Understanding Hamstring Injuries — Causes, Symptoms & Why They Happen

What Is a Hamstring Injury?

Hamstring injuries are among the most common muscle injuries, especially in athletes, gym-goers, and even active individuals. But what exactly are your hamstrings?

Your hamstrings are a group of three muscles located at the back of your thigh. These muscles help you bend your knee and extend your hip, which is essential for walking, running, jumping, and even simple activities like climbing stairs.

A hamstring injury usually refers to a strain or tear in one or more of these muscles. It can range from a mild pull to a complete muscle tear.

Why Do Hamstring Injuries Happen?

Hamstring injuries occur when the muscle is overstretched or overloaded. This could happen when:

• You sprint suddenly.
• You don’t warm up properly before exercise.
• Your muscles are imbalanced (weak hamstrings vs. strong quads).
• You return to sports too early after a previous injury.

During the event, Ms. Martina Johnson (Orthopedic Physiotherapist, Apollo Hospitals, Bangalore) explained the functional anatomy of the hamstring, shedding light on how improper posture, inactivity, or poor biomechanics can contribute to injuries.

“Many people assume hamstring injuries are only for athletes, but we’re seeing them even in office workers who suddenly take up weekend sports or gym workouts without preparation,” said Ms. Martina.

Types of Hamstring Injuries: Know the Grades

When we talk about hamstring injuries, they’re not all the same. Some are mild and heal with rest, while others need weeks of physiotherapy or even surgery. Doctors usually classify hamstring injuries into three grades depending on the severity of the muscle damage.

Let’s break it down:

Grade 1: Mild Strain (Pulled Muscle)

What it feels like:

• A slight twinge or tightness in the back of your thigh.
• Discomfort when walking, climbing stairs, or bending the knee.
• Mild swelling or tenderness.

What’s happening inside:

• In a Grade 1 strain, only a few muscle fibers are overstretched or slightly torn.
• There’s no significant bleeding or bruising.
• You can usually still move, but there’s a noticeable lack of flexibility.

How long to recover:
1 to 3 weeks with rest, ice, and gentle stretching.

Speaker Tip:
Dr. Pradeep Kocheeppan shared that many people ignore Grade 1 strains, thinking it’s “just tightness.” But without proper rehab, these can progress into more serious injuries.

Grade 2: Partial Tear

What it feels like:

• Sharp pain that may stop you mid-activity.
• Swelling, tenderness, and sometimes visible bruising within 24 hours.
• Difficulty walking or straightening the leg.
• Weakness in the leg.

What’s happening inside:

• A moderate number of muscle fibers are torn.
• There may be some internal bleeding and inflammation.
• Movement becomes painful, especially when you try to stretch or contract the muscle.

How long to recover:
4 to 8 weeks, often involving guided physiotherapy and progressive strengthening exercises.

Speaker Insight:
Mr. Wongchuk Sherpa emphasized that in Grade 2 injuries, early clinical evaluation is crucial. He stated:

“Pain might seem tolerable, but unless we assess tear size and location, patients risk developing chronic weakness or repeat injuries.”

Grade 3: Complete Tear (Rupture)

What it feels like:

• A sudden, intense, tearing pain — like being hit or kicked at the back of your thigh.
• Inability to bear weight on the affected leg.
• Significant bruising, swelling, and sometimes a visible gap or lump in the muscle.
• You may hear or feel a “pop” at the time of injury.

What’s happening inside:

• The muscle is completely torn, sometimes from the tendon or even from the bone (avulsion).
• There is heavy internal bleeding and muscle dysfunction.
• In severe cases, the muscle may retract, causing visible deformity.

How long to recover:
3 to 6 months. This may require surgery, followed by an intensive rehabilitation program.

Speaker Insight:
In the concluding session, Dr. Kocheeppan addressed surgery in Grade 3 injuries, noting:

“When we see tendon avulsion or complete rupture, conservative treatment isn’t enough. Surgical repair ensures better strength restoration and prevents long-term disability, especially in active individuals.”

Who Is at Risk?

While athletes are more vulnerable, anyone can suffer from hamstring injuries, especially if they:

• Lead a sedentary lifestyle with occasional activity bursts.
• Don’t stretch regularly.
• Sit for long hours (tight hamstrings).
• Are middle-aged or older.

According to Mr. Wongchuk Sherpa, Physiotherapist at Move and Shine, “Clinical features of hamstring strain can often be misleading. Some people ignore the dull ache until it worsens, while others misinterpret sciatica or back pain as hamstring injuries.”

Warning Signs to Watch For

If you experience any of the following, it could be a sign of a hamstring injury:

• Sudden, sharp pain in the back of the thigh.
• Swelling or bruising in the thigh area.
• Difficulty bending the knee or walking.
• A popping or snapping sound during the injury.

Diagnosing Hamstring Injuries: What Really Happens Behind the Scenes

When you pull a muscle or feel a sudden pain in the back of your thigh, it’s tempting to assume it’s “just a strain.” But proper diagnosis is key to avoiding long-term damage, especially with hamstring injuries.

During the CME session, Ms. Anju V. Joy (MPT, Sports Physio) emphasized:

“No two hamstring injuries are the same. A detailed assessment helps decide whether a person needs a few days of rest or a surgical consult.”

Let’s walk through how doctors and physiotherapists diagnose hamstring injuries step by step.

1. Clinical History & Physical Examination

What they ask:

• When and how did the injury occur?
• Was there a popping sound?
• Can you walk or bend the knee?
• Is the pain dull or sharp?
• Was it during sprinting, stretching, or sudden movement?

What they look for:

• Swelling
• Bruising
• Tenderness when pressing the muscle
• Muscle weakness or imbalance
• Changes in gait or posture

This helps classify the injury into Grade 1, 2, or 3, as explained earlier.

Speaker Note:
Mr. Wongchuk Sherpa added,

“We use simple strength and flexibility tests during the clinical exam to estimate the severity even before imaging. If pain limits testing, we suspect a higher-grade tear.”

2. Imaging Tests – Seeing Beneath the Surface

If your physiotherapist or doctor suspects a serious injury, they may recommend imaging tests for a more accurate picture.

✅ Ultrasound

• Best for: Quick initial assessment.
• Detects swelling, tears, and hematoma (blood collection).
• Can be done bedside by trained physiotherapists or sports doctors.
• Useful in ongoing rehab to track healing.

✅ MRI (Magnetic Resonance Imaging)

• Best for: Accurate grading of the injury.
• Shows exact location and extent of muscle fiber or tendon damage.
• Essential before planning surgery or advanced rehab.

Insight from Ms. Elizabeth Joy (PT, Head of Physiotherapy):

“MRI isn’t just about spotting the tear. We also use it to understand healing progress and guide patients on when it’s safe to return to sports or active work.”

✅ X-Rays (in special cases)

• Hamstring tears near the pelvic bone may cause tiny pieces of bone to pull off (called avulsion fractures). These are visible on X-rays.
• Rare, but common in teenage athletes.

3. Functional Tests

After the initial pain phase, patients may undergo:

• Strength tests (resistance against movement)
• Flexibility tests (range of motion of hip and knee)
• Balance and stability assessments
• Video gait analysis (used in sports injury clinics)

These tests are usually conducted by physiotherapists during rehab to monitor recovery.

Why Accurate Diagnosis Matters

Getting the diagnosis right does more than confirm if it’s a muscle pull. It helps:

• Prevent recurring injuries.
• Choose the right rehab protocol.
• Avoid unnecessary surgery or delay essential treatment.
• Ensure a safe return to sport or work.

Key Takeaway from the CME:
As Ms. Anju Joy summarized,

“Hamstring injuries might look similar, but only a thorough diagnosis tells us whether someone can be treated conservatively or needs imaging, injections, or even surgical intervention.”

Can You Prevent Hamstring Injuries?

Yes! Prevention is always better than cure.

Here are a few easy prevention tips:

• Warm up before workouts: Light cardio and mobility drills.
• Stretch regularly: Especially hamstrings and hip flexors.
• Strengthen your hamstrings: Include exercises like bridges, Nordic curls, and single-leg deadlifts.
• Don’t overdo it: Increase workout intensity gradually.
• Avoid long sitting hours without breaks.

Workplace Orthopedic Wellness Programs for Modern Lifestyles

Move and Shine Clinic goes beyond the clinic walls by offering customized workplace wellness programs that tackle the orthopedic challenges of desk jobs and modern working habits. With rising cases of neck stiffness, back pain, and carpal tunnel syndrome among working professionals, the clinic designs onsite ergonomic workshops, posture correction modules, and chair-based exercise sessions that help employees maintain musculoskeletal health at work. These programs are highly interactive and guided by physiotherapists and orthopedic consultants, educating individuals on ideal desk setups, stretching routines, and early warning signs of orthopedic distress. It’s a unique approach to corporate health that not only improves employee well-being but also enhances productivity and reduces absenteeism.

Conclusion

The CME session by Move and Shine made one thing clear: hamstring injuries are common, but preventable. With the right awareness, warm-ups, and early care, you can avoid long recovery periods or surgery altogether.

Stay tuned for our next blog on “From Injury to Recovery: Medical and Physiotherapy Approaches to Hamstring Strain.”