Hamstring Strain and Pulled Hamstring Injury Treatment
Discover the causes behind hamstring injury, and what you can do to treat it and prevent it.
by Brad Walker | First Published April 15, 2001 | Updated May 16, 2019
A hamstring injury is also commonly called a hamstring strain, a hamstring tear, a pulled hamstring (or pulled hammy).
What is a Hamstring Injury?
A hamstring injury or strain is an injury that results from a pulling action, which pulls or tears the hamstring muscles and/or tendons.
The term sPrain refers to an injury of the ligaments, as opposed to a sTrain, which refers to an injury of the muscle or tendon. Remember; ligaments attach bone to bone, were as tendons attach muscle to bone.
Injuries to the muscles and tendons of the hamstrings are usually graded into three categories, and these injuries are referred to as: first; second; or third degree strains.
- A first degree strain is the least severe. It is the result of some minor pulling of the muscles and tendons, and is accompanied by mild pain, some swelling and stiffness. There is usually very little loss of function as a result of a first degree strain.
- A second degree strain is the result of both pulling and some tearing of the muscles and tendons. There is increased swelling and pain associated with a second degree strain, and a moderate loss of function.
- A third degree strain is the most severe of the three. A third degree strain is the result of a complete tear or rupture of one or more of the hamstring muscles and tendons. A third degree strain will result in massive swelling, severe pain and gross instability.
The hamstrings are located at the back of the upper leg, and are actually a group of three separate muscles. The top of these muscles are attached to the lower part of the pelvis (origin), and the bottom of the hamstring muscles are attached to the lower leg bone just below the knee joint (insertion).
The technical or anatomical names for the three hamstring muscles are:
- Semitendinosus; and
- Biceps femoris.
The picture to the right shows the muscles located at the rear of the upper right leg. The three specific hamstring muscles can be seen on the picture, by looking for the anatomical names located half way down the picture.
What Causes Hamstring Injury?
Now that we know exactly what and where the hamstrings are, let’s take a look at some of the most common causes for hamstring injuries. By far the most common cause of hamstring injuries originates from a forceful contraction, which is often the result of a strength and/or flexibility imbalance between the hamstrings and quadriceps muscles (located at the front of the upper leg).
The quadriceps are a very large, strong group of muscles that help to extend the leg. These muscles can become so strong that they overpower the hamstrings, putting a massive amount of tension on the hamstring muscles. Combine strong quadriceps with weak hamstrings and you have a hamstring injury waiting to happen.
Other factors that contribute to hamstring injuries are a lack of flexibility and poor strength of the hamstring muscles. Also, when the hamstrings become fatigued or tired they are more susceptible to injuries.
Athletes at Risk of Hamstring Strain
Athletes particularly vulnerable to a pulled hamstring injury are competitors involved in sports that require a high degree of speed, power and agility, including fast accelerations and quick changes of direction.
Sports such as Track & Field (especially the sprinting and jumping events) and other sports such as soccer, basketball, tennis and football seem to have more than their fair share of hamstring injuries.
Hamstring Injury Treatment
If you do happen to suffer from a pulled hamstring injury, it’s important that correct first aid principles are applied immediately. The RICER regimen explains the correct treatment for all muscle strain injuries. RICER stands for Rest, Ice, Compression, Elevation, and then obtaining a Referral from a qualified sports doctor or physiotherapist.
As soon as a hamstring injury occurs…
- Rest the injured limb, apply ice to the affected area, apply a compression bandage and elevate the limb if possible. This initial treatment needs to continue for at least 48 to 72 hours. This is the most critical time for the injured area; correct treatment now can mean the difference between an annoying short-term injury or a permanent, re-occurring, debilitating injury.
- After the first 72 hours obtain a referral from a qualified professional and start a comprehensive rehabilitation program. This should include rehabilitation activities such as heat, massage, ultra-sound and TENS (transcutaneous electrical nerve stimulation).
- Once most of the pain has gone start conditioning the hamstrings with balance, strength, agility and flexibility exercises and drills.
Preventing Hamstring Injury
Mark my words, “Prevention is much better than Cure.” Anything you can do to prevent an injury from occurring is worth it. Preventing a pulled hamstring injury comes down to the conditioning of the hamstring muscles and tendons, which ultimately involves improving both the strength and flexibility of the hamstring muscles and tendons (and the surrounding muscle groups).
But don’t forget common injury prevention strategies like, warming up properly and using a bit of old-fashioned common-sense. Even if you don’t have a hamstring problem now, the following suggestions will be helpful.
- Completely rehabilitate a hamstring injury before returning to activity.
- Always include a general warm up, followed by an activity specific warm up before training and especially competition.
- Cool down thoroughly after training and competition.
- Include an eccentric strength training program (muscle contraction and lengthening at the same time) for the hamstrings.
- Practice balance, agility and proprioception drills to improve knee and hip stability.
- Reduce the frequency of, or stopping completely, any activities that aggravate the hamstring.
- Rest in between training sessions or competition allows the body to heal minor injuries and repair the muscles to be ready for the next round of activity.
The best preventative measures however, involve a consistent program of increasing the strength and flexibility of the hamstring muscles. Increasing flexibility will contribute greatly to the ability of the hamstring muscles to resist strains and injury. Get videos and photos of hamstring stretches here.
Research and References
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Tortora, G. Derrickson, B. (2009) Principles of Anatomy and Physiology, 14th Edition (ISBN: 978-1118866096)
- Martini, F. Tallitsch, R. Nath, J. (2009) Human Anatomy, 9th Edition (ISBN: 978-013432076X)
- Wikipedia contributors. (2019, May 8). Hamstring, In Wikipedia, The Free Encyclopedia.
- Jones, O. (May 2, 2018). Muscles in the Posterior Compartment of the Thigh. Retrieved May 16, 2019, from https://teachmeanatomy.info/lower-limb/muscles/thigh/hamstrings/.
- Arnason, A. Andersen, T. Holme, I. Engebretsen, L. Bahr, R. (2008). Prevention of hamstring strains in elite soccer: an intervention study. Scandinavian Journal of Medicine & Science in Sports, 18(1), 40-48.
- Brughelli, M. Cronin, J. (2008). Preventing hamstring injuries in sport. Strength & Conditioning Journal, 30(1), 55-64.
- Croisier, J. Ganteaume, S. Binet, J. Genty, M. Ferret, J. (2008). Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. The American Journal of Sports Medicine, 36(8), 1469-1475.
- Heiderscheit, B. Sherry, M. Silder, A. Chumanov, E. Thelen, D. (2010). Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 67-81.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.