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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 term “hamstring”  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.


symptoms of a hamstring strain include:


pain in the back of your thigh when you bend or straighten your leg

tenderness, swelling, and bruising in the back of the thigh

weakness in your leg that lasts for a long time after the injury.


How Can You Prevent a Hamstring Strain?

Keeping your muscles in good shape is the best way to prevent hamstring injuries. Here are some ways to help protect yourself against them (and other sports injuries!)


Warm up properly before exercise or intense physical activity.

Keep your muscles strong and flexible year-round

 Increase the duration and intensity of your exercise slowly

 If you feel pain in your thigh, stop your activity immediately


 Diagnostic Procedures:


Most of the acute injuries can easily be found by letting the patient tell how the injury occurred. To be sure they must do a little investigation of the hamstrings as well.


When the therapist isn’t too sure, he can ask for medical imaging. This will exclude all other possibilities.



Ultrasound (US)

Magnetic Resonance Imaging


 Risk factors:


Hamstring injury risk factors include:

Sports. Sports that require sprinting or running might make a hamstring injury more likely. So might other activities that can require extreme stretching, such as dancing.

Earlier hamstring injury. People who have had one hamstring injury are more likely to have another one. This is especially true for people who try to go back to the same activities before the muscles have time to heal.

Tired muscles, weak muscles and muscles that don’t stretch well. Tired or weak muscles are more likely to be injured. Muscles with poor flexibility might not be able to bear the force of the action that certain activities require.

Muscle imbalance. Although not all experts agree, some suggest that a muscle imbalance may lead to a hamstring injury. If the quadricep muscles along the front of the thigh are stronger and more developed than the hamstring muscles, injury to the hamstring muscles might be more likely.

Age. Risk of injury increases with age




Hamstring stretch


The first goal of treatment is to reduce pain and swelling.

Take a break from strenuous activities to allow the injury to heal.

Apply ice packs several times a day to relieve pain and reduce swelling.

Wrap the injured area with a compression bandage or wear compression shorts to minimize swelling.

Rest with the leg elevated above the level of the heart, if possible, to lessen swelling.

Take pain medicine you can get without a prescription. Examples include ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others).


 Rehabilitation Protocol

Phase I (week 0-3)



Protect healing tissue

Minimize atrophy and strength loss

Prevent motion loss




Avoid excessive active or passive lengthening of the hamstrings

Avoid antalgic gait pattern




Ice – 2-3 times daily

Stationary bike

Sub-maximal isometric at 90, 60 and 30

Single leg balance

Balance board

Soft tissue mobs/IASTM

Pulsed ultrasound (Duty cycle 50%, 1 MHz, 1.2 W/cm2)

Progressive hip strengthening

Painfree isotonic knee flexion

Active sciatic nerve flossing

Conventional TENS

Criteria for progression to the next phase


Normal walking stride without pain

Pain-free isometric contraction against submaximal (50%-75%) resistance during prone knee flexion at 90.


 Phase 2 (week 3-12)



Regain pain-free hamstring strength, progressing through full ROM

Develop neuromuscular control of trunk and pelvis with a progressive increase in movement and speed preparing for functional movements



Avoid end-range lengthening of hamstring if painful



Ice – post-exercise

Stationary bike

Treadmill at moderate to high-intensity pain-free speed and stride

Isokinetic eccentrics in the non-lengthened state

Single limb balance windmill touches without weight

Single leg stance with perturbations

Supine hamstring curls on theraball


Nordic hamstring Ex

Shuttle jumps

Prone leg drops

Lateral and retro band walks

Sciatic nerve tensioning

Eccentric protocol


Once non-weight bearing exercises are tolerated start low-velocity eccentric activities such as stiff leg deadlifts, eccentric hamstring lowers/Nordic hamstring Ex*, and split squats.



 Phase 3 (week 12+)



Symptom-free during all activities

Normal concentric and eccentric strength through full ROM and speed

Improve neuromuscular control of trunk and pelvis

Integrate postural control into sport-specific movements



Train within symptoms free intensity



Ice – Post-exercise – as needed

Treadmill moderate to high intensity as tolerated

Isokinetic eccentric training at end ROM (in hyperflexion)


Plyometric jump training

5-10 yard accelerations/decelerations

Single-limb balance windmill touches with weight on an unstable surface

Sport-specific drills that incorporate postural control and progressive speed

Eccentric protocol


Include higher velocity eccentric exercises that include plyometrics and sports-specific activities

Examples: include squat jumps, split jumps, bounding and depth jumps, single leg bounding, backward skips, lateral hops, lateral bounding, zigzag hops, bounding, plyometric box jumps, eccentric backward steps, eccentric lunge drops, eccentric forward pulls, single and double leg deadlifts, and split stance deadlift (good morning Ex)

Return to sports criteria


Full strength without pain in the lengthened state testing position

Bilateral symmetry in knee flexion angle of peak torque

Full ROM without pain

Replication of sport-specific movements at competition speed without symptoms.

Isokinetic strength testing should be performed under both concentric and eccentric action conditions.