Bodyworks: Hamstring Injuries

How to recognise them, how to overcome them

by Patrick Milroy

Hamstrings are unusual in that they pass over two joints, the hip and the knee. They are therefore most likely to be injured when the hip is bent and the knee fully straightened. Further stretching may cause an injury that varies from a strain to a classic rip.

Hamstring Strains

Although the hamstrings run down the back of the thigh, injury to the lower part may well be felt behind the knee, either on the inside or outside.

Not only may there be pain behind the knee, but, depending on whether the muscle sheath higher up the thigh is breached, there may or may not be visible tracking of blood down the thigh.

While the knee is bent and the area is not under pressure, there may appear to be little wrong. Straightening the knee and stretching the hamstrings, however, should show all the classic signs of a hamstring injury.

Medical investigations
Are probably not necessary unless the condition, as may happen with hamstring injuries, fails to resolve.

What else could it be?
A bursa around the hamstring insertions, a Baker’s cyst or ligament strains may all cause pain in roughly the same site. Careful examination should eliminate these.

Following the 48 hours of obligatory RICE, any bleeding should have died down and you can start to stretch. If it's painful still, see Hamstring tears.

Medical treatment
Combining the use of ice and educated stretching with interferential physiotherapy or ultrasound should bring about a complete cure.

Can you run through it?/ Recovery time
This sort of minor hamstring tear ought not to bother a runner for more than three or four weeks and the more obsessive among us will find ways of limping through training that may be of doubtful value.

Hamstring Tears

You feel sudden pain when the muscle is over-stretched – for example, when hurdling an obstacle or sprinting at the end of a race. It then hurts when you straighten the knee, and running will be slow, if not impossible.

The professional can usually put a finger on the site of a tear and induce appropriate discomfort. There may be a gap within the muscle, or hardened bruising, but it is encouraging if there is visible bleeding under the skin and tracking of the blood flow towards the knee. This indicates that the sheath of muscle has been breached, blood has escaped and healing will therefore be more rapid. Pain occurs if bending the knee is resisted, or if the patient attempts to stretch the muscle.

What else could it be?
Damage to the sciatic nerve by a lumbar disc is a well-recognised red herring which causes pain in the back of the thigh. The doctor will also wish to exclude those infections, tumours and bone and muscle disease which strike these areas once in his professional lifetime.

You cannot go wrong with RICE, always remembering that this should be continued through rehabilitation, as the muscle is stretched and power is regained. Not only is the commonest cause of hamstring injury an unrehabilitated prior tear, but a weak hamstring muscle also predisposes to knee injury.

Can you run through it?/Recovery time
Recovery time may be days, weeks or months, depending on the severity of the tear and how rapidly you treat it. Running through it is unwise, but that is unlikely to stop the masochists among you.

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Discuss this article

I have had a hamstring injury for 10 months now. In that time it has not got any better, despite stopping running completely for 5 months of that time. I am now running again, but only very gently, If I try and push it the pain comes back. The pain starts the next day, never when I'm running - and can last for 4 or 5 days. I've tried everything: massage, manipulation, cortizone injections, even alternative therapy! I have been told it's 'Weaver's Bottom'. Can someone who has suffered from this please tell me how long it will last. It's all getting very depressing as I can't see an end to it.
Posted: 19/10/2002 at 20:38

Sorry I can't help with this. Why not post on the injury forum.
Posted: 23/10/2002 at 21:07

Hi Steve , I sympathise as I have had PF< for a year, decided that conventional t'ment had not worked.So decided to srart trainingnagain. I had 9 weeks of building up , despite pain in foot. Then guess what!! Hamstring ,probably due to the fact I got greedy and decided to do some speedwork. Result, I am off the road for at least another 4 wks. Physio says I have bruising 7swelling where the hamstring bunches into thethigh. SO I am working out on my Eliptical trainer which is boring, but better , than nothing, and stretching. Not a lot more to do . I did try to run after a week's rest but not a good idea . So be patien , and do some alternative stuff to compensate. Cheerio Anne
Posted: 30/10/2002 at 00:36

I have had what I thought was a knee problem for the past month. I had apain at the back of my knee and was unable to bend it easily and also pain at the outer side. Used RICE and massage and rest for about 2 and a half weeks and the pain got better then after one normal short run I thought everything was ok but the next one after that and the pain was back and after seeing a sports physio have found that it is a hamstring injury. I have no idea how it occured as I do not remember doing anything out of the ordinary at all thime during the run when it must have happened.
Now that I know what it is I am preparing more than I did before running and for longer with stretching and warm ups and also cooling down. I am also doing some light weight work to try and strengthen the hamstrings.
So far I have run twice since my "diagnosis" but only for a short time and have not had any pain afterwards but I feel really wary in case it starts up again. I feel conscious about it all the time in case something happens. Am I paranoid now? Has anyone suffered from something similar and can calm my fears for me?
Posted: 29/08/2003 at 13:17

Since about August 2002 I have experienced a wierd twisted type feeling at the inside rear of my right knee. I have not injured myself, this feeling just appeared. I went to see a physio who couldn't find anything wrong but suggested changing my work shoes. I ran in this year's London Marathon with no problems, but the feeling just won't go away. I've tried stretching but this actually made it worse and created a tearing feeling. The feeling is still there but is not painful and I don't feel it when running, only when I'm walking or sitting...wierd or what? Does anyone have any ideas as to what it may be?
Posted: 31/10/2003 at 17:24

i have just started running (tho if you saw me doing it you'd probably call it something else)! i few months ago i was late for work so started running fast up the road. i felt a real tug at the bottom of my right right bottock where it meets the leg.
ever since i have started running i have had this pain before and after my runs.
i have overpronating feet but wear brooks beast - maybe my leg is still twisting? i dont know - can anyone help.

thanks .
Posted: 18/11/2003 at 15:25

I too am an injured hamstring victim. It started niggling after a half-M in July. I rested for almost 5 weeks, but it comes back whenever I do a plus-7 mile run (the day after, like Steve W)

I finally went to a physio the other day and what he told me makes sense. My pain is about 3 inches above my knee where the hamstring splits around the sciatic nerve. The irritation is due a tilt in my pelvis which extends the hamstring beyond what is comfortable and it inflames the nerve.

It's nice to know I know what the problem is, and I have a long list of exercises to strengthen the muscles to hold my pelvis more securely. However, seems it's just the way I'm built and this will be a recurring problem unless I keep up the exercises.

Good news then is it's not serious and I can run and am unlikely to cause tearing or serious damage. The bad news is that I'm likely to have to do these exercises for life and work on changing my running style.

I guess my point for Steve and others is that you may need good biomechanical analysis and keep up treatments of any kind rather than expect a wonder cure.

Hope that's been somewhat useful

Posted: 19/11/2003 at 10:49

thanks for the good news. any chance you could let me know the sorts of exercises you have to do?
it's true what they say about runners; very friendly, very helpful.

thanks again.

Posted: 19/11/2003 at 13:19

Hi Jon,

You should get yourself checked first as my exercises may not help your particular problem.

I will however try to post them up when I get them in an emailable format soon.
Posted: 19/11/2003 at 14:20

Have tried to explain my exercises on this thread:
Posted: 21/11/2003 at 11:19

When I start running I have a sharp pain at the top back of my right leg, it also is sore when I walk or climb stairs.
Is this a tare in my hamstring?

If so what can I do about it?
Posted: 14/02/2004 at 18:58

My goodness so much of this sounds familiar to me (especially Steve). I have had problem with my hamstrings for over 18 months in which time I've not been able to do any serious exercise and hence have gained 10kilos in weight (which I'm now losing through dieting).
After numerous xrays and scans and months on anti-inflammatory drugs I have finally been told that I have a tear right at the top of my hamstring. Great - my physio was giving stretching exercises based on a wrong diagnosis and I have been constantly tearing the the same tissue so that now the muscle is fibrous and will take much longer to heal and tears more easily.
I'm sure the cause was combining a lot of exercise each evening with sitting down in front of screen for 10hours a day, siiting down driving and flying long distances and of course not acting quickly enough when I first got the pain in my leg. I have also developed a bursitis in my left buttock (Weavers Bottom again!)and behind my left knee.
I am now about to start a treatment where a machine will pound the injured area to reduce the fibrous muscle - I'm nervous as I really don't want to make the problem any worse.
Anyone got any better ideas for my recovery?
Posted: 08/08/2006 at 11:14

JJ you're right! No I still have the injury! It's worth posting in case somebody else picks up the thread through Google like I did.
And I've found lots of other stuff on this site that's useful.
I've seen 5 different physios - and the first one I saw I think was spot on. He told me that I needed to strengthen my left glute as my left hamstring was compensating for it being weak - which I now know is caused by a twist in my back causing my pelvis to be lower on one side. A number of other people on this site seem to have hamstring injuries related to the same problem.
Hope all this helps other resolve their injuries quicker than me.

Posted: 08/08/2006 at 11:31

I think I picked up this injury through speed sessions on the track.Classic hamstring feelings but also pain in the front of my right knee.I have an on going foot injury in my right arch and I think its this plus sciatic nerve problems that cause this problem.I am still running but find that after seven or more miles the pain starts to kick in.I overcame the foot and hope to do the same with this.Good luck all.Pete
Posted: 30/08/2006 at 21:52

I am 57 and I have had a right hamstring problem for nearly 18 months. An osteopath thinks the cause is a weak right glute, my usual sports injury masseur thinks it all relates back to a spondilolithesis I have had since I was 14. However, when ever it seems to be getting better something happens and it deteriorates again; the last occasion was a week ago when I was digging up bits of turf to plant bulbs for next spring. Although it always seems to give me trouble shortly after I have reached running 11k in an hour and feel that I am at a point to lift off to something half descent. The only thing I can really suggest to people who have hamstring problems and get frustrated at not being able to exercise is to try other forms of exercise; maybe biking or using a cross trainer - these work for me when the hamstring isn't too bad, and then I find a gentle run seems to actually ease it.
Posted: 10/11/2006 at 18:41

A female running colleague has developed a severe pain to the back of her right thigh when running. I thought that it could be a hamstring injury. Sometimes it eases on gentle slow runs then returns again at any given time during running. What would you advise her to do.I have suggested keeping the muscle warm when running via either cycling type shorts under her long running pants,heat generating cream on thigh when running ie gel etc. She finds it very difficult when I tel her to rest it.
Posted: 30/11/2006 at 23:10

I have had an injury to my hamstring for about 2 years now and have managed to do some good training and hard events on it (I am a fell runner so it takes quite a beating!)
I have recently noticed that I have aquired a 'ridge' across my hamstring about halfway up the muscle which I can only assume is scar tissue (?). I have also recently suffered a groin strain and running on that seems to have made the hamstring issue worse!! I am hoping to start some training again soon and am making some tentative steps towards my bike.

Posted: 03/01/2007 at 22:43

I damaged my hamstring almost a year ago after returning from the gym using the treadmill. I had warmed up and cooled down and then proceeded to prove to my daughter I could still do the splits at 44! - my hausband said he heard it go! Physio, sports masseur, heat, ice and very broke I still have pain. I have just started doing deep water running with a flotation aid as I read somewhere this was a good alternative to keeping up your training without the painful impact from running I plan to do my first 10k this year so fingers crossed!
Posted: 10/01/2007 at 00:14

Hamstrings are a complete nightmare and mine is still not completely clear from injury after 19 months. All I can say is; go gently, don't annoy it too much. If things get bad try the cross-trainer. Strangely, I sometimes find now that running helps it rather than hinders it but I don't try any kind of weight resistance on the hamstring. Patience seems the only way. PS I am male, 57 and have NEVER tried to do the splits, not that I think my daughter would be impressed even if I did!
Posted: 10/01/2007 at 09:54

Steve: very sorry. I am now in month 19 without a clear hamstring although it seems to be allowing me to run. There are two issues (neither of which I have resolved); 1. diagnosis, 2. cause. I seem to have some scar tissue fairly deep in the muscle but can currently do most things although I would not dare to do weight resistance. Cause: hmmm, well, the expert athletics osteopath thinks I have a weak right glute, the expert sports injury masseur thinks it all relates back to my lumbar vertebae problem that I have had since age 14. Patience, avoiding aggravating it and finding satisfying ways of working around it, testing it gently periodically seem the best ways forward. If you are desperate and/or wealthy, there are sports injury specialist orthopaedic surgeons who can run diagnostics only available to them, which ultimately where one has to go. Good luck.
Posted: 10/01/2007 at 10:02

Well have finally decided to make a Drs appt for referral to a sports injury physio as the back of my left leg is now causing me real grief. Felt it pull last June (yep 8 whole months ago) whilst doing a cartwheel about 30 mins before a 5K race! ran on it for a while afterwards but then stopped running for 2 months. Been back running, playing Netball and working out in the gym on the Cv machines but it is now worse than before. It aches all the time, especially after a run. Can't get up from my desk at work without it pulling and am totally fed up. it's a dull ache which runs from the back of my knee to the bottom of my buttock and if I press it in a certain place it disappears ! as I'm not a contortionist I can't run holding onto it and whilst it aches when running it's not bad enough to stop me. It's afterwards that it hurts. Any advice appreciated, will the physio actually be able to help? I've got a 1/2 Marathon in 8 weeks and I don't want to pull out. Thanks.
Posted: 25/01/2007 at 11:58

Read it this weekend in the Sundays. Top Premiership footballer (insert name) has a hamstring injury after yesterday's game - expected to be back for next week ! Makes you weep.
Posted: 26/01/2007 at 10:29

Sorry a trifle over optimistic. Alexander Hleb (Arsenal) - one month. Weep.
Posted: 26/01/2007 at 11:45

About 10 years ago I was showing off about how I could do the splits. There was an audible rip? which has resulted in constant pain since. After the injury I rested for about 3 months with no running at all. Over the years the pain has altered from pain travelling all around the hamstring area, both sharp and dull but for the last 5 years or so I have had pain around the 'sit-bones'. This is constant but tends to fluctuate in intensity, getting so bad at times that walking and even just sitting is very uncomfortable and painful. After the initial resting period I started training again, gentle runs and stretching and thankfully I am able to train most of the time to some degree. I have had various diagnosis for this and tried all the usual actions, including cortisone injections which only resulted in a bad 'flare-up'. I am wondering if I may have cysts in the bursae around my 'sit-bones'. Has anyone got any ideas -HELP - this has been going on for so long now it has become rather depressing. PS. I have entered my first marathon (February 08) and would love to solve my problem as it really hinders the training and may stop me completing if I experience a 'flare-up' which can last for months.
Posted: 19/12/2007 at 12:20

Hi everyone,

I pulled my hamstring in July 06 (6 months ago). I did it sprinting on grass at the end of a 7 mile session at my running club (so was very warmed up). It just felt like a small tug, no pain but just felt unusual - because I never go any pain, I never saw any physio staight away. Problems started when I started to limp when running an the hamstring tightened up. I eventually saw a physio 1 month later (stupid I know) and she said there could've have been a possible tear but she wasn't sure. It seemed to almost go a few weeks later, but after some fast track work the dreaded thing came back! I have had about 3 massages on it over the next 3 months put it still was tight. Anyway, the last 2 months I've not done any fast efforts and now do various hamstring stretches every day + use ibuprofen gel and bio-gel to keep the temp down straight after a run.

 Bad news is my hamstring is STILL tight and I have no confidence in running any quicker, so I resigned to the fact that my pace will not improve. I only started running in May 2006 and I think i've done too much too soon.

 I'm going to book a recommended physio next week so I will let you all know how it goes and if I can tell you anything new.

 Cheers Steve

PS I would recommed however slight a pull you get on your hamstring, that if you find it uncomfortable to run / walk the next day book in a physio reight away and don't delay it like I did.  

Posted: 18/01/2008 at 13:50

Pulled my hamstring July 07 (not 06)!!
Posted: 18/01/2008 at 13:53

I had pain behind my knee on a training run and stupidly thought I could run through it. It appears I was mis-advised on the correct running shoes many years back. I was told I was a neutral runner but years later had a video gait analyisis andwas told I was a a quite severe over -pronater! I have seen several physios and still 18 months on I cannot run. Just runnng  20-30 metres after one of my children on their bikes & the tightness and stiffness is there. It is so frustrating! Running makes me feel so much better about myself and I'm stuck!

Posted: 13/09/2008 at 01:08

Date now Sep 2008 - Hamstring has been ok now for about 4 months and running has improved. So hamsting injury lasted about 10 months and I wouldn't consider it a bad pull, so goes to show how bad hamstring pulls are compared to other muscle injuries.

Running great now tho.....

Posted: 14/09/2008 at 09:11


I overdid  session 2 of my new hill training regime and developed a tightness right behind my thigh, thought it would go away on my run next day - it didnt and I've still got it 3 weeks later.
I thought it was too slight for a hamstring strain but reading this lot - thats probably what it is.

I'm off to the physio this week, wish me luck

Posted: 13/10/2008 at 11:21

2 months ago I started to develop pain in my heels and the arches of my feet. I stopped running staright away. It was diagnosed as plantar fascitis, caused in part by my over pronation which I was already wearing Brooks for. I saw a physio, had two weeks off and put insoles in my trainers. The problem cleared up. I even did a half marathon, very stupiddly, 3 weeks ago. However, the last couple of weeks the hamstrings in my right leg have been tight, then over the last few days I have developed discomfort in the side of both of my knees, hips and lower back. I had a sports massage and was diagnosed with tight hamstrings in both legs which can cause pain in the side of the knee. However, I have now started to develop pain in my glutes which is a long standing problem which I thought I had cured by doing stregthening exercises over the last 6 months. I am now wondering whether the insoles are causing all these aches. I went to a running store where they told me to stop using the insoles, but I am a bit worried if I do this then my plantar fascitis will come back? Should I consider changing my trainers? I have been given lots of exercises to do but I am quite frustrated and not sure what advice to follow. Can anyone suggest anything?   

Posted: 01/12/2008 at 19:53

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