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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A pulled hamstring is diagnosed by history and physical examination. The circumstances of the injury will give a clue as to the type of injury, while the physical examination will be used to grade the amount of damage to the muscle or tendon.

Questions may be asked as to when the injury occurred, to analyze the mechanism of injury, and review what home treatments were attempted. Past medical history may also be important since previous injury or arthritis of the back, hip, or knee can decrease range of motion and flexibility of the muscles, causing those muscles to become more prone to injury.

Physical examination often consists of touching (palpation) the muscle to assess swelling and tenderness. Grade 2 or 3 tears may have a defect or divot that can be felt along the course of the muscle, confirming the diagnosis. Range of motion of the hip and knee may be tested with and without resistance, trying to unmask pain that is not necessarily appreciated by palpation.

Often the doctor will lay the patient prone (flat on their stomach) and bend the knee to 90 degrees. This relaxes the hamstring muscles and may minimize muscle spasm. The hamstring muscles can then be felt and a defect appreciated.

Other potential sources of pain may be considered, and the physical examination will help to differentiate a pulled hamstring from bone or joint pain. Sciatica, a pain that originates in the nerves as they leave the spinal cord, can also mimic hamstring injury.

Most patients do not need further testing. If there is concern that the pain is due to an avulsion fracture or other injury to the pelvis, femur or knee, X-rays may be suggested. Magnetic resonance imaging (MRI) is able to evaluate the extent of muscle and tendon injury but is not necessary for most patients. MRI scanning can be used to help plan rehabilitation and time to recovery and return to competition.

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