Condition
Hamstring Strains
A hamstring strain is a tear in one of the three muscles at the back of the thigh, graded one to three by how much of the muscle is involved.
- Seen at
- All three offices
- Typical wait
- Within the same week
- Treated with
- 3 procedures
In short
What hamstring strains actually is.
Hamstring Strains
A hamstring strain is a tear in one of the three muscles at the back of the thigh, graded one to three by how much of the muscle is involved. A grade one is a small tear with minimal strength loss, a grade two is a partial tear with clear weakness, and a grade three is a complete tear. They recur more than almost any other muscle injury, usually because people return to sprinting once the pain has gone but before strength and length have come back. A sudden pop with bruising high in the thigh near the sitting bone is a different and more serious injury, a proximal tendon avulsion, and needs prompt orthopedic assessment.
Symptoms
How it shows up.
If several of these sound like your week, it is worth having the source looked at properly.
- A sudden grabbing pain at the back of the thigh during a sprint or a stretch
- Bruising that appears over the next day or two and tracks down toward the knee
- Pain bending the knee against resistance or reaching for your toes
- Tenderness in a specific band of muscle you can find with your fingers
- Limping, or being unable to lengthen your stride
- Pain sitting on a hard chair when the injury is high up near the sitting bone
- The same hamstring going again within weeks of returning to sport
What causes it
- Sprinting, particularly the moment the leg swings forward before the foot lands
- A sudden stretch such as a split, a slide tackle or a hurdle
- Returning to full speed before strength has recovered, which is the main reason they come back
- Weak hamstring strength through lengthening, and a large imbalance with the quadriceps
- Fatigue late in a game or at the end of a heavy training week
- Restricted movement at the hip and lower back, including old nerve irritation from the spine
When to act
Stop waiting when this happens.
Do not sit on these
Any one of the following is a reason to be seen rather than to wait it out.
- You heard or felt a pop, have bruising high in the thigh near the sitting bone and struggle to walk, which suggests a proximal tendon avulsion and needs prompt orthopedic assessment
- You cannot bear weight, or the leg feels like it will not hold you
- Pain has not improved meaningfully after two weeks
- The same hamstring has now gone two or more times
- There is numbness or tingling down the back of the leg, which points at the sciatic nerve or the lower back rather than the muscle
Diagnosis
Finding the actual source.
A diagnosis is not a guess from an image. It comes from the exam, the history and, where nerves are involved, electrodiagnostic testing.
- Locating exactly where the tenderness sits, since an injury in the muscle belly behaves very differently from one at the tendon near the sitting bone
- Testing knee flexion strength at several angles and comparing it directly against the other leg
- Measuring hamstring length with a straight leg raise, repeated through recovery as an objective return to sport measure
- Examining the lower back and the sciatic nerve, because a hamstring that keeps tearing is sometimes nerve irritation from the spine rather than a muscle problem
- Ultrasound or MRI when a high grade tear or a tendon avulsion is suspected, since that changes both the timeline and who should be treating it
- EMG and nerve conduction studies when there is numbness, tingling or weakness beyond what the muscle injury explains
Nerve testing happens here, not elsewhere
EMG and nerve conduction studies are done in the office and read by Dr. Sheikh the same day, rather than sent out and waited on.
Treatment
How hamstring strains is treated.
Ordered from the most common first step to the options reserved for pain that has not responded.
45–60 minPRP TherapyPRP therapy concentrates the platelets from a sample of your own blood and injects them into an injured tendo…Read more →
Trigger Point InjectionA trigger point injection treats a knot in a muscle, a tight band that will not release and that often refers…Read more →
15–45 minNerve BlockA nerve block is an injection of local anesthetic, often with a steroid, placed next to a specific nerve or c…Read more →Questions
Hamstring Strains, answered.
Why does my hamstring keep tearing?
Most often because the first one was never fully rehabilitated. Pain settles long before strength and length return, and going back to sprinting in that gap re-tears the same scarred tissue. The other common reason is that the muscle is not the real problem: nerve irritation from the lower back produces a tight, vulnerable hamstring that keeps failing. A hamstring that has gone three times deserves a proper look at the spine.
How long does a hamstring strain take to heal?
A grade one is often two to three weeks, a grade two commonly four to eight, and a grade three or a tendon injury takes months and sometimes surgery. Injuries close to the tendon take considerably longer than injuries in the middle of the muscle, even at the same grade. Return should be decided on strength testing and pain free sprinting rather than on the calendar.
What is a proximal hamstring avulsion?
It is the tendon pulling off the sitting bone, usually with a pop, immediate severe pain, extensive bruising high in the thigh and real difficulty walking. It is a different injury from an ordinary strain and it is an orthopedic problem, not a pain management one. In active patients, surgical repair within the first few weeks gives better results than waiting, so this is one to have assessed promptly rather than treated as a pulled muscle.
Does PRP help hamstring injuries?
It is used mainly for chronic high hamstring tendinopathy that has not responded to months of proper loading work. For a straightforward acute muscle strain the evidence is not convincing, and rehabilitation is what gets you back to sport. Dr. Sheikh will be direct about which situation you are in, and PRP is usually not covered by insurance.
When is it safe to sprint again?
When strength is within about ten percent of the other side across the range, a straight leg raise matches the uninjured leg, and you can run at full speed without hesitating. The hesitation matters: people who do not trust the leg change their stride and injure something else. Rushing this is the single most common reason a hamstring becomes a recurring problem.
Get a real diagnosis for hamstring strains.
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