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Hamstring strains- symptoms, causes and treatment Part Two

Hamstring strains- symptoms, causes and treatment Part Two

Here is Part Two of our mini series on hamstring strains covering the types of  hamstring strain and how the management and treatment may differ once the diagnosis is made. If you have suffered from this kind of leg pain, do make an appointment to see a physio, osteopath or chiropractor in any of our Blackberry Clinics offering musculoskeletal services. This is a very common injury in footballers, rugby players and squash players.



An acute injury that usually occurs during dynamic running: sprinting, jumping, fast stop/starts
The strain is graded:
Grade 1 – minor tear of a few muscle fibres

Grade 2 – tearing of a larger number of fibres but muscle still intact

Grade 3 – complete rupture of the muscle


Sudden onset of pain while running

Sharp, stabbing, possibly even a snap or pop sound
Bruising on back of the thigh
Can have associated back and buttock pain

In grade 2 or 3 injuries may have difficulty walking


Acute phase:

R.I.C.E – rest, ice, compression, elevation and refer yourself to a physical therapy specialist after 48–72 hours.

Physical therapy to promote tissue healing and ensure minimal scar tissue formation
Massage and manual therapy to release tight surrounding structures and address any underlying back or hip issues

Exercise therapy – slow and progressive over stages depending on the severity of the initial tear


Strengthen pelvis and core including the gluteal (buttock) muscles as they work together with the hamstrings.
Manage any muscle imbalances in weakness or flexibility through exercise correction.
Neural mobilisation stretches.
Progression to full leg strengthening exercises, squats, deadlifts and finally eccentric strengthening of the hamstring.



An overuse/overloading of the muscle tendon attachment at the origin of the hamstring on the ischial tuberosity deep in your buttocks.
History of increased load, more hill running, increased speed work, unaccustomed deep lunges, yoga and deadlifts.
The tendon has poor blood flow which makes healing and recovery slow.


Buttock pain
Point specific pain on or just below the ischial tuberosity (sit bone)
Chronic stiffness
Aggravated by periods of sitting and driving deep lunges, hamstring stretches and running at high speeds and uphill
Stiffness or soreness first thing in the morning followed by a ‘warming up period’ where the pain disappears
Following exercise pain may be delayed by 24 to 48 hours


Early stages:
Ice regularly through the day
Stop stretching your hamstring as this compresses/squashes the tendon
Sit as little as possible, use a soft roll under your buttock to relieve pressure on tendon

Physical therapy to mobilise tight structures and promote tissue healing using massage, acupuncture and other modalities
Isometric exercises 2–3 times per week especially if still painful

Load modification; manage muscle imbalances in weakness and flexibility through exercises
Strengthen the core, pelvis and gluteal (buttock) muscles
Neural mobilisation stretches
Eccentric strengthening in latter stages of rehabilitation

Complete rest may be advised depending on severity of injury; otherwise, reduce intensity and training volume
Avoid speed and hill work
Find a comfortable pace and distance that causes no pain and stick to that during training
Train on softer surfaces if possible and avoid wet slippery fields
Cross train with cycling, water running, swimming, elliptical trainer
Address underlying contributing factors, such as biomechanics (do you need orthotics for your arches?) or a difference in leg-length


The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical
care or as a substitute for specialist medical advice in each individual case. ©Co-Kinetic 2018 Blackberry Clinic 2021

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