How to Treat a Hamstring Pull, Strain, Tear, or Rupture (2023)

Hamstring injuries, such as strains and tears, are common in sports that require either a lot of running or powerful accelerationsand decelerations. The hamstrings are comprised of a group of muscles and tendons that extend along the back of the leg from the base of the pelvis to the shinbone. While their primary role is to bend the knee, hamstrings also contribute to the rotation of the lower leg.

A hamstring strain refers to an injury in which the muscle or tendon is stretched or torn. Less severe strains are often referred to as a "pulled hamstring." A hamstring tear, also known as a rupture, infers a more serious injury.

Some hamstring injuries are mild and improve with rest and over-the-counter (OTC) pain relievers. Others are more severe and may require surgery and extensive rehabilitation.

Symptoms of a Hamstring Injury

An acute hamstring injury will typically cause sudden, sharp pain in the back of the thigh that can stop you mid-stride. In some cases, you may hear an audible "pop" or feel your leg giving out from under you. A chronic hamstring injury can occur if an untreated tear or strain worsens over time.

After the injury occurs, you will often be unable to extend your knee for more than 30 to 40 degrees without pain. Acute injuries are almost always accompanied by spasm, tightness, and tenderness, either developing immediately or after several hours. In the case of a rupture, you can often feel or see an indentation where the tear has occurred. Swelling and severe bruising will typically follow.

Hamstring Injury Causes

Most hamstring injuries are caused when the muscles are overloaded. These include the biceps femoris, semitendinosus, and semimembranosus. Muscle overload occurs when a muscle is either stretched beyond its limits or challenged with a sudden, excessive weight load.

Most strains occur when the hamstring muscles are lengthened and contracted at the same time (known as an eccentric contraction). One such example is sprinting, during which the back leg is straightened while you propel yourself forward on bent toes.

Other injuries occur when the hamstring is overexerted when lifting weight with a sudden thrust of energy. Powerlifting is one such example.

Risk Factors for Hamstring Injury:

  • Differences in leg length
  • An imbalance between the quadriceps (front of the thigh) and hamstring muscles
  • Improper or no warm-up before exercise
  • Muscle fatigue during activity
  • Poor flexibility
  • Poor muscle strength
  • Pushing beyond your current limits
  • Tight hip flexors
  • Weak gluteus muscles (buttocks)

Diagnosis of Hamstring Injuries

Hamstring injuries can usually be diagnosed by the location and intensity of the pain as well as the restriction of movement. Most tend to occur either in the middle of the back of the thigh or just beneath the gluteus muscle near the point where the tendon connects to the bone.

(Video) How to Treat Hamstring Strains or Tears

Most cases do not require imaging tests to confirm the diagnosis. However, severe injuries may need to be assessed with magnetic resonance imaging (MRI), the gold standard for visualizing soft tissue injuries. Alternately, an ultrasound can provide a qualitative assessment of an injury by viewing the muscles and tendons in real-time. X-rays, while useful, can sometimes miss smaller tears.

Based on the evaluation, a hamstring injury can be classified as grade I, grade II, or grade III.

Grade I Hamstring Injury

  • Ability to flex the knee
  • Little noticeable swelling
  • Muscle stiffness, soreness, and tightness
  • A normal gait and range of motion, albeit with discomfort

Grade II Hamstring Injury

  • An affected gait
  • A limited range of motion
  • Muscle pain, sharp twinges, and tightness
  • Noticeable swelling or bruising
  • Pain to the touch and when flexing the knee

Grade III Hamstring Injury

  • Difficulty walking without assistance
  • Noticeable swelling and bruising
  • Pain during rest, becoming severe with movement

Treatment for Hamstring Injuries

The treatment of a hamstring injury is based on the severity of the symptoms. All but the most severe can usually be treated non-surgically. Those involving tendon avulsions, in which the tendon has pulled completely away from the bone, require surgery and an extensive rehabilitation program.

Non-Surgical Treatments

Most acute hamstring injuries can be treated at home with the RICE protocol, which involves:

  • R: Rest, often with crutches, to avoid placing any weight on the leg
  • I: Ice using a cold compress to reduce pain and inflammation
  • C: Compression with a compression bandage to reduce swelling, prevent tissue bleeding, and avoid further expansion of the tear
  • E: Elevation of the leg above the heart to direct blood away from the leg, thereby reducing pain and swelling

More serious injuries may require immobilization with a knee brace to keep your leg in a neutral position. Pain can be treated either with an analgesic such as Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen) or Aleve (naproxen).

Once the injury is stabilized and the pain and swelling have subsided, physical therapy can be started, using gentle stretching to restore range of motion and strengthening exercises to increase muscle mass and weight-bearing strength.

Surgical Treatment

Avulsions of the hamstring invariably require surgery to reattach the rupture. Avulsions most commonly occur near the pelvis (proximal tendon avulsion), although they can also happen nearer to the shinbone (distal tendon avulsion ).

If an acute rupture occurs, the surgeon will usually wait 72 hours to allow the recoiled muscles to "relax." Delaying beyond this point is usually unadvised as the muscle can begin to waste away (atrophy) and develop extensive scarring (fibrosis).

During the tendon avulsion repair, the surgeon will pull the hamstring muscles back into their original position and cut away any scar tissue at the ruptured end. The tendon will then be reattached to the bone with staples and/or stitches. If the muscle itself is ruptured, sutures will be used to reattach the ends without shortening the length too excessively.

After surgery, you would need to use crutches and a brace to keep your leg in a neutral position. Once ample healing has occurred, physical therapy and rehabilitation would begin, lasting anywhere from 3 to 6 months. Every effort would be made to control pain with regular ice application and OTC pain relievers. If needed, stronger NSAIDs may be prescribed.

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Preventing a Hamstring Injury

Since hamstring injuries typically occur during sports and athletics, routine precautions should be taken in advance of the activities. Among the key prevention tips:

  • Add retro-running (running backward) to your workout which helps balance the gluteus and hamstring muscles while strengthening those around the knee.
  • Approach squats and other exercises that engage the gluteus and hip flexor muscles with caution, starting slowly and gradually increasing in depth.
  • Follow the 10% rule in which you increase the intensity, distance, or duration of your workout by no more than 10% week on week to avoid overexertion.
  • Stretch after your workout as well as before. It is important to remember that, with strength training, muscles tend to retract. If stretching is avoided, these muscles can eventually become fixed in this semi-flexed position.
  • Warm-up before exercise with eccentric hamstring stretches.

Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Pombo M, Bradley JP. Proximal hamstring avulsion injuries: a technique note on surgical repairs. Sports Health. 2009;1(3):261-4. https://doi.org/10.1177/1941738109332259

    (Video) Hamstring Strain Healing - How Your Body Heals A Hamstring Strain

  2. Knapik DM, Metcalf KB, Voos JE. Isolated Tearing and Avulsion of the Distal Biceps Femoris Tendon During Sporting Activities: A Systematic Review. Orthop J Sports Med. 2018;6(7):2325967118781828. https://doi.org/10.1177/2325967118781828

Additional Reading

By Elizabeth Quinn
Elizabeth Quinn is an exercise physiologist, sports medicine writer, and fitness consultant for corporate wellness and rehabilitation clinics.

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(Video) The Top Treatment for Hamstring Injury, Pull, Tear, or Strain- Quick Recovery.

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FAQs

How long does it take for a tear in the hamstring to heal? ›

Mild to moderate (grade 1 or 2) tears or strains can heal within three to eight weeks with diligent home therapy. For a grade 3 hamstring tear or strain, recovery may be as long as three months. Returning to sports before the injury is fully healed can cause more severe injuries.

Can a hamstring tear heal on its own? ›

What's the Treatment for a Hamstring Strain? The good news is that only the most severe muscle tears require surgery. Most hamstring strains will heal on their own or with some physical therapy.

What does a torn hamstring feel like? ›

In addition to weakness when moving or bending your leg, hamstring tears can make it difficult or impossible to bear weight on the leg. Many people report their leg feels like it will buckle or give way when attempting to put weight on it. Weight-bearing can also cause significant pain.

What happens if you hear a pop in your hamstring? ›

Grade 3: With severe hamstring tears, or a grade 3 injury, you may have a “popping” sensation at the time of injury. In this case, the tendon may tear completely away from the bone and may even pull a piece of bone away with it. These usually cause a very severe amount of bruising.

What does a Grade 2 hamstring strain feel like? ›

Types of a hamstring tear or strain

Grade 2 — moderate injury that is typically a partial tear in the muscle; patients are likely to limp when walking and will have occasional twinges of pain during activity.

Can you walk on a Grade 2 hamstring strain? ›

Walking will likely be unaffected, you may feel minimal symptoms with sprinting. Grade 2 Strain- Moderate, a partial muscle tear up to half of the muscle. You may experience a limp with walking, and running may not be an option due to weakness and pain.

Should you stretch a pulled hamstring? ›

Gentle stretching is helpful for recovery. Aggressive stretching of your hamstring will delay your recovery. Hold this position for 3 to 5 seconds, and then lower your leg back down. Perform 3 sets of 12 repetitions once per day.

Should you massage a hamstring injury? ›

Yes. Once the acute phase of healing is over, sports massage can be of great benefit. It can: Flush out excess fluids and swelling from the tissue.

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