You hear the sound followed by intense pain shooting along the back of your thigh that stops you dead in your tracks. You may have pulled or “strained” a hamstring muscle (there are 3). This injury occurs when the muscle fibers overstretch so quickly that they cannot contract to protect themselves in time.
Hamstring strains often happen during a quick sprint effort, such as picking up the pace during a running workout or stopping short to avoid crashing into a slow pedestrian. Even a quick burst effort to chase after your dog on a breakaway from the leash can land you in some severe hamstring hurt.
While most hamstring strains will heal without the need for major treatment, how you take care of the injury in the early days can greatly impact how fast you recover.
In this article we’ll go over three topics:
- First aid for a pulled hamstring caused by sprinting or running (PACE program)
- Key signs to help you judge the urgency of seeking professional care
- Lessons we’ve learned over the years about running-related hamstring injuries
Remember: good judgment is your responsibility. No article can replace the advice of a healthcare professional who has examined you and knows your situation. While some injuries will heal on their own, many others will require additional attention. Consider this info as a starting point, not a treatment plan.
Part 1: First aid for a pulled hamstring: PACE yourself
PACE is a self-care first aid method to mitigate further damage and prepare for rapid recovery following an injury:
- Protection – prevent further injury so healing can begin.
- Activity Modification – encourage the repair process while staying active.
- Comfort – manage pain and circulation to promote normal healing.
- Exercise – maintain nutrition and circulation while preventing a loss of motion.
Protection: Compression Wrap
The fastest way to protect a pulled hamstring is to wrap it with a compression bandage. The bandage works to assist the injured muscle and provide a mild protective limit to how far you can swing your leg in either direction as you walk.
A 6-inch wide by 6-foot long compression wrap (aka ACE bandage) is ideal for most hamstring strains. This video shows two ways to apply a compression bandage to support a pulled hamstring:
Activity Modification: “stand tall, short steps”
A pulled hamstring does not like to be stretched and will reflexively spasm and cramp to protect itself from over-stretching. It also doesn’t want to be working too long, as the more effort it exerts, the less energy is available for healing, creating a limp. Both overstretch and overload can delay your ability to walk normally again, which is the very first milestone back to running.
Two simple cues, “stand tall” and “short steps,” are easy ways to accelerate your ability to walk with a regular pattern. Before you start walking (or immediately upon getting up from a chair or out of the car), pause momentarily before taking a step and “stand tall.” Place your weight evenly across both feet and from the heel to the ball of each foot.
Only when you have equalized the load across all four footpoints should you take a step. When you do, think “short steps” – take half the distance you usually would extend your legs so that you are not limping. By standing tall and taking short steps to avoid limping, you’ll retrain your walking pattern (“gait”) much faster and with less pain.
The RICE protocol of Rest-Ice-Compression-Elevation is old-school first aid for a fresh muscle injury. It’s not considered treatment, as it can’t reverse the harm already done. However, RICE can be quite helpful for many athletes in the first few days after an injury, reducing pain and cramping, and speeding recovery.
For hamstring strains, RICE involves a 15-20 minute rest break with your leg elevated higher than your body, and a bag of ice wrapped to your thigh with a compression bandage. This article provides more details of the protocol.
Exercise: Heel Slides
During your recovery periods, perform a set of 25 assisted heel slides. Loop a rope or jacket around the middle of your foot with leg outstretched. Sit up or lie down, to avoid pressure on the painful area. Keeping your toes pointed upward, slowly bend your knee by pulling the rope and sliding your heel along the floor towards your buttocks.
Use your arms and rope to supply most of the pulling effort in the early days, but gradually increase the pulling force from your hamstring muscles until you can perform full repetitions without any arm assistance or muscle cramping. Be sure to reach the limits of your motion in each direction – pulling the heel back as far as you can, and also straightening out your leg as much as you can – on every repetition.
Part 2: When should you get help?
While most hamstring strains involve only a small portion of the muscle’s fibers, a severe injury can affect a large amount of tissue and damage nearby blood vessels and nerves. To avoid long-term problems, seek guidance from a physical therapist, physician, medic, or athletic trainer:
Urgently (today) if you notice:
- Visible muscle deformity
- Inability to bear any weight on the injured side
- The muscle doesn’t work correctly after injury, such as you can’t bend your knee to pull your foot close to your butt. It may actually be a pain-free weakness.
- Numbness, tingling or loss of feeling along the back of the thigh or anywhere in the foot
Promptly (within a few days) if you notice:
- Deep bruises develop along the back of the thigh (some bruising may travel down below the knee)
- Inability to walk, even at a slow pace
- Low back pain in addition to hamstring pain
- Persistent difficulty with fully straightening your leg
Schedule an appointment soon if you notice:
- Persistent thigh muscle or back pain when bending forward (like reaching down to put on your shoes) after 2 weeks
- Difficulty or pain with single-leg activities such as going up and downstairs after 3 weeks
- Inability to tolerate impact such as hiking an incline or running after 4 weeks
- Repeated hamstring pain or injuries in both legs
Part 3: Lessons we’ve learned about hamstring injuries
Hamstring strains that don’t heal properly can lead to a loss of flexibility and strength, limiting squats, deadlifts, and running performance. Most serious, though, is the loss of explosive power that is typical of athletes with chronic hamstring issues.
Sometimes a loss of hamstring power is due to poor tissue quality. Scar tissue naturally forms after a strain injury, but sometimes the new fibers don’t organize themselves well without rehabilitation and soft tissue treatments. Other times, the loss of power is caused by a nerve injury that wasn’t apparent during the early stages of the injury.
The largest nerve in your body, the sciatic nerve, sits underneath the hamstring muscles, traveling from your hip down the back of your leg. When the sciatic nerve is injured, communication to other leg muscles is compromised, resulting in a loss of strength and power, and causing overuse pain in the opposite leg as it tries to compensate.
If you have a history of hamstring injuries and struggle to regain speed and power, you might need an assessment to test the function of the hamstrings and the nerves.
A quick transition often causes pulled hamstrings from running, speeding up to a sprint, or putting on the brakes to stop. While most strains affect only a small portion of the muscle and recover quickly, others are more serious and can lead to long-term muscle weakness and repeated injuries.
To manage a pulled hamstring, PACE yourself. If you have signs of a severe injury or lingering pain, look for an athletic trainer or physical therapist who can help you get back to 100%.
Questions about hamstring pain or repeated injuries? Send us your question at email@example.com. We answer every question.
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- Erickson LN, Sherry MA. Rehabilitation and return to sport after hamstring strain injury. J Sport Health Sci. 2017; 6(3): 262-270.
- Kouzaki K, Nakazato K, Mizuno M, et al. Sciatic nerve conductivity is impaired by hamstring strain injuries. Int J Sports Med. 2017; 38(11): 803-808.
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