Ouch I’ve pulled my hamstring! Does this sound familiar? If so, this blog will explain all you need to know about a pulled hamstring, what it is, and how to treat it to avoid injury recurring.
What are the hamstrings?
The hamstrings are a group of muscles at the back of the thigh. There are 3 main hamstring muscles that all attach up onto the hip bone at the bottom of your buttock. They attach past the inside and outside of the knee and help to bend your knee.
How do they get injured?
Typically hamstring injuries occur due to overstretching. This could be when the muscle isn’t fully warmed up when performing a movement e.g. sprinting. There are different terms used for pulling a hamstring. Have you heard of a hamstring tear? Or a hamstring strain? These words are often used interchangeably depending on the severity of the injury.
There are four main grades of hamstring muscle tears:
Grade 0 – normal hamstring muscle – able to bend the knee and walk as normal with no pain or issues. General muscle fatigue and delayed onset of muscle soreness (DOMS) falls into this category i.e. that feeling you get after a workout.
Grade 1 – micro tears that occur within the muscle fibres. These tears are microscopic. Usually, this is accompanied by the feeling of tightness and pain doing certain movements involving bending the knee and stretching the back of the thigh. Typically, this grade is called a muscle strain.
Grade 2 – a larger tear of the muscle that can be seen on an MRI or ultrasound scan. Usually accompanied by loss of strength, power, pain and bruising at the site of tear. Walking may be difficult and painful.
Grade 3 – a full rupture of the muscle leading to almost no power or strength when bending the knee. Difficulty when walking or complete inability to do so. There may be less pain than grade 2 when doing these actions.
These grades can vary depending on what scale is used and can be further broken down into the location, length, size and direction of the tear e.g. is it more towards your buttock or towards the knee? Or is it horizontal or longitudinal? This is important to take into consideration throughout the rehabilitation and treatment process.
How do physiotherapists treat a pulled hamstring?
There are various steps in treating a pulled hamstring. The first being immediate acute care including first aid, and subacute care involving exercises and hands on treatment.
Have you heard of ‘RICE’?
Over the years RICE (Rest, Ice, Compression, Elevation) has evolved into a more advanced acronym called ‘PEACE & LOVE’. For the first 1–3 days we use ‘PEACE’. This stands for Protect, Elevate, Avoid Anti-inflammatories, Compression and Educate. After the first few days ‘LOVE’ can be applied. This stands for Load, Optimism, Vascularisation and Exercise.
What exercises are appropriate to do?
The grade / severity of the tear will depend on how we treat the injury. Grades 1–3 are typically treated conservatively.
Exercises in the initial phases may include:
- Hamstring glider (start by lying on your back and gently straighten and bend the leg perform 10–16 reps 3x daily) – this helps keep the leg moving and prevents stiffness.
- Isometric leg curl (start by sitting, bend your knee and resist the movement with the other leg holding for 30–60 secs 3x daily).
- Glute bridge (starting on your back, knees bent, feet on the floor. Lift your bottom and hold for 30–60 secs 3x daily).
Exercises in the middle phase may consist of:
- The diver (start with the arms above the head, standing on one leg, extend one leg behind you as you bend forwards hinging at the hips. Soften your knee slightly and make sure you keep your back straight throughout the movement. When you reach horizontal, come back up to the start position. Perform 3×10 daily).
- Hamstring curls (start by lying on your front with a band around your ankle attached to a sturdy object behind you. Bend the knee by pulling the heel towards your bottom. The band creates resistance. Slowly lower back down to the start position. Perform 3×10 3–4x weekly).
- Single leg glute bridges (start on your back with the knees bent at 45 degrees and hands on the floor. Lift one leg up straight in the air. This is the start position. Then lift your bottom up off the floor pushing through your one foot before returning to the start position. Perform 3×10 3–4x weekly).
Exercises in the late phase may consist of:
- Romanian Deadlifts (RDL’s) (Stand with feet shoulder width apart. Hold a weight e.g. barbell close towards your legs. Keeping your shoulders back and back straight, hinge the hips backwards until you feel a stretch into the hamstring. Repeat 3×10 3–4x weekly).
- A/B skips (start by hopping up towards the ceiling opposite arm and opposite leg, moving forwards as doing so. Then start to kick the leg out in front of you at the same time as you hop forwards. Repeat 3×10 3–4x weekly).
- Bridge hops and deceleration (start on your back with your hands by your side. Bend both knees up and lift one leg in the air. Dig your heel into the floor and lift your bottom. Hop from one leg to the other keeping your bottom up in the air. Stick each landing. You can also practice hopping away from you).
Summary
A pulled hamstring can range from mild tightness to a complete muscle rupture, and understanding the severity of the injury is key to successful recovery. Early management using the PEACE principles helps protect the muscle and control symptoms, while the LOVE approach encourages gradual loading and active rehabilitation.
Rehabilitation should be progressive – starting with gentle mobility and isometric strength work, moving into controlled strengthening, and eventually returning to more dynamic, sport-specific movements. Rushing the process can increase the risk of reinjury, so patience and structured progression are essential.
With the right treatment plan, most hamstring injuries recover well, allowing you to return to activity stronger and more resilient than before.
If you are interested in booking some physiotherapy, then please get in touch. Book an appointment with a physio online.
