The short answer. A torn hamstring usually announces itself with a sudden, sharp pain in the back of the thigh, sometimes with a popping or tearing sensation1. Most hamstring injuries are strains that heal with rest and a structured rehabilitation program1,2. Surgery is mainly considered when a tendon has pulled completely away from the bone2,3.
The hamstrings are three muscles that run down the back of the thigh, from the sitting bone at the bottom of the pelvis to just below the knee1. A "pulled" hamstring and a "torn" hamstring describe the same kind of injury at different severities: the muscle is stretched or overloaded beyond its limit1, and in more serious cases the fibers are disrupted, up to a complete tear2,4.
The typical signs are:
The three hamstring muscles are the biceps femoris, the semimembranosus and the semitendinosus4. Injuries are grouped by where they happen: near the top, where the tendons attach to the sitting bone (proximal); in the muscle belly; or near the knee (distal)5.
The muscle belly of the biceps femoris is the most common site. In a study of 516 hamstring injuries in professional soccer, 83% involved the biceps femoris, 11% the semimembranosus and 5% the semitendinosus4. Stretching-type injuries look different: in professional dancers, every injury was high in the back of the thigh close to the sitting bone, and 87% involved the semimembranosus6.
It depends on how bad the injury is. Some people have weakness or cannot put weight on the injured leg at all1. Mayo Clinic advises seeing a healthcare professional if you cannot bear weight on the leg, or if you cannot walk more than four steps without a lot of pain1. A doctor may recommend crutches for the first days to keep weight off the leg2.
Walking alone does not tell you how serious it is. In the most severe injuries the tendon tears completely away from the bone2, and those are best assessed early, because repairs done within about four weeks have better results than later repairs7.
Muscle overload is the main cause2. During sprinting, the hamstrings are lengthened and loaded at the same time, as the back leg straightens and the toes push off2. Hamstring injuries are common in soccer, football, basketball, tennis and running, and in dancers1,2.
Researchers describe two broad types6:
Known risk factors include a previous hamstring injury, tired or weak muscles, poor flexibility, an imbalance between strong quadriceps and weaker hamstrings, and older age1.
Hamstring strains are graded by severity. A grade 1 strain is mild and usually heals readily, and a grade 3 strain is a complete tear of the muscle that may take months to heal2. On MRI, grades 2 and 3 show actual disruption of the muscle fibers4.
A study of 23 European professional soccer teams measured how long players were out after hamstring injuries graded on MRI4:
| MRI grade | Average time out |
|---|---|
| Grade 0 (no visible damage on MRI) | 8 days |
| Grade 1 | 17 days |
| Grade 2 | 22 days |
| Grade 3 | 73 days |
These are averages for professional athletes with full-time medical staff, so treat them as a rough guide rather than a promise. In the same study, 70% of the injuries were grade 0 or 1, meaning no fiber disruption on MRI, yet those injuries still caused most of the total time lost4.
Most hamstring injuries do not need an operation; Mayo Clinic notes that surgery is rarely needed1. Surgery is most often performed for a tendon avulsion, where the tendon has pulled completely away from the bone2. Published surgical indications include complete avulsions at the top of the hamstring, and partial avulsions involving at least two tendons with more than 2 cm of retraction in young, active patients3.
Timing matters. In a systematic review of 300 proximal hamstring injuries, repairs done within four weeks of the injury had better satisfaction, strength and return to sport than repairs done later7. A larger 2018 review of 795 avulsions also found that acute repairs did better than chronic ones, and that repair gave better strength and satisfaction than nonoperative care, with a complication rate of about 23%8. If an avulsion is suspected, it is worth being seen promptly rather than waiting to see whether it settles.
Recovery after surgery takes time: repair of the upper (proximal) hamstring typically takes at least 6 months, and repair at the knee end about 3 months2.
Diagnosis starts with how the injury happened and a hands-on examination of the leg. For stretching-type injuries, researchers found that a precise history and careful palpation gave the clinician enough information to predict a long recovery6.
Imaging is used selectively. Most hamstring injuries do not need an MRI right away; it is most useful for injuries near where the tendons attach and for muscle tears that are not improving5. When an MRI is done, the grade it shows is associated with how long recovery takes4.
For most strains, treatment starts with rest, ice, compression and elevation, then moves to physical therapy once the swelling settles2. At first, your doctor may recommend crutches to keep weight off the leg, and sometimes a brace that holds the hamstring in a relaxed position2.
The exercises matter. In a randomized trial of 75 elite soccer players, a rehabilitation program built around lengthening exercises returned players to full training in an average of 28 days, compared with 51 days for a conventional exercise program9. A 2015 meta-analysis of randomized trials pointed the same way, finding that rehabilitation built on lengthening exercises significantly reduced the time to return to play10. In that rehabilitation trial, only one re-injury was recorded in the following 12 months9.
Platelet-rich plasma (PRP) can be combined with a rehabilitation program5,11. A review of evidence-based hamstring care describes nonsurgical treatment as centered on eccentric strengthening, with the possible addition of PRP low in white blood cells, which may have the potential to speed recovery5.
Where PRP is used, it is added to a strengthening program5, and whether it fits your injury is a conversation to have with your doctor. You can read more about PRP treatment.
Re-injury is common. In professional soccer, 16% of hamstring injuries were re-injuries4, and across studies the recurrence rate ranged from 13.9% to 63.3% within the same season or up to two years after the first injury13. Going back to hard activity before the muscle has fully healed is a known reason it happens again1.
The best-supported prevention step is the Nordic hamstring exercise. A 2019 meta-analysis of 8,459 athletes found that injury prevention programs that included it cut the rate of hamstring injuries by up to 51%14. Rehabilitation that includes agility and stabilization exercises may also help: in a systematic review of recurrent hamstring injuries, athletes who followed agility and stabilization exercises appeared to be at lower risk of re-injury13.
See a healthcare professional if you cannot put weight on the leg or cannot walk more than four steps without a lot of pain1. Also get it checked if the pain is severe or the leg stays weak, because a tendon torn away from the bone is best treated early2,7.
If you are in the Santa Barbara area, Dr. Scheinberg can examine the leg, review any imaging and walk you through the options. See sports injury treatment or call (805) 682-1394.
Quick answers to the questions people search most about hamstring tears.
Have a question about your own injury?
Call (805) 682-1394Most hamstring injuries do not need an MRI right away. It is most useful for injuries near where the tendons attach, or for tears that are not improving5.
You can lower the risk. Programs that include the Nordic hamstring exercise cut hamstring injuries by up to 51% in a meta-analysis of 8,459 athletes14.
Reviewed by Dr. Richard Scheinberg, MD, a board-certified orthopedic surgeon in Santa Barbara with 40 years of surgical experience.
