Olympic gold medallist Usain Bolt famously took a tumble in the final of the 4x100m relay at the World Athletics Championships in London in 2017 - the final race of his career - after tearing his hamstring muscle. Bolt, the fastest man in the world, left the track on a wheelchair.

You would have seen several athletes hobbling off the field after getting injured, and clutching onto the back of their thighs, a telltale sign that they have injured their hamstrings. 

The hamstrings are a group of three muscles and tendons in the back of the thigh that gives us the power to run and jump.

The three muscles run from the hip to below the knee, and allow the hip to extend, the knee to flex and rotate, the thigh to extend and rotate and also the shin bone (tibia) to rotate. The tendon attaches the large thigh muscles to the bone.

Standing or walking does not involve the use of the hamstring, but any activity that involves bending the knee or straightening the leg does.

  1. Causes of Hamstring Muscle Pain
  2. Types of Hamstring Muscle Pain
  3. Symptoms of Hamstring Muscle Pain
  4. Diagnosis of Hamstring Muscle Pain
  5. Treatment of Hamstring Muscle Pain
  6. Risk Factors for Hamstring Muscle Pain
  7. Prevention of Hamstring Muscle Pain

The hamstrings are made up of three muscles:

  • Biceps Femoris in the outer thigh is responsible for hip extension and knee flexion and knee rotation.
  • Semimembranosus, which runs from the pelvis to the shin bone at the back of the leg, is responsible for thigh extension and knee flexion. It also allows the shin bone to rotate.
  • Semitendinosus, the longest muscle in the hamstring, runs from the hip to the shin. It is responsible for thigh extension, knee flexion and rotation of the tibia or shin bone.

Overworking the hamstring muscles or the tendon can cause either a strain or a complete tear in any of the components at the back of the thigh. Anyone involved in activities that include sprinting and sudden stopping is prone to hamstring injuries. These include sports such as tennis, football and cricket as well as day-to-day activities like running and dancing.

Here are a few common causes that lead to a hamstring strain:

  • Not warming up or stretching before exercise or playing sport.
  • Not enough strength in your glutes (muscles in the buttocks). Glutes and hamstrings work together during intense physical activities.
  • If your front thigh muscles (quadriceps) are too tight.
  • Poor running technique, like uneven strides or pelvic motion.
  • Playing or running on uneven surfaces.
  • Overtraining or overworking the hamstring muscles.

The intensity of pain depends on the extent of the hamstring injury, which is categorised into three grades:

  • Grade I tear: A strain where there is mild pain while moving the leg but no loss of strength in the muscles. This is also known as a pulled hamstring.
  • Grade II tear: Partial tear of any of the three hamstring muscles, leading to pain and swelling of the back of the thigh.
  • Grade III tear: Complete tear in the hamstring muscles which is followed by a popping sound, extreme pain and inability to walk.

Hamstring injuries are quite common. Stands to reason that there is also high awareness around them - especially in the sports and fitness community. The signs of a hamstring injury are usually hard to miss. They include:

  • Pain in the buttocks and back of the thigh while walking as the injured leg can’t support your weight.
  • Stiffness in the back of the knee
  • Tenderness in the back of the knee
  • Bruising or discolouration in the back of the knee
  • Sudden and severe pain along with a popping sensation in the thigh
  • Swelling at the back of the thigh
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Despite some obvious signs, your doctor will still have to identify the exact location as well as the extent of the injury:

  • A doctor will conduct a physical exam to check for the range of mobility and the pain you have, along with understanding the nature of your injury. The doctor will also advise whether you need further imaging to determine the extent of the damage.
  • An MRI scan is done to get a clear view of the damage and to check for tears in the muscle tissue.
  • An ultrasound is conducted to see further evidence of the damage along with the location of the injury.
  • An X-ray is recommended to check if the injury suffered was due to an accident, collision or a fall, which may have resulted in an avulsion fracture - when a small piece of the bone that the muscle is connected also comes off in the injury.

In most cases, like Grade I injuries, patients recover through home care alone. What they need is plenty of rest, frequent application of ice to the injured area to reduce the swelling and to limit movement. In more severe cases, walking or moving with the help of crutches also keeps the pain and inflammation in check.

Over-the-counter medication also helps in keeping pain and tenderness in check, while physical therapy helps in restoring muscle strength and movement as recommended by doctors. Hamstring strengthening exercises are essential for restoring full mobility and avoiding future injury.

In the case of Grade III tears, where the tissues in the muscle have become detached from the bone, the doctor may recommend surgery. The recovery process can take up to months. Severe hamstring tears have been career-ending for some athletes.

Whether you’re an athlete used to regular movements or someone looking to get into distance running or working out in the gym after a long break, the chances of suffering an injury are quite high.

  • Playing sports that involve sprinting and frequent stopping
  • Not warming up or stretching before beginning an exercise or sport
  • If you have had a prior hamstring injury
  • Lack of flexibility during movements

It may be an injury commonly associated with athletes, but that doesn’t mean it excludes everybody who doesn’t play sports. Recovery from hamstring injuries can take a long time, and it is much better to exercise precaution rather than spend all that time recovering.

  • Stretch and warm-up before pursuing a sport or exercise in the gym
  • Strengthen your hamstring muscles by doing specific exercises
  • Gradually increase the intensity of your physical activity
  • Stop exercising or playing if you feel even the slightest pain from the back of the knee
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