A hamstring strain is one of the most common injuries in running, kicking and change-of-direction sports. It usually announces itself: a sudden pull or twinge at the back of the thigh mid-sprint, mid-kick or mid-lunge, often with the sense that you can’t carry on. It’s also one of the injuries most likely to come back, which makes how you rehabilitate it as important as the injury itself.
Understanding hamstring strains
The hamstrings are three muscles running down the back of the thigh: biceps femoris, semitendinosus and semimembranosus. They help straighten the hip and bend the knee, and in sprinting they work hard to slow the leg down just before the foot lands. That’s why many strains happen at high speed.
Hamstring strains tend to fall into two patterns:
- Sprint-type: a sudden injury during fast running, usually involving the biceps femoris on the outer back of the thigh
- Stretch-type: an injury at extreme range, such as high kicking, lunging or sliding, which often involves the muscle close to the sit bone and can take longer to recover
Hamstring injuries are a major part of the injury burden in elite football. A large study of men’s professional football found they now make up around a quarter of all injuries.
Symptoms we commonly see
- A sudden sharp pain at the back of the thigh, sometimes with a “pop” or pulling sensation
- Pain that stops you sprinting or kicking, and tenderness when you press on the area
- Bruising that appears in the day or two after the injury and can track down the leg
- Pain when stretching the hamstring or bending forward, and weakness bending the knee against resistance
- Stiffness and aching the next morning
Our evidence-based approach
Good hamstring rehab is progressive, specific and measured. Our approach includes:
- Accurate assessment to confirm the grade and location of the strain, test strength and movement, and rule out other sources of back-of-thigh pain, such as referred pain from the lower back
- Early management of pain and swelling, with load adjusted so the muscle isn’t aggravated but doesn’t waste away
- Progressive strengthening, moving from gentle isometric holds through to heavier loaded work, with eccentric strength a priority
- A graded running program that builds from walking to jogging to high-speed running and sprinting as the hamstring tolerates it
- VALD NordBord testing to measure eccentric hamstring strength, compare left and right, and track your numbers across rehab
- Criteria-based return to sport, using strength, sprint capacity and confidence rather than the date
- A long-term strength plan, because low eccentric hamstring strength is associated with a higher risk of future strains, and building it back up is protective
You can see how your numbers compare with our targets on the strength standards page.
What to expect: recovery timeline
- Mild (grade 1) strains: often one to three weeks
- Moderate (grade 2) strains: typically four to eight weeks of structured rehabilitation
- Severe (grade 3) strains and tears close to the bone: may take several months, and sometimes need a surgical opinion
- Recurrence: returning early is a common cause of a repeat strain, which is why we progress you on measured criteria rather than a date
When to seek help urgently
Get assessed promptly if you felt a pop with severe pain and can’t walk comfortably, have significant swelling or bruising high in the thigh near the buttock, or have numbness, tingling or weakness down the leg. Calf pain, swelling and warmth after a leg injury also needs prompt medical review to rule out a blood clot.
References
- Hickey JT, Opar DA, Weiss LJ, Heiderscheit BC. Hamstring strain injury rehabilitation. J Athl Train. 2022;57(2):125-135.
- van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. 2019;53(21):1362-1370.
- Opar DA, Williams MD, Timmins RG, et al. Eccentric hamstring strength and hamstring injury risk in Australian footballers. Med Sci Sports Exerc. 2015;47(4):857-865.
- Timmins RG, Bourne MN, Shield AJ, et al. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study. Br J Sports Med. 2016;50(24):1524-1535.
- Ekstrand J, et al. Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22. Br J Sports Med. 2023;57(5):292-298.