Hip & Thigh

What It Is

Line drawing of the back of the thigh, showing the hamstring muscles running from the sit bone at the bottom of the pelvis down past the back of the knee. — The hamstrings cross both the hip and the knee, which is why a fast stride or a big kick can overload them.

Hamstring muscle injuries, such as pulled hamstrings, occur quite frequently in athletes. They are more common in sports that involve sprinting, such as football, soccer, track and basketball, and in dancers (AAOS, n.d.). Pulled hamstrings, or strains, are injuries to one or more of the muscles in the back of the thigh. Most hamstring strains heal very well with simple, non-surgical treatment (AAOS, n.d.).

Hamstring Muscle Strain Anatomy

Hamstring muscles run down the back of the thigh. Three hamstring muscles make up the area: the semitendinosus, the biceps femoris and the semimembranosus. They begin at the bottom of the pelvis, on a bone called the ischial tuberosity (your "sitting bone"). They cross the knee joint and end at the top of the lower leg. Hamstring muscle fibres join with the tough connective tissue of the tendons near the places where the tendons attach to the bones. The hamstring muscles help you to extend your leg straight back and to bend your knee (AAOS, n.d.).

How is the Hamstring Injured?

In most cases, the load applied through the muscle is too great for the strength or flexibility of the muscle fibres. Muscle overload is the main cause of hamstring strain: the muscle is stretched beyond its capacity or challenged with a sudden load (AAOS, n.d.). This often happens during sprinting, when the hamstring is being lengthened and loaded at the same time (AAOS, n.d.). Tight muscles are more vulnerable to strain, and weak muscles are less able to cope with the stress of exercise (AAOS, n.d.).

A hamstring muscle strain can be mild, and just feel like an ache at the back of the leg. Or it can be severe, with a full tear of the muscle – or, in the most severe injuries, the tendon tearing away from the bone (AAOS, n.d.). Strains are graded I, II and III depending on their severity: a grade I strain is mild and usually heals readily, while a grade III strain is a complete tear of the muscle that may take months to heal (AAOS, n.d.). You may feel a sharp pain in the back of the leg, and with a severe injury you may feel a snap or hear a "pop". The back of the thigh may become tender, swollen and bruised (NHS, 2025).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat a Hamstring Muscle Strain

Once the initial pain and swelling have settled, massage, gentle stretching and a graded exercise programme, including eccentric strengthening and movement-control exercises to help reduce the risk of re-injury, are part of treatment (AAOS, n.d.; Heiderscheit et al., 2010). I can guide you through each stage, from hands-on work to strength and your return to sport. See the My Approach tab for how I work.

1. Protect and Rest for the First 2 to 3 Days

Protect your leg from further injury, stop any exercise or activities, and try not to put weight on the injured leg (NHS, 2025). Depending on the severity of the injury, your doctor may recommend using crutches (AAOS, n.d.). When you can move your leg without the pain stopping you, try to keep moving it gently so the hamstring does not become stiff (NHS, 2025).

2. Ice

Apply an ice pack (or a bag of frozen vegetables) wrapped in a tea towel to the injured area for up to 20 minutes every 2 to 3 hours (NHS, 2025). Never apply ice directly to the skin. To help prevent swelling, avoid heat (such as hot baths and heat packs), massage and alcohol for the first 3 days (NHS, 2025).

3. Physical Therapy

Early treatment that includes rest, ice, compression and elevation followed by physical therapy has been shown to lead to better function and a quicker return to sport (AAOS, n.d.). If your injury is severe, is taking longer to heal than expected, or you have had hamstring injuries before, you may need to see a physiotherapist (NHS, 2025). I can work with you directly if your strain is mild, and support your recovery from a more severe injury once a doctor has checked it.

4. Compression

To help prevent further swelling, use a tubular or standard elastic bandage around the injured leg. It should be snug but not tight, and you should take it off before going to sleep (NHS, 2025).

5. Elevation

To help reduce swelling, keep your leg raised on a pillow as much as possible, ideally higher than your heart while you are resting (NHS, 2025; AAOS, n.d.).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Knee brace: a doctor may recommend wearing a knee brace for a short time to keep the leg in a neutral position while it heals (AAOS, n.d.).
Surgery: for the most serious injuries, where the tendon has pulled completely away from the bone, surgery may be needed to reattach it (AAOS, n.d.; NHS, 2025).

How I can help (see the My Approach tab)

Hands-on work and gentle stretching once the early pain settles
A graded strengthening programme, including eccentric work
A step-by-step return to running and sport

Tips

Muscle overload is the main cause of hamstring strain. This happens when the muscle is stretched beyond its normal capacity or suddenly challenged with a heavy load (AAOS, n.d.).
Tight muscles are vulnerable to strains, and stretching exercises can help (AAOS, n.d.). Strengthening exercises are just as important (Heiderscheit et al., 2010).
If the muscles are weak, they are less able to cope with the stress of exercise, which can lead to injuries (AAOS, n.d.).
When one muscle group is much stronger than the opposing group – usually the quadriceps at the front of the thigh compared with the hamstrings – the imbalance can lead to strains (AAOS, n.d.).
Fatigue reduces the muscles' ability to absorb energy, which makes them more prone to injury. Avoid exercising when you are feeling tired (AAOS, n.d.; NHS, 2025).
Warm up before exercising, build up your fitness gradually, and stop if you start to feel pain in your hamstrings (NHS, 2025).
Repeated hamstring strains are common. They can be a sign that rehabilitation was not complete or that return to sport was too early, so follow your rehabilitation programme through to the end (Heiderscheit et al., 2010).

Treatment

My Approach

A hamstring strain means some fibres at the back of your thigh are overstretched or torn. My aim is to help the muscle heal, regain full movement and strength, and get you back to sport without it going again.

Which path we take depends on how bad it is

If it's a mild or moderate strain (grade I or II) and you can still walk and stand on the leg, I can usually work with you directly from the start.
If it's a severe tear (grade III), with a snap or pop, a lot of swelling or bruising, or real difficulty walking or standing, see a doctor first (see When to Get Help); then I work within your medical team's plan, and after surgery I need your surgeon's okay before hands-on treatment.

I start by assessing how you walk, your leg's movement and strength, and your hips and low back. The hamstrings start at the sitting bone, so any work near the buttock is only with your informed consent and a written consent form.

First Few Days

No heat or massage on the injured area for the first 3 days; I'll show you how to use ice, compression and elevation at home
Easing the low back, hips and other leg, which tighten up to protect it
Gentle, pain-free tightening of the hamstring without moving the leg

As It Heals

Hands-on work moving gradually closer to the injury, then cross-fibre work on tight spots, followed by gentle stretching only to the start of discomfort
Warm and cool applications in the clinic
Strength from static holds to bridges and slow lifting-and-lowering work, plus movement-control drills

Back to Sport

Eccentric strengthening, building to Romanian deadlifts and Nordic curls
Gym-based progressions and a graded return to running and sprinting
Taping if it helps, and I'll show you how to tape it yourself

After a severe tear, the same stages run more slowly, within your team's limits, with scar work once any incision has fully healed.

What to Expect

Typical Course

Typical course: For a mild or moderate strain, most people come once or twice a week early on, then weekly, then less often as they manage more on their own, with a reassessment at about 4–6 weeks; a mild strain usually heals within a few weeks, and a moderate one takes longer. For a severe tear, visits follow your medical team's plan, and recovery usually takes months.

What I Focus On

Assessment

Protect Early

Hamstring Release

Eccentric Strength

Return to Sport

Please read

When to See a Doctor First

When to Get Help

Get urgent medical advice if you think you have injured your hamstring and (NHS, 2025)

it is very painful, or the pain is getting worse
there is a large amount of swelling or bruising, or the swelling or bruising is getting worse
it hurts to walk or stand on the injured leg
your leg feels very stiff or is difficult to move
it is not feeling any better after treating it yourself
you have a very high temperature, or feel hot and shivery – these could be signs of an infection

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Hamstring muscle injuries. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/hamstring-muscle-injuries/ (Accessed: 7 October 2026).
NHS (2025) Hamstring injury. Available at: https://www.nhs.uk/conditions/hamstring-injury/ (Accessed: 7 October 2026).
Heiderscheit, B.C. et al. (2010) 'Hamstring strain injuries: recommendations for diagnosis, rehabilitation and injury prevention', Journal of Orthopaedic & Sports Physical Therapy, 40(2), pp. 67–81. doi: 10.2519/jospt.2010.3047. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2867336/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooHamstring Muscle Strain

What It Is

Hamstring Muscle Strain Anatomy

How is the Hamstring Injured?

Self-Care & Treatment

How to Treat a Hamstring Muscle Strain

1. Protect and Rest for the First 2 to 3 Days

2. Ice

3. Physical Therapy

4. Compression

5. Elevation

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

First Few Days

As It Heals

Back to Sport

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooHamstring Muscle Strain

What It Is

Hamstring Muscle Strain Anatomy

How is the Hamstring Injured?

Self-Care & Treatment

How to Treat a Hamstring Muscle Strain

1. Protect and Rest for the First 2 to 3 Days

2. Ice

3. Physical Therapy

4. Compression

5. Elevation

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

First Few Days

As It Heals

Back to Sport

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Quadriceps Strain

Sports Massage

Hyperlordosis

Book a session