1. Least Effective Exercises Slideshow
2. Dehydration Slideshow
3. First Aid Care and Pain Relief for Minor Injuries

Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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The symptoms of a pulled hamstring depend upon the severity of the injury. Strains can be described by how much damage occurs to the muscle and tendon fibers. A grade 1 strain describes fibers that are stretched but not torn. A grade 2 strain occurs if there is a partial tear of some of the muscle or tendon fibers. A grade 3 strain describes the rare situation where there is complete tear or rupture of the muscle or tendon.

Muscles strains may occur over time as a result of overuse injury, or they may occur acutely with an abrupt specific injury. Moreover, there can be worsening of the severity of a hamstring pull if strenuous activity is attempted before the muscle has fully healed.

Muscle or tendon strains cause inflammation surrounding the injury site and symptoms include tenderness, pain, and swelling. Muscle spasm may also occur. Since muscles have excellent blood supply, a tear can cause bruising at the site of injury. Also, blood can ooze downward by gravity, so that bruising may be noted in the back of the knee or in the calf.

A grade 1 strain of the hamstring may be felt as a slight pull or ache in the back of the thigh. The exact injury may not be remembered or recognized, and onset of the pain may be gradual. There may be minimal swelling and a nonspecific pain when the knee is extended. A limp may or may not be present, but the pain is usually worsened with aggressive activity like running or walking up or down stairs.

Grade 2 strains often occur with an acute event, and an immediate sharp pain is felt in the back of the thigh or higher up toward the buttock. Walking may be difficult because extending the knee stretches the injured muscle, and a limp is often present. Swelling and tenderness can be appreciated at the area of injury.

Symptoms of a grade 3 strain are a progression of a grade 2 strain with symptoms of pain and swelling being more pronounced. Many times in athletic injuries, the muscle can be so aggressively stretched that it tears with a pop so loud that it can be heard by other players on the field. If there is a significant tear, a divot can sometimes be felt in the belly of the muscle at the site of injury.

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