By Mark Howlin

Associate Physiotherapist · Registered with the AHPRA (PHY0004060355)

Mark Howlin is an Associate Physiotherapist at Physio K, with a focus on sporting injuries and post-operative rehabilitation, with advanced dry needling training from Ireland and Sydney. Across six years of clinical practice in Ireland and Australia, he has developed particular expertise in chronic conditions such as anterior knee pain and Achilles tendinopathy, and acute lower limb muscle strains, using an integrated approach combining manual therapy, dry needling, and progressive rehabilitation. He has also served as team physiotherapist to elite GAA athletes, including during a championship-winning run at Croke Park

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Last reviewed: 15 October 2026

What Is Hamstring Injuries | Physio K? Symptoms, Causes and Treatment

A hamstring injury is damage to one or more of the three muscles at the back of your thigh, the group that bends your knee and extends your hip. Most happen suddenly during sprinting, acceleration or kicking, when the muscle stretches rapidly under high force. You might feel a sharp pull or pop, followed by pain, tenderness and difficulty walking or running. The medical name for this is a hamstring strain. Severity ranges from minor fibre disruption that settles in a few weeks to larger tears that can take several months to rehabilitate fully. Most hamstring injuries recover well with progressive strengthening and a carefully staged return to activity, but reinjury is common if you go back to sport before the muscle has regained its strength and capacity to handle high-speed running.

Common symptoms: Sudden sharp pain at the back of the thigh, tenderness, difficulty walking or running, bruising that may appear a few days later

Who it affects: Most common in people who play running-based sports such as football, rugby, soccer and athletics, and in recreational runners; risk increases with age and previous hamstring injury

Typical recovery: Minor strains may settle in 2 to 4 weeks; moderate tears typically take 6 to 12 weeks; more severe injuries can require several months of rehabilitation before return to unrestricted sport

What the muscles do and how they get injured

The three hamstring muscles run from your sitting bone down the back of your thigh to just below the knee. Together they bend your knee, bring your heel toward your bottom, and extend your hip, the movement you use when you stand up from a chair or push off when you run. During sprinting, the hamstrings work hardest in the split second before your foot hits the ground, when they're lengthening rapidly while also contracting to control your leg. It's this combination of high force and high speed that makes them vulnerable.

Most hamstring injuries happen during that late-swing phase of running, when the muscle is stretched long and working hard to slow your leg down. The muscle that runs down the outer back of your thigh is injured most often. Less commonly, the injury occurs near the sitting bone, where the tendons attach to the pelvis, or at the other end near the knee. Overstretching, a direct blow, or heavy lifting can also cause damage, though these are less typical. The severity depends on how many muscle fibres tear, where the injury sits, and how much the torn ends pull apart.

What it feels like: symptoms

• Sudden sharp pain or a "pop" at the back of your thigh during running, kicking or stretching

• Tenderness when you press the sore area

• Pain when you try to bend your knee against resistance or straighten your hip

• Difficulty walking, especially taking a full stride or climbing stairs

• Stiffness and tightness at the back of the thigh

• Bruising that may track down toward the knee over the first few days

• Weakness when you try to run, accelerate or push off

  
  

Why it happens and who is at risk

Hamstring injuries most often occur during high-speed running, particularly when you're accelerating, sprinting flat out, or changing direction quickly. Sports that involve repeated sprinting and kicking, rugby, soccer, Australian Rules football, athletics and cricket, carry the highest risk. Recreational runners can also strain a hamstring, especially during interval training, hill sprints or a sudden increase in training volume.

Previous hamstring injury is one of the strongest predictors of another one. If you've had a hamstring strain before, your risk of reinjury is substantially higher, particularly if you returned to sport before your strength fully recovered. Older athletes face greater risk, as do those with reduced strength in the muscles at the back of the thigh compared to the front, inadequate exposure to high-speed running in training, or a sudden jump in training load. Fatigue, poor warm-up habits, and incomplete rehabilitation from an earlier injury all contribute.

The evidence for flexibility as an independent risk factor is less consistent. While limited range of motion may play a role in some cases, strength and the ability to tolerate high-speed lengthening of the muscle appear more important than static flexibility alone. Similarly, pelvic posture and previous ankle injuries have been proposed as contributing factors, but the direct causal links are less well established in the research.

How it is diagnosed and when you need imaging

A physiotherapist can usually diagnose a hamstring strain from your history and a physical examination. You'll be asked how the injury happened, where it hurts, and what movements are difficult. The assessment typically includes feeling for tenderness, testing your strength when you resist pressure, and checking your range of motion. The location of pain, how much strength you've lost, and whether you can walk normally all help gauge severity.

Imaging is not required for every hamstring injury. An MRI scan can show the extent of the tear, where it sits, and whether the muscle has pulled away from the bone, but it doesn't always change the initial management, which is usually conservative rehabilitation regardless. Your physiotherapist or doctor may recommend an MRI if the injury seems severe, if there's concern about a complete rupture or tendon avulsion, if symptoms aren't improving as expected, or if the diagnosis is uncertain. Ultrasound can also be used, though MRI generally provides more detail.

If you've felt a sudden, severe pain near your sitting bone, have a visible deformity, can't walk at all, or have rapidly increasing swelling, you should seek urgent medical assessment. These can be signs of a more substantial injury that may need specialist review.

Treatment and what recovery looks like

Most hamstring strains are managed without surgery. In the first few days after injury, the focus is on protecting the muscle while keeping comfortable movement going. You'll usually be advised to avoid activities that hurt, such as running or heavy stretching, but to keep walking as much as you can without significant pain. Ice and compression may help with early discomfort and swelling, though they don't replace rehabilitation.

A 2023 British Journal of Sports Medicine consensus recommends that rehabilitation should be tailored to the injury characteristics and the demands of your sport, and should progress according to your capacity and symptoms. The goal is to rebuild the muscle's strength, its tolerance to lengthening under load, and its ability to handle high-speed running before you return to unrestricted activity.

Rehabilitation typically starts with gentle range-of-motion exercises and isometric strengthening, where you contract the muscle without moving the joint. As pain settles, you'll progress to exercises that involve moving through range, including work at longer muscle lengths. Eccentric strengthening, where you slowly lower a weight or your own body weight while the muscle lengthens, is a key part of hamstring rehabilitation. This might include exercises such as slowly lowering your heel below the level of a step while standing on one leg, or controlled hamstring curls with resistance.

Running is reintroduced gradually, starting with walking, then jogging, then building up speed and distance over several weeks. High-speed running, acceleration and maximal sprinting are added only once you can jog comfortably and your strength has recovered substantially. Sport-specific drills, such as kicking, cutting and jumping, come last. Progression is guided by symptoms, strength testing and your ability to perform each stage without pain or loss of control.

"Treating hamstring strains can vary depending on severity and location of injury, but the basic principles consistently remain: get strong in different ranges, through different contraction types, and incorporate sports-specific drills to ensure patients are clear to return to the sport or activity of choice," says Mark Howlin, AHPRA-registered physiotherapist. "Quantitative strength assessment is something I always insist on throughout hamstring rehab. Every session, testing hamstring strength in different ranges and seeing the strength values increase is not only a sign of progress but it also serves as a great motivator for the patient."

A 2017 systematic review in Sports Medicine examined nine studies involving 601 acute hamstring injuries and found that pain, clinical assessment and functional performance commonly guided rehabilitation and return-to-play decisions, with reported mean return times varying according to assessment methods. There is no single test that guarantees safe return to sport, but most protocols require you to be pain-free during sprinting, to have regained strength close to your uninjured side, and to complete several sessions of unrestricted training without setback before full clearance.

Manual therapy, such as soft tissue massage and joint mobilisation, may provide short-term symptom relief and help you move more comfortably during rehabilitation, but exercise and progressive loading are the central interventions. Evidence for routine use of electrotherapy, acupuncture or taping is limited, and these should not replace active rehabilitation. Dry needling may be used to address muscle tightness or trigger points, particularly where these are limiting movement or contributing to pain.

A pharmacist or GP can advise on pain relief. Non-steroidal anti-inflammatory drugs such as ibuprofen may help in the first few days, but they're not suitable for everyone, particularly if you have a history of stomach, kidney or heart problems, or if you're pregnant. Corticosteroid injections are not routine treatment for hamstring strains and are outside the scope of physiotherapy practice in Australia.

If there's concern about a complete rupture, a tendon pulled off the bone, or if you're not improving as expected, your physiotherapist will refer you to a sports physician or orthopaedic specialist. Surgery is rarely needed, but it may be considered for high-grade proximal tendon avulsions, particularly in athletes.

Recovery time varies. A mild strain with minimal fibre disruption may settle enough for you to return to jogging within two to four weeks, though full return to sport often takes longer. Moderate tears typically require six to twelve weeks of rehabilitation. More severe injuries, particularly those involving the tendon near the sitting bone, can take several months. Reinjury is common if you return to sport before your strength and high-speed running capacity have been restored, so the timeline is guided by objective progress rather than calendar weeks alone.

Different approaches at Physio K

At Physio K, both physiotherapy and massage therapy contribute to hamstring injury management, each with a distinct role.

Physiotherapy leads the diagnosis and rehabilitation. Your physiotherapist will assess the injury, guide you through a progressive strengthening programme, monitor your strength in different ranges and contraction types, and make the call on when you're ready to return to running, training and competition. The approach includes manual therapy, dry needling where appropriate, and a structured exercise programme that you'll work through both in the clinic and at home. The focus is on rebuilding the muscle's capacity to handle the demands that caused the injury in the first place, whether that's sprinting for a ball, kicking, or running long distances.

Massage therapy supports the rehabilitation process by addressing muscle tightness, improving tissue mobility and helping you stay comfortable as you progress through the strengthening stages. It's particularly useful in the subacute phase, once the initial inflammation has settled, to work on areas of tension in the hamstring, hip and lower back that may be contributing to your movement patterns. Massage doesn't replace the need for progressive loading, but it complements it by keeping the surrounding tissues moving well and reducing discomfort during rehabilitation.

The two approaches work together. Your physiotherapist sets the rehabilitation plan and monitors your progress toward return to sport, while massage therapy helps keep you moving comfortably through that plan. Both are tailored to where you are in your recovery and what you're working toward.

What the research shows

The evidence base for hamstring injury management emphasises progressive rehabilitation, objective assessment and a cautious return to high-speed activity. A 2010 clinical guideline in the Journal of Orthopaedic & Sports Physical Therapysupports progressive rehabilitation incorporating range of motion, neuromuscular control, eccentric strengthening and objective functional assessment before unrestricted sport. Eccentric exercises, where the muscle works while lengthening, are particularly well supported.

Research in elite Australian footballers has examined factors associated with return to competition and recurrence. A 2008 cohort study in the British Journal of Sports Medicine found that rehabilitation status and prior injury history were clinically important predictors, reinforcing the need for complete recovery before clearance. Previous hamstring injury consistently emerges as one of the strongest risk factors for reinjury across multiple studies.

Return-to-sport criteria remain an area of active research. The 2023 British Journal of Sports Medicine consensus panel noted that rehabilitation should include running and sport-specific exposure before return to sport, and that decisions should be individualised to injury characteristics and sporting demands. Pain-free sprinting, near-symmetrical strength, and successful completion of sport-specific drills are commonly used benchmarks, though no single measure eliminates reinjury risk entirely.

Prevention programmes, particularly those including Nordic hamstring exercises (a partner-assisted exercise where you kneel and slowly lower your body forward while someone holds your ankles), have shown promise in reducing hamstring injury rates in some sporting populations, though compliance remains a challenge. The evidence supports continued strength training even after return to sport, rather than stopping once symptoms resolve.

When to seek urgent help

Seek urgent medical assessment if you experience any of the following:

• Sudden severe pain near your sitting bone with inability to walk

• A visible lump or deformity at the back of your thigh or near your buttock

• Rapidly increasing swelling or bruising around the thigh or buttock

• Complete inability to bear weight or take a step

• Severe weakness where your leg gives way

• Numbness, pins and needles, or burning pain extending below the knee

• Swelling, warmth or pain in your calf, particularly if it's only on one side

These may indicate a more substantial injury, a tendon avulsion, or in rare cases a vascular problem, and require prompt assessment.

Cost and funding in Australia

Physiotherapy for hamstring injuries may be funded through several pathways. If you have a chronic condition and are eligible under a GP Chronic Condition Management Plan, Medicare may provide a rebate for up to five allied health sessions per calendar year, though a gap payment usually applies and rebate amounts change, so confirm the current amount with your GP or the clinic. Many private health insurers cover physiotherapy under extras policies, with the amount depending on your level of cover. If your hamstring injury occurred at work and has been accepted by your employer's WorkCover insurer, treatment costs are usually covered. NDIS participants may access physiotherapy where it is reasonable and necessary under their plan. Check your eligibility and current costs with your GP, insurer, plan manager or the clinic before your first appointment.

Common questions

Should I stretch it or rest completely?

Complete rest isn't usually best. Keep walking as much as you can without significant pain, but avoid running, heavy stretching and any activity that reproduces the sharp pain. Aggressive stretching in the first few weeks can disrupt healing, so we start with gentle range-of-motion exercises and progress stretching only as the muscle tolerates it. At Physio K, we guide you through what's safe at each stage, because the right amount of movement helps recovery, but too much too soon is one of the main reasons people end up back at square one.

Can I keep walking, working or training?

Walking is usually fine and encouraged, even in the first few days. Most people can continue working unless their job involves heavy lifting, climbing, sprinting or awkward positions that load the hamstring. Training depends on severity. You'll need to stop running and high-speed work initially, but you can often continue upper-body gym work, swimming with a pull buoy, or cycling if it doesn't hurt. We assess what you can safely do and modify your training around the injury, because staying active in other ways helps both physically and mentally while the hamstring heals.

When can I run or play sport again?

Running is reintroduced gradually once you're pain-free with daily activities and your strength is improving. That might be a few weeks for a minor strain, or several months for a more severe tear. Sport-specific training and competition come last, only after you can sprint pain-free and your strength testing shows you're ready. At Physio K, we test your hamstring strength in different ranges every session and track the numbers, so you can see the progress and we can make the return-to-sport decision based on objective criteria, not guesswork. Returning too early is the single biggest reason hamstring injuries come back.

Will it keep coming back?

Reinjury risk is real, but it's not inevitable. Previous hamstring injury does increase your risk, but the main reason people reinjure is returning to sport before strength has fully recovered. "Once the pain is gone and it feels fine walking around, that is not enough to return to training," says Mark Howlin. "For hamstring injuries in particular, after five days some feel perfectly fine again. This is the danger period, as this is the time where reinjury rates can be highest. It is so important to understand that hamstring strains go far beyond the feeling of pain, and that there is muscle dysfunction that needs time to heal properly and adapt to load again." Completing the full rehabilitation programme, meeting objective strength targets, and continuing hamstring strengthening even after you're back playing all reduce the chance of it happening again.

Reviewed by Kenny Merlevede. Kenny Merlevede is a Senior Physiotherapist with 18 years of experience in private practice, with a focus on complex cervical presentations and persistent musculoskeletal conditions. Registered with AHPRA (PHY0002060505).

This article is for general information only and is not a substitute for personal medical advice. If you have concerns about your health, please consult a qualified clinician or your GP.