Hamstring Injuries: Why They Happen, What to Do, and How to Come Back Stronger

If you've ever sprinted too hard, stretched too far, or even just moved the wrong way during a

workout, you might know the sudden, sharp pain of a hamstring strain. It literally stops you in your tracks. Hamstring injuries are one of the most common soft tissue injuries in both

athletes and weekend warriors alike. And while they’re frustrating, they’re also very

treatable if you handle them the right way.

Anatomy Review

The hamstrings are a group of three muscles at the back of your thigh: the biceps femoris,

semitendinosus, and semimembranosus. These muscles help you bend the knee and extend

the hip, all key movements for walking, running, jumping, and even just standing up from a chair.

What are the different types of hamstring injuries?

Hamstring Strain

A strain happens when the muscle fibers are overstretched or torn acutely. This can range from a mild "pull" (Grade I) to a full-blown rupture (Grade III). The injury often occurs during high-speed movements like sprinting or sudden deceleration. Think: soccer, football, or even a pickle ball game! Most common is a high hamstring injury. This could be strain, partial tear of hamstring tendons at their origin on the sit bones of the pelvis.

Proximal Hamstring Tendinopathy

When a hamstring issue becomes chronic or degenerative, is is often labeled as proximal hamstring tendinopathy (PHT).

Hamstring injuries usually result from:

• Overuse: Repetitive running, sprinting, or kicking motions.

• Sudden acceleration or deceleration: Especially in sports like soccer, track, and CrossFit.

• Poor hip mobility or pelvic alignment

• Muscle imbalances: Weak glutes or tight hip flexors may overload the hamstrings.

• Extended sitting: Long hours seated can compress and irritate the tendon insertion.

Symptoms You Shouldn’t Ignore

Acute Hamstring Strain:

Most people describe it as a sudden "pop" or tight grab in the back of the thigh. You might feel:

• Sudden sharp pain during activity

• Swelling or bruising, Tenderness when you touch the muscle

• Weakness or difficulty walking

• Pain when bending forward or kicking your leg back

If you're limping or can’t extend your leg without pain, it's time to take it seriously.

If you're dealing with a chronic hamstring injury, you might experience:

• Deep, aching pain in the buttock or upper thigh

• Pain that worsens with running, lunging, or hamstring stretching

• Discomfort when sitting, especially on hard surfaces

• Tenderness to touch just below the gluteal crease

• Occasional referred pain down the leg (not to be confused with sciatica)

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Why Hamstring Strains Happen

Hamstring injuries are rarely random. In most cases, there’s a deeper mechanical or movement issue going on. Some of the most common culprits we see in the clinic:

• Poor eccentric control – The hamstrings have to slow down your leg as you swing it forward. If they’re not strong enough eccentrically, they can tear under load.

• Pelvic alignment issues – An anterior pelvic tilt can chronically shorten the hamstrings, putting them at higher risk during activity.  Issues with L5 or S1 can inhibit hamstring strength.

• Glute weakness – If your glutes aren’t firing properly, the hamstrings may try to do their job, leading to overuse.

• Lack of flexibility or mobility – Tight hip flexors and poor dynamic flexibility can mess with your running mechanics.

• Muscle Imbalance – An imbalance between the proximal and distal hamstrings as well as medial vs lateral. (upper/lower and outer/inner) can create overuse or excessive strain.

Re-injury is also a huge concern—once strained, the muscle is more vulnerable. That’s why rushing the recovery process or skipping rehab is a huge mistake.

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What Physical Therapy Can Do for You

A proper rehab program isn’t just about rest—it's about retraining the body. Here's what we focus on in the clinic:

1. Load Management

In the acute phase, we reduce load while maintaining blood flow and promoting healing. That might mean gentle isometrics or pain-free mobility work.

2. Restore Normal Movement Patterns

We assess gait, pelvic alignment, core control, and glute activation. It’s not just about the hamstring—it’s about how the entire kinetic chain is functioning.

3. Eccentric Strengthening

Eccentric exercises (like Nordic hamstring curls or slow RDLs) are essential. They help rebuild the muscle’s capacity to lengthen under tension, which is where most injuries occur.

4. Return-to-Sport Progression

We don’t just get you back to walking—we get you sprinting, cutting, and changing direction with confidence. This includes progressive loading, agility drills, and sport-specific movement.

For a High Hamstring Treatment and Recovery

High hamstring injuries can be slow to heal due to poor blood flow at the tendon origin. Recovery often takes 8–12 weeks or longer, depending on severity.  Some can be solved in a few weeks to a month if mild.

Phase 1: Reduce Pain and Irritation

• Relative rest: Avoid aggravating activities like sprinting, deep stretching, or prolonged sitting.

• Ice and anti-inflammatory modalities: To manage pain and swelling.

• Isometric exercises: Gentle, static hamstring contractions to maintain strength without aggravation.

Phase 2: Rebuild Strength and Load Tolerance

• Eccentric loading: Exercises like Nordic hamstring curls or single-leg deadlifts to rebuild tendon resilience.

• Core and glute strengthening: Improve pelvic control to offload the hamstring.

• Soft tissue mobilization and dry needling (if needed)

Phase 3: Return to Sport or Full Activity

• Dynamic movements: Plyometrics, agility drills, and sport-specific training.

• Gradual return to running: Using walk-run intervals and close monitoring of symptoms.

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Key Takeaway: Treat the Cause, Not Just the Symptoms

The truth is, most hamstring strains aren’t just bad luck—they’re a sign of imbalance. If we just rest and return, we’re missing the bigger picture. Real recovery means addressing the root causes, rebuilding strength, and optimizing movement patterns.

So, if you’ve pulled your hamstring (or pulled it again), don’t just stretch it and hope for the best. Let’s figure out what’s really going on—so you can come back smarter, stronger, and more resilient than before.

When to See a Physical Therapist

If you've been dealing with upper hamstring pain for more than two weeks, or it’s interfering with your daily life or training, it’s time to consult a physical therapist. Early diagnosis and a tailored rehabilitation plan can dramatically reduce your downtime and help you return to pain-free movement.

Need help with a nagging hamstring injury? Our team at Manual Therapy Specialists specializes in sports injury rehab and performance optimization. Contact us today for a comprehensive evaluation and personalized recovery plan.

Reach out and let’s set up a session. We’ll take the guesswork out of your recovery.

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About the author: David Potucek, PT, MSPT, CFMT

David is an orthopedic physical therapist with over 20 years of experience. He has successfully helped countless individuals with hamstring issues. From Olympians to weekend warriors, he has been able to find a solution for everyone. He is a former D1 athlete, and currently keeps active with lifting and running.