What are the symptoms of a hamstring strain?

Symptoms of a Hamstring Strain

The primary symptoms of a hamstring strain include localized pain, swelling, and limited range of motion in the posterior thigh, which typically worsen with activity and improve with rest. 1

Key Clinical Presentation

• Pain characteristics: Sharp or stabbing pain in the posterior thigh that increases with activity and may subside after a warm-up period 2
• Pain location: Typically well-localized to the posterior thigh, with tenderness that corresponds to the location of pain experienced during activity 2
• Onset pattern: Usually occurs during running or sprinting activities, often with an insidious onset related to increased activity or intensity 2, 3
• Functional limitations: Decreased range of motion and walking impairment that varies with the severity of the strain 4
• Visual signs: Possible swelling, ecchymosis (bruising), and asymmetry in the affected area 2, 1

Severity Classification

Hamstring strains are typically classified by degree of injury:

• First-degree strain: Mild discomfort, minimal strength loss, and minimal restriction of movement 3
• Second-degree strain: Moderate pain, noticeable strength loss, and limited range of motion 3
• Third-degree strain: Severe pain, significant functional impairment, and possible complete rupture of the musculotendinous unit (less common) 3, 1

Physical Examination Findings

• Inspection: Visible swelling, asymmetry, and possible ecchymosis in the posterior thigh 2, 1
• Palpation: Well-localized tenderness that corresponds to the injury site 2
• Range of motion: Limited and painful, especially with hip flexion combined with knee extension 5
• Muscle testing: Weakness with resisted knee flexion or hip extension 1
• Special tests: Pain reproduction with maneuvers that simulate hamstring loading 2

Timing of Symptom Progression

• Early stage: Pain primarily during activity that may subside after warm-up 2
• Progressive stage: Pain increases in intensity and duration as the condition worsens 2
• Advanced stage: Pain may be present even at rest 2, 6

Common Pitfalls in Diagnosis

• Misdiagnosis: Hamstring strains may be confused with other conditions such as:
  • Sciatic nerve irritation or compression 2
  • Piriformis syndrome 7
  • Hip arthritis 2
  • Chronic compartment syndrome 2
• Inadequate assessment: Failure to properly evaluate the severity can lead to premature return to activity and increased risk of recurrence 4, 5

Warning Signs Requiring Medical Attention

• Severe pain that does not improve with rest 2
• Inability to bear weight on the affected leg 2
• Significant swelling or bruising in the posterior thigh 1
• Audible "pop" or sensation of tearing at the time of injury (suggesting a more severe strain) 6
• Persistent symptoms despite appropriate rest and conservative measures 2

Proper identification of hamstring strain symptoms is crucial for appropriate management and prevention of recurrence, as nearly one-third of these injuries recur within the first year following return to sport 4, 5.