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Hamstring Injuries

As athletes, encompassing the elite, the amateur and “the weekend warriors” all make their comeback to sport after a significant lay off due to the current global pandemic, in the clinical setting, we are seeing a significant rise in acute soft tissue injuries.

Hamstring injuries are the most common type of muscular strain to effect the lower limb in the elite athlete.

Hamstring injuries commonly occur in sports which involve high speed sprinting and kicking, such as soccer, rugby and gaelic football / hurling.

Method of Injury:

Hamstring tears do not often result from direct trauma, but rather are stretch induced injuries, caused by a sudden forced lengthening occurring during a powerful contraction.

The most common timing of injury is during the terminal stage of the swing phase of running, as the hamstring eccentrically contracts or lengthens.

Athletes often report a sudden, and often severe, pain along the posterior aspect of the thigh, with occasional subsequent pain or difficulty walking.


Diagnosis is based on clinical findings, with a comprehensive subjective and objective assessment. MRI findings can also be beneficial in clarifying the extent of the injury.


Hamstring tears can be graded by severity –

- Grade 1: Mild strain – minimal tissue disruption, with minor loss of strength.

- Grade 2: Moderate strain – with partial disruption / “tearing” of the musculotendinous unit, with loss of strength and functional limitations.

- Grade 3: Complete disruption of the musculotendinous unit, with severe loss of muscle strength and functional disability.

Grade 3 injuries can occasionally result in an avulsion fracture of the ischium bone, or a pure avulsion of the hamstring tendons, which can occasionally warrant surgery to repair the injury.

Risk Factors:

There are both modifiable and non-modifiable factors which contribute to hamstring injury.

Modifiable factors include

- Strength imbalance

- Lack of flexibility

- Fatigue

- Poor lumbar posture

- Lower back injury

- Increased muscle neural tension

- Insufficient warm up

Non-modifiable factors include

- Age

- Previous Injury


With hamstring rehabilitation, it is important to focus not only on the hamstrings, but also the entire kinetic chain, addressing any biomechanical and movement pattern dysfunctions which may arise from muscular imbalances.

The rehabilitation programme should focus on criteria based progression of Key Performance Indicators, with consistent sequential progressions through

- Acute injury management

- Neuromuscular control

- Muscular strengthening

- Power & endurance

- Running mechanics

- Sport specific drills prior to return to chosen sport.


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