Hamstring Injuries – the what, where, how and why?

Dr Penny White (Osteopath)

Have you ever heard someone say I’ve ”done” my hamstring and thought what exactly does that mean?! Where are your hamstrings even located on your body? Are they the muscles on the front or back of your leg? Your hamstrings are the three muscles (biceps femoris, semimembranosus and semitendinosus) that run down the back of your thigh. They help flex (bend) your knee and extend (straighten) your hip. You use your hamstrings to walk, run, kick, squat, even to get up from sitting – this means a hamstring injury can be a real pain in the bum (sometimes literally!). Read on to learn what the common hamstring injuries are, why they occur and how best to manage them so you can recover as quickly as possible. 

Let’s take a look at some of the most common hamstring injuries! 

Hamstring strains + hamstring tears:

Hamstring strains or tears are some of the most common injuries for athletes involved in speed-power sports (sprinting, football, soccer etc). 

How do I know if I’ve strained or torn my hammi?:

A hamstring strain/tear usually presents as acute pain experienced during exercise such as sprinting or kicking. Pain can range from tenderness to severe pain with loss of strength, range of motion and inability to use that limb. There can also be swelling and bruising in the area and you may hear a popping sound at the time of injury. 

Hamstring tears are classified as Grade 1-3. This ranges from only a few muscle fibres being torn to complete rupture of the muscle that may require surgery. Your symptoms following injury, combined with assessment by one of our practitioners can help identify injury grade.

Why do hamstring strains and tears occur?

Hamstring tears and strains occur if the muscles or tendons are stretched beyond their limit. They usually begin during sudden explosive movements such as lunging, jumping, sprinting or kicking. 

Some predisposing factors to hamstring strain include:

  • Previous hamstring injury
  • Sudden change in direction (acceleration, deceleration)
  • Increasing age of athlete
  • Poor flexibility and strength
  • Hamstring fatigue
  • Muscle imbalances between the hamstrings and quadriceps
  • Lack of appropriate warm up

How can I prevent my  hamstring from strains and tears?

  • Completing a thorough full body warm up that includes sport specific muscle stretching and drills. 
  • Train speed work so your hamstrings are capable of sustaining high acceleration forces.
  • Maintaining cardiovascular fitness and muscle endurance to prevent fatigue.
  • Appropriate cool down and stretching habits after training 
  • Gradual increase in training load (intensity and duration).
  • Adequate recovery time between training sessions.

Ouch – I’ve strained my hammi, what do I do?

Immediately after the injury – follow the RICER protocol for 48-72 hours (rest, ice, compression, elevation and referral).

Appropriate treatment and rehabilitation is important as it is common to reinjure the same hamstring. This can be due to a number of reasons including insufficient rehabilitation and strength training,  returning to sport too quickly or scar tissue in the area.

The recovery for a hamstring tear depends on the grade of the injury, appropriate treatment and rehabilitation and patient compliance with the rehabilitation plan. A guide to hamstring tear recovery times are:

  • Grade 1: 3 weeks
  • Grade 2: 4-8 weeks
  • Grade 3: up to 3 months (post surgery if surgery is required)

Our highly skilled practitioners can assist you with your injury management throughout the entire recovery process including during the acute phase, treatment to the area, rehabilitation and your return to sport plan.

Hamstring tendinopathy:

Hang on, I have buttock pain – why does my Osteopath say I have a hamstring tendinopathy?

Your hamstring muscles originate from your ischial tuberosity (your sitting bone), which means injury to this tendon will present as buttock pain. This pain will be aggravated by exercise (but will often ease as you warm up), stretching and prolonged sitting. 

Why do people get a hamstring tendinopathy?

The cause of a hamstring tendinopathy is often a combination of risk factors and training load. 

Risk factors:

  • Increasing age
  • Genetics + family history
  • Hormonal changes at menopause
  • Some autoimmune conditions
  • Diabetes

Training load changes:

  • Sudden or dramatic increase in hill running or speed work 
  • Sudden or dramatic increase in training distance or time
  • Inadequate recovery periods
  • Sudden addition of heavy squats or deadlifts causing unaccustomed strain and load on the tendon 
  • Strong hamstring stretching

Ok, so I have a hamstring tendinopathy, now what?

Recovery from a hamstring tendinopathy requires specific management, exercise prescription and progression and patience. Even the best rehabilitation program followed by the most compliant person can take several months to see a full recovery. Your recovery plan will typically include:

  • Altering the training load, whether its a decrease is speed or length of runs, removing hills or resting from running for a short period of time whilst staying fit and strong doing some form of cross training. This could mean decreasing weights or depth of squats or deadlifts for a gym goer. The key is to not rest completely as this will further decondition your tendon and prevent recovery and return to sport.
  • Careful monitoring of symptoms. You want to keep any pain to less than 4/10 on a pain scale. You also don’t want any pain to linger for longer than 24hours following exercise. 
  • Avoid stretching and stretching with load (lunges, prolonged sitting on hard seats, heavy and full range of motion deadlifts).
  • Isometric loading of the hamstring is often a great place to start, this involves the hamstring working without any joint movement. This form of exercise has been found to reduce pain and increase strength to protect the tendon whilst rehabilitating the tendinopathy. 
  • As able, you slowly progress hamstring strength training until return to full training load is achieved. Throughout this process, appropriate rest periods are required between training sessions for best tendon healing results. 

So next time someone says they have ‘done’ their hamstring you can hopefully help them point them in the right direction! If you have a hamstring injury it is important to work closely with your Beyond practitioner throughout your tendinopathy recovery so we can ensure you’re making the best training modifications and completing the right additional exercises for your recovery and goals. This way we can help you MOVE THROUGH LIFE (minus the pain in the bum) as quickly as possible!

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