Depending on initial severity and location of a hamstring injury, a person can be significantly debilitated and be forced to take extensive time away from activity.1Marshall S, Covassin T, Dick R, Nassar L, Agel J. Descriptive epidemiology of collegiate women's gymnastics injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train 2007;42:234-40.,2Caine D, Nassar L. Gymnastics injuries. Med Sport Sci 2005;48:18-58.,3Feeley B, Kennelly S, Barnes R, et al. Epidemiology of National Football League training camp injuries from 1998 to 2007. Am J Sports Med 2008;36:1597-603.,4Brooks J, Fuller C, Kemp S, Reddin D. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med 2006;34:1297-306.

Most people who suffer an acute hamstring strain will experience some of the following:

Sharp pain. When the injury occurs, one may feel an abrupt, sharp pain at the back of the thigh or buttocks.

A “pop” sound or sensation. This sudden pain is sometimes accompanied by an audible or palpable “pop” and a sensation of the leg giving way.5Garrett W. Muscle strain injuries. Am J Sports Med 1996;24 S2-S8.,6Ali K, Leland J. Hamstring strains and tears in the athlete. Clin Sports Med 2012;31:263-72.32. Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.,7Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.,8Clanton T, Coupe K. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg 1998;6:237-48.

Difficulty moving and bearing weight. Following a hamstring injury, it may be hard or impossible to continue activity. The person may even have trouble walking with a normal gait, getting up from a seated position, or descending stairs.9Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.,10Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8.,11Cacchio A, Borra F, Severini G, et al. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med 2012;46:883-7. Acute hamstring injury patients can also have a “stiff legged” gait with noticeable limp.6Ali K, Leland J. Hamstring strains and tears in the athlete. Clin Sports Med 2012;31:263-72.32. Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.

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Bruising. Sometimes bruising and discoloration can be seen along the back of the thigh.

Swelling and deformity. For cases in which there has been a complete tear of the muscle-tendon junction (myotendinous rupture), there may be bruising along with palpable defects, such as muscle lumpiness, under the skin. These defects can be felt and seen with contraction.5Garrett W. Muscle strain injuries. Am J Sports Med 1996;24 S2-S8.,6Ali K, Leland J. Hamstring strains and tears in the athlete. Clin Sports Med 2012;31:263-72.32. Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.,8Clanton T, Coupe K. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg 1998;6:237-48.

Pain and discomfort when sitting. In avulsion type and proximal hamstring injuries, where the tendon breaks away from the pelvic bone, patients will commonly have sitting pain and discomfort.12Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.,13Puranen J, Orava S. The hamstring syndrome--a new gluteal sciatica. Ann Chir Gynaecol 1991;80:212-4.,14Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8.,15Cacchio A, Borra F, Severini G, et al. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med 2012;46:883-7.

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In the rare case of a distal avulsion, in which the hamstring tendon has torn away from the tibia or fibula, a patient may experience significant bruising and thickening of soft tissue that can be felt near the site of the injury, which results in an inability to walk without assistance.16Cohen S, Bradley J. Acute proximal hamstring rupture. J Am Acad Orthop Surg 2007;15:350-5.,17Folsom G, Larson C. Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 2008;36:104-9.,18Colosimo A, Wyatt H, Frank K, Mangine R. Hamstring Avulsion Injuries. Oper Tech Sports Med 2005;13:80-8.,19Domb B, Linder D, Sharp K, Sadik A, Gerhardt M. Endoscopic repair of proximal hamstring avulsion. Arthrosc Tech 2013;2:e35-9.,20Harris J, Griesser M, Best T, Ellis T. Treatment of Proximal Hamstring Rupture- A Systemic Review. Int J Sports Med 2011;32:490-5.,21Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 2008;36:1110-5.

  • 1 Marshall S, Covassin T, Dick R, Nassar L, Agel J. Descriptive epidemiology of collegiate women's gymnastics injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train 2007;42:234-40.
  • 2 Caine D, Nassar L. Gymnastics injuries. Med Sport Sci 2005;48:18-58.
  • 3 Feeley B, Kennelly S, Barnes R, et al. Epidemiology of National Football League training camp injuries from 1998 to 2007. Am J Sports Med 2008;36:1597-603.
  • 4 Brooks J, Fuller C, Kemp S, Reddin D. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med 2006;34:1297-306.
  • 5 Garrett W. Muscle strain injuries. Am J Sports Med 1996;24 S2-S8.
  • 6 Ali K, Leland J. Hamstring strains and tears in the athlete. Clin Sports Med 2012;31:263-72.32. Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.
  • 7 Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.
  • 8 Clanton T, Coupe K. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg 1998;6:237-48.
  • 9 Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.
  • 10 Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8.
  • 11 Cacchio A, Borra F, Severini G, et al. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med 2012;46:883-7.
  • 12 Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.
  • 13 Puranen J, Orava S. The hamstring syndrome--a new gluteal sciatica. Ann Chir Gynaecol 1991;80:212-4.
  • 14 Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8.
  • 15 Cacchio A, Borra F, Severini G, et al. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med 2012;46:883-7.
  • 16 Cohen S, Bradley J. Acute proximal hamstring rupture. J Am Acad Orthop Surg 2007;15:350-5.
  • 17 Folsom G, Larson C. Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 2008;36:104-9.
  • 18 Colosimo A, Wyatt H, Frank K, Mangine R. Hamstring Avulsion Injuries. Oper Tech Sports Med 2005;13:80-8.
  • 19 Domb B, Linder D, Sharp K, Sadik A, Gerhardt M. Endoscopic repair of proximal hamstring avulsion. Arthrosc Tech 2013;2:e35-9.
  • 20 Harris J, Griesser M, Best T, Ellis T. Treatment of Proximal Hamstring Rupture- A Systemic Review. Int J Sports Med 2011;32:490-5.
  • 21 Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 2008;36:1110-5.

Dr. Adam Pourcho is a sports medicine physician specializing in the treatment and prevention of sports and musculoskeletal injuries. Dr. Pourcho practices at Swedish Spine, Sports & Musculoskeletal Medicine, where he uses his training in diagnostic and interventional ultrasound for minimally invasive treatments and serves as a faculty member.

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