From the Research
Hamstring pain is most commonly caused by muscle overload, often during rapid acceleration or deceleration activities, leading to strain or injury in the hamstring muscles. The most recent and highest quality study on this topic is from 2024 1, which highlights the evaluation and workup of hamstring injuries, nonoperative treatment options, and surgical decision-making based on patient presentation and injury patterns. According to this study, hamstring injuries can occur in the proximal tendon at the ischial tuberosity, in the muscle belly substance, or in the distal tendon insertion on the tibia or fibula.
Causes of Hamstring Pain
- Muscle overload during rapid acceleration or deceleration activities
- Forceful eccentric contraction mechanisms
- Proximal tendon injuries at the ischial tuberosity
- Muscle belly substance injuries
- Distal tendon insertion injuries on the tibia or fibula
Diagnosis and Treatment
The diagnosis of hamstring injuries is typically made using magnetic resonance imaging (MRI), which can help guide treatment 1. Nonoperative treatment options include activity modification, physical therapy, and adjuncts such as platelet-rich plasma injections. Operative treatment is typically reserved for more severe injuries, such as 2-tendon injuries with >2 cm of retraction, 3-tendon injuries, or injuries that do not improve with 6 months of nonoperative management.
Prevention and Rehabilitation
Prevention of hamstring injuries is crucial, and exercises such as Nordic hamstring exercises have been shown to be effective in reducing the incidence of these injuries 2. Rehabilitation of hamstring injuries should focus on gradual progression of stretching and strengthening exercises, as well as addressing factors such as flexibility, warm-up, and fatigue 3. A progressive strengthening program should include exercises like hamstring curls, bridges, and eventually deadlifts with light weights. Apply heat before exercise to increase blood flow and ice afterward to minimize inflammation. If pain persists beyond two weeks, worsens with activity, or is accompanied by significant swelling or inability to bear weight, consult a healthcare provider as you may need physical therapy or further evaluation.