Hamstring injury: symptoms, rehabilitation and prevention

How does a hamstring injury occur?

Most injuries occur without any external influence. Two patterns are typical. In the first case, the injury occurs when the Sprint type The muscle tears when running fast or braking abruptly, usually during the transition from muscle to tendon. Type of stretch The injury occurs during wide movements such as high kicks, pull-ups, or when slipping. It is more often located near the sacrum and often takes longer to heal.

What increases the risk

• an earlier injury in the same area (hamstring injuries recur at an above-average rate)
• Fatigue and suddenly increased training volumes or sprints
• Insufficient strength in the back of the thighs, especially when braking (eccentric) load, compared to the front of the thighs
• a lack of or too short warm-up
• limited mobility in the hip and pelvis, as well as low back stability

Symptoms: Sprain or muscle tear?

Typically, there is a sudden, stabbing pain in the back of the thigh, sometimes accompanied by a noticeable «knocking». After this, the speed and strength can usually no longer be maintained. Depending on the severity, there is pressure pain, swelling, and after one to two days a blood blister develops that can descend towards the knee.

• Mild strain (Grade 1): Pain when moving, walking is possible; often only slight swelling.
• Muscle tear (Grade 2): Pain that is more pronounced, loss of strength, visible bruising, climbing stairs and running are painful.
• Complete tear or rupture of the tendon (Grade 3): Severe pain, pronounced bleeding, sometimes a palpable scar; the leg hardly bears any weight anymore.

Complaints in the back of the thigh without a clear cause sometimes have another cause, such as irritation at the iliac crest or a connection with the lower back (see). Lumbago and sciaticaTherefore, a thorough investigation is worthwhile.

When should you see a doctor?

Have the injury evaluated by a doctor as soon as possible if

• You felt a significant «pulling» sensation during the event and were barely able to bear weight on the leg,
• a large blood blister forms or you feel a crack in the muscle,
• Numbness, tingling, or weakness in the leg occur,
• the leg swells severely without falling or injury, is warm and red, or hurts in the thigh,
• the complaints do not improve noticeably after one to two weeks.

In cases of severe pain, an unclear diagnosis, or suspicion of a fracture, the doctor may order imaging tests such as ultrasound or MRI.

What you can do yourself in the first few days

• Immediately stop the stressful activity that triggered the problem; the activity that triggers the problem will initially subside.
• Protect your leg, but don’t keep it completely immobile. Short, pain-free walks around the house are usually fine.
• You are allowed to cool or store them at high temperatures if that suits you.
• In the first few days, avoid vigorous stretching, massages, and heat directly on the injured area.
• Take painkillers only after consulting your doctor or pharmacist.
• Schedule an appointment for a consultation as early as possible. The sooner the rehabilitation program begins, the more targeted the course of recovery can be controlled.

Treatment and rehabilitation in physiotherapy

At the beginning, a detailed examination is carried out: where does the pain originate, how much strength and mobility have been preserved, and what type of injury is present? Based on this, we create a plan that suits your sport and your daily routine. Sports Physiotherapy This usually follows these phases:

1. Acute phase: Relieve pain and swelling, adjust the intensity of the exercise, and start with gentle movement early on.
2. Build-up phase: Targeted strengthening of the back of the thighs, complemented by the gluteal, hip, and trunk muscles. This includes braking (eccentric) loading, which has been shown to significantly reduce the risk of re-injury.
3. Sports-specific phase: Running technique, acceleration and braking, changing direction, and a controlled return to sprinting.
4. Return to sport: Only when everyday life and training are pain-free and the strength in the side is in proportion. We measure it digitally, more about that below. Power measurement and Return to Sport.

Depending on the results, we supplement the treatment with manual therapy and, in tense or painful muscle areas, with Dry needling. How long the healing process takes depends on the severity of the injury. As a rough guideline, for mild strains it usually takes about two to three weeks, and for muscle tears it usually takes several weeks to about two months. Injuries to the tendon sheath take significantly longer. Returning too soon risks a recurrence.

Prevention: This is how you protect the back of your thighs

• Train the strength of the back of the thighs regularly, also eccentrically (for example with the Nordic Hamstring Curl).
• Warm up thoroughly before sprints and competitions.
• Increase the pace and scope gradually.
• Keep your hips and torso flexible and stable. More about this in Stretching program.
• After an injury, plan to return to sports consciously and with strength checks.

For related injuries, see our article on Muscle and tendon injuries after a sports accident.