What are the hamstrings?

The hamstrings are a group of muscles at the back of the thigh.

They include:

• Biceps femoris

• Semitendinosus

• Semimembranosus

The hamstrings cross both the hip and knee and are involved in:

• Bending the knee

• Extending the hip

• Controlling the leg during running

• Decelerating the lower limb

• Sprinting

• Jumping

• Changing direction

The hamstrings are particularly heavily loaded during high-speed running, making sprinting a common trigger for injury.

What is a hamstring injury?

A hamstring strain occurs when the muscle or musculotendinous tissue is exposed to a load that exceeds its current capacity.

Injury severity can range from minor disruption of muscle fibres to a complete tear.

Hamstring injuries most commonly occur during running, particularly when the leg is rapidly moving into hip flexion and knee extension while the hamstrings are working at high force.

What causes hamstring injuries?

Hamstring injuries can occur suddenly or develop more gradually.

Common situations include:

• Sprinting

• Accelerating

• Decelerating

• Changing direction

• Kicking

• Jumping

• Returning to sport after a break

• Rapidly increasing running volume

• Rapidly increasing high-speed running

• Fatigue during exercise

Previous hamstring injury is one of the most important risk factors for sustaining another hamstring injury.

Symptoms of a Hamstring Injury

Typical symptoms include:

• Sudden pain at the back of the thigh

• A pulling or tearing sensation

• Pain during running

• Pain when accelerating

• Tenderness in the hamstring

• Pain when stretching the hamstring

• Weakness

• Bruising

• Swelling

• Reduced running speed

• Pain when sitting in some cases

A significant tear may cause immediate difficulty continuing exercise.

Where does hamstring pain occur?

Hamstring pain can occur anywhere along the back of the thigh.

The most commonly injured area is around the musculotendinous junction of the biceps femoris, although injuries can affect the semitendinosus, semimembranosus or the tendon near the sitting bone.

The location of pain can provide useful information, but a detailed clinical assessment is needed to establish the likely structure involved.

Hamstring Injury Grades

Hamstring injuries are sometimes described according to severity.

Grade 1

A relatively minor injury involving a small amount of tissue damage.

There may be pain or tightness, but strength and function are usually relatively well preserved.

Grade 2

A partial tear involving more significant tissue damage.

There is generally greater pain, weakness and functional limitation.

Grade 3

A severe or complete tear involving substantial disruption of the muscle or tendon.

This can cause significant weakness and difficulty walking or running and may require specialist assessment.

The grade of injury is only one part of determining recovery. Your symptoms, strength and ability to progressively load the hamstring are also important.

Hamstring Injury Assessment

A physiotherapy assessment will consider both the injury itself and the factors that may have contributed to it.

Your physiotherapist may assess:

• Location of pain

• Mechanism of injury

• Hamstring tenderness

• Strength

• Pain during resisted knee flexion

• Hip extension strength

• Hamstring length and tolerance to stretch

• Single-leg control

• Running technique

• Sprinting capacity when appropriate

• Recent training load

• Previous hamstring injuries

The aim is to establish the likely severity of the injury and determine how best to progress your rehabilitation.

Hamstring Treatment

The most important component of hamstring rehabilitation is progressive loading.

Rather than simply waiting for the pain to disappear, rehabilitation aims to gradually restore the hamstring's ability to tolerate the high forces required for running and sport.

Early rehabilitation

In the early stages, treatment may include:

• Relative rest from aggravating activities

• Maintaining comfortable movement

• Gradual walking

• Isometric strengthening

• Maintaining general fitness where appropriate

High-speed running, sprinting and aggressive stretching are generally avoided initially if they significantly aggravate the injury.

Hamstring Strengthening

Strengthening should progress as your symptoms and capacity improve.

Exercises may include:

• Hamstring isometrics

• Hamstring curls

• Bridges

• Single-leg bridges

• Romanian deadlifts

• Hip extension exercises

• Slider or towel curls

• Nordic hamstring exercises

• Progressive gym-based strengthening

Both the hamstring muscles and surrounding hip and lower-limb muscles should be considered.

Eccentric Hamstring Strength

Hamstrings need to tolerate high levels of force while lengthening during running.

For this reason, rehabilitation often includes exercises that challenge the hamstrings under eccentric loading.

Examples include:

• Romanian deadlifts

• Nordic hamstring exercises

• Slider curls

• Single-leg hip hinge exercises

These exercises should be introduced progressively rather than immediately after an acute injury.

High-Speed Running Rehabilitation

One of the most important aspects of hamstring rehabilitation is progressively exposing the hamstring to higher running speeds.

A person may be able to jog comfortably but still not have sufficient capacity for sprinting.

A typical progression might be:

Walking → jogging → faster running → controlled acceleration → high-speed running → sprinting

The exact progression depends on the injury and the demands of your sport.

Returning to maximum-speed running without adequate preparation is a common reason for recurrent hamstring injuries.

Return to Sport

Returning to sport should involve more than simply being pain-free.

Depending on your sport, rehabilitation may include:

• High-speed running

• Sprinting

• Acceleration

• Deceleration

• Cutting

• Jumping

• Kicking

• Sport-specific drills

Your rehabilitation should progressively reproduce the demands you will encounter during competition.

How Long Does a Hamstring Injury Take to Heal?

Recovery varies considerably depending on the severity and location of the injury.

A mild strain may improve within a few weeks, while a more significant injury can require several months of rehabilitation.

Recovery can be influenced by:

• Severity of the injury

• Location of the injury

• Tendon involvement

• Previous hamstring injuries

• Strength

• Running demands

• Rehabilitation progression

• How quickly high-speed running is reintroduced

Pain often improves before the hamstring has regained its previous capacity, which is why a structured return-to-running programme is important.

Recurrent Hamstring Injuries

Hamstring injuries have a relatively high recurrence rate, particularly during the early stages after returning to sport.

Potential contributors include:

• Returning to sprinting too quickly

• Inadequate strength rehabilitation

• Insufficient exposure to high-speed running

• Sudden increases in training load

• Previous hamstring injury

• Failure to restore sport-specific capacity

A successful rehabilitation programme should therefore continue beyond the point where everyday activities become pain-free.

Preventing Hamstring Injuries

It is not possible to completely eliminate the risk of hamstring injury, but appropriate preparation can help reduce risk.

Useful strategies include:

• Regular hamstring strengthening

• Progressive exposure to high-speed running

• Maintaining strength during periods away from sport

• Gradually increasing training volume

• Appropriate recovery between high-intensity sessions

• Continuing rehabilitation after symptoms resolve

The Nordic hamstring exercise is commonly incorporated into injury-prevention programmes for field and running athletes, although it should form part of a wider strength and conditioning programme.

Hamstring Tendon Injuries

Not all hamstring problems are muscle strains.

Pain near the sitting bone, particularly pain that develops gradually and is aggravated by prolonged sitting, running or stretching, may involve the proximal hamstring tendon.

This is sometimes referred to as proximal hamstring tendinopathy.

The rehabilitation approach can differ from that used for an acute muscle strain, making an accurate assessment important.

Do I Need an MRI for a Hamstring Injury?

Most straightforward hamstring strains can be diagnosed clinically and do not require imaging.

MRI may be considered when:

• The diagnosis is uncertain

• The injury is severe

• There is significant weakness

• A major tendon injury is suspected

• Symptoms are not improving as expected

• The injury occurred close to the sitting bone

• Surgery may be being considered

Imaging findings should always be interpreted alongside your symptoms and physical examination.

When Should I See a Physiotherapist?

Consider a physiotherapy assessment if:

• You felt a sudden pain or tearing sensation

• You cannot run normally

• You have significant bruising or swelling

• You have persistent hamstring pain

• Your symptoms return whenever you increase running

• You have suffered repeated hamstring injuries

• You are unsure when to return to sport

• You want to reduce your risk of re-injury

Early assessment can help establish an appropriate rehabilitation plan and identify factors contributing to recurrent problems.

Frequently Asked Questions

How do I know if I have torn my hamstring?

A hamstring tear often causes sudden pain during sprinting, acceleration or another high-load movement.

You may experience a sharp pulling or tearing sensation, followed by pain, weakness and sometimes bruising.

Should I stretch a hamstring strain?

Aggressive stretching is generally not recommended during the early stages of a significant hamstring injury.

As the injury progresses, movement and loading can be gradually increased. Your physiotherapist can determine when stretching is appropriate.

Should I massage a hamstring strain?

Deep massage is generally avoided immediately following a significant muscle injury.

Manual therapy may sometimes be used later in rehabilitation, but progressive strengthening and exposure to running loads are usually more important for restoring function.

Can I run with a hamstring injury?

Running is usually reduced or temporarily stopped following an acute hamstring strain.

You can progressively return to running once you have regained sufficient strength and tolerance. High-speed running should be reintroduced gradually.

How long should I rest after a hamstring strain?

There is no fixed rest period that applies to every injury.

The early aim is to reduce activities that significantly aggravate symptoms while maintaining appropriate movement and general fitness. Progressive strengthening should then be introduced as soon as appropriate.

Why does my hamstring keep getting injured?

Recurrent hamstring injuries can be associated with inadequate strength, rapid increases in training, insufficient exposure to high-speed running and returning to sport before the hamstring has regained its previous capacity.

A detailed assessment can help identify the likely contributing factors.

What are the best exercises for a hamstring injury?

Rehabilitation usually progresses from isometric exercises and basic strengthening towards heavier resistance, eccentric loading and eventually high-speed running.

Exercises may include bridges, Romanian deadlifts, hamstring curls, slider curls and Nordic hamstring exercises.

Are Nordic hamstring exercises good for preventing injury?

Nordic hamstring exercises can improve hamstring strength and are commonly used as part of injury-prevention programmes.

They should be introduced progressively and incorporated into a wider strength and conditioning programme.

When can I return to sport after a hamstring injury?

You should be able to tolerate the demands of your sport before returning fully.

This may include high-speed running, sprinting, acceleration, deceleration and sport-specific movements.

Do I need an MRI for a hamstring injury?

Most uncomplicated hamstring strains do not require an MRI.

Imaging may be considered when the injury is severe, symptoms are persistent or a significant tendon injury is suspected.

Can a hamstring injury cause long-term pain?

Most hamstring injuries recover well with appropriate rehabilitation. However, persistent symptoms can occur, particularly following recurrent injuries or injuries involving the proximal hamstring tendon.

Persistent pain should be reassessed rather than simply ignored.

Hamstring Injury Physiotherapy in Newcastle

At NE Physio, we provide assessment and rehabilitation for hamstring strains, muscle tears and persistent hamstring pain in Newcastle.

We assess your injury, strength, running capacity and training load before developing a progressive rehabilitation programme tailored to your goals.

Whether you want to return to running, get back to football, resume competitive sport or exercise without pain, we can help you work through the stages of recovery.

Book Your Hamstring Injury Assessment

If you have injured your hamstring or are experiencing persistent or recurrent hamstring pain, book a physiotherapy assessment with NE Physio in Newcastle.