The hamstrings are tendons (strong bands of tissue) at the back of the thighs that attach the large thigh muscle to the bone.
The term “hamstring” also refers to the group of 3 muscles that run along the back of your thigh, from your hip to just below your knee.
The hamstring muscles are not used much while standing or walking, but they’re very active during activities that involve bending the knee, such as running, jumping, and climbing.
inflammation and swelling of a tendon, typically in the wrist, often caused by repetitive movements such as typing.
What causes hamstring injuries?
A hamstring injury can occur if any of the tendons or muscles are stretched beyond their limit.
They often occur during sudden, explosive movements, such as sprinting, lunging, or jumping. But they can also occur more gradually, or during slower movements that overstretch your hamstring.
Recurring injury is common in athletes and sportsmen, as you’re more likely to injure your hamstring if you’ve injured it before.
Regularly doing stretching and strengthening exercises, and warming up before exercise, may help reduce the risk of injuring your hamstring.
How do I know if I’ve injured my hamstring?
Mild hamstring strains (grade 1) will usually cause sudden pain and tenderness at the back of your thigh. It may be painful to move your leg, but the strength of the muscle should not be affected.
Partial hamstring tears (grade 2) are usually more painful and tender. There may also be some swelling and bruising at the back of your thigh and you may have lost some strength in your leg.
Severe hamstring tears (grade 3) will usually be very painful, tender, swollen, and bruised. There may have been a “popping” sensation at the time of the injury and you’ll be unable to use the affected leg.
Rest and recovery from a hamstring injury
Recovering from a hamstring injury may take days, weeks, or months, depending on how severe it is.
A completely torn hamstring may take several months to heal and you’ll be unable to resume training or play sport during this time.
During the first 2 or 3 days, you should care for your injury using RICE therapy:
- Rest – keep your leg as still as you possibly can and avoid physical activity. Your GP may recommend using crutches in more severe cases.
- Ice – apply cold packs (a bag of frozen peas wrapped in a tea towel will also work) to your hamstring for up to 20 minutes every 2 to 3 hours during the day. Do not apply ice directly to your skin.
- Compression – compress or bandage the thigh to limit any swelling and movement that could cause further damage. You can use a simple elastic bandage or elasticated tubular bandage available from a pharmacy.
- Elevation – keep your leg raised and supported on a pillow as much as possible, to help reduce any swelling.
Regular painkillers, such as paracetamol or a non-steroidal anti-inflammatory drug (NSAID) cream or gel, may also help relieve the pain.
Short-term use of oral NSAIDs, such as ibuprofen tablets, can also help reduce swelling and inflammation. However, these are not suitable for everyone. Check the leaflet that comes with your medicine to see if you can take it.
Gentle exercises and stretches
Returning to strenuous exercise too quickly could make your injury worse, but avoiding exercise for too long can cause your hamstring muscles to shrink and scar tissue to form around the tear.
To avoid this, you should start doing gentle hamstring stretches after a few days, when the pain has started to subside.
This should be followed by a program of gentle exercises, such as walking and cycling, and hamstring strengthening exercises.
Your GP can give you further advice and, if necessary, refer you to a physiotherapist for a suitable exercise program.
To avoid injuring yourself again, you should only return to a full level of activity when your hamstring muscles are strong enough. Your physiotherapist or GP will be able to advise you about this.
Many people need to avoid sports for at least a few weeks, but the length of time you need off will depend on the severity of your injury.
Hamstring tendonitis occurs when the soft tissues that connect the muscles of the back thigh to the pelvis, knee, and lower legs become inflamed. Tendonitis is often brought on by overuse and causes acute, or immediate, pain that decreases with rest and minor first aid. Most people can return to regular activity after a week or so. Full recovery typically involves rehabilitative exercises and takes several weeks.
What is hamstring tendonitis?
The hamstring muscle group includes two inner, or medial, muscles. These muscles are known as the semitendinosus and semimembranosus. There’s also an outer, or lateral, muscle — the bicep femoris. Tendons, a type of connective tissue, attach these muscles to the pelvis, knee, and shinbones, and allow the knee to flex and the hip to extend.
When hamstring tendons are overused or misused, tiny tears occur, causing inflammation and pain.
Cases of hamstring tendonitis can be lateral or medial depending on the muscles involved. They can also be described as distal, involving the tendons around the:
- back thigh
Tendon inflammation is technically called tendinitis, but popular use of tendonitis has made the terms interchangeable. Tendonitis is often confused with tendinosis, a chronic condition caused by repetitive overuse or injury.
The most common symptoms of hamstring tendonitis include:
- sharp, burning pain
- muscle and joint weakness
- aching or a dull throbbing
- muscle and joint stiffness
- swelling or inflammation
Symptoms get worse with further exercise or use and are often worse after long periods of inactivity, like sleeping or sitting.
Symptoms often worsen in the first few hours immediately following injury, then gradually lessen. Tight or inflamed hamstring tendons often cause radiating pain in the:
- lower back
To properly diagnose hamstring tendonitis a doctor or physiotherapist will order an MRI scan or X-ray. They will use these images to confirm tendonitis, rule out other causes, and evaluate the injury to guide treatment plans.
In some cases, you can self-diagnose hamstring tendonitis at home. Any activity that activates the hamstring and causes a sudden spike in pain is likely a sign of hamstring tendonitis. A few different stretching tests are considered telltale signs of the injury.
One test involves resting the foot on a solid surface, straightening the leg to a 90-degree angle, and pulling or flexing the foot toward the chest. An alternative test involves lying on your back with a bent knee and slowly straightening the leg to a 90-degree angle. Both stretches can be done with or without the use of an assist like a rope, belt, or yoga strap. If the stretches cause pain, you likely have hamstring tendonitis.
For most people, using the RICE method (rest, ice, compression, and elevation) for 72 hours is enough to treat symptoms.
Ice causes blood vessels to constrict, reducing blood flow and, in turn, inflammation. Ice should be applied for a maximum of 10 minutes at a time. After a 20-minute break, ice can be reapplied a few times following the same 10-minute on, 20-minute off schedule as needed. Icing sessions can be done two or three times throughout the day.
Compressing and elevating the injured area also lessens inflammation by reducing blood flow to the region.
Over-the-counter non-steroidal anti-inflammatories like ibuprofen (Advil, Motrin) and naproxen (Aleve) can make symptoms more manageable in the days following the injury. If intense pain continues for more than a few days or doesn’t respond well to basic treatment, talk to a doctor.
When injured tissues are forced into use too soon they often don’t entirely recover. Weakened tendons are far more likely to become reinjured. The more times the same tissue is damaged, the greater the chances of developing long-term damage.
It generally takes people several days to start to feel major relief, and six weeks or more to feel entirely better.
Avoid anything that activates the tendon for the first 48 hours. After that, exercises should only be done if they don’t cause additional pain.
In the first week after injury, you can start reintroducing slow, steady movements that focus on maintaining general strength. A good starting exercise is isometric knee flexes, where the injured hamstring is placed over the opposite leg and contracted at 30, 60, and 90-degree angles, as comfortable.
It’s usually safe to begin range of motion, lengthening, and strengthening exercises after a week or so. An easy starting point is a single-leg windmill. To do this exercise:
- Rest the uninjured leg on a chair while keeping the other straight.
- Reach downward with a flat back.
- Hold the stretch for 30 seconds.
You can add handheld weights to make the stretch more difficult.
The Nordic hamstring exercise is another useful stretch:
- Kneel and bend forward as far as comfortable with a neutral hip.
- Have a helper restrain your feet.
- Hold the stretch for 30 seconds.
After a few weeks, you can start adding additional exercises that work the muscle in a lengthened state. A good exercise involves lying on the back with a bent knee and using an elastic resistance band to create an opposing force while slowly flexing the knee.
Four to six weeks after the injury, you can start adding more intensive exercises like squats, hamstring curls, and hamstring bridges. These can help strengthen the entire region and prevent future injury.
A majority of tendonitis cases are caused by overuse. Running, kicking, and jumping activities that involve intensive knee flexion and hip extension are common causes. Sports that involve sudden bursts of use or abrupt changes in speed and direction, like football and soccer, are often common causes for this injury.
Overuse can also occur when the tendons are forced to work for longer than normal. Failing to warm-up can also cause tendonitis. Warming up helps to gradually prepare muscle tissue for exercise.
In some people, tendonitis occurs because of imbalanced thigh muscles or weak core muscles. Poor posture, especially slumping of the lower back or lumbar region, has also been linked to tendonitis.
This injury is usually treatable with rest, ice, compression, and elevation. Once the pain starts to improve, slowly reintroduce exercise, starting with gentle stretches to target the hamstring.
If your pain doesn’t improve, or if you are continually injuring your hamstring, see a doctor.
More exercises that are good for a pulled hamstring.
- Lie on your stomach with your knees straight. …
- Lift the foot of your affected leg by bending your knee so that you bring your foot up toward your buttock. …
- Slowly move your leg up and down.
- Repeat 8 to 12 times.
- When you can do this exercise with ease and no pain, add some resistance.
The 3 grades of hamstring injury are:
- grade 1 – a mild muscle pull or strain – likely to recover in a few days.
- grade 2 – a partial muscle tear
How long does a Grade 2 hamstring strain take to heal?Timeframes for rehabilitation and return to sport vary depending on the nature and severity of the strain. As a general rule, Grade 1 hamstring strains should be rested from sporting activity for about three weeks and Grade 2 injuries for a minimum of four to eight weeks.
- grade 3 – a complete muscle tear or tear of an attachment – may take weeks or months to heal.
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).
The most severe hamstring tear is a grade 3 hamstring tear. It occurs when the hamstring muscle rips completely or tears off the bone. A tear that pulls the muscle off the bone is called an avulsion. If you have a grade 3 tear, you likely heard a “popping” sound or sensation when you got the injury.
Benefits of Massage for Hamstrings Injuries
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. Sports massage or soft tissue massage is important for recovering from pulled hamstrings as well as preventing injury. Here we explain how sports massage is applied to the hamstrings for recovery and injury prevention.
Sports Massage or soft tissue massage or soft tissue massage can be used during the subacute stage of hamstring rehabilitation, but the pressure must be very light and superficial, to begin with. Later, as your injury heals techniques can become gradually get deeper as the days/weeks pass.
Massage can help to break down any scar tissue that has formed and can help to relax tight muscles and stimulate blood flow to the area and all of this aids the healing process and may increase flexibility. Light massage can be applied daily initially but later on, as the techniques become deeper, more recovery time between sessions may be required.
Sports massage can help lengthen and relax the muscles, flush toxins out of the tissues and soften muscles to prevent future injury. It can also help build healthy (aligned) scar tissue, reduce pain, help speed blood flow and nourishment to damaged tissue, and can rebalance the hip-pelvis-knee dynamic by restoring normal muscle function.
Sports massage isn’t usually engaged until there is no pain on touching the area. This usually occurs beyond the first 4-5 days of injury. In this acute stage of recovery, RICE protocols are applied (Rest, Ice, Compression, and Elevation).
When massage is initiated, the process begins with warming up the area to help relax the muscles. This is followed by an examination of the area to rule out any contraindications for massage. The therapy will use such techniques as gentle massage to reduce swelling and speed healing, lymph drainage massage, or gentle Swedish massage to stretch the muscle fibers followed by techniques to soften and mobilize tissues in the injured area.
more info at:
Therapeutic Swedish Massage, Sports Massage Therapy in Santa Barbara, Goleta
*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.
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