Hamstring Strain
upper legAlso known as: pulled hamstring, hamstring tear, hammy strain, back of thigh pain, hamstring pull
Last reviewed: 2026-04-11
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Interventions
Nordic hamstring exercises (eccentric strengthening)
8 RCTsThe Nordic hamstring exercise involves a partner holding your ankles while you slowly lower your body forward from a kneeling position. This eccentric exercise has strong evidence for both prevention and rehabilitation of hamstring strains. It increases fascicle length and eccentric strength, addressing two key risk factors for injury.
Evidence does not support: Nordic exercises alone may not be sufficient for complete rehabilitation. They should be part of a comprehensive programme including running progression and neuromuscular control.
- Acute hamstring tear (wait until pain-free walking is achieved)
- Severe low back pain exacerbated by the exercise position
Progressive agility and trunk stabilisation (PATS) programme
4 RCTsA rehabilitation programme combining progressive agility drills with core and trunk stabilisation has been shown to reduce re-injury rates compared to isolated hamstring stretching and strengthening. The programme addresses the full kinetic chain rather than the hamstring in isolation. It typically runs 4-12 weeks depending on injury severity.
Evidence does not support: Isolated passive stretching of the hamstring is not supported as a primary treatment and may delay healing if performed aggressively in the acute phase.
- Complete (grade III) hamstring rupture requiring surgical consultation
- Acute phase with significant haematoma (first 48-72 hours)
Load management and graduated return to running
3 RCTsA structured return-to-running programme with progressive increases in speed and volume is essential for safe recovery. Criteria-based progression (rather than time-based) using pain levels, strength testing, and functional tests reduces re-injury risk. Most runners can return to easy running within 2-6 weeks depending on injury grade.
Evidence does not support: Returning to full training based on time alone (e.g. "rest for 4 weeks") without meeting functional criteria is associated with higher re-injury rates. Complete rest beyond the acute phase is also not recommended.
- Pain during running that worsens with continued activity
- Failure to meet return-to-running strength criteria
Corticosteroid injection
2 RCTsCorticosteroid injections for hamstring strains have very limited supporting evidence and are generally not recommended. They may provide short-term pain relief but do not address the underlying tissue healing and may impair tendon and muscle repair.
Evidence does not support: Routine use of corticosteroid injections for hamstring strains is not supported. Evidence suggests they may delay healing and increase recurrence.
- Complete muscle tear
- Multiple previous injections at the same site
Red Flags
Sudden sharp pain with an audible pop during sprinting or acceleration
Action: Stop activity immediately. Apply ice, compress, and elevate. See a clinician within 24-48 hours for assessment of tear severity.
Significant bruising extending down the back of the thigh toward the knee
Action: See a clinician promptly — extensive bruising suggests a higher-grade tear that may require imaging.
Inability to walk without significant pain or a limp
Action: Seek medical assessment — may indicate a grade II-III tear requiring imaging and structured rehabilitation.
Pain at the ischial tuberosity (sitting bone) that persists beyond 8 weeks
Action: Seek specialist review — may indicate proximal hamstring tendinopathy or avulsion fracture requiring imaging.
Differential Diagnoses
- Sciatic nerve irritation or radiculopathy
- Proximal hamstring tendinopathy
- Ischial tuberosity avulsion fracture (especially in adolescents)
- Referred pain from the lumbar spine
Frequently asked questions
What is the best evidence-based treatment for Hamstring Strain?
The highest-rated treatment for Hamstring Strain based on peer-reviewed research is Nordic hamstring exercises (eccentric strengthening) (Trust Score: 88/100). The Nordic hamstring exercise involves a partner holding your ankles while you slowly lower your body forward from a kneeling position. This eccentric exercise has strong evidence for both prevention and rehabilitation of hamstring strains. It increases fascicle length and eccentric strength, addressing two key risk factors for injury.
How many treatments are there for Hamstring Strain?
There are 4 evidence-based interventions for Hamstring Strain, ranked by Trust Score from peer-reviewed research including RCTs and systematic reviews. The top treatments are: Nordic hamstring exercises (eccentric strengthening), Progressive agility and trunk stabilisation (PATS) programme, Load management and graduated return to running.
When should I see a doctor for Hamstring Strain?
Seek medical attention immediately if you experience any of the following red flags: Sudden sharp pain with an audible pop during sprinting or acceleration; Significant bruising extending down the back of the thigh toward the knee; Inability to walk without significant pain or a limp; Pain at the ischial tuberosity (sitting bone) that persists beyond 8 weeks.
What conditions are similar to Hamstring Strain?
Conditions that may present similarly to Hamstring Strain include: Sciatic nerve irritation or radiculopathy, Proximal hamstring tendinopathy, Ischial tuberosity avulsion fracture (especially in adolescents), Referred pain from the lumbar spine. A healthcare professional can help differentiate between these.