If you’re an athlete, you can probably rattle off a list of teammates who “pulled a hammy” through the years. Read on to learn how to treat a pulled hamstring to get back as quickly as possible after this common injury.
The Classic “Pulled Hammy”
Let’s say you take off on a sprint.
Maybe you’re running intervals or you like to finish off the last 100 meters of your weekly jog strong, so you go for it and take off.
Then all of a sudden, you feel a pop and an intense pain in the back of your leg.
You stumble over your feet as you try to slow down while standing on that leg as little as possible. It takes you a while, but you’re able to hobble back home.
A few hours later the back of your thigh is still painful, but now it’s swollen and perhaps even bruised.
“I guess I won’t be training for a while,” you think to yourself, pissed and depressed at the thought.
Let’s talk a bit about what happened and how to treat a pulled hamstring so that you can get back to business ASAP.
Symptoms of a Hamstring Strain
All signs and symptoms in the above tale point to one culprit – a pulled or strained hamstring.
Most of the time, you notice this injury when it happens – the sudden pain in the back of your leg won’t leave you with any questions about when you hurt your leg.
Some people even hear a pop or feel a tear as the injury occurs [1].
Usually, a hamstring pull will become swollen and tender within hours, possibly bruising as time goes on.
The injured leg will feel weak, a symptom which can linger for quite some time [2].
The pain may show up when you walk, bend over or try to straighten your injured leg [3].
Hamstring Anatomy & Mechanics
Although we tend to think of them as one unit, there are 3 heads that make up the hamstrings – the biceps femoris, the semimembranosus and the semitendinosus. Any one of them could be involved in a hamstring strain.
The muscles in this group are biarticular, meaning they cross two joints – the hip, and the knee.
These muscles start at your ischial tuberosity, the bony bump at the bottom of your pelvis sometimes called the sit bone [4].
From here, the muscles travel down the back of your thigh and cross your knee joint, where they attach to the bones of the lower leg.
The hamstring muscles have two principle functions – extending your leg back behind you, straightening at the hip joint, and bending your knee.
The muscles also work to help provide some rotation at the knee and at the hip [5].
These functions of extending the hip and flexing the knee are both at work when running.
When sprinting, the hamstring muscles take on another crucial function – trying to decelerate the lower leg right before your foot hits the ground [6].
And studies have shown that the hamstrings also play an important part in acceleration during sprinting, especially in experienced sprinters [7].
Root Causes of Hamstring Injury
Since hamstrings play such a big role in that final step of a sprint, the pressure on the muscles here can often be behind an injury.
At this point in the gait cycle – when your leg is swinging forward and about to hit the ground – the hamstrings are exerting a lot of force and lengthening to extend the leg, AND working eccentrically to absorb the energy required to slow your lower leg down before it hits the earth [8].
This lengthened, end range of motion with both hip flexion and knee extension is when all three hamstring muscles are exerting the greatest force, and it’s exactly when a hamstring muscle typically tears [9].
This is especially true in sprinting versus walking or even jogging – the high velocity and large forces at play increase the force required by your hamstrings, increasing the likelihood of an injury.
How to Treat a Pulled Hamstring
When this happens, most people immediately blame tight hamstrings as the culprit.
While hamstring length is a factor, there’s more to consider when thinking about how to treat a pulled hamstring. To prevent and heal the injury, you have to address overall hip function.
Because you need greater range of control, not just an increased range of motion, static stretching isn’t the answer (try these techniques for greater hamstring range of control instead).
And, you can’t just address one muscle group here because if one group is short or tight because it’s likely compensating for something else.
For these reasons, I’ve got one thing to stress before we move into the steps for treating this injury – definitely DO NOT DO STATIC STRETCHES on hamstring strains.
If your hammie is pulled, it means there’s some damage/tearing involved and static stretching can easily cause further damage.
Steps to Rehab:
I’ve got a good friend who was an elite soccer player when we were growing up.
He was good enough to receive a full scholarship to a US college, which is quite the accomplishment, especially being Canadian.
He was well-known for two things growing up: being super fast and having massive, ripped quads.
I would stare in amazement as his quads would bust out of his shorts whenever we played sports and they got the “pump”.
They also made my legs look like strings of spaghetti.
But in high school and beyond, he was always pulling or straining a muscle, including his hamstrings.
He was the first guy I ever knew who went to physiotherapy and he would describe his treatment, which seemed to revolve around ultrasound.
Back then I didn’t know what I know now, but looking back I would bet the farm that his quads (and calves) were way more powerful relative to the rest of his lower body muscles, simply based on his pattern of muscular development and effectively treating him would have to involve restoring proper muscular function and strength balance, not just treating the symptoms.
STOP
Before you can do anything meaningful for treating your hammies, you’ve got to do one thing first: stop doing anything that provokes pain.
Take it easy and allow yourself to heal.
TREAT
Next you need to tackle inflammation. For that I recommend three things – turmeric, fish oil and cool temps.
Curcumin, an active ingredient in turmeric, has been found to ease inflammation in the body, including inflammation tied to arthritis [10]. Check out PuraThrive if you’re in the market for a quality turmeric supplement.
Fish oil has also been found to reduce inflammatory markers [11], and as such, could speed healing and recovery.
When it comes to using cold exposure, I recommend only using ice for the first 24 to 72 hours after the injury. After this, only ice your leg if excessive pain is provoked again.
But, you should run cold water over the injured area when you’re in the shower as you continue to heal (fun stuff).
CIRCULATION
As soon as possible, begin to perform simple movements involving the injured leg.
Just remember to avoid anything that causes pain!
Flexing and extending the knee gently will promote circulation. An increase of blood flow can help speed healing, so this is an important step.
RESTORE
Now you’re ready to start restoring function of that hamstring.
I’ve provided some exercises below that will help you do that by simultaneously rebuilding mobility and rebuilding strength.
Again, if anything causes pain, stop immediately. Pain means the technique is too aggressive for your current state so try it again in a few days to a week.
In addition to these exercises, you can start slow and gradually start to ramp up your running speed week to week.
Just make sure you don’t go to fatigue – you need to be careful to maintain proper form as your body recovers and restores.
Exercises for Pulled Hamstring Rehab: Mobility
The techniques below will build strength in opposing muscle groups to create length in the hamstrings and increase mobility.
This will help you restore function and help prevent future injury.
3 Unique Hamstring Stretches Everyone Needs
1. Supine Active Knee Extension
- Lay flat on your back to start
- Leave your left leg outstretched as you flex your right hip to bring your right leg toward your chest while keeping a neutral lumbar spine
- Your right thigh should extend straight up from your hip – but allow your knee to bend and heel to relax down toward your glutes
- Slowly and with control, start to straighten the right leg – maintaining that natural curve in the lumbar spine
- Continue to straighten your leg and reach the toes toward the sky (your range of motion will likely increase as you do more reps)
- Start to bend at the knee, bringing the right heel back down towards your butt
- Resist the urge to grab the back of your thigh – instead let your hip muscles build strength as they maintain the position of your femur
- Repeat 10 times with control and then switch legs
2. Standing Active Knee Extension PNF
- Switch legs and repeat for 2 sets of 3 cycles on each leg
- Keep alternating – lift, relax, drive down, relax – for 3 full cycles
- Relax again and feel the stretch for 5 seconds
- Release the stretch and contract your hamstrings to drive your heel down into the surface for 5 seconds
- Relax your foot back on the surface so that you feel a mild stretch, holding for 5 seconds
- Stand up straight and contract to lift the heel off the surface for 5 seconds
- Start with one foot outstretched on the surface
- For this stretch, you’ll need to find something that you can rest your leg on that’s both stable and the proper height. Experiment until you find the right spot!
- This “proprioceptive neuromuscular facilitation” or PNF exercise will allow you to strengthen the hamstrings and antagonizing muscles in an extended range of motion
3. Hip Hinge with Adduction and TKE
- Start standing with straight legs
- Hinge at your hips and reach down to grab your leg just below the patella
- Internally rotate your legs while contracting your quadriceps to straighten the legs – this will lead to “terminal knee extension” or TKE
- Keep squeezing your legs for 5 seconds – making sure to stay internally rotated so that your adductor muscles along the inside of your thigh are activated
- Release and come back up to standing with control
- Repeat for 5 to 10 reps
Controlled Hurdler:
- Start in a quadruped stance
- Lift your right hand off the ground
- Thread the needle with your left leg and reach it as far forward as possible
- Plant the left foot and pull yourself forward with the left hamstring (don’t just propel yourself forward with your right leg/left hand)
- Return to the quadruped stance and repeat with the opposite leg
- Complete 2 sets of 6 reps per leg
Exercises for Pulled Hamstring Rehab: Strength
These next techniques strengthen 2 different functions of the hamstrings – knee flexion and hip extension, respectively.
SB Leg Curls:
- Grab a stability/Swiss ball
- Get into a supine position with your feet resting on the ball and hands relaxing by your side
- Lift your hips up off the ground into a bridge
- Pull the ball in, bringing your heels toward your butt as you drive your hips up (don’t just bend at the hips!)
- Roll the ball back out
- If you want to make it harder, bring the ball in with both legs, but lift one leg off as you roll back out
- Another advanced option is to lift one heel slightly off the ball before you roll in, performing both the in and out motions with one leg
Deadlifts:
- Stand with feet a little wider than shoulder-width, toes pointed out slightly, and with arms hanging down inside your knees
- Hinge at the hips, with your weight back in your heels
- Maintain the curve in your lumbar spine and keep your chest up tall
- Grab the bar and take a deep breath in
- Drive the hips forward as you lift up, exhaling at the top
- Keep the back straight, knees slightly bent as you lower the bar back down
Now that you’ve learned how to treat a pulled hamstring, it’s time to put it to use.
Get going on these steps, starting first with gentle movement in a pain-free range and building from there.
As I mentioned before, overall hip function must be addressed in order to really heal your legs and protect you from future injuries.
While you may have tight hamstrings, the cause of that tightness can be from many factors…
