Physical Therapy for Hamstring Injuries

The hamstrings are set of muscles behind the thigh bone and behind the knee. A hamstring injury is when one of the three hamstring muscles are injured in the muscle belly or its tendon. It is one of the most common leg injuries of the lower extremity. Hamstring injuries are predominantly athletic injuries and particularly affect participants of the following sports: football, soccer, running.

The set of three hamstring muscles are comprised of the semitendinosus, semimembranosus, and the biceps femoris. These Hamstring Painmuscles are responsible for bending the knee and/or straightening the hip.

Patients are two to six times more likely to have re-injury after injuring a hamstring muscle. Most cases are managed and resolved with physical therapy, and in severe cases surgical intervention may be needed.  

Hamstring injuries can occur at the following anatomical locations on the body:Muscle and hamstring injuries occur when a load is given to the muscles that it cannot handle. This may mean the amount of the force, or the acceleration of it. In the case of the hamstring muscles, injuries happen during sudden starts and stops during running, cutting maneuvers with sudden changes in direction and speed, and when a lot of strain is put on the overstretched hamstring muscles when sprinting, hurdling, kicking, or in weightlifting.  

  • The hamstring muscle belly and/or its tendon attachment.
  • The hamstring bursa, which is a fluid-filled sac that mitigates the friction between the hamstring tendon and the bone. Chronically injured hamstrings usually present with irritation of this bursa
  • The Ischial tuberosity, or the “sit bone” of the pelvis. This can get fractured in severe and sudden injuries.

Some factors may increase a patient’s risk of hamstring injury (and re-injury). They are:

  • A history of previous hamstring injury
  • Hamstring weakness and surrounding muscle imbalances
  • Excessive hamstring tightness and inflexibility
  • Poor warm up routine before intense activity
  • Hamstring muscle fatigue

Signs and Symptoms of a Hamstring Tear or Injury

Symptoms can vary between hamstring injuries, and largely depend on the severity of the tear. The patient may feel a slight pull or cramping, if the injury is mild; and in some cases the patient may not feel anything at all until they have stopped performing the activity. The patient may even feel a latent effect the next morning with feelings of unusual soreness or tightness. However, sometimes hamstring injuries can be more immediate and severe. This would indicate a larger tear in the muscle or tendon, and may be more severe in its injury site. The symptoms a patient would feel in a severe hamstring tear would be:

  • An immediate sharp pain felt in the buttocks or back of the thigh
  • A feeling or sound of a “pop” or tear in the muscle during the injury
  • Bruising  in the limb within a couple of hours after the injury
  • Swelling in the muscle
  • The area will be tender to light touch
  • Pain with sitting
  • Difficulty in movement such as in lifting the leg or straightening the knee
  • Difficulty and pain with walking, causing a limp in the gait.

How Are Hamstring Tears Diagnosed?

Your physical therapist will conduct a thorough subjective evaluation in the beginning of your session to properly ascertain the region of injury and the cause of it. A detailed health history,even including history of muscular strains – is precious data for the PT. The questions your physical therapist may ask you would be:

  • If you have experienced a similar hamstring injury before
  • What activities you were doing when you felt your pain, or if latent, what strenuous activities were you going the day before
  • The location of the pain and whether you felt/heard a “pop” in the muscle
  • What the aggravating and alleviating factors are in your hamstring injury (e.g. how you feel when you walk, sleep, go up and down stairs, sit, etc)

Your physical therapist will then proceed to do a clinical evaluation to get a better sense of the injury and this includes:

  • Observation and palpation of the injury site to note any bruising, swelling, tenderness and degree of muscle tension.
  • Range of motion measurements of the leg, with comparison to the non-injured limb, to see how severe the movement deficits are and which specific movements elicit your pain.
  • Test your muscle strength to see which muscles in and around the hamstring are deficient and unstable.
  • Perform a walking or running Gait analysis to see whether you are performing any compensations while running or walking that may be contributing to the hamstring injury. In our clinic we take this a step further with Video recording and playback so we can watch what every joint is doing at different phases of running or walking.
  • Assess nerve involvement through range of motion maneuvers and nerve tension tests to see if the sciatic nerve (which runs through the same site as the hamstrings) is involved.

In general muscle tears and hamstring muscle injuries are graded by the following system according to severity:

  • Grade I: Mild strain and minimal tearing of the muscle; the muscle will feel pulled or cramped
  • Grade II: Moderate strain of the muscle with partial tearing; the muscle may feel like a stinging or burning sensation at the back of the thigh
  • Grade III: Severe or complete muscle tear; the muscle may curl up into a ball or lump that can easily be felt at the back of the thigh

In in the event that your physical therapist suspects a severe injury or severe involvement of the sciatic nerve, he/she will refer you out to an orthopedic physician for further diagnostics. After the initial consultation with the ortho, they will likely perform an MRO or an X-Ray to get a more detailed picture of the severity of the tear. When a fracture of the ischial tuberosity is determined or when there is evidence of a complete tear of the hamstring, surgical intervention might be indicated.  

Physical Therapy Treatment

Your physical therapist will design an individualized plan of care to treat your hamstring injury that is specific to its severity and also the nature of mechanism of injury. Judging on its severity, he/she will give you recommendations on how much to back off from activity.  

Range of motion

Muscles become tight and stiff after an injury and it is necessary to maintain the length and flexibility of these muscles, or scar tissue may form that would compromise it in the long run. Prompt treatment by a physical therapist will help in minimizing the tightness and spasms. This would come in the form of soft tissue mobilization and massage, or in flexibility maneuvers and exercises.

Building Muscle Strength

Injured muscles also tend to get weak very quickly and lose their ability to handle load. Hamstring strengthening will be a part of your strengthening program in physical therapy. Additionally, there may be other exercises thrown in to your program to address weaknesses or compensations in other parts of your body that may have contributed or resulted from your hamstring injury.

Functional and Sports-Specific Training

As flexibility, soft tissue health and strengthening improves in your hamstring, it is also necessary to slowly regain functionality in your sport or activity because we want to make sure that you can handle the loads that you give it during functional movements. Your physical therapist will work closely with you to mimic the sports-specific motion and progress its difficulty so we can appropriately and confidently discharge you to playing your sport again.

After Surgery Physical Therapy

If your hamstring tear warranted surgical intervention, physical therapy is a very important stage of healing. Though the process might take longer, physical therapy will allow for a gradual and progressive rehabilitative process that would get you back to full strength and ability.  

Prevention of Hamstring Injuries

Hamstring injuries can be prevented in the first place. Here are some things you can do if you feel you are more prone to one::

  • Never skip warm up before performing sports, proper blood flow must be encouraged before a load is given to muscles.
  • Make sure you have a progression plan when beginning a new sport or activity. Gradually increase the intensity rather than jumping into full intensity sports too quickly – this would allow muscle tissue time to adapt and grow as the load and forces increase.
  • Be in tune with your body – notice tightness, unusual soreness and treat it appropriately with ice, massage, rest or stretching.
  • Use proper lifting biomechanics when lifting heavy weights. When in doubt, ask a physical therapist on proper posture during lifting, and we can show you how to prevent a myriad of injuries from moving the right way.

If you are experiencing pain from a hamstring pull or other leg injury, please contact one of our Portland Physical Therapy Clinics and get treated today!

Follow Me @

Alice Holland, DPT

Doctor of Physical Therapy, Director at Stride Strong Physical Therapy
Alice earned her Doctorate of Physical Therapy from USC in 2007, and have practiced Physical Therapy for 12+ years in the Outpatient Orthopedic Setting. Certified in ASTYM, she also has been a featured expert on Physical Therapy on numerous publications including health.com, healthline.com and yahoo.com.
Follow Me @

Latest posts by Alice Holland, DPT

Ana Lucia Pinheiro
Ana Lucia Pinheiro
02:18 20 Oct 17
This place is amazing. I am so happy I found Stride Strong PT. Alice pays attention to all of the details, she watches every single move I make, my posture, and the way I move through every exercise. She is very knowledgeable, she was able to pin-point the problems in my back and she has a plan to help me become stronger where I need. The place is brand new, huge, and has nice exercise machines. I tried a few physical therapists in the area, and Alice is TOP, second to none, and I feel super lucky to have found her. Highly recommended!!
Prashant Gupta
Prashant Gupta
01:00 02 Oct 17
Dr. Alice at Stride Strong is one of the best PTs I have come across. Her attention to detail and assessment of the root cause of injury is very good. She is excellent in evaluating pain patterns and giving a training schedule for a rehab & injury prevention, she is extremely knowledgeable. I would strongly recommend Stride Strong to anyone looking for PT. It is easily the best PT clinics in Hillsboro area.
steven zollin
steven zollin
20:57 14 Sep 17
Highly recommend Stride Strong Physical Therapy , Alice showed me proper form to assist in recovery with my shoulder and is very knowledgeable.
Lindsay Nied
Lindsay Nied
23:33 18 Dec 17
I recently had a massage from Joel at the Hillsboro location. He was able to work on an ongoing issue I have been experiencing with my back after a sports injury, and I left feeling so much better. The whole facility looked incredible, and everyone I met was friendly and welcoming. I would highly recommend Stride Strong for massage and physical therapy.
JoAnn Hatch
JoAnn Hatch
08:20 08 Nov 17
Dr. Sydney is by far the absolute best physical therapist I've worked with ever! Her expertise in designing highly effective and efficient exercise plans is beyond compare. I feel so much better as my strength and function increases. She comes up with the most brilliant and fun ideas to motivate. To my delight she even offered to come to my home in Vancouver and work with me on my own equipment including a Stott Pilates Reformer. Talk about going above and beyond! Couldn't be more grateful I found her!!!
Clare Perry
Clare Perry
21:58 23 Oct 17
A full hour of a dedicated PT professional's time without aides or techs? That's just one of the things that sets this clinic apart from others. Competent, professional, and amiable, Dr. Alice Holland and her team are the best in the area. While I generally see them at the Cedar Mill Clinic on Cornell, situational constraints took me to their new Hillsboro clinic today near Intel Jones Farm. Beautifully furnished, spacious with easy parking and access. May you continue to grow and thrive, Stride Strong!
Joyce Heideman
Joyce Heideman
08:28 11 May 18
After foot surgery I went to Stride Strong for therapy with Alice Holland. She helped me reach my full mobility again by continuously introducing new and challenging exercises. The entire staff is friendly and professional. They are always on time and do not rush. I look forward to doing 1/2 marathons again and riding my recumbent trike. Thank you Stride Strong for your care and high level of expertise.
Suad Daher
Suad Daher
20:48 28 Feb 18
The best physical therapy ever. Both JP and Sydney were a great PT, they helped me understand how I can help treat my injury and how it may have caused. And also they informed about so many techniques that I can use to help my injuries or any other injuries I get in the near future. They are both friendly and nice to talk too, and verbunformative. And there is also Krystal, she is the best front desk receptionist ever, she is nice and friendly and can easily manage your schedule based on the patients comfort if they want to schedule or not. She can help and she replies fast to any patients email. And she is easy to talk to. Thank you Stride Strong Physical Therapy.
Amanda O'Rourke
Amanda O'Rourke
21:38 15 Jun 18
In just a month I've seen great progress! I've been incorporating the exercises taught to me into my daily workout routine. Im very happy with my continued results.
Albert Szal
Albert Szal
23:43 10 Jun 18
Mary Szal here: I've had three sessions with Brittany at the Hillsboro location. I can say that she has been the most effective and instructive physical therapist I've ever experienced. Her personality, energy, knowledge and results are top notch.
Osa Phiangdae
Osa Phiangdae
00:05 22 Mar 18
Awesome place for PT. Hillsboro location has plenty of parking and very spacious. I had the pleasure to work mostly with Dr. Alice Holland and JP. I came in with a shoulder injury and thank goodness they understood what I was going through. They are the best of what they do, I would recommend Stride Strong to anyone who needs PT.
See All Reviews

© Copyright 2019 STRIDE STRONG