Different Ways to Treat a Hamstring Pull or Tear

Non-Surgical and Surgical Recommendations

man using a resistance band to stretch leg

Verywell / Ryan Kelly

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Hamstring injuries, such as strains and tears, are common in sports that require either a lot of running or powerful accelerations and decelerations. The hamstrings consist 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

Depending on the specific injury, symptoms can vary in terms of their intensity, as well as how long they last. In general, symptoms tend to include varying degrees of pain, swelling, and bruising. In many cases, it is difficult to extend the knee more than 30 to 40 degrees without pain.

An acute, or short-term, hamstring injury typically causes sudden, intense 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. Swelling, bruising, spasms, tightness, and tenderness may appear within hours to days after the injury.

A chronic, or long-term, hamstring injury can occur if an untreated tear or strain worsens over time. In the case of a rupture, a severe tear, you can often feel or see an indentation where the tear has occurred. Swelling and severe bruising will typically follow, along with muscle weakness.

Hamstring Injury Causes

Most hamstring injuries are caused when its three 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, which is known as an eccentric contraction. An example of this 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 an example of this.

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.

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

A grade I hamstring injury describes a mild muscle pull or strain that may heal within a few days.

With a grade I injury, an individual may have:

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

Grade II Hamstring Injury

A grade II hamstring injury describes a partial hamstring muscle tear that can take weeks to months to heal.

With a grade II injury, you may experience:

  • 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

A grade III hamstring injury is the most severe and describes a complete muscle tear. This can take weeks to months to heal and may require surgery.

With a grade III injury, you may have:

  • 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:

  • Rest, often with crutches, to avoid placing any weight on the leg
  • Ice applied to the injury, using a cold compress, to reduce pain and inflammation
  • Compression with a compression bandage to reduce swelling, prevent tissue bleeding, and avoid further expansion of the tear
  • 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 begin. This may involve gentle stretching to restore range of motion, and strengthening exercises to increase muscle mass and weight-bearing strength.

Surgical Treatment

Avulsions of the hamstring typically 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 will need to use crutches and a brace to keep your leg in a neutral position. Once ample healing has occurred, physical therapy and rehabilitation may begin, lasting anywhere from three to six months. Every effort is made to control pain with regular ice application and OTC pain relievers. If needed, stronger NSAIDs may be prescribed.

Preventing a Hamstring Injury

Since hamstring injuries typically occur during sports and athletics, routine precautions should be taken in advance of the activities. It's important to note that hamstring re-injury is most likely to occur within the first two weeks of returning to a sport.

Prevention tips:

  • Add retro-running, or 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 you skip stretching, these muscles can eventually become fixed in this semi-flexed position.
  • Warm-up before exercise with eccentric hamstring stretches, which involve focusing on lengthening muscle contractions.
  • If you're recovering from a hamstring injury, be sure to follow your healthcare provider's treatment plan and only return to exercise after you've been cleared. Keep in mind that hamstring re-injury can lead to more severe damage.
  • If you experience hamstring pain while exercising, stop and rest. Use appropriate treatment methods and contact your healthcare provider if symptoms are severe and/or chronic.
6 Sources
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. American Academy of Orthopaedic Surgeons. Hamstring muscle injuries.

  2. Penn Medicine. Hamstring injuries.

  3. Mount Sinai. Hamstring strain - aftercare.

  4. 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. doi:10.1177/2325967118781828

  5. DeWitt J, Vidale T. Recurrent hamstring injury: consideration following operative and non-operative managementInt J Sports Phys Ther. 2014;9(6):798-812.

  6. Nemours TeensHealth. Hamstring strain.

Additional Reading

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