The back of your thigh contains three muscles – the biceps femoris, semitendinosus, and semimembranosus and these connect your hips to your knees so you can walk, run, jump, kick, dance, squat, and bend over. These are your hamstrings.
Your hamstrings are crucial for movement but are also vulnerable to injury because they lengthen and contract to accelerate and decelerate your legs.
Sports and activities with lots of sprinting or quick direction changes put a lot of force on your hamstrings. Even running for the bus can put undue strain on your hamstrings, causing minor tears that restrict your mobility for a week or so.
The good news? Most minor hamstring injuries recover in one to four weeks with physiotherapy. Severe injuries, like ruptures, can take several months to heal, but most patients go on to fully recover.
Symptoms of Hamstring Injuries
A minor hamstring strain may only cause mild muscle tightness or a pulling sensation when stretching or contracting the muscle. More significant injuries lead to pain, swelling, muscle spasms, weakness, and reduced range of motion.
For instance, losing strength and muscle control when bending the knee against resistance can indicate a partial or complete tear.
With severe, high-grade hamstring strain or tear, people typically describe a sudden, sharp pain in the back of the thigh and may hear a “popping” sound.
Here are some general pointers:
- Mild tightness or pulling sensation when stretching – likely a minor strain.
- Moderate pain when contracting the muscle – probably a grade 1 strain.
- Sharp pain when sprinting or accelerating – signs of grade 2 strain.
- Sudden, severe pain like being “shot” in the back of the thigh – high grade or complete hamstring tear.
- Audible “pop” at time of injury – potential tear or avulsion fracture.
- Bruising down the back of the thigh – severe muscle belly damage.
- Significant swelling around the hamstring – extensive injury and bleeding.
- Difficulty walking without severe pain – moderately or completely torn hamstring.
- Significant weakness bending the knee – partial or complete tendon tear.
- Loss of muscle control when resisting knee flexion – potential rupture or detachment.
- Pain sitting or straightening the leg – strained hamstring, minor injury.
- Discomfort when pointing toe – tension in the semimembranosus tendon.
What Causes Hamstring Injuries?
Hamstring injuries most often occur during activities that involve sprinting, jumping, or rapid speed changes. The hamstrings eccentrically contract to decelerate the leg during the swing phase of running. When overloaded, the muscles can become strained.
But poor flexibility, muscle imbalances, weakness and overuse over time can also lead to hamstring injuries. Fatigue makes the muscles more susceptible to damage.
Improper warm-up and training errors like progressing too quickly are additional contributing factors. Underlying lumbar spine issues, sciatic nerve tension and hip flexor tightness can also increase hamstring vulnerability.
Diagnosis of Hamstring Injuries
A physician or physiotherapist can diagnose a hamstring injury through a medical history, physical examination, and diagnostic testing. They will palpate the hamstring to pinpoint pain and swelling, assess range of motion and observe gait and movement patterns.
Hamstring injuries are unfortunately prevalent among athletes and recreational runners, ranging from mild to severe. There are three primary graded levels of hamstring strains:
- Grade 1 strain: This is a minor muscle pull without significant tearing. There may be mild pain and tightness with activity. Healing usually occurs in under 2 weeks.
- Grade 2 strain: This involves a partial muscle tear, with more notable pain and loss of strength. There will be muscle spasms and clear evidence of injury. Complete recovery typically takes 2-6 weeks.
- Grade 3 strain refers to a complete rupture or tear of the muscle. There is sudden, severe pain and a complete loss of function. Significant swelling and bruising develops. Healing can take over 6 weeks, and surgery may be required.
Imaging studies like X-rays can check for bone injuries, while ultrasound and MRI scans provide detailed views of muscle tissue and damage.
Provocative testing like the passive straight leg raise assesses the hamstrings in a controlled manner to aid diagnosis, and comparison to the uninjured leg helps determine the severity of weakness and functional loss.
Treatments for Hamstring Injuries
Physiotherapy is ideal for treating acute or chronic hamstring injuries with techniques like joint mobilisations, heat, ice, electrical stimulation, and ultrasound. Gentle stretching and eccentric exercises can also restore flexibility and strength in the healing muscle, while agility drills, sport-specific training, and plyometrics help to safely return the hamstrings to pre-injury function.
Sports massage for hamstrings is another useful rehabilitation technique, helping relax the hamstrings after acute healing.
Early rehabilitation usually provides the quickest recovery within the first few days of injury, but more severe injuries often warrant immobilisation, bracing for tears, anti-inflammatory drugs, and therapeutic modalities like ice, heat, electric stimulation, ultrasound, and massage.
Complete hamstring tears and avulsion fractures may need surgical repair and extensive rehabilitation. Even major hamstring injuries can fully recover within 3-6 months with proper long-term care and rehabilitation. However, the time frame depends on individual factors like age, fitness level and extent of damage. Patience during rehabilitation is critical to ensuring adequate healing and minimising recurrent injury risk.
Hamstring Injury Prognosis
The prognosis for hamstring injuries depends on the location and the extent of muscle damage. Minor strains involve microscopic tears and typically heal within 2-3 weeks with conservative treatment. Partial tears take 2-6 weeks to repair as scar tissue bridges the gap between muscle fibres. Grade 3 complete ruptures sometimes require surgical intervention and extensive rehab over 3-6 months.
Most hamstring injuries recover successfully with appropriate rest, physiotherapy exercises, and a gradual return to activity. However, reinjury risk remains elevated if flexibility deficits persist. Prognosis worsens with age and chronic injuries.
How ProPhysiotherapy Can Help
We specialise in treating hamstring injuries to get you back to full strength. Our experienced physiotherapists utilise a range of therapies, including soft tissue mobilisation, eccentric exercises, stretching, and therapeutic modalities with customised rehabilitation programs. Get in touch today to find out more about how we can help you.