- Hamstring Strain (Pulled Hamstring) Symptoms
The hamstring refers to a group of three muscles that run down the back of the upper leg, from the thigh to the knee (the biceps femoris, semitendinosus, and semimembranosus) that function together to flex (bend) the knee and extend (straighten) the hip.
A hamstring strain, also called a pulled hamstring, occurs when one or more of the hamstring muscles is stretched too far and starts to tear.
Hamstring strains are graded based on the severity of the injury:
- Grade 1: a mild strain
- Grade 2: a partial tear of one or more of the hamstring muscles
- Grade 3: a complete tear of one or more of the hamstring muscles
The time it takes for a hamstring strain to heal depends on the severity of the strain. Grade 2 injuries usually require a minimum of four to eight weeks to heal, depending on the nature of the injury.
What Are Symptoms of a Grade 2 Hamstring Strain?
Symptoms of a grade 2 hamstring strain include:
- When the injury first occurs:
- Sharp, immediate pain in the back of the thigh
- A popping sensation at the back of the leg or an audible pop (sometimes)
- Inability to keep running or performing an activity
- Other symptoms a grade 2 hamstring strain include:
- Pain in the back of the thigh when bending or straightening the leg
- Inability to straighten the leg all the way
- Tenderness, swelling, and bruising in the back of the thigh
- Pain during activity
- Leg weakness that lasts for a long time after the injury
What Causes a Grade 2 Hamstring Strain?
A hamstring strain of any grade is usually caused by an imbalance between the quadriceps muscle at the front of the thigh and the hamstring muscles in the back of the thigh. The quadriceps may forcibly overstretch the hamstring, placing excessive tension and causing muscle overload on the hamstring muscles.
Acute hamstring strains are caused by a sudden movement or force impacting the hamstring muscles. It commonly occurs in people who participate in sports and activities that involve sprinting or jumping, such as:
- Track and field sports
Factors that can increase the risk of a hamstring strain include:
- Sudden change in direction (acceleration or deceleration)
- Failure to sufficiently warm up before exercise
- Overdoing it
- An imbalance in the size of the leg muscles between the quadriceps and hamstrings.
- Poor running technique
- Returning to activities too quickly after injury
- Previous hamstring injury
- Increased age
- Poor flexibility
- Being out of shape/muscle weakness
- Hamstring muscle fatigue
How Is a Grade 2 Hamstring Strain Diagnosed?
A hamstring strain is diagnosed with a history including how the injury occurred and a leg examination.
The physical examination can help determine the grade of the hamstring strain.
If the injury is more severe, imaging tests may be used to determine the extent of the injury, such as:
- Magnetic resonance imaging (MRI) scans
What Is the Treatment for a Grade 2 Hamstring Strain?
Most of the time, grade 2 hamstring strains heal on their own or with physical therapy.
Treatment for a grade 2 hamstring strain includes:
- The RICE method:
- Especially if you are a runner: avoid running
- Ice the affected area
- Use a cold pack or ice wrapped in a towel
- Ice 20 minutes at a time, several times a day
- Compression with a compression bandage or stocking
- Elevation of affected leg
- Over-the-counter (OTC) pain relievers, such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn)
- Stretching, strengthening and flexibility exercises
- Talk to your doctor or a physical therapist to determine when it is safe to start exercises and which exercises you can do
- Do no HARM: No Heat, no Alcohol, no Running or activity, and no Massage
- Pushing yourself or returning to activity too soon can cause re-injury
Grade 2 hamstring strains usually do not require surgery.
How Do You Prevent a Grade 2 Hamstring Strain?
Hamstring strains may be prevented in some cases by:
- Properly warming up before exercise or physical activity
- Keeping muscles strong and flexible
- Maintaining cardiovascular fitness and muscular endurance
- Slowing increasing the duration and intensity of exercise
- A good rule of thumb is to add no more than 10% per to weekly running miles or to the time spent playing a sport
- Including speed work for distance runners
- If pain in your thigh occurs, stop the activity immediately
- Use the RICE method (rest, ice, compression, elevation)
- Rest and do not return to the activity until the leg feels strong, there is no pain, and the injured leg moves freely
- Stretching and cooling down after every workout, training session, and competition
- Allowing adequate recovery time between workouts
- Wearing the proper footwear for the sport
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