Hamstring injuries: what are they and what does recovery involve?

Hamstring injuries most commonly occur in athletes, although they can also occur after a high-impact trauma, road traffic accident, or trip or fall, especially in older individuals. These injuries involve tearing or straining your hamstring tendons or muscles — a hamstring injury is also commonly known as a pulled hamstring. To better understand hamstring injuries, it helps to first understand the anatomy of your hamstrings.

What are the hamstrings?

Your hamstrings refer to the tendons and muscles at the back of your thigh, specifically three muscles that run from the top of your hip down to your knee and the tendons that attach these muscles to your bones. Damage to either the muscles or tendons is called a hamstring injury.

Risk factors for hamstring injuries

Hamstring injuries usually occur during intense physical activity, such as climbing, jumping, lunging, overstretching, running or sprinting. This is why the individuals most at risk of hamstring injuries are athletes.

Specific risk factors for athletes or anyone who plays sports include not warming up properly before exercising and exercising too intensively. You are also more likely to have a hamstring injury if you have previously had one or sustain a direct impact to your thigh.

Types of hamstring injury

Hamstring injuries are categorised into three grades depending on their severity, with each grade being progressively more painful. Grade 1 refers to a mild strain, grade 2 refers to a partial tear, and grade 3 refers to a severe or complete tear.

Signs of a hamstring injury

Symptoms of a hamstring injury depend on how severe it is. Grade 1 hamstring injuries usually cause sudden pain and tenderness along the back of your thigh, which doesn't affect the strength of your muscle but can make it difficult to move your leg.

Grade 2 hamstring injuries cause more pain and tenderness, as well as bruising, swelling and loss of strength in your muscle.

Grade 3 hamstring injuries are very painful and tender and also cause bruising and swelling. You may not be able to walk or stand and may have noticed a popping sensation at the time you were injured.

When to see a doctor

Most hamstring injuries can be treated at home. However, if you are in severe pain, your symptoms are not getting better or are getting worse, you should see your GP.

Treating hamstring injuries

Hamstring injuries can usually be treated at home by resting and elevating your affected leg on a pillow, taking over-the-counter painkillers and anti-inflammatory drugs, and applying an ice pack for up to 20 minutes several times a day. This should help ease your symptoms in the first few days. However, complete recovery can take weeks or even months for moderate to severe hamstring injuries.

You should not quickly return to your usual activity levels. Instead, start by performing gentle hamstring stretches and then move onto hamstring-strengthening exercises, walking and cycling. Once you are comfortable with these gentle exercises, slowly ease yourself back into your usual exercise routine. In most cases, it will take several weeks before you can return to high-intensity sports.

A physiotherapist can help you during your recovery by tailoring a programme of exercises to strengthen and improve the flexibility of your hamstrings. They can also ensure you perform the exercises properly — carrying out exercises incorrectly or too quickly can further damage your hamstring.

In rare cases, where your hamstring has pulled away from your bone, you may need surgery to reattach it.

Preventing hamstring injuries

If you have already sustained a hamstring injury or want to avoid doing so, it is important to strengthen and improve the flexibility of your hamstrings through tailored exercises. You should also warm up properly before any physical activity and gradually increase the intensity of your exercise regimen. Sudden changes in duration or intensity put you at greater risk of a hamstring injury.