Hamstring Injury (Pulled Hamstring): Treatment, Return to Sport and Exercises

48–72 hoursThe first phase: rest, ice, light compression and raising the leg

15–20 minutesHow long to apply ice wrapped in a damp towel, every 2–3 hours during the day

3 degreesSeverity, from a mild strain to a complete tear

~50%Reduction in injury rates with programmes that include the Nordic hamstring exercise

Symptoms and severity

Grade 1 (mild strain): Sudden pain and tenderness at the back of the thigh, pain when moving the leg; muscle strength is usually unaffected.
Grade 2 (partial tear): More pain and tenderness, possible swelling and bruising, and some loss of strength in the leg.
Grade 3 (severe tear): Very painful, swollen and bruised; there may have been a “popping” sensation at the time of injury, and the leg cannot be used.

What causes it?

When a muscle or tendon is stretched beyond its limit.
Most often during sudden, explosive movements such as sprinting, lunging and jumping.
It can also happen through gradual overstretching over time.
It commonly comes back in people who have injured their hamstring before.

The first 2–3 days

Protect and rest: Avoid strenuous activity for the first 48–72 hours.
Ice: Apply ice wrapped in a damp towel for 15–20 minutes every 2–3 hours during the day; do not leave it on while you sleep.
Compression and elevation: You can use an elastic bandage that is snug but not tight (take it off before sleeping) and raise your leg on a pillow.
Avoid: Heat, alcohol, running and massage for the first 72 hours.
Painkillers: Paracetamol or a painkilling gel can be used; medicines such as ibuprofen after the first 48 hours. You can ask your doctor or pharmacist.

After that

Once the pain starts to ease, after a few days, you can begin gentle stretches.
Then come walking, cycling and hamstring strengthening exercises.
Pushing too early can make the injury worse; staying inactive for too long can lead to muscle wasting and scar tissue.
Return to full activity when your hamstring muscles are strong enough.

Exercises at home

Six exercises to strengthen the hamstrings

The exercises go from easiest to hardest. Do them in a pain-free or only mildly painful range; if the pain is worse the next day, go back a level. The last exercise is only for after full recovery, to prevent the injury coming back.

Heel slides

Lie on your back. Slide your heel along the floor or bed towards your bottom, bending your knee as far as is comfortable, then slowly straighten it. In the first days, it is an easy way to work the back of the thigh without pain.

10 reps, 2–3 times a day

Bridge

Lie on your back with your knees bent and feet on the floor. Press your heels into the floor and squeeze your buttocks to lift your hips, making a straight line from your shoulders to your knees. Hold for 3–5 seconds and lower slowly. As it gets easier, you can place your feet a little further away.

10–15 reps, 2–3 sets

Seated hamstring stretch

You can start after a few days, once the pain begins to ease. Sit on the front edge of a chair and stretch one leg out in front with the heel on the floor. Keeping your back straight, lean forward slightly from the hips; feel only a mild stretch and do not push into pain.

20–30 seconds, 2–3 times

Brisk walking

Walking and cycling

Start with short, comfortable walks as the pain allows; an exercise bike is also a good option. Increase the time day by day. Put off running and sprinting until your muscles are strong enough.

10–20 minutes, every day

Hip hinge

Stand with your feet hip-width apart and your knees slightly bent. Keeping your back straight, lean your upper body forward from the hips; when you feel a stretch at the back of your thighs, squeeze your buttocks to stand back up. As long as it is pain-free, you can hold a light weight over time.

10 reps, 2–3 sets

Nordic hamstring exercise

Only after recovery, to prevent injury. Kneel with a cushion under your knees; have a helper hold your ankles, or hook your heels under a sofa. Keeping your body upright and your hips straight, lower yourself forward as slowly as you can, catch your fall with your hands, then push back up with your hands to the start.

Once or twice a week, 2–3 sets × 3–6 reps

Frequently asked questions

How long does it take to heal?

Depending on how severe the injury is, it can take days, weeks or months. In mild strains, muscle strength is usually unaffected; partial tears can cause loss of strength and bruising. A completely torn hamstring can take several months to heal. Many people need to stay away from sport for at least a few weeks.

Can I have a massage or use heat in the first few days?

For the first 72 hours, it is recommended to avoid heat, alcohol, running and massage. During this time, rest, ice, light compression and raising the leg are recommended.

When can I return to sport?

When your hamstring muscles are strong enough. Returning too early can make the injury worse, while staying inactive for too long can lead to muscle wasting and scar tissue. Deciding when to return together with a physiotherapist or doctor is the safest approach.

How can I stop it coming back?

People who have injured their hamstring before are at high risk of injuring it again. Warming up before exercise, regular stretching and strengthening may help. In a review covering 8,459 athletes, programmes that included the Nordic hamstring exercise roughly halved hamstring injuries.

For other sports injuries around the hip and knee, you can look at the hip impingement and jumper’s knee guides.

When should you see a doctor?

If you think the injury is severe
If it is not healing or the symptoms are getting worse
If you felt a “pop” at the time of injury, cannot use your leg, or have widespread bruising and swelling (it could be a severe tear)
If you have any concerns about the injury

Sources

nidirect. Hamstring injury (muscle strain). Last updated 19 December 2024.
van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. British Journal of Sports Medicine. 2019;53(21):1362.