Hamstring Injury: Physiotherapy Treatment and Return-to-Sport Guide

How it happens

Most hamstring strains occur during high-speed running, when the muscle is lengthening under heavy load just before the foot strikes the ground. Some happen in kicking or stretching movements, like an overreaching lunge in badminton.

You typically feel a sudden sharp pain in the back of the thigh and have to stop. Bruising may appear a day or two later.

Severity varies a lot

Mild strains may let you walk normally within days. More severe tears involve larger areas of the muscle or the tendon and need longer recovery. Injuries near the top of the hamstring, close to the sitting bone, sometimes need imaging and a specialist opinion.

Early treatment

The first days focus on protecting the muscle while keeping it moving. Walking within comfort, gentle range of motion and early pain-free contractions all help. Complete rest slows recovery.

Rebuilding strength

The key to hamstring rehab is progressive strengthening, particularly strength in lengthened positions. Typical progressions move from bridges and gentle holds to hamstring curls, single-leg bridges, Romanian deadlifts and eventually eccentric exercises like Nordic curls.

Running is reintroduced gradually, starting slow and building towards sprinting over weeks.

Why re-injury is common

People return when it stops hurting. But pain often settles before full strength and sprint readiness have returned. The muscle then meets high-speed load it can't yet handle.

Return-to-sport criteria

Before full return, a physiotherapist will usually check:

• full, pain-free range of motion
• strength close to the other leg
• pain-free sprinting at near-maximum speed
• completion of sport-specific drills, such as changing direction and kicking

Our guide to return-to-sport rehabilitation explains how those tests fit together.

Why sprinting is part of rehab

It might seem logical to avoid sprinting until the hamstring is fully healed. But sprinting is exactly what the hamstring needs to be prepared for. Gradual exposure to faster running, as part of rehab, helps the muscle adapt to the loads it will face in sport.

Running progressions usually start with easy jogging, then build to faster strides, then near-maximum sprints, over several weeks. Each stage should be pain-free before moving on.

Athletes who return without being exposed to high-speed running in rehab are more likely to re-injure the hamstring the first time they sprint in a match.

Prevention

Regular eccentric hamstring strengthening, sensible sprint exposure and gradual increases in training load reduce the risk of hamstring injury. Many teams build Nordic curls into their weekly routine for exactly this reason.

If you've strained a hamstring, early physiotherapy shortens recovery and reduces the chance of doing it again. Our hamstring strain page covers the injury in more detail.