Hamstring strain
It is a severe strain or tear of the muscle fibers in the hamstrings, which are located at the back of the thigh.
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A sudden pain in the back of your thigh while sprinting. You may have suffered a hamstring strain, one of the most common muscle injuries among athletes. This injury accounts for 37% of muscle injuries in professional soccer and affects both amateur and professional athletes.
Good news: with the right treatment and proper rehabilitation, the vast majority of hamstring strains heal completely. Here's what you need to know to recover well.
What is a Hamstring Strain?
A hamstring strain is a tear in the muscle fibers at the back of the thigh, affecting one or more of the three muscles that make up this group: the biceps femoris, semitendinosus, and semimembranosus.
The hamstrings are made up of three distinct muscles. The biceps femoris is located on the outer side of the thigh, while the semitendinosus and semimembranosus are on the inner side.
The biceps femoris is the most frequently affected, accounting for 53% of hamstring injuries. These injuries typically occur at the musculotendinous junction, where the muscle meets the tendon.
Two types of strains exist:| Type | Affected muscle | Mechanism | Typical example |
|---|---|---|---|
| Type 1 (sprint) | Biceps femoris | Explosive contraction | Sprint, acceleration |
| Type 2 (stretch) | Semimembranosus | Excessive stretch | Splits, high kick |
The hamstrings play an essential role: they bend the knee, extend the hip, and stabilize the pelvis during running.
What Causes a Hamstring Strain?
A strain occurs during a powerful eccentric contraction, typically during the acceleration phase of a sprint, when the muscle lengthens while contracting to slow down the leg's movement.
The critical moment is just before the foot touches the ground during a sprint, specifically during the late swing phase. Contrary to popular belief, the risk is highest not at maximum speed, but during maximum acceleration.
Main Risk Factors:A meta-analysis published in the British Journal of Sports Medicine identifies the following risk factors:
| Risk factor | Relative risk | Impact |
|---|---|---|
| History of hamstring injury | 2.7 to 6x higher | Most important factor |
| Age over 25 years | 1.3 to 1.9x higher | Progressive risk |
| Low eccentric strength | Significant | Measurable by tests |
| Bilateral imbalance >10-15% | Significant | Correctable |
Fatigue at the end of a game significantly increases the risk. This is why injuries are more frequent in the second half.
High-risk sports:| Sport | Prevalence | Typical mechanism |
|---|---|---|
| Track and Field Sprinting | 16-26% of injuries | Acceleration |
| Soccer | 12-16% of injuries | Sprinting, Shooting |
| American Football | 12% of injuries | Sprinting, tackling |
| Dance and Ballet | 8-17% of injuries | Split, extension |
Who is at Risk of a Hamstring Strain?
Athletes who have previously suffered a hamstring strain have the highest risk of re-injury, with recurrence rates ranging from 12% to 33% according to studies.
The incidence in professional soccer ranges from 0.87 to 1.8 injuries per 1000 hours of play. Players who have previously suffered a hamstring strain are particularly vulnerable.
High-risk profile:| Factor | Risk Threshold | Measurement |
|---|---|---|
| Previous hamstring strain | Any previous injury | Medical history |
| Age | Over 25 years old | Non-Modifiable Factor |
| H:Q Ratio | Less than 0.6 | Strength Test |
| Unilateral Deficit | More than 10% | Bilateral Comparison |
| Knee Flexibility | Reduced | Mobility test |
Recurrence is often more severe than the initial injury. This is why complete rehabilitation before returning to sport is essential.
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How to Recognize the Symptoms of a Hamstring Strain?
The main symptom is a sudden, localized pain at the back of the thigh, often accompanied by a snapping sensation. Approximately 70% of athletes report feeling a "pop" at the moment of injury.
Typical symptoms by severity:| Symptom | Mild grade | Moderate grade | Severe grade |
|---|---|---|---|
| Pain | Mild, localized | Moderate, widespread | Intense, disabling |
| Walking | Possible with discomfort | Difficult | Impossible |
| Bruise | Absent or mild | Visible within 48-72 hours | Extensive |
| Swelling | Minimal | Moderate | Important |
- Palpation: precise tender point at the back of the thigh
- Active knee extension test: painful limitation
- Passive stretch test: pain when the muscle is lengthened
- Isometric resistance test: weakness and pain
- Complete inability to put weight on the leg
- Extensive bruising extending towards the knee
- Palpable depression in the muscle (suggests a tear)
- Persistent severe pain even at rest
What are the different grades of severity?
Hamstring strains are classified into four grades based on the extent of tissue damage, ranging from simple pain with no visible injury to a complete muscle tear.
The British Athletics Muscle Injury classification distinguishes these grades:
| Grade | Description | Affected fibers | Expected return to sport timeframe |
|---|---|---|---|
| Grade 0 | Pain without structural injury | 0% | Less than one week |
| Grade 1 | Small tear within muscle fibers | Less than 10% | 1 to 3 weeks |
| Grade 2 | Moderate tear between muscle bundles | 10 to 50% | 4 to 8 weeks |
| Grade 3 | Extensive tear or rupture | More than 50% | 3 to 6 months |
| Method | Sensitivity | Indication |
|---|---|---|
| Ultrasound | 68-92% for grades 2-3 | Initial assessment, quick |
| MRI | Guidance for all injury levels | Precise location, prognosis |
Two factors worsen the prognosis: a proximal location (near the buttock) and tendon involvement rather than muscle involvement.
How to treat a hamstring strain?
Treatment is based on the PEACE and LOVE protocol, a modern approach that replaces the older RICE protocol and promotes optimal tissue healing.
Acute phase (0-72 hours): PEACE| Letter | Principle | Practical Application |
|---|---|---|
| P | Protection | Avoid activities that cause pain |
| E | Elevation | Elevate the leg to promote drainage |
| A | Avoid anti-inflammatories | Avoid anti-inflammatory medications that may slow down healing |
| C | Compression | Bandage to reduce swelling |
| E | Education | Understanding that appropriate activity levels promote healing |
| Letter | Principle | Practical Application |
|---|---|---|
| L | Load | Gradually introduce controlled physical demands |
| O | Optimism | A positive attitude improves the prognosis |
| V | Vascularization | Pain-free cardiovascular activity |
| E | Exercise | Restore mobility, strength, and body awareness |
| Phase | Type of exercise | Goal |
|---|---|---|
| 1 | Isometric | Muscle activation without movement |
| 2 | Concentric | Strengthening while shortening (muscle) |
| 3 | Eccentric | Strengthening while lengthening (muscle) |
| 4 | Sport-specific | Preparing for return to activity |
The Nordic hamstring exercise reduces the risk of injury by 51% and speeds up recovery. Askling's L protocol allows for a faster return to sport compared to conventional approaches.
Criteria for returning to sport:- Strength greater than 90% compared to the uninjured side
- No pain upon palpation
- Successful completion of functional tests (jumps, accelerations, decelerations)
- Regained psychological confidence
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Make an appointmentHow long does recovery take?
Healing time ranges from 2 weeks for a Grade 1 injury to 6 months for a complete tear, with a gradual return based on objective criteria rather than a fixed timeline.
| Grade | Protected phase | Active rehabilitation | Return to sport |
|---|---|---|---|
| Grade 1 | 3 to 5 days | 1 to 2 weeks | 2 to 3 weeks |
| Grade 2 | 1 to 2 weeks | 3 to 5 weeks | 4 to 8 weeks |
| Grade 3 | 4 to 6 weeks | 6 to 12 weeks | 3 to 6 months |
In professional soccer, the average time off for a Grade 1-2 injury is 17 days. Returning to sport too soon is the number one factor for recurrence.
Criteria-based approach:Return to sport should be guided by achieving objective criteria, not by a fixed timeline. This approach significantly reduces the risk of recurrence.
How to prevent recurrence?
Prevention relies on eccentric hamstring strengthening, an appropriate dynamic warm-up, and smart management of training load. The FIFA 11+ program reduces hamstring injuries by 60%.
Evidence-based preventive protocol:| Element | Frequency | Proven Benefit |
|---|---|---|
| Nordic Hamstring Exercise | 2-3x/week pre-season, 1x/week in-season | Reduces risk by 51% |
| Dynamic Warm-up | Before every training session | Superior to static stretches |
| Load Monitoring | Continuous | Optimal Ratio: 0.8-1.3 |
| Eccentric Strength | Maintain >337N | Identified Protective Threshold |
- Maintain a hamstring/quadriceps strength ratio greater than 0.6
- Monitor your fatigue (rating of perceived exertion scale, sleep quality)
- Do not neglect pre-season training to develop eccentric strength
- Avoid sudden increases in training volume or intensity
Key takeaways
- Hamstring strains are common but treatable injuries
- A history of injury is the main risk factor for re-injury
- The PEACE and LOVE protocol guides modern treatment
- Returning to sport should be based on objective criteria, not a fixed timeline
- The Nordic hamstring exercise reduces injury risk by 51%
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