Hamstring Injuries

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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How are hamstring injuries diagnosed?

Injury to the hamstring muscle is diagnosed by the rapid onset of intense pain in the back of the mid-thigh during running or similar activity. Athletes will often instantly grab in pain at the back of the thigh, being unable to walk without limping. There is often focal tenderness where there is pain that is aggravated by stretching the affected thigh. In most patients, imaging is not necessary. However, if imaging is done to more completely view the muscle, tendon, or bone involvement with the injury, MRI gives the best views, although CT and ultrasound studies have also been used.

What is the treatment for hamstring injuries?

Most hamstring injuries heal without surgery. Rarely, when there is a complete rupture at the ischium, or when a significant piece of ischial bone is jerked away, surgery is necessary. Essentially, all other grade I-III tears are best treated without surgery.

The goal of treatment is to restore muscle function and prevent scar formation. Initially, treatment consists of rest, ice, compression, and elevation (RICE). Rest refers to avoidance of offending activities and oftentimes includes immobilization. In severe cases, crutches or splinting may be necessary. Ice, compression, and elevation all assist in controlling pain and swelling. A short course of nonsteroidal anti-inflammatory medication, such as aspirin, ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and others), or naproxen (Anaprox, Naprelan, Naprosyn, Aleve), may be helpful.

As soon as pain permits, it is important to begin a program of stretching and range-of-motion rehabilitation exercises because prolonged immobilization and inactivity results in muscle shrinkage (atrophy) and scar tissue (fibrosis). Excessive scar tissue is incompatible with healthy muscle function. Atrophy and fibrosis are best avoided or reduced by a program of motion and stretching implemented early in the rehabilitation process.

It should be emphasized that an early rehabilitation program does not mean a quick return to the desired usual activity. Given the type of individual that usually sustains a significant hamstring injury, it is usually a difficult task to keep athletic patients off the playing field. Reinjury is extremely common and is often due to avoidable premature return to sport. Reinjury not only prolongs recovery, it also increases the risk of permanent damage. People with these injuries should be informed early in the rehabilitation program about the risks of reinjury.

After pain and swelling have been controlled and acceptable range of motion and flexibility has been attained, a gradual strengthening program should follow. After adequate strength has returned, then a gradual return to the desired activity is attempted. Full return is usually possible only after maximal flexibility and optimal strength have been obtained. Depending on the severity of injury, the entire rehabilitative process may take several months. Physical therapists can assist in guiding the exercise program.

Medically Reviewed by a Doctor on 7/20/2015

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