A blog by runners. For runners.

Hamstring Strains: Treatment and Prevention

Last month Dr. Nace wrote about the causes of muscle strains. This month our physical therapist blogger shares how to prevent and treat hamstring muscle strains. This article explains the rehab process for a hamstring strain, and also offers some great strengthening exercises.

Muscle strains are one of the most common acute injuries that occur in runners of all levels. I'm going to discuss hamstring strains in detail here since that is the most common strain. There are three grades of a hamstring strain, grade I is minimal damage, II moderate damage and III severe damage, which is a complete tear or rupture of the muscle.

Quick Anatomy of the Hamstring

The hamstring is comprised of three muscles: biceps femoris, which covers the mid to outer posterior thigh; the semitendoninosus, which starts about two-thirds down the thigh; and the semibranosus, which is the most medial of the muscles. The biceps femoris is the part of the hamstring that is most commonly strained in runners.

Risk Factors

Prior hamstring strains, hamstring weakness, and strength imbalance between the hamstring and the quadriceps are all risk factors, as are age, fatigue, limited flexibility in hamstrings and quadriceps, and decreased core strength.

A majority of people who experience sudden posterior thigh pain typically do from high-speed running. Some describe hearing a “pop” followed by severe pain and are unable to continue running. People who experience this injury also complain of pain at the lower buttock when sitting.


Initially, you should restrict movement of the hamstring during the first five days based on when you start to have pain. This means shorter steps and maybe even crutches. DO NOT perform excessive stretching, which can increase scar tissue and stop muscle formation. Ice the muscle 2-3 times a day for 20 minutes with an ice pack or 5 minutes with an ice cup to the area.

When you can walk without pain, you can progress your activity level. Make sure that you have full range of motion without pain in your knee and hip. Work on hamstring, hip, and core strengthening. Then add hamstring stretching, making sure to stretch all three muscles by turning your foot inward, outward, and upward. I recommend holding 20-30 seconds, 4 sets of each. Continue to ice the area after strengthening exercises. As long as there is no pain, you can return to light jogging.

When your hamstring has full strength, meaning you can run at 50% of your maximum at least and are still not experiencing pain, then you can increase the intensity of the strengthening exercises and gradually increase the speed and distance of your running. Also, continuing to ice the area after exercise will help decrease possible inflammation.

I recommend seeking medical advice if the pain does not go away within a couple weeks.


As I mentioned earlier, one of the biggest risk factors of a hamstring strain is a previous hamstring strain. You need to properly rehabilitate your hamstring before you return to running, regardless of the race you may have been training to run. The second hamstring injury is usually much more severe than the first, requiring even more time away from running.


Make sure that you have a daily stretching routine and not one that only happens just before and after a run. Stretching daily is much more effective in preventing injury, and that includes not only your hamstrings, but your gastrocs, quadriceps, hip flexors, and rotators. It is also important to have a strengthening routine that you perform at least a couple of times per week. That would include hip, hamstring, and core-strengthening exercises. Work on standing-stability exercises, which would include single-leg activities.

Please refer to my blog on runner's knee for some pictures of stretching and strengthening exercises. I've also added a few new ones below.

Eccentric hamstring exercises

  1. Stand on one leg, keeping the knee straight and with the opposite arm try to touch the floor and slowly return to starting position. To make it more difficult try and touch down with the same arm as the the single leg.
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  3. In the tall kneeling position, cross your arms across your chest and have someone hold your ankles. Keeping the abdominals tight slowly lower your body towards the floor and return to starting position when you feel that you are unable to control the movement.
  4. hamstring strains

Running Injuries

Meredith Franczyk, PT, MPT

Meredith has over ten years of experience and is currently working in outpatient orthopaedics at lakeshore physical therapy. Over this time, she has developed specialities in general orthopaedics, manual therapy, and sports rehabilitation. Meredith has specific interests in sports related injuries. She takes a keen interest in new methods and advancements in physical therapy practice and has taken multiple continuing education courses to improve her skills and enhance her knowledge. If you have any questions or are looking for physical therapy please contact her at Lakeshore Physical Therapy.