Health Topics for Sports Medicine

Department of Orthopaedic Surgery

UI Family Care

Hamstring injuries

The term hamstring refers to three large muscles and their tendons in the back of the thigh. They start at the bone in the buttocks and attach below the knee. Hamstring injuries are very common in people who have an imbalance in their upper leg muscle strength. When the front thigh muscles, the quadriceps, are stronger than the hamstring tendons and muscles in the back of the thigh, there is risk for a hamstring injury. This makes them hard to rehabilitate after injury.

Hamstring injuries include avulsions and strains. In growing children, when a violent contraction of the hamstring takes place, the muscle tendon will not tear. Instead, it pulls off a portion of the bone attachment to the buttocks. This is called an avulsion injury. It is most likely to occur when the child is jumping or sprinting, as in soccer or football. The severe pain and disability require immediate medical care.

A hamstring strain, sometimes called a pull, is a stretch, tear, or complete rupture of one or more of the tendons or muscles in the back of the thigh. These injuries can be caused by a violent contraction of the hamstring muscles, such as jumping or sprinting. Over-stretching and failure to warm up sufficiently can cause a strain. Hamstring strains tend to recur. Scar tissue forms when they heal, making the entire tendon and muscle less flexible and more at risk for future injury.

There are 3 degrees of strains:

1. A slight strain or pull results in a sore muscle the next day. Walking or slow jogging is not inhibited and recovery time is 1 to 2 weeks.
2. A hard strain or pull occurs while exercising, as in sprinting. The exercise must be stopped right away. The muscle is tender and aches, and bruises may develop 3 to 6 days later. Bending the knee, walking, and jogging are difficult and recovery takes 3 to 4 weeks.
3. The most serious hamstring strain produces such severe pain that the person may collapse. Walking is impossible. Severe bruising occurs in 3 to 4 days. Crutches may be needed for a week or two and recovery can take as much as 10 weeks. Seek medical care for severe strains.

At the time a strain occurs, treat it with rest, ice, compression, and elevation, a regimen known as RICE. Rest the affected area, do not use or bear weight (standing, walking, etc.), until evaluated by provider. Apply a cloth-covered ice pack to the affected area for no more than 20 minutes at a time, 4 to 8 times a day. The healthcare provider may suggest using an elastic bandage to the area to help reduce swelling. The affected part should be elevated so it is 12 inches above the heart to help reduce swelling. Ice it for 10 to 30 minutes intermittently for 48 to 72 hours.

Wear a neoprene thigh sleeve when returning to activity. Rehabilitation for all strains should include stretching and strengthening exercises.

Take medications, such as aspirin, acetaminophen, or NSAIDs, as directed on the label and if approved by your healthcare provider. Aspirin or medicines that have aspirin in them should not be given to anyone younger than 18 years of age. Taking aspirin is a risk for a serious illness called Reye's syndrome.

Non-steroidal anti-inflammatory drugs (NSAIDs) should be taken with food or milk to prevent stomach upset. NSAIDs should not be taken by anyone who has been diagnosed with asthma, ulcer disease, or a bleeding disorder. Taking NSAIDs increases the risk of bleeding with trauma, dental work, surgery, or if taking blood thinners (anticoagulants).

Acetaminophen should not be taken by anyone with known liver or kidney disease. Do not drink alcohol when taking more than 1 dose of acetaminophen.

Last Reviewed 2005

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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