A Short Guide to Hamstring Tears and Strains

This short guide will cover:

• What is a hamstring tear or strain?
• What are common symptoms of a hamtring injury?
• How long does it take a hamstring tear to heal?
• What exercises should you do for a hamstring injury?

What is a hamstring tear or strain?

Hamstring muscle tears are a very common lower limb injury, impacting all different types of people and sports. Oftentimes, injury is due to a stretch mechanism, a contraction mechanism or a combination.

A classification system has been used to determine where the injury is and the extent of the injury. I always recommend seeing a health professional to assess and evaluate an injury.

As per the British Athletics Muscle Injury Classification system, muscle tears can occur on a scale of 1-4 and within three areas: myofascial, musculotendinous or intra-tendious (see the image below). This gives clinicians and patients a better understanding of the injury type, the rehab needed and the healing timeframe(1).

Without MRI, a clinician cannot be 100% positive on the diagnosis, but can still determine a treatment pathway. Measures that are used in clinic to determine injury type and progression through rehab include: loss of range of motion, tension/contraction ability, pain, bruising, swelling, the mechanism (how it happened), the sound/feeling at the time of the injury, previous injury and type of sport(2).

This is general information regarding hamstring tears, and I recommend seeing a healthcare professional for a diagnosis

General muscle tears and strains – grade 1, 2 or 3 muscle tears

A hamstring tear, also known as a hamstring strain, is a common sports injury that involves the tearing or stretching of the muscles and tendons in the back of the thigh. A tear in these muscles can range from mild to severe and is often categorized into three grades:

1. Grade 1: Mild strain, with minimal tearing of muscle fibers.
2. Grade 2: Moderate strain, involving a more significant tear of muscle fibers.
3. Grade 3: Severe strain, where the muscle is often completely ruptured.

What are some symptoms you may experience?

You may have experienced some of these symptoms from a hamstring tear:

• pain
• swelling
• bruising
• weakness
• limited range of motion in the affected leg
• you may have trouble walking
• you may have fell down after the injury if it was severe

I always recommend seeing a physiotherapist to diagnose your injury. A physiotherapist will use these symptoms to help diagnosis the severity of your injury.

Diagnosis and rehabilitation is usually based on:

• The location of the injury – this can be in any of the hamstring muscles including the biceps femoris, semitendinosus or semimembranosus
• The extent of the injury – this includes being myofascial (least serious), musculotendinous, or intratendinous (most serious)
• Your current function – your rehab will likely be based on criteria (what you can do) rather than just the timeline of the injury (how long it has been)
• Your current pain levels – some research has shown that exercise rehab doesn’t need to be completely pain free

Recovery timeframe for a hamstring tear injury

Treatment will differ depending on the injury and severity. The healing timeframe for a hamstring tear can be anywhere from one week (mild injury) to 6 months (for a more severe injury).

Exercises for hamstring strains or hamstring injury recovery

Exercise rehab for hamstring injuries should be individualized. I always recommend being assessed and diagnosed by a physiotherapist prior to starting an exercise program.

Most hamstring rehabilitation programs will be criteria-based, meaning you will progress based on your hamstring’s ability to do certain tasks without flaring up or causing more pain.

Hamstring injury rehab programs should include progression through the rehab phases:

• Acute phase exercises to restore range of motion, movement patterns and competencies and very basic running shapes
• Foundations phase exercises to increase the lengthening ability of the hamstrings and return to running protocols
• Strength phase exercises to build back the strength and power of the hamstrings while incorporating higher speed running
• Return to activity/sport phase exercises to gradually return to full sprinting and change of direction, as well as unplanned and game-specific training

Acute Phase

• range of motion of the hamstring
• squats and step ups within tolerance
• isometrics within tolerance
• normalizing walking
• double leg exercises, progress to single leg when able

Foundations Phase

• resistance through range of the hamstring as tolerated
• weighted squats and single leg squats as tolerated, glute bridges, calf raises and maintaining strength in the hip
• hinge movement patterns starting double leg and progressing to single leg
• lengthening as tolerated
• hip and knee dominant hamstring exercises

Strength Phase

• Weighted deadlift and hinge position exercises
• Hamstring bridges through range and weighted isometric holds
• Re-introducing plyometrics and running relevant to the patient and sport goals
• Progressing back to full deadlifts, RDLs, hip thrusts, kettlebell swings
• Including variations and modifications of nordic hamstring curls, razor curls, harop curls, all to tolerance of the patient

Return to sport phase

• build up to full speed sprinting through a gradual and phased running and sprinting introduction program
• Increasing rate of force development through weighted exercises like RDL drop catch, hamstring bridge switches and hamstring tantrums
• Inner range hamstring strength
• Cutting, change of direction, unplanned movements and sport specific training

References:

1. Pollock N, James SL, Lee JC, Chakraverty R. British athletics muscle injury classification: a new grading system. British journal of sports medicine. 2014 Sep 1;48(18):1347-51.
2. Hickey JT, Timmins RG, Maniar N, Rio E, Hickey PF, Pitcher CA, Williams MD, Opar DA. Pain-free versus pain-threshold rehabilitation following acute hamstring strain injury: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy. 2020 Feb;50(2):91-103.
3. Hickey JT, Opar DA, Weiss LJ, Heiderscheit BC. Hamstring strain injury rehabilitation. Journal of athletic training. 2022 Feb 1;57(2):125-35.