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Why Does Your Hamstring Still Hurt?

Hamstring injury is one of the most common muscle related injuries, especially with sports. Thus, we have all probably experienced the pain of a strained hamstring first hand. Whether it was just a gnarly cramp or a sudden sharp pain in the back of the leg, when the hamstring is injured it quickly grabs our attention.

What is a hamstring strain?

A hamstring strain is an injury to one of the three muscles groups in the back of the thigh: the semimembranosus, semitendinosus and/or biceps femoris. 1
A strain results in muscle tissue damage due to overstretching, imbalanced movement of the leg, or attempting to sustain too much force through the muscle itself.
The hamstring is a somewhat complicated muscle because it has two different major roles related to moving the lower leg. Due to its attachment points that cross over the hip and knee, it assists with both extending the hip and bending the knee (only a few muscles in the body have dual responsibility like this).
Thus, it is a key muscle in lower leg stability with all weight bearing activity, especially higher level and forceful movements.

hamstring 1

Why are hamstring strains so common anyways?

There are several factors that are hotly debated and considered to contribute to this common injury: poor flexibility, general deconditioning, and muscle imbalances with the quadriceps and/or the glut muscles.
Since the hamstring has a complicated bi-involvement in the use of the thigh, it can easily run into trouble. For example, if the knee is bent and the hip is extended, this puts the muscle in a shortened position that makes it more prone to both cramping and injury.
On the other end of the spectrum, injury can occur if the hamstring endures an extreme stretched position as well. Research consistently shows that over-dominant quadriceps (the muscle that helps move the leg in the opposite direction of the hamstring) is one the biggest risk factors for injury.2
Hamstring injuries are most common with sprint related activities that require sudden strong muscle contractions such as running, dancing and ball sports. Plus, once an injury is sustained it is significantly more likely to happen again.

The different grades of hamstring strain.

Hamstring strains are classified into three groups depending on the severity.3

  • A grade 1 strain causes mild symptoms. Little to no muscle fibers are torn. Typically, soreness from this injury is delayed and results in soreness in the back of the leg that may mildly limit a person’s ability to fully participate in their daily routine. However, their flexibility and strength are minimally affected.
Close-up Of A Female Runner Holding His Injured Leg
  • A grade 2 strain results in moderate symptoms from partial tears of the muscle. This usually results in more immediate sensations of pain that result is loss of strength and flexibility. Swelling, tenderness to the touch, potential bruising and an inability to comfortably extend the hip or bend the knee are normal with this type of strain.
  • A grade 3 strain involves a severe or even complete tear of the hamstring muscle. There may be a palpable ball of tissue from the tear in addition to visible bruising or discoloration. Pain and swelling are usually severe and will require extensive rest to allow proper healing. Depending on the severity of the tear and functional deficits of the muscle, surgery may be required.

The healing process after a hamstring strain.

When healing a strained muscle, it requires a different focus with each stage of the process.  In general, healing of muscle tissue requires around 6 weeks to heal, but it will of course vary with the severity of the injury.

Initially, the hamstring requires adequate time to heal.  Signs that the body is healing itself include heat, swelling, and moderate pain.  These symptoms are our body’s way of telling us to take it easy and let it do its job!  This is a time to focus on things like rest, ice, and gentle movement.

Once these symptoms begin to subside, it is time to start gradually re-stressing the muscle fibers to promote optimal return of strength and endurance.

Eventually, it will be time to push the limits and make sure the hamstring is ready for fully returning to sport.

Young beautiful woman at gym

Why it might not be healing properly.

Unfortunately, lingering hamstring pain or frequent re-injury of the hamstring muscle is common.  Again, this is due to the complexity of the muscle and joint dynamics in the upper leg. However, there are some issues that are frequently overlooked that you should consider:

  • Poor training habits. If you have muscle imbalances related to the quadriceps, gluts, or general strength or flexibility, they most likely contributed to the injury and will not magically go away without giving them attention.  These poor habits are likely to still be there after you have given your hamstring time to rest, putting you right back where you started if you don’t take the time to restore proper balance and mechanics.
  • Over or under loading of the hamstring. Throughout the recovery process, the hamstring can withstand different levels of load based on strength, flexibility and other lingering symptoms related to healing.  Having a trained eye and paying close attention to what your body is telling you can help you decide when you can push yourself and when you need to rein it in: it’s a delicate balance!
  • You may need to consider other issues going on in the body. For example, lower back pain, stress fractures, and glut tendonitis can refer pain to the hamstrings, resulting in the feeling of a strained hamstring.

Why physical therapy will give you all the answers.

No matter what stage of the healing process you’re in physical therapy can help, especially if it has been 2-3 months and you aren’t recovering as quickly or getting the results you hoped for. A proper assessment will take all the guesswork out of your injury recovery.

A Male Osteopath Treating Female Patient With Hip Problem

A physical therapist will help you learn how to optimally load your muscle groups at different stages of healing so that you can properly progress and get back to your sports, hobbies, and daily activities.4 Plus, they will help you identify and learn how to restore any imbalances that are the root cause of the issue.

What are you waiting for? Maximize your recovery.

When you get to the true cause of an injury that is when true long term healing can occur. It may even help you reach a new level of strength and endurance in your sport that you didn’t know was possible!
Now that you understand the process of healing specific to the hamstring, you should feel empowered and ready to take action. With a physical therapist by your side, you will get back to where you want to be while optimizing your performance and minimizing the risk of future injury.

Why Does Your Hamstring Still Hurt infographic