Hamstring Tear
The most common non-contact muscle injury in sport, usually from high-speed running.
Mechanism
- Sprinting (dominant): terminal swing, when the hamstring lengthens under high eccentric load. Biceps femoris long head is most often involved.
- Stretch or kicking: hip flexion with knee extension (high kick, sliding tackle, dance), often semimembranosus.
- Sports: football, rugby, AFL, athletics, basketball, dance.
Risk factors
| Non-modifiable | Modifiable |
|---|---|
| Previous hamstring injury (strongest), increasing age, genetics | Low eccentric strength, low hamstring:quadriceps ratio, short biceps femoris fascicles, poor warm-up, fatigue, poor lumbopelvic control |
Presentation
- Sudden posterior thigh pain, “pull” or “pop”, unable to continue
- Localised tenderness, palpable defect in complete tears
- Bruising that appears after 24 to 48 hours and tracks distally
- Pain on passive straight leg raise
- Proximal injuries (ischial tuberosity), including adolescent avulsions, are more serious.
Grade clinically or by MRI, as for any muscle tear. Intratendinous injuries take longest.
Management
Progressive rehab: pain-free isometrics, then eccentric loading, then sport-specific sprint mechanics. Eccentric strengthening is central to rehab and prevention.
| Option | Verdict |
|---|---|
| Acute care: relative rest, POLICE, early pain-free movement | Yes |
| Nordic hamstring exercise | Strongest evidence for prevention: about 50% fewer injuries |
| Blood flow restriction | Useful when high loads are not yet tolerated |
| NSAIDs | Symptomatic only, use sparingly |
| Corticosteroid injection | Avoid, raises re-injury risk |
| PRP | No consistent benefit |
| Surgery | Complete proximal avulsion, especially with retraction or bony avulsion in adolescents |
Return to play
- Grade I: 1 to 2 weeks. Grade II: 4 to 6 weeks. Grade III: considerably longer. Overall range 1 to 8 weeks by severity and site.
- Re-injury 20 to 30% (up to 30% without eccentric work), highest in the first 2 weeks back.
- Return on functional criteria, not the calendar.
References
- Opar et al., Sports Med 2012, doi:10.2165/11594800-000000000-00000
- Rehabilitation of acute hamstring strain injuries, Clin Sports Med 2015, doi:10.1016/j.csm.2014.12.009
Related
Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.