Hamstring strain: rehab, recovery time and prevention

What a hamstring strain is

The hamstrings are three muscles at the back of the thigh that bend the knee and extend the hip. They work hardest during sprinting, when they have to slow the lower leg down just before the foot hits the ground, while being stretched at the same time. That combination makes them one of the most commonly strained muscles in sport.

Strains range from mild, with a few fibres affected, to severe, with a large tear. Injuries that involve the tendon inside the muscle, or the tendon where it attaches at the sitting bone, tend to take longer. The most commonly injured is biceps femoris, on the outer side of the back of the thigh.

How it happens and who gets it

There are two main patterns. Sprint-type injuries happen at high speed, often late in a match or session, with a sudden sharp pain that stops you running. Stretch-type injuries happen in slower, extreme stretches, such as a high kick, a slip into the splits or a dance move, and often involve the tendon near the sitting bone. These are often less dramatic at first but can take longer to recover.

• A previous hamstring strain, which is the strongest single risk factor
• A sudden increase in sprinting volume, or returning to sprinting after a break
• Low eccentric hamstring strength
• Fatigue, poor sleep and a crowded training week
• Older age in sprinting sports

Typical symptoms

• A sudden sharp or pulling pain at the back of the thigh, sometimes with a pop
• Having to stop running and grabbing the back of the leg
• Pain walking with a long stride, bending forward or getting up from a chair
• Tenderness and sometimes a dip in the muscle
• Bruising appearing a day or two later, sometimes tracking down towards the knee

A strong pop right up at the sitting bone, with heavy bruising, difficulty walking and weakness bending the knee, can mean the tendon has pulled away from the bone. This is less common but needs prompt assessment, because some of these injuries do best with early surgical repair.

What a physio assessment looks at

Your physio will ask how the injury happened, then feel for the location and size of the tender area, test hamstring strength in different positions and check how far you can raise the straight leg compared with the other side. They will screen the lower back, because back problems can refer pain into the hamstring and a sensitive sciatic nerve can mimic a strain.

An MRI is not usually needed for a typical muscle strain, but it may be requested if a tendon injury is suspected, if the injury is at the sitting bone, or for athletes who need a precise return-to-play estimate.

The assessment is also a chance to look at why it happened. Crowded training weeks, a sudden jump in sprint work or a lack of eccentric strength are all things that can be changed, and addressing them is what lowers the risk of a repeat injury.

What usually helps

Research consistently shows that starting pain-guided loading within the first few days speeds return to sport compared with waiting. In the first 48 to 72 hours, walk within comfort, avoid stretching and running, and use compression or ice if it helps with pain. Then begin isometrics and progress through bridges, hip hinges, eccentric work and running drills.

Eccentric strength is a big part of the plan. The Nordic curl has good evidence for reducing hamstring injury risk and is usually added in the later stages of rehab and kept in training afterwards. The Romanian deadlift builds strength in a lengthened position. Running is rebuilt gradually from easy jogging to strides and then full-speed sprinting.

A staged plan to start at home

1. Days 1 to 3: walk within comfort, gentle knee bending and straightening, and isometric holds pressing the heel into the floor while lying on your back, 5 x 20 to 30 seconds.
2. Week 1 onwards: glute bridges with both legs, then single-leg bridges, 3 sets of 10 to 12.
3. As pain allows: long-lever bridges with the heels further away, and light hip hinges.
4. Then: Romanian deadlifts with light weights, slow on the way down, progressing load weekly.
5. Later: easy jogging, then strides at gradually increasing speed, and eccentric exercises like the Nordic curl.

Move to the next stage when the current one feels comfortable and there is no flare the next day. Our guide to returning to running after injury covers the running stage in more detail.

Recovery time and when to get help

Mild strains may settle in 1 to 3 weeks, moderate strains often take 3 to 8 weeks, and tendon injuries can take several months. Re-injury risk is highest in the weeks after returning to sprinting, so finish the plan rather than stopping when it feels better. The on-site physio at Lycan Strength can guide your return, with 20% off for members; book a physio appointment online.

• See a GP, physio or urgent treatment centre within a few days if you felt a pop at the sitting bone with heavy bruising and difficulty walking.
• Call 999 if you have a swollen, warm, painful calf or thigh together with chest pain or breathlessness, as this can be a blood clot.
• Call NHS 111 or see a GP urgently for a swollen, warm, painful calf or thigh without an obvious injury.
• Go to A&E if you cannot bear weight after a fall or collision.
• See your GP if you have numbness or tingling down the leg, or back pain with leg symptoms.

Questions