Hamstring Injury - Not just a pain in the leg.

21st December 2015

Injury to the hamstring muscle complex is one of the most common injuries seen in sport - particularly sports where a high degree of running, speed, power and agility is required. Unfortunately, hamstring injuries are often underestimated and therefore, often mismanaged by the injured person which can then lead to further injury, delayed healing and ultimately longer recovery and rehab.

The hamstring complex consists of 3 muscles - biceps femoris, semitendinosis and semimembranosus. These muscles originiate at the lower part of the pelvis and insert just below the knee joint and function to extend the hip and bend the knee. This 'two joint muscle' complex is involved in both the 'braking' and movement of these joints which can make it vulnerable to injury.

The hamstring is often injured during sudden acceleration or deceleration forces - such as in sprinting or running at high speed, or during a stretching movement - such as high kicks, bending to pick up a ball and sliding or tackling manouevres. Signs of a strain or injury include a sudden sharp onset of pain in the back of the leg, with ongoing pain during activity and stretching. Swelling may accompany more severe injuries and bruising may be present.

A major risk factor to hamstring injury is a history of previous hamstring injury, with as high as a 30% re-injury rate in the first month of return to sport. Excessive or sudden changes to training load, poor biomechanics, a lack of strength and endurance in the hamstring and gluteal muscles, inadequate core strength and hypomobility of the spine may also predispose the hamstring to injury. Furthermore, an imbalance between the hamstring and quadriceps muscles, inappropriate or inadequate warm up and increasing age are also risk factors to hamstring injury.

If a hamstring injury is sustained, you should cease play or activity immediately - regardless of the severity of pain or perceived degree of injury. The RICER protocol should be applied in the initial 24-72 hours to minimise the initial bleeding and swelling at the site of the injury - Rest, Ice, Compress, Elevate and Refer to your physiotherapist at NESP. It is recommended you seek opinion as soon as possible to begin rehabilitation, minimise secondary complications and guide return to sport whilst minimising the risk of re-injury.

Like all conditions, management of a hamstring injury is based on a thorough assessment to confirm the diagnosis, rule out other possible conditions and then address the underlying causes.


Treatment may include:

  • Techniques to decrease pain and inflammation.
  • Specific advice and guidelines on rest, activity and training modifications.
  • Specific and progressive rehabilitation program involving strength and conditioning training, sport specific exercises and return to running.
  • Graded return to sport including thorough assessment of sport-related activity.
  • Thorough gait analysis and biomechanical assessment of the whole body to evaluate any underlying causes pre-disposing the hamstrings to injury.
  • Maintenance exercise programs to prevent re-injury of the hamstring.


As well as providing optimal rehabilitation and guiding appropriate return to sport to minimise re-injury, the team at NESP can screen you or your team for injury risk factors and advice on preventing injury.

 Injury prevention may include:

  • Functional movement assessment - a biomechanical assessment of the whole body to evaluate any dysfunctional movement patterns that can be pre-disposing to injury.
  • Thorough gait and running analysis to assess any deficits or poor mechanics pre-disposing to injury.
  • Baseline strength and conditioning assessment.
  • Strength training programs.
  • Advice on preseason training to ensure season readiness and match day fitness.
  • Evaluation of training load and guiding load progression to ensure adequate conditioning and minimise overloading.


So to get you moving pain free again, or to keep you moving pain free, give us a call and make an appointment.