Runners, Here’s How to Manage a Pesky Hamstring Injury

Hamstring injuries are all too familiar to runners, especially those who train for long-distance races. These injuries not only keep you from racing, but they can also be serious. Learning about hamstring injuries — both how to treat them, and, most importantly, how to prevent them — will help you in the long run … pun intended. 

The function of the hamstrings 

The hamstrings are a group of three muscles on the back of the thigh that act to bend the knee and extend the hip. They play a key role in slowing the leg as it swings forward during running, a type of muscle contraction called an eccentric contraction. This means that your hamstrings are most at risk of injury during sudden stopping or starting.

Understanding hamstring injuries

There are a few different types of hamstring injuries:

A posterior thigh injury is a general term that indicates that the injury is on the back of the thigh but isn’t always hamstring-specific.

A hamstring strain consists of tiny tears of the muscle that you need a microscope to see. They’re commonly caused by over-stretching. 

Hamstring tendinopathy is an injury to the hamstring tendon, which attaches the muscle to the bone.  

A hamstring tear is a macroscopic — or visible — tear of the muscle or tendon. The tears can be partial or complete. 

Risk factors of hamstring injuries

A variety of risk factors could contribute to hamstring injuries. Ones that you can manage include: 

• The quality of your warm-up 
• The quality and frequency of your training 
• Your hamstrings’ flexibility 
• Your hamstrings’ overall strength and relative strength compared to your quadriceps muscles 

Risk factors for a hamstring injury that you can’t manage include: 

• A previous injury (especially if you didn’t get proper rest and rehabilitation afterwards) 
• Being older in age 

What hamstring injuries look, feel and sound like  

Hamstring injuries generally present as sudden back thigh pain that’s felt during activity or exercise. Some people report hearing a pop (especially in partial or complete tears) or a feeling of warmth in the area. As a runner, your risk of a hamstring injury is higher when you’re moving at a high speed. Hamstring injuries can also happen while stretching when the muscle is lengthened beyond its elastic capability.  

After a hamstring injury, you may notice swelling or bruising within the following hours or days. Additionally, those muscles may be tender to the touch and painful to stretch. Significant bruising, a large bulge at the back of the thigh, or an inability to bend the knee against gravity may indicate a hamstring tear. 

How to manage a hamstring injury  

There’s no running from it: Hamstring injuries are painful. The good news? Most hamstring injuries can be managed without seeing a doctor.  

You can typically treat mild hamstring injuries with rest, ice, compression and elevation (RICE). This helps to minimize any bleeding, swelling and pain that may be associated with a strain. For compression, you can use elastic wrap or taping. Ice should be applied to the area of pain for 20 minutes at a time. You can also alternate ice with heat for acute sprains.  

Over-the-counter medications, like acetaminophen or ibuprofen, can help with pain, but remember not to exceed the dosage recommended on the bottle unless directed by a doctor to avoid injury to the liver, kidneys and stomach. 

You should go to a doctor if you have any of these symptoms:  

• Severe pain 
• Pain that persists for a week, even with rest from usual activities 
• Significant swelling or bruising 
• Inability to bend or straighten the knee 
• Inability to bear weight

For severe hamstring injuries (for example, you heard the “pop”), seek medical attention. Your doctor may want to order an x-ray, ultrasound imaging or an MRI to further evaluate your injury and decide if surgical care is needed. 

Recovering from a hamstring injury is a walk, not a sprint 

For hamstring injuries that aren’t severe, it's recommended you wait two to six days after your injury to restart normal activities to reduce the possibility of reinjury — but only start moving on it if you are pain-free.  

Generally, a hamstring injury rehabilitation program starts with light stretching and progresses to strength training and sport-specific training. Getting back to full participation in your running program can safely be done when you’re at full strength, have full range of motion and can replicate sport-specific movements without pain. 

For some chronic hamstring tendon injuries (tendinopathy), certain types of injections may be helpful to manage pain and even improve the tendon structure. 

How to prevent a hamstring injury 

To avoid injury and keep you in the race, make sure you complete a sufficient warm-up, especially before sprints. In addition, strength training; progressive increase in your running frequency and distance during race training; and avoiding sudden stops, starts or sharp changes in direction will help keep your hamstrings feeling good. 

Mark Harrast, MD, is a sports medicine physician and medical director of the Sports Medicine Center at Husky Stadium and the UW Medicine Seattle Marathon. He specializes in diagnosing and treating sports-related injuries and illnesses in endurance athletes, runners and triathletes. He is also an accomplished competitive endurance athlete himself.