Hamstring strain – The who, what, where, why and how!

What is a hamstring strain?

The hamstrings are a group of muscles at the back of the upper leg. There are three main muscles in this group, biceps femoris, semimembranosus and semitendinosus.  A strain of these muscles is a common leg injury involving a tear in one or more of these muscles.  Strains can range from mild to very severe and in extreme case even rupture.

What causes a hamstring strain?

The hamstrings become strained when the muscle fibre struggle to cope with the stress or demand placed upon them.   They are most likely to be strained by acceleration or deceleration activity like high speed running or kicking, or an extreme movement like doing the splits.  Hamstrings are being injured at an alarming and increasing rate in many sports around the world.  This is despite us having the best and most up to date hamstring injury preventative programs in place.

A research paper written by Vern Gambetta et al (2004) divides the hamstring strain causes into primary and secondary. They are as follows :

Primary causes

  • Poor timing-intermuscular coordination and eccentric strength in the short head of the biceps femoris muscle during the switch between late leg recovery and initial leg approach in the swing phase of sprinting (Woods et al. 2004).
  • Lack of stiffness and eccentric strength in the short and long head of the biceps femoris muscle during the ground contact phase of running (Bosch and Klomp 2005). Stiffness refers to the ability of the muscle to absorb shock and rebound. Dropping a golf ball onto concrete is an example of stiffness, it immediately rebounds off the surface. The opposite would be would be sagging or a slight collapsing on contact.
  • Previous strain — prior hamstring injury is a very good indicator of potential for future injury (Crosier 2004)

Secondary causes

  • Poor running mechanics — this consists primarily of overstriding or poor pelvic control which puts the hamstrings in a vulnerable position at ground contact.  Likewise excessive lateral hip/pelvic movements that force the stabilising muscles to overwork can subsequently shift more stress to the hamstrings.
  • Improper warm-up or lack of warm-up — a warm-up must be active and dynamic to prepare the muscles for the forces involved.  Stretching is only one part of a warm-up.
  • Inappropriate training loads —The hamstrings are primarily fast twitch Type II fibres that fatigue quickly. This means that high speed work should be done early in workout, as close to warm-up as possible to avoid fatigue.  Higher intensity speed endurance work must be gradually built into the program to allow for adaptation.
  • Fatigue (neural and local muscle) — because the hamstrings are primarily fast twitch Type II fibre, all activities that occur in the course of a game must be taken into consideration, for example, in AFL fatigue arising from running then sprinting and kicking.
  • Lower back pathology — abnormalities of the lumbar spine that potentially could cause nerve dysfunction and subsequent muscle weakness.
  • Playing surfaces — a wet slippery surface will put more strain on the hamstring due to slipping.

As with most injuries, accurate diagnosis is vitally important.  Pain in the hamstring muscles can be from direct cause as discussed, i.e. a hamstring strain, however it can also be from an indirect cause like knee, gluteals, SIJ and/or lower back.  Correct diagnosis, treatment and adequate rehabilitation will improve healing time and aim to prevent any future recurrence. 

Imaging, such as an MRI or ultrasound, can help identify the severity of a hamstring injury but they are often unnecessary and rarely required.

What are the symptoms of a Hamstring strain?

A hamstring strain usually:

  • starts with a sudden onset.
  • moderate to severe pain.
  • pain located in the back of the thigh or upper leg.
  • occasionally a popping sensation immediately preceding the pain.
  • difficulty to walk or straighten leg.
  • marked tenderness around the site of pain.
  • may have visible swelling and bruising.

How is a Hamstring Strain Diagnosed?

On examination, your Osteopath will look for signs of a hamstring strain like pain on contraction, reduced hamstring flexibility, tenderness or a palpable lump or gap within the hamstring muscle bulk.  Pulled hamstrings are then graded 1, 2 or 3 depending on the severity.

 - Grade 1 Hamstring Strain (1 to 3 weeks recovery time)

With a grade 1 strain, tightness in the back of the leg/thigh will exist but often this will not effect your gait.  Awareness of hamstring discomfort and an inability to run at full speed are common indicators.  Generally there is mild swelling and spasm. Bending your knee by actively contracting your hamstring muscle is unlikely to reproduce much pain.

 - Grade 2 Hamstring strain (4 to 8 weeks recovery time)

With a grade 2 hamstring strain, an altered walking pattern will be present and more than likely an obvious limp caused by sudden twinges of hamstring pain during activity.  Commonly there will be hamstring swelling and tenderness to palpate.  Bending your knee by actively contracting your hamstring muscle will now reproduce pain.

 - Grade 3 Hamstring strain (3 to 6 months recovery time – dependent on whether surgery is required)

A grade 3 hamstring strain is a severe injury involving a complete tear to half or all of the hamstring muscle. Crutches are often required to walk due to severe pain and significant weakness.  Immediate swelling will be noticed and bruising usually appears within 24 hours.

Adelaide key position player Mitch McGovern after a serious hamstring injury (photo courtesy Adelaidenow.com)

Hamstring Strain treatment

Many patients will feel better within a few days of injury. Often this leads to people deciding they don’t need profession assistance with their injury however, there is an extremely high hamstring re-injury rate (as discussed previously) due to poor rehabilitation. It is strongly recommended you seek Osteopathic guidance within 48 hours of the injury is highly recommended for both accurate diagnosis, to aid a rapid recovery and to provide you with the best chance of avoiding repeat hamstring injuries.

How can an Osteopath help?

The purpose of osteopathic treatment will vary greatly depending on the injury…….but in a nutshell we will aim to

  • Reduce hamstring pain and inflammation.
  • Normalise your muscle range of motion and extensibility.
  • Strengthen your hamstrings.
  • Strengthen your other important lower limb muscles; namely calves, hip and pelvis muscles.
  • Normalise your neurodynamics to enable structures such as the sciatic nerve to pass freely without interruption.
  • Improve your speed, proprioception, agility and balance.
  • Improve you technique and function.
  • Minimise your chance of hamstring re-injury.

If you or anyone you know has strained their hamstring, make sure immediate advice is sort from their local Osteopath.  Early intervention is more often than not the best way to enhance your chances of an early recovery.

If you live in Albury/Wodonga and surrounds and have “done” a dreaded hamstring,​ ​book an appointment ASAP with one of our Osteopaths here at Sports & Spinal Albury.


-  Dr Vaughan Saunders

B Sc (Clin Sc) M Hlth Sc (Osteo)