that both sides of your buttocks are flat on the floor.
5. Keep your raised leg bent and plant your stabilizing leg on the ground.
6. Hold here, breathing deeply.
7. To come out of this pose, bring your raised knee to your chest before lowering it, and repeat on the other side.

Tips, tricks and variations:

• Use the wall for stability by placing the ball of your lowered foot against the wall. It takes an incredible amount of core strength to keep from tipping over in this pose.
• Bend your lowered leg and plant your foot firmly on the mat for extra stability.
• Still feeling tense? The most effective for stretching, loading and relaxing the hamstrings is eccentric muscle training in hammocks.

Aerial yoga studio Vladimirskaya

Cycling Knee Pain: How to Build Hamstring Strength to Avoid Injury – Bicycles

Strong hamstrings will allow you to pedal more efficiently throughout your ride and reduce your risk of injury.

Common forms of cycling pain, such as back pain, are often due to hamstring weakness. Therefore, strength training for cycling should target these often overlooked muscles.

The muscles used during cycling are primarily the quadriceps in the front of the thigh and the hamstrings. They can be underdeveloped, leading to muscle imbalances, a common cause of knee pain when you pedal.

While this article is more about stretching and strengthening the hamstrings, we also recommend foam roller exercises to stretch tight muscles and core training to make your back more resilient for long rides.

When it comes to positioning on a road bike, it is very important to know how to choose the right saddle height. A saddle that is too high can place undue stress on the hamstrings.

What kind of hamstrings do you have?

Hamstrings is a collective term often used for the hamstrings.

They consist of the semitendinosus, semimembranosus, and biceps femoris, a series of muscles that encircle the thigh, crossing the thigh and knee.

Muscles start just below the buttocks where they attach to the lower thigh and connect to the top of the lower leg bones (tibia and fibula). The hamstrings flex the knee and straighten the hip.

How do the hamstrings work when cycling?

When you pull your leg up at the bottom of the pedal stroke, the hamstrings are the most stressed.

But because pedaling doesn’t fully extend the hip, cyclists can injure their hamstring muscles over time.

Why do my hamstrings hurt when I ride a bike?

Cycling for long periods, especially when you are very tired, can increase your risk of developing a hamstring strain, which usually occurs at the junction of a muscle with a tendon (myotendin junction).

The risk of injury is also increased when the hamstrings become fatigued from pedaling in low gear and/or maintaining a low cadence.

How to get rid of hamstring pain while cycling?

Doing a series of hamstring exercises 2-3 times a week can improve pedaling and reduce the chance of muscle strain or tear.

It’s also helpful to stretch your hamstrings after riding, holding each stretch for at least 30 seconds while taking a deep breath.

Cyclist Hamstring Stretch

1. Box Stretch

Lie on your back and raise your legs to about 45 degrees, then bend one of them to rest your feet on a box 30-40 cm high.

Gently lift your hips, keeping your abs tight and pushing your heel into the box.

Raise your hips until a straight line forms between your knee, hip and shoulder. Hold this position for 2 seconds and repeat 10-12 times. Don’t forget about the other leg too – do the same.

2.

Upside Down Dog Pose

Downward Dog Pose relieves tension in the spine, hips and hamstrings.

Get on all fours and put your hands in front of your shoulders. Stretch your toes forward.

Exhale, then, pulling your toes in, lift your knees, straighten your legs and lift your bottom. At the same time, move onto your feet and try to press your heels into the ground.

Press down on your shoulders and push your buttocks back to feel the stretch in your back and hamstrings.

Hold for 10 seconds, then repeat several times.

3. Abs/hamstring stretch

Although this movement is called a stretch, it tests your stability and balance.

Get down on one knee and then extend the other leg in front of you, gradually lowering your heel to the floor.

Be careful not to twist your hips or turn towards the outstretched leg. This exercise relaxes the hamstrings and hip flexors, another area where cyclists tend to lack tension.

4. Towel exercise

Lie on your back with one leg extended along the door.

Take the other leg behind the knee and, keeping it straight as you feel comfortable, pull the knee towards the head.

A towel around the leg will help create more tension in the muscle and stretch the Achilles.

5. Squat and stretch

Sit straight and stretch both legs out in front of you. Lean forward from your hips.

Hold on to your legs as far as you can reach, either by your fingertips or by your feet.

If you are a flexible person, you can increase the difficulty of the exercise by reaching for a towel.

Try to keep your chest up to better stretch your leg muscles.

Hamstring Strengthening for Cyclists

1. Hamstring Crunches

Hamstring Crunches can be performed with a band, leg weights, or leg extension machine.

To perform a free weight or band variation, lie on your back with your legs extended straight behind you.

Raise your legs to the bottom, hold briefly, then slowly lower them to the floor.

Add weight or resistance (with band) if you don’t feel your hamstrings contract.

Repeat 12-15 times for 2-3 sets. Hamstring crunches can be done on one leg or both at the same time.

2. Glute bridge with ball

The glute bridge also strengthens the hamstrings, especially if you use the exercise ball.

To perform this exercise, lie on your back with your legs straight and feet on the ball.

Raise your hips and pull your legs (still on the ball) towards you.

Hold for a couple of seconds, then slowly lower your hips and straighten your legs, pushing the ball away from you.

Since this is a heavy exercise, do 5-6 reps and 2-3 sets.

3. Squats

Squats and all variations of this exercise work the hamstrings in a very different way than we use this muscle group on a bicycle.

The technique for doing most squats is to start with your feet shoulder-width apart or slightly wider.