A hamstring tear is agonizing – just imagine a rugby player intercepting the ball and sprinting towards the goal line. But then something goes wrong, he slows down suddenly, clutching the back of his thigh. Torn hamstring muscles are extremely common sports injuries, accounting for up to 30% of the leg injuries seen in athletes.

Even though many of the hamstring tears we see are in athletes, sprinting isn’t the only activity that leads to this kind of problem. The sudden pull on your hamstring from slipping on wet tiles or quickly picking up something off the floor can also strain or even tear your hamstring.

Your hamstring is actually a group of three muscles: the semimembranosus, semitendinosus, and biceps femoris. The latter consisting of a long head and a short head. These muscles form the back part of your thigh, running from your ischium, or “sitting bone”, to your knee. Semimembranosus and semitendinosus are located on the inside, in other words closest to your other leg, while the biceps femoris forms the outer part of your thigh. All these muscles attach to both your thigh bone (femur) and hip/pelvic bone (ischium). A pull, strain or tear in any of these muscles at the back of your thigh is referred to as a hamstring injury.

Probably the best known function of your hamstrings is bending your knee. Without this group of muscles you wouldn’t be able to sit down in a chair, put on your shoes or even get into a car. As each muscle inserts at a different point around your knee, your hamstrings also play a vital role in the stability of your knee. This becomes more and more important the faster you move, especially when it comes to changing direction.

Another major, but lesser known function of your hamstrings, is extending your hip. In a nutshell, this means the backwards movement of your hip and thigh. The bigger picture is actually much more intricate and complex than simply taking a step back. Your hamstrings play a crucial role in the balance and stability of your pelvis whenever you’re standing, walking or running. Without hamstring control, flexibility and strength, everything above and below your hips will be out of alignment.

The last function that’s worth mentioning is your hamstrings’ ability to decelerate movement. When you kick a ball or sprint, your leg has a natural stopping point before it comes back to its starting position. Without hamstring flexibility, strength and motor control, you won’t be able to stop this forward motion, leading to muscle-, ligament- or even nerve injuries.

Imagine yourself running a race. As another runner prepares to pass you, you instinctively speed up to maintain your position in the race. This sudden increase in force and tension means that your hamstrings work extremely hard to push your forwards and then pull your leg back again to restart the cycle. The rapid contraction (shortening) and lengthening of muscles result in overloading or ‘pulling’ on the muscle, causing tears due to strain.

Does this mean that a torn hamstring only happens during running? Unfortunately not. If you’re rushing around your house or a shop then trip and fall, the sudden pull on your hamstrings can also result in a strain or tear.

Overuse: Increasing your running distance too fast or sudden high repetition of hamstring contractions.
Overload: Often a single episode of overuse, for instance doing 100 lunges at once or lifting a heavy object from the floor.
Overstretch: Running or even a brisk walk downhill will force your hamstring muscles to contract from a lengthened position where it needs to work much harder to keep you upright.
Weakness: Similar to overload, this happens when you do a exercise or activity you aren’t used to and your hamstrings aren’t strong enough to do.
Poor technique: During training that overloads or puts excessive strain on your hamstrings.
Inadequate warm-up: Warm-ups prepare your muscles and nerves for the activity you are about to do, especially when you need flexibility for the task.
Excessive stretching: A hamstring that feels tight doesn’t necessarily need stretching; a weak muscle often feels tight without actually being in a shortened position.

Grade 1 (mild)

A small amount of muscle fibers are torn, so there won’t be any bruising or swelling. You will feel tension in your injured hamstring when you stretch, like touching your toes, but your range of movement won’t be noticeably less. Your hamstring muscles will feel stiff early in the morning when you start walking or at the beginning of training. This tightness eases as soon as you warm up. You can still carry on with your normal day to day activities like sitting, walking, driving or jogging, but will have some discomfort when climbing stairs or taking big steps.

Grade 2 (moderate)

Grade 2 tears are when less than 50% of the muscle fibers are torn. You will notice some swelling and bruising, although this might only happen a day or two after the injury. Stretching to touch your toes or bending forwards at a kitchen counter will be painful. Getting out of bed in the morning will be challenging due to discomfort and stiffness. The stiffness eases after about 30 minutes, but doesn’t go away completely. In your daily activities you will always be aware of a painful spot in your hamstring, and will instinctively take shorter steps to avoid the pain.

Grade 3 (severe)

This is the most severe tear with a complete rupture of 50% or more of the the muscle fibers. There will be significant swelling and bruising over the painful area. Any movement that stretches your hamstring will be excruciating, even something as simple as straightening your leg to take a step. In less severe tears, the dominant feature is stiffness and discomfort, but in a grade 3 tear the most noticeable feature is pain. Taking any weight on your leg is agony and you will need support to walk. Instead of a painful spot, as with a grade 1 and 2 tear, a large area of your thigh will be painful.

Physiotherapists diagnose injuries through physical examination and palpation of all the muscles and tendon attachments. We test the different muscles by contracting and stretching them in various positions to precisely determine the location and severity of the tear.

This approach allows us to form a clear picture of where and how severe the tear is. With this information, we can estimate the duration of recovery and best treatment plan for your injury. We guide you through a rehabilitation program focused on gradual strengthening, lengthening, and conditioning of the muscle. During each session, we monitor your progress to determine when it’s safe to start walking without crutches, add stretches, climb stairs, and return to training. In most cases, additional tests such as X-rays, CT scans, or MRI scans are unnecessary.

An x-ray image does not show muscles, so it’s not a useful test to diagnose your torn hamstring. We will refer you for x-rays if necessary, for example if we suspect an avulsion fracture or other bony defects associated with your injury.

We can refer you for an ultrasound assessment (diagnostic ultrasound) to determine the depth and length of the hamstring tear or rupture. This provides a more detailed and accurate indication of how long your recovery will take.

An MRI scan is unnecessary in most hamstring tears, unless we suspect a bigger problem that can’t be picked up with diagnostic ultrasound.

When you have a muscle tear, your body starts to repair the injured fibers by sending cells to bridge the gap between the torn ends of the muscle fibers. This process is exactly the same as when your body heals a cut or laceration in your skin. However, if you keep pulling and twisting the injured area, you will keep on tearing the newly repaired cells. The more you walk or run through the pain, the longer it will take to heal.

If the pain returns every time you start running, you’ve overlooked the most vital aspect of the cause of the muscle tear. Your muscle must return to its normal length before you go back to your normal activities. If you take a few days off the pain you’re aware of in your thigh will disappears, but the underlying healing and recovery still needs time to get your muscle back to normal again. If the muscle length is not restored, you will rip the wound wide open and have to start from the beginning again.

Unfortunately, patients often arrive at our practice too late, typically 4 to 6 weeks after the initial injury. During these crucial initial weeks, there is much we can do to aid in the healing process and facilitate a shorter recovery time through guided progress. Without early treatment, considerable scar tissue forms as the hamstring tear heals. Scar tissue is less flexible than muscle fibers, so now you’re stuck with a permanent “knot” in your hamstrings. Additionally, in a tear in the upper part of your hamstrings, the scar tissue can entrap your sciatic nerve, resulting in nerve pain similar to sciatica.

Another problem we see is resting and protecting the area too long. Keeping your knee bent during healing might help with pain, but now your torn hamstring heals in a shortened position. A tight, inflexible hamstring is a recipe for reinjury.

Physiotherapists effectively treat hamstring strains, focusing on regaining full muscle length and strength. We also play a vital role to monitor your progress, prevent complications, and guide you to the best possible healing outcomes. If you are uncertain about the diagnosis, rather contact us for an assessment and advice.

We apply various modalities, including ultrasound and laser, to stimulate healing. Other treatment modalities like rigid taping and kinesiology taping are used to protect the injured structures. For pain management, physiotherapists apply treatment techniques like dry needling, myofascial release and joint mobilization and other electrotherapy modalities to support the recovery process and get you up and about as soon as possible. Throughout the whole healing process, we will also guide you through an individualized rehabilitation program to regain full function of your hamstring muscles.

Recovery time will be determined by the severity of your injury. If you see a medical professional shortly after injury, we can diagnose and grade your hamstring tear. This allows us to give you advice about pain management, relative rest and which activities to avoid during each phase of healing. Starting physiotherapy treatment during the acute phase, will ensure that you have the best possible chance to heal without complications.

Your hamstring can handle a certain amount of loading, strain or tension during each phase of healing. Therefore, we will see you twice in the first week after your injury to monitor your progress. As you heal, the amount of tension on your torn hamstring can gradually increase, so we need to see you for a follow-up once a week to keep on monitoring progress and adapt your exercises. After the first 3-4 weeks of treatment, we will see you every second week and then once a month to ensure that your rehabilitation program is matched with your phase of healing.

• Your doctor (GP) can prescribe pain medication, if necessary.
• The use of medication that stops inflammation is not recommended for a hamstring tear.
• Chiropractic adjustment or back “alignment” will not fix your hamstring injury or get you better any faster. Strong techniques, like an adjustment, could actually make your injury worse.
• A biokineticist plays a role in the final stages of your rehabilitation, after tissue healing and recovery.
• Wearing a knee brace is useful in the case of more severe hamstring tears when you need to limit or block knee movement to ensure healing or the damaged muscle.
• The effects of stretching or foam-rolling will depend on the severity of your injury and, more importantly, the phase of healing you are in. Stretching is not advisable in the early stages of healing, because it will cause more bleeding and further damage. 

Non-surgical management is the first choice of treatment for clear-cut, isolated injuries of the hamstring muscles. Surgery is a last resort, and only considered if your hamstring injury fails to respond to physiotherapy treatment or in the case of tendon rupture – in other words if the muscle tears at its origin at your hip or insertion at knee. However, surgical intervention on the hamstring muscle carries its own risks, as the procedure tends to result in larger areas of scar tissue. Any additional scarring increases the risk of developing sciatic nerve entrapment, leaving you with more problems than solutions.

• Adductor muscle strain – pain will be felt over the inner part rather than the back of your thigh.
• Piriformis syndrome – symptoms include tingling or numbness.
• Sciatica – more difficult to pinpoint the painful area and often also includes numbness or a “pins ‘n needles” sensation.
• Popliteus muscle strain – pain is located at the back of your knee.
• Radiating pain from your lower back – dull ache that is difficult to pinpoint, pain doesn’t change with knee movements.

• Pulled hamstring muscle
• Hamstring muscle strain
• Injured thigh muscle