Hamstring Injury Pain Pulls Tears Tendonitis Tendinopathy Tenosynovitis

hamstring injury is a strain or tears to the tendons or large muscles at the back of the thigh. It’s a common injury in athletes and can occur in different severities. The three grades of hamstring injury are grade 1 – a mild muscle pull or strain.

Straining of the hamstring, also known as a pulled hamstring, is defined as an excessive stretch or tear of muscle fibers and related tissues. Hamstring injuries are common in athletes participating in many sports and are very difficult to treat and rehabilitate.

How do I know if I have a tear in my hamstring?

  1. Feel for a quick sharp pain in the back of the thigh when participating in sports. …
  2. Listen for a sharp popping sound, indicating the tear of a hamstring. …
  3. Attempt to bear weight on the injured leg. …
  4. Bend your knee

What is a Hamstring Tendonitis?

The Hamstring tendon is the soft tissue which connects the hamstring muscle to the outer aspect of the knee. Hamstring tendonitis occurs when this tendon becomes damaged or inflamed due to excessive strain or force being placed on the tendon.

How do I heal a hamstring injury?

To speed the healing, you can:
  1. Rest the leg. …
  2. Ice your leg to reduce pain and swelling. …
  3. Compress your leg. …
  4. Elevate your leg on a pillow when you’re sitting or lying down.
  5. Take anti-inflammatory painkillers. …
  6. Practice stretching and strengthening exercises if your doctor/physical therapist recommends them.
How long does it take to recover from a hamstring injury?
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).
What happens when you pull a hamstring?
A sudden jump, stretch, or impact can tear the muscle away from its connection to the bone. If you strain your hamstring while sprinting in full stride, you will notice a sudden, sharp pain in the back of your thigh. It will cause you to come to a quick stop and either hop on your good leg or fall.
How do you rehab a pulled hamstring?
Grade Two Hamstring Strain. RICE protocol – rest, ice, compression and elevation (never apply ice directly to the skin). This is aimed at reducing the bleeding and damage to the muscle tissue. Gentle Hamstring stretching can begin, sitting on a Gym Mat and slowly bending forward, sliding the hands down the thighs
What is the Semitendinosus muscle?
The semitendinosus muscle is one of three hamstring muscles that are located at the back of the thigh. The other two are the semimembranosus muscle and the biceps femoris. The semitendinosus muscle lies between the other two. These three muscles work collectively to flex the knee and extend the hip.
Is Semitendinosus medial to Semimembranosus?
It is inserted mainly into the horizontal groove on the posterior medial aspect of the medial condyle of the tibia. The semimembranosus is wider, flatter, and deeper than the semitendinosus (with which it shares very close insertion and attachment points).

Hamstring injuries, such as pulls, tears, and strains, are common among athletes who play sports that require powerful accelerations, decelerations or lots of running. The hamstring muscles run down the back of the leg from the pelvis to the bones of the lower leg. The three specific muscles that make up the hamstrings are the biceps femoris, semitendinosus, and semimembranosus. Together these powerful knee flexors are known as the hamstring muscle group.

An injury to any of these muscles can range from minor strains, a pulled muscle or even a total rupture of the muscle.


A hamstring injury typically causes a sudden, sharp pain in the back of the thigh that may stop you mid-stride. After such an injury, the knee may not extend more than 30 to 40 degrees short of straight without intense pain. Like most sprains and strains hamstring injuries are usually caused by excessive stretching (tearing) of muscle fibers or other soft tissues beyond their limits.

Severity of a Hamstring Injury

Hamstring strains are classified as 1st (mild), 2nd (moderate), or 3rd (severe) degree strains depending on the extent of the muscle injury.

Mild (Grade I) Hamstring Injury

  • Muscle stiffness, soreness, and tightness in the back of the thigh
  • Little noticeable swelling
  • A normal walking gait and range of motion with some discomfort
  • Flexing the knee to bring the heel up

Moderate (Grade II) Hamstring Injury

  • Gait will be affected-limp may be present
  • Muscle pain, sharp twinges, and tightness in the back of the thigh
  • Noticeable swelling or bruising
  • Painful to the touch
  • A limited range of motion and pain when flexing the knee

Severe (Grade III) Hamstring Injury

  • Pain during rest which becomes severe with movement
  • Difficulty walking without assistance
  • Noticeable swelling and bruising

Common Causes

Hamstring pulls or strains often occur during an eccentric contraction of the hamstring muscle group as an athlete is running. Just before the foot hits the ground, the hamstrings will contract to slow the forward motion of the lower leg (tibia and foot). Less commonly, a hamstring injury is the result of a direct blow to the muscle from another play or being hit with a ball. Some of the factors which may contribute to a hamstring injury include:

  • Doing too much too soon or pushing beyond your limits
  • Tight hip flexors
  • Weak glutes (butt muscles)
  • Poor flexibility
  • Poor muscle strength
  • Muscle imbalance between the quadriceps and hamstring muscle groups
  • Muscle fatigue that leads to over-exertion
  • Leg length differences. A shorter leg may have tighter hamstrings which are more likely to pull
  • Improper or no warm-up.
  • A  history of a hamstring injury


Treatment for hamstring injuries depends upon the severity of the injury. Due to the pain and limited ability to use the muscle, a third-degree strain usually results in a visit to a physician for evaluation and treatment. Less severe hamstring strains may be treated at home.

  • After an injury, it’s important to rest the injured muscle, sometimes for up to two or three weeks before you can return to sports after your injury.
  • R.I.C.E — Rest, apply Ice and Compression. Elevate the leg if possible.
  • An anti-inflammatory can be helpful to reduce pain and inflammation.
  • A stretching program can be started as soon as the pain and swelling subsides.
  • A strengthening program should be used to rebuild the strength of the injured muscle in order to prevent re-injury. Make sure you increase this gradually.
  • A thigh wrap can be applied to provide support as the muscle heals.


  • Warm up thoroughly. This is probably the most important muscle to warm-up before and stretches after a workout.
  • Performing specific movement prep exercises that activate the glutes and lengthen the hip flexors may help.
  • Stretching after the workout may be helpful.
  • Try adding a couple sessions per week of retro-running or backward running which has been shown to decrease knee pain and hamstring injuries.
  • Follow the “Ten Percent Rule” and limit training increases in volume or distance to no more than ten percent per week.
  • Other ways to prevent injury are to avoid doing too much, too soon, avoid drastic increases in intensity or duration, and take it easy if you are fatigued.

Symptoms of Chronic High (Proximal) Hamstring Tendinopathy

People with chronic high (proximal) hamstring tendinopathies will often complain of deep posterior hip/buttock pain of gradual onset aggravated by repetitive activities, such as running or biking and often will have pain that is worsened by prolonged sitting. Occasionally pain may radiate down the hamstring and be felt at the back of the thigh.

Below are some common features of the pain associated with high (proximal) hamstring tendinopathy.

Pain when sitting. Pressing or sitting down on the ischial tuberosity (sit bone) may be uncomfortable or even painful.

Pain with repetitive activity. Biking, hiking, running and other repetitive activities can exacerbate the posterior pain. People with high (proximal) hamstring tendinopathy will often notice a pattern of their pain. For example, the pain may appear at the same time as a workout.

Pain with acceleration or sprinting. Runners may notice that pain appears or gets worse while accelerating or sprinting. The pain is typically worse just prior to heal strike when the hamstring is firing to slow the body down. In some cases, severe pain may prevent athletes from sprinting.

Pain when bending at the hip. Similar to acute hamstring strains, chronic tendinopathy may cause pain at the ischial tuberosity, or sit bone when the hip is fully flexed.  An example of this would be a pain in tying shoes or bending at the waist to pick something up off the ground.

Occasionally the sciatic nerve may become irritated or entrapped by an affected tendon’s scar tissue, causing sciatica-like symptoms down the leg.

A person experiencing sciatic pain should report it to his or her doctor. This pain may be related to hamstring tendinopathy or it may be a sign of another problem, such as a pinched nerve in the lower back, piriformis syndrome, or sacroiliac dysfunction.

What are plasma (PRP) injections?

The use of platelet-rich plasma (PRP), a portion of the patient’s own blood having a platelet concentration above baseline, to promote healing of injured tendons, ligaments, muscles, and joints, can be applied to various musculoskeletal problems.

How much does platelet-rich plasma therapy cost?
The Washington Post reports that knee injections of PRP can cost anywhere from $500 to $1,200 per treatment
What is a PRP injection used for?
According to the research studies currently reported, PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow. 
Do platelet-rich plasma injections hurt?
Do PRP Injections Hurt? The level of discomfort of the treatment depends in part on the area being treated. … There is usually a moderate pain for the next few days. For the first week after the injections, it is critical to avoid anti-inflammatory medications, including Advil, Motrin, ibuprofen, Aleve, Celebrex, and Mobi.
How is PRP administered?
How this process works is that the physician will withdraw your blood, put the blood into a centrifuge where the platelets are extracted (platelets are now known to release healing proteins known as growth factors) and then inject the platelet solution directly into the injured site using an ultrasound-guided technique …
How long does platelet-rich plasma last?
You will see results from your first session itself. Caution: The procedure may result in swelling and bruising. It may last for about 3-4 days and will subside to reveal good healthy skin. Results will last about 3 months and after that, touch up treatments might be necessary.
Do plasma injections work?
Phys Ed: Does Platelet-Rich Plasma Therapy Really Work? … The treatment,platelet-rich plasma therapy, or P.R.P., involves centrifuging a person’s own blood until it contains a concentrated mix of plasma cells and growth factors and then injecting the resulting substance directly into the injured tissue.
Bottom line is that you should do your research and decide if this might be something that you want to try.

Further Reading

What is Prolotherapy (Regenerative Injection Therapy) for the Hamstrings


Prolotherapy (Regenerative Injection Therapy) is the only treatment technique that rebuilds tendons, ligaments, and joints through injection of small amounts of natural substances to stimulate healing and regenerate new connective tissue.

What is Prolotherapy
Prolotherapy or Regenerative Injection Therapy (R.I.T.) has been used for over 60 years for rebuilding joints, ligaments, and tendons. Olympic Ski Team members say they would not be skiing without it, and The New York Times, Adventure Magazine and ESPN are talking about it. For 16 years Dr. Kramer has been helping runners get back on the road after they thought they would have to give up running by using Prolotherapy.

Prolotherapy stimulates low-grade inflammation to start the healing process. The New York Times article by Health Columnist Jane Brody is titled, “Injections to Kick Start Tissue Repair”, which is a good description of what Prolotherapy does.

Prolotherapy is an effective therapy where small amounts of natural substances are injected to stimulate healing and regenerate new connective tissue, rebuilding ligaments, tendons, and cartilage. Prolotherapy does not just cover up the pain, but actually heals and cures the condition.

Superior to Cortisone
Commonly used anti-inflammatories and cortisone shots interfere with the healing process and can weaken tendons and actually soften cartilage and accelerate degenerative arthritis. Sports Medicine specialists now recommend what prolotherapists have for years: to avoid ibuprofen or other anti-inflammatories in the first several days after an injury such as an ankle sprain/strain. We need the right amount of inflammation to stimulate healing; anti-inflammatories shut off the healing process. Prolotherapy provides the kickstart for healing and tissue repair.

Runners Back on the Road
Prolotherapy restores function and gets to the cause of pain and strengthens the joint ligaments and tendons. Most running injuries are from overuse and breakdown of connective tissue and that needs to be strengthened. Many runners with patellofemoral pain or degenerative menisci have avoided knee surgery with prolotherapy. Prolotherapy preserves the cartilage and can strengthen the ligaments without removing any tissue. Chronic heel pain, or plantar fasciitis, is treated with appropriate supports but also strengthening the arch and the heel through stimulating strengthening of ligaments and tendons. Hip pain and IT band pain responds well to prolotherapy as do many other running injuries.

A runner needs the right diagnosis to evaluate and correct the cause of the condition and not just cover up the pain. Prolotherapy can rebuild and strengthen tissue, and this coupled with good nutrition and proper exercises can help you get back on the road. Prolotherapy can cure, not just cover up the pain, and have you running pain-free for good.

Further Reading






Trigger Points in Hamstrings

Myofascial trigger points, also known as trigger points, are described as hyperirritable spots in the fascia surrounding skeletal muscle. They are associated with palpable nodules in taut bands of muscle fibers. … Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response.

plural noun: trigger points
  1. a particular circumstance or situation that causes an event to occur.
    “the army’s refusal to withdraw from the territory was the trigger point for military action”
      a sensitive area of the body, stimulation or irritation of which causes a specific effect in another part, especially a tender area in a muscle that causes generalized musculoskeletal pain when overstimulated.


What causes myofascial trigger points?
Myofascial pain syndrome is a chronic pain disorder in myofascial pain syndrome, pressure on sensitive points in your muscles (trigger points) causes pain in seemingly unrelated parts of your body. This is called referred pain. Myofascial pain syndrome typically occurs after a muscle has been contracted repetitively.
Why do we get trigger points?
Myofascial Made Simple. The word myofascial means muscle tissue and the connective tissue in and around it (fascia). Myofascial pain often results from muscle injury or repetitive strain. When stressed or injured, muscles often form trigger points, like contracted knots, that cause pain and tightness.


Benefits of Massage for Hamstring Tears, Pulls, and Tendonitis

Massage has many benefits but specifically for hamstring strains, it can help loosen scar tissue and tight muscles, stimulate blood flow and therefore healing and aid in the stretching of the muscles. Massage should not be done in the acute stage as this may increase bleeding and prolong the healing process.

Massage for hamstring strains

Massage has many benefits but specifically for hamstring strains, it can help loosen scar tissue and tight muscles, stimulate blood flow and therefore healing and aid in the stretching of the muscles.

Massage should not be done in the acute stage as this may increase bleeding and prolong the healing process. The acute stage may last from 48 hours (for a grade 1 tear) up to a week for more severe injuries.

Technique 1 – Effleurage

Effleurage is used to spread the oil and warm up the muscles ready for deeper techniques.

Technique 2 – Petrissage

Petrissage is another technique used to loosen the muscle fibers. It is a kneading type technique in which one hand moves the muscles in one direction whilst the other pulls them the other way.

Technique 3 – Stripping the muscle

Stripping is a technique used to iron out any lumps and bumps in the muscle. Usually, one thumb is used although it can be reinforced with other fingers. It is a slow, purposeful movement in the direction of the blood flow (towards the heart) which can help to remodel the scar tissue.

Technique 4 – Circular frictions

Circular frictions are applied to areas of muscle tightness such as knots, as well as to the scar location to break down the scar tissue and help to realign it.

Hamstring injuries are graded into three categories: minor tears within the muscle, a partial tear of the muscle or a severe tear or rupture. Strain, or minor tears, will feel somewhat painful but not interfere significantly with movement. A muscle tear will be more painful, there may be swelling, and bending or straightening the knee will be difficult. If there is a severe tear or rupture, there will be immediate swelling and bruise, severe pain and you may need to use crutches to walk. You will be able to feel a depression in the muscle where the rupture occurred.


The usual treatment for hamstring injuries is rest, ice, compression, elevation and massage. People with minor hamstring strains or tears often won’t see a doctor but will self-treat or seek out a massage therapist for treatment. A severe tear or rupture often require surgery to reattach the muscle and tendon. If the pain is severe, your movement is significantly limited and the condition is not improving, see a physician rule out a ruptured muscle or a fracture before having a massage.


The goal of massage is to speed healing, reduce muscle tightness and build healthy scar tissue. Once the injury has been examined to rule out any contraindications, the therapist begins with gentle massage to reduce swelling and speed healing using lymph drainage massage or gentle Swedish massage to stretch the muscle fibers. After stretching the entire muscle, the therapist will work to soften and mobilize tissues in the injured area.


As the injury heals the therapist will switch to deeper work, including transverse friction, across the injured muscle fibers, to help build healthy scar tissue. The massage therapist will use deep lengthwise strokes and knead to make the muscle more pliable and will move the leg to engage the muscles while simultaneously massaging the injured muscle, mimicking the effects of exercise.


Further Reading






Hamstring Tendinopathy – A Breakdown of Causes, Treatment & Prevention


*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.


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