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How To Treat A Hamstring Injury with Physical Therapy

How To Treat A Hamstring Injury with Physical Therapy

The hamstrings are a group of powerful muscles and tendons that are located in the back of the thigh. Injury to the hamstrings is common, especially in athletes. While hamstring injuries are often quite painful, they typically resolve on their own. However, for the hamstrings to return to normal functioning in athletes, a specific rehabilitation program under the supervision of a qualified physical therapist is recommended. 

Hamstring Anatomy & Function

The hamstring group of muscles consists of three muscles found in the back of the thigh between the knee and the hip, including the biceps femoris, semimembranosus, and semitendinosus. The hamstrings function to pull the leg backward and propel the body forward when walking or running (hip extension), and also act to bend the knees (knee flexion).

Hamstring Injuries

Most injuries to the hamstrings occur at the musculotendinous complex, which is the area where the tendons and muscles join, and occur when the muscle is stretched too far. 

With a hamstring injury, the fibers of the tendon or muscles are torn and the body responds to this damage by producing enzymes and chemicals around the injury site, resulting in pain and inflammation. If the injury is severe, the small blood vessels in the muscles can tear as well resulting in bleeding into the muscle tissue. When the small blood vessels are injured, there is decreased blood flow to the area and the area cannot begin to heal. In very rare cases, injury to the hamstring can cause the tendons and muscle to tear away from the bone. These injuries are referred to as avulsions, and may require surgical repair.

Symptoms of Hamstring Injury

Mild hamstring injuries may not cause too much pain, however, severe hamstring injuries can cause severe pain and make standing and walking extraordinarily difficult.

Hamstring injuries can present with a number of symptoms including:

  • Sudden, severe pain during exercise accompanied by a popping or snapping sensation.
  • Pain in the back or the thigh or buttocks with certain movements including walking, and extending the leg.
  • Tenderness and bruising.

The Role of Physical Therapy

Treating and rehabilitating your hamstring injury properly is essential to decrease symptoms and return to normal functioning. Each individual recovers at a different rate, however, typically mild hamstring injuries require about two to four weeks to safely return to activities, while more severe injuries may require physical therapy for two to three months, and may take up to six months to heal fully.

The goals of physical therapy are to decrease pain and swelling, and optimize function. Initially, hamstring injuries are treated with rest, ice, compression, and elevation (RICE treatment). During this time, non-steroidal anti-inflammatory drugs (NSAIDs) may also be recommended to relieve swelling and pain.

After this point, your physical therapist will design a program that will help you regain your range of motion and strength. The specific exercises prescribed also help to prevent re-injury to the area.

In the early phase of your rehabilitation program, low-resistance exercises, including swimming or stationary biking will be recommended to allow your hamstrings to move through their entire range of motion with little resistance. Once you’re able to walk without a limp and you have little or no tenderness, a walking program will be introduced, followed by jogging.

Stretching is another key component of your rehabilitation program. The trained physical therapists at Blue Hills Sports & Spine Rehabilitation can teach you how to stretch properly to increase your flexibility.

Strengthening is often the last component of your rehabilitation program and typically begins with isometric exercises, which involve muscle contraction without joint movement. As your hamstrings strengthen, weights will be added to your strengthening exercises to further improve muscle strength.

It’s important to maintain strength and flexibility of your hamstrings by continuing your stretching and strengthening program once your rehabilitation program is complete. This will help to prevent future hamstring injuries.


In rare cases, such as severe avulsions, surgical repair may be necessary. However, the good news is that most hamstring injuries improve with proper rehabilitation. The physical therapists at Blue Hills Sports & Spine can help to properly rehabilitate your hamstring injury and get you back to the activities that you enjoy.