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Hamstring Injury: Recovery, Rehabilitation and Return to Sport

Hamstring strains are common in sports involving sprinting, kicking, jumping and rapid acceleration. Although many people recover well, returning to sport before rebuilding strength and high-speed running capacity can increase the risk of another injury.

Effective hamstring injury recovery involves more than waiting for the pain to disappear. Rehabilitation should gradually prepare the hamstring for the forces and movements your sport requires.

What Is a Hamstring Injury?

The hamstrings are a group of three muscles at the back of the thigh:

  • Biceps femoris

  • Semitendinosus

  • Semimembranosus

These muscles help bend the knee, extend the hip and control the leg during walking, running and landing. During sprinting, the hamstrings must manage very high forces – particularly as the leg swings forward and prepares to contact the ground.

A hamstring injury occurs when one or more of these muscles or their tendons are loaded beyond their current capacity.

Hamstring injuries range from a relatively mild strain to a major muscle or tendon tear. The location and mechanism of the injury can influence the rehabilitation process and expected recovery time.

How Do Hamstring Injuries Happen?

There are two common injury patterns.

High-speed running injuries

These frequently occur during sprinting or rapid acceleration. An athlete may feel a sudden pain or grabbing sensation in the back of the thigh and be unable to continue running normally.

Stretch-related injuries

These occur when the hip and knee move into positions that place the hamstring under considerable stretch. Examples include slipping, high kicking, dancing or performing the splits.

Stretch-related injuries may affect the upper hamstring tendon near the sitting bone and can sometimes take longer to recover.

Common Symptoms of a Hamstring Strain

Symptoms can include:

  • Sudden pain in the back of the thigh

  • Pain when walking, running or bending forward

  • Tenderness over the injured area

  • Weakness when bending the knee or extending the hip

  • Bruising or swelling

  • A popping or tearing sensation at the time of injury

  • Difficulty accelerating or running at speed

The severity of pain does not always reveal the full extent of the injury. An assessment can help distinguish a hamstring strain from tendon injuries, referred pain from the back or other causes of posterior thigh pain.

What Should You Do After a Hamstring Injury?

Stop the activity that caused the injury rather than trying to run through sudden pain.

During the first few days, it may be helpful to:

  • Protect the area from further aggravation

  • Keep gently moving within a tolerable range

  • Temporarily avoid sprinting and explosive movements

  • Use compression if it feels comfortable

  • Avoid aggressive stretching or heavy hamstring loading

  • Seek advice about an appropriate starting point for rehabilitation

Complete inactivity is rarely required for a straightforward strain. However, the amount of movement that is appropriate depends on the severity and location of the injury.

An early physiotherapy assessment can be useful, especially if you need to return to sport or physically demanding work. 

When Should You Seek Prompt Assessment?

Arrange an assessment promptly if:

  • You felt or heard a significant pop

  • You cannot walk normally or bear weight comfortably

  • There is extensive or rapidly increasing bruising

  • You notice a visible change in the shape of the muscle

  • Pain is located close to the sitting bone

  • You have marked weakness

  • You experience numbness or tingling

  • The injury followed a fall that forced your legs apart

  • You are an adolescent athlete with pain near the pelvis

These features may indicate a more substantial muscle or tendon injury. Imaging is not required for every hamstring strain, but it may be recommended if the result would change management.

What Does Hamstring Rehabilitation Involve?

Rehabilitation should progress according to your symptoms, strength and function rather than following the same timetable for everyone.

Stage 1: Settle symptoms and restore movement

The initial aim is to regain comfortable walking and gentle movement without unnecessarily aggravating the injury.

Treatment may include:

  • Education about the injury

  • Advice about temporarily modifying activity

  • Gentle range-of-motion exercises

  • Early hamstring contractions at an appropriate intensity

  • Maintaining fitness through suitable alternative activities

Stage 2: Rebuild strength

As symptoms settle, hamstring loading is gradually increased.

A comprehensive program may include exercises that work the hamstrings at different muscle lengths and challenge both major functions of the muscle group: bending the knee and extending the hip.

Exercises may include:

  • Hamstring bridges

  • Leg curls

  • Hip-hinge exercises

  • Romanian deadlifts

  • Sliding hamstring curls

  • Nordic hamstring exercises

The right exercise and starting level depend on the injury. Nordic hamstring exercises can be valuable, but they are not necessarily the first or only exercise required.

Stage 3: Develop strength, power and running capacity

Gym strength alone is not enough to prepare an athlete for sprinting.

Rehabilitation should progressively include:

  • Running drills

  • Gradual acceleration

  • Increasing running speed

  • Change-of-direction work

  • Jumping or kicking where relevant

  • Sport-specific conditioning

  • Exposure to training under increasing fatigue

High-speed running should be reintroduced gradually rather than left until the final session before returning to sport.

Stage 4: Return to training and competition

The athlete progresses from controlled rehabilitation into modified training, full training and then competition.

The exact sequence depends on the sport, playing position, competition schedule and nature of the injury.

Why Do Hamstring Injuries Recur?

A previous hamstring injury is an important risk factor for another strain. Reinjury is particularly common soon after returning to sport.

Contributing factors may include:

  • Returning before rehabilitation is complete

  • Inadequate hamstring strength

  • Limited exposure to high-speed running

  • Sudden increases in sprinting or training demands

  • Poor preparation for the athlete’s position or sport

  • Ending rehabilitation as soon as everyday activities are pain-free

  • Not maintaining strength exercises after returning

Reinjury does not always mean someone made a mistake. Hamstring injuries are influenced by several factors, and no program can completely remove the risk.

How Can Hamstring Injuries Be Prevented?

Prevention should prepare the hamstrings for the demands they will encounter during sport.

A useful program may include:

  • Regular progressive hamstring strengthening

  • Exercises that load the hamstrings while lengthened

  • Gradual exposure to sprinting and high-speed running

  • Strength and power training for the whole lower limb

  • An appropriate sport-specific warm-up

  • Consistent training rather than sudden workload increases

  • Continued strengthening throughout the playing season

Programs containing Nordic hamstring exercises have been shown to reduce hamstring injury rates. However, they work best as part of a broader program that athletes complete consistently and that reflects the demands of their sport.

When Can You Return to Sport?

There is no single timeframe that applies to every hamstring injury. A mild strain may recover relatively quickly, while a major muscle or tendon injury can take considerably longer.

Return-to-sport decisions should consider more than whether the athlete is pain-free.

Depending on the sport and injury, useful milestones may include:

  • Comfortable walking and everyday activity

  • Restored range of movement

  • Minimal or no pain during strength testing

  • Adequate hamstring strength and endurance

  • Successful progressive running exposure

  • Near-maximal or maximal sprinting where required

  • Completion of kicking, jumping or change-of-direction tasks

  • Tolerance of full-intensity training

  • Confidence in the injured leg

No single test can guarantee that an injury will not recur. The decision should combine clinical findings, objective testing, sport-specific performance and the athlete’s confidence.

How FutureReady Physiotherapy Can Help

At FutureReady Physio & Wellness, we assess the injury itself as well as the physical demands you need to return to.

Your rehabilitation may include:

  • Assessment of hamstring and lower-limb strength

  • An individualised gym program

  • Objective strength and performance testing

  • A graded return-to-running plan

  • Sport-specific strength, power and movement exercises

  • Guidance on returning to training and competition

  • An ongoing injury-prevention program

Whether this is your first hamstring strain or an injury that keeps returning, the aim is to restore your capacity—not simply wait for the pain to settle.

Book a physiotherapy appointment or call 08 9450 4433 to begin your hamstring injury recovery.

References

  • Martin, R. L., Cibulka, M. T., Bolgla, L. A., et al. (2022). Hamstring strain injury in athletes: Clinical practice guidelines. Journal of Orthopaedic & Sports Physical Therapy, 52(3), CPG1–CPG44.

  • Paton, B. M., Read, P., van Dyk, N., et al. (2023). London International Consensus and Delphi study on hamstring injuries. British Journal of Sports Medicine, 57(5), 278–291.

  • van Dyk, N., Behan, F. P., & Whiteley, R. (2019). Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries. British Journal of Sports Medicine, 53(21), 1362–1370.

  • Erickson, L. N., & Sherry, M. A. (2017). Rehabilitation and return to sport after hamstring strain injury. Journal of Sport and Health Science, 6(3), 262–270.