Updated 1 February 2022 | Approved By Dr. Umberto Russo
What is a Hamstring Strain?Hamstring strains are one of the most common sports injuries globally. According to the official 2020 injury report by the AFL, hamstring strains were the highest rate of injury in the league. Also known as a ‘pulled hamstring’ or ‘hamstring tear’, this type of injury frequently occurs during powerful activities, such as running or kicking. Muscle fibres in the hamstring can overstretch or tear upon injury. Seeking the support of a GP is recommended for getting a prompt diagnosis and necessary treatment. Recurring injuries and delayed recovery is a possibility if it is not appropriately managed.
What is a strain?‘Strain’ is a medical term used to describe a stretch or tear injury to the muscle and/or tendon. It can be graded into three different categories based on the severity of the injury .
- Grade 1 strain: Mild injury leads to the overstretching of muscle/tendon structures and a loss of 5% of function.
- Grade 2 strain: Moderate injury leads to tearing muscle/tendon structures and losing 5-50% of function.
- Grade 3 strain: A complete tear or rupture of the muscle/tendon. More than 50% of the function has been lost.
Overview of the Hamstring AnatomyThe anatomy of the hamstring describes the location and function of this muscle group. Having an understanding of how it works can assist with your recovery.
Where is your hamstring?Your hamstring is located at the back of your thigh. It is a group of 4 muscles called the short head of biceps femoris, long head of biceps femoris, semitendinosus and semimembranosus. They start at the hamstring origin (i.e. ischial tuberosity and linea aspera) located at the back of the hip and bottom. These muscles then travel downwards to the back of the knee, where they attach behind the knees at the hamstring insertion (i.e. tibia, fibula).
Hamstring FunctionThe hamstring function describes the role that these muscles play during our day-to-day movements, including:
- Knee flexion (i.e. the ability to bend our knee)
- Hip extension (i.e. the ability to bring our hip backwards)
- Providing stability and some rotation around the knee
- Helping push-off the ground when walking, jogging and running
SymptomsSymptoms of hamstring strains can generally be felt immediately after the injury, which includes:
- Swelling around the back of the thigh.
- Hamstring pain, especially as you bend and straighten the knee (e.g. walking, kicking, etc.).
- Tenderness around the hamstring when you touch or press it. Bruising around this area can also appear shortly after injuring it.
- Weakness during knee and hip movement.
Hamstring Strain CausesLike many strain injuries, this condition is caused by stretching and/or overload to the hamstring. Overload occurs when the muscles are under too much weight or intensity. The risk of overload can happen if you are fatigued, experienced previous hamstring injuries, have insufficient conditioning or have not recovered enough. Examples of common causes include:
- Overstretching movements, particularly during quick and vigorous activities (e.g. kicking, running, etc.)
- Loading against heavy resistance (e.g. squatting, picking up heavy boxes from the ground, etc.)
- Sudden and explosive movements (e.g. sprinting, hopping, etc.)
Tests and Diagnosis
Clinical ExaminationHamstring strains can be diagnosed clinically after your GP takes your medical history and conducts a physical examination. Information that may be required includes how it happened, understanding your previous injuries and your current symptoms. Additionally, signs such as limping, bruising, weakness, tightness and tenderness on touch may also be used to determine signs of injury.
Imaging investigationsImaging techniques will not always be required for a diagnosis. However, your GP may refer you for a scan to determine the severity of the strain and/or rule out other conditions. Examples of imaging that may be recommended include ultrasounds and MRIs.
Hamstring Strain Treatment
Pain Management and AdviceEspecially during the first stage of the hamstring injury, pain can be a limiting factor during your day-to-day activities. Your GP may recommend treatment and advice to help manage your discomfort.
- Resting from activities that may aggravate your injury
- Wearing a compression stocking
- Elevating the leg
- Applying ice on the muscle
- Temporarily using a crutch to help you move
- Supplements and/or medications
PhysiotherapySeeking physiotherapy is vital for the recovery and prevention of future injuries. Treatments, such as sports massage, dry needling and electrotherapy, can help with reducing symptoms. However, hamstring strain rehabilitation is the most pivotal part of physiotherapy. Especially if you’re looking to return to sports or work safely, regular guidance with specific hamstring strain exercises is necessary. Your GP can help refer you to a qualified physiotherapist where several sessions may be required.
Specialist ReferralYour GP may also choose to refer you to consult with an orthopaedic specialist or sports physician if you have sustained a severe injury. Further treatment options, such as injections or surgery, may be recommended.
Hamstring Strain RecoveryA hamstring strain recovery timeline can vary depending on several factors, such as the injury severity and previous hamstring injuries. Mild injuries, such as grade 1 hamstring strains, can heal as soon as 4-6 weeks. In contrast, grade 3 hamstring strains may require 6-12 months of medical treatment and rehabilitation before recovery. Research has shown that, on average, it takes 23-43 days to return to sports after a hamstring strain .
ComplicationsWith proper treatment and rehabilitation, most hamstring strains will recover and have positive outcomes. More severe injuries, such as complete tears and ruptures, may require surgery. Additionally, there is a risk of re-injuring the hamstring upon returning to your usual activities . Seeking advice from your GP can help with a safe long-term recovery and reduce the risk of another injury.
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- Grassi, A., Quaglia, A., Canata, G. L., & Zaffagnini, S. (2016). An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints, 4(01), 039-046.
- Erickson, L. N., & Sherry, M. A. (2017). Rehabilitation and return to sport after hamstring strain injury. Journal of sport and health science, 6(3), 262-270.
- Brukner, P., Nealon, A., Morgan, C., Burgess, D., & Dunn, A. (2014). Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. British journal of sports medicine, 48(11), 929-938.