The Hamstring Muscles

How Physical Therapy Works on a Hamstring Injury

The hamstring muscles are a group of three muscles located on the back of your thigh. The three muscles are called the biceps femoris, the semimembranosus, and the semitendinosus. These three muscles work together to help bend your knee. They can also help with hip extension, when your hip and thigh move towards the back of your body.

A man with pain in his hamstring
Jan-Otto / Getty Images

The hamstring muscles all arise from a bone on the bottom of your pelvis called the ischial tuberosity. The muscles then course down the back of your thigh. The biceps femoris muscle attaches past your knee on the lateral, or outside, part of your leg. The semimembranosus and semitendinosus attach on the medial, or inside, aspect of your knee and shin bone.

Common Injuries to the Hamstring Muscles

Trauma, which may occur during sports participation, is a frequent cause injury to the hamstrings. This may cause partial or full tears through the muscles or tendons of the hamstrings. Occasionally, repetitive strain during walking or running may cause hamstring problems.

Injury to the hamstrings may include tears in the muscles or tendons referred to as strains. Sometimes the tearing occurs near the ischial tuberosity causing hip pain. Occasionally, hamstring problems are felt in the tendons near your knee and manifest as knee pain.

Signs and Symptoms of Hamstring Injury

Common signs and symptoms of a hamstring injury include but are not limited to:

  • Pain in the back of your hip
  • Pain in the inner or outer part of your knee
  • Tenderness and increased temperature in the back of your thigh
  • Bruising or discoloration on the back of your thigh
  • Pain or weakness when bending your knee or when lifting your leg behind you

Pain in the back of your thigh and leg may also be symptoms coming from your low back. Occasionally problems like sciatica can mimic a hamstring injury. If your hamstring pain was accompanied by a recent onset of low back pain, you may be experiencing sciatica and not a hamstring strain.

If you suspect that you have injured your hamstring muscles, you should consult with your healthcare provider. He or she can examine your injury and help provide the right treatment for your condition.

How Can Physical Therapy Help?

If you have had a hamstring injury, your healthcare provider may refer you to physical therapy to help you regain normal function and mobility. Common impairments that your physical therapist may assess include:

Your treatment will typically focus on correcting the impairments that are found during your initial evaluation with your physical therapist. Your physical therapist will work with you to devise a plan of care to treat your hamstring injury to help you return to normal function.

Your physical therapist may choose to use various treatment techniques as a part of your rehabilitation. Ice may be used to control inflammation during the initial, or acute, phase of your injury. Heat may then be used to increase blood flow to the injured area and to help improve the elasticity of the injured hamstrings.

Occasionally, therapeutic modalities like ultrasound may be used to help provide deep heat to the injury site. Electrical stimulation like TENS may also be used to help reduce pain. Caution should be used when being treated with these modalities. There is very little evidence that these kinds of treatments are beneficial to the overall healing of the body. Be sure to speak with your physical therapist to understand the rationale behind using such treatments, and be sure that you are also actively engaged in your rehabilitation. High quality evidence that these kinds of treatments are beneficial to the overall healing of the body are limited.

If your hamstring muscle or tendon has partially torn, scar tissue may have developed over the site of injury. Your physical therapist may utilize scar massage and mobilization to help remodel the scar tissue and improve the elasticity of the injured hamstring muscle or tendon. A full thickness tear through a hamstring tendon may require surgery to fix. If you have had surgery, scar tissue massage may also be used to help improve the mobility of the surgical incision.

Active exercise has been proven to help improve the strength and flexibility of the hamstrings after an injury. Towel hamstring stretches can be done, or you can stretch the hamstrings with the help of another person. The standing hamstring stretch is another easy way to improve the flexibility of this muscle group.

Strength exercises may include knee curls while lying on your stomach and seated knee curls with an exercise machine. If you don't have access to a machine, you can use an exercise band or tubing around your ankle to provide resistance. However, each exercise should be tailored to your specific level of strength and progress in recover. The ball bridge with knee flexion is also a great exercise that you can perform to improve the strength of the hamstrings.

Other exercises that focus on balance, proprioception, and plyometrics may be beneficial to help you regain normal mobility and function after a hamstring injury. Be sure to consult with your healthcare provider or physical therapist before starting any exercise program.

A Word From Verywell

The hamstrings are a big muscle group that cross over your hip joint and knee joint and are essential for normal function related to walking and running. Injury to these muscles can cause significant knee, thigh, or hip pain. By keeping the hamstrings flexible and strong, you may be able to reduce the risk of injury and prevent future problems with your hamstrings.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Messer DJ, Bourne MN, Williams MD, Al Najjar A, Shield AJ. Hamstring muscle use in women during hip extension and the Nordic hamstring exercise: a functional magnetic resonance imaging study. J Orthop Sports Phys Ther. 2018;48(8):607-612. doi:10.2519/jospt.2018.7748

  2. Moatshe G, Chahla J, Vap AR, et al. Repair of proximal hamstring tears: a surgical technique. Arthrosc Tech. 2017;6(2):e311-e317. doi:10.1016/j.eats.2016.10.004

  3. Erickson LN, Sherry MA. Rehabilitation and return to sport after hamstring strain injury. J Sport Health Sci. 2017;6(3):262–270. doi:10.1016/j.jshs.2017.04.001

  4. Cleveland Clinic. Is your leg pain sciatica or something else?

  5. Schmitt B, Tim T, McHugh M. Hamstring injury rehabilitation and prevention of reinjury using lengthened state eccentric training: a new conceptInt J Sports Phys Ther. 2012;7(3):333–341.

  6. American Academy of Pediatrics. Treating sports injuries with ice and heat.

  7. Shanks P, Curran M, Fletcher P, Thompson R. The effectiveness of therapeutic ultrasound for musculoskeletal conditions of the lower limb: A literature review. Foot. 2010;20(4):133-139. doi:10.1016/j.foot.2010.09.006

  8. Ramos GA, Arliani GG, Astur DC, Pochini AC, Ejnisman B, Cohen M. Rehabilitation of hamstring muscle injuries: a literature reviewRev Bras Ortop. 2016;52(1):11–16. doi:10.1016/j.rboe.2016.12.002

  9. Chu SK, Rho ME. Hamstring injuries in the athlete: diagnosis, treatment, and return to playCurr Sports Med Rep. 2016;15(3):184–190. doi:10.1249/JSR.0000000000000264

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.