Hamstring Injury Guide: Hamstring Tear Types, Symptoms and Treatment

Hamstring injuries are one of the most common reasons people visit Synergy Physio, especially athletes, runners, or those involved in sports with sudden starts and stops. However, they can also happen during day-to-day activities, even something as simple as slipping on a wet floor.

In this blog, we’ll explain the three different grades of hamstring tears, their symptoms, how we treat them and the exercises we use to support your recovery, including what physiotherapy and sports massage might be needed at each stage.

What are the Hamstrings?

The hamstrings are made up of three muscles: biceps femoris, semitendinosus, and semimembranosus, running down the back of your thigh. They help bend the knee and extend the hip — essential for walking, running, jumping, and climbing.

Types of Hamstring Tears

Hamstring injuries are graded based on severity:

• Grade 1: Mild strain or overstretch (micro-tears)
• Grade 2: Partial muscle tear
• Grade 3: Complete muscle or tendon rupture

Grade 1: Mild Hamstring Strain

Symptoms

• Mild tightness or discomfort during activity
• Minimal or no bruising or swelling
• Soreness when stretching or contracting the muscle
• Able to walk, though sprinting or running causes pain
• Tender to touch over the back of the thigh

Treatment Plan

In-clinic physiotherapy:

• Soft tissue therapy (massage and myofascial release) to reduce muscle tone
• Dry needling or acupuncture to manage pain and tightness
• Education on load management and return to activity
• Progressive strengthening and neuromuscular control work

Example Exercise Program:

• Week 1–2:
  • Isometric hamstring contraction (lying face down, press heel into surface):
    3 sets of 10 reps, 5-second holds, 1–2x daily
  • Heel slides on the floor or bed (if tolerated):
    3 sets of 10 reps
• Week 2–3:
  • Glute bridge (double-leg):
    3 sets of 12 reps
  • Wall sits with hamstring activation (pressing heels into the floor):
    3 sets of 30 seconds

Progression Criteria:

• Pain-free walking and daily activities
• Full range of motion without discomfort
• Able to perform exercises above without symptoms

Expected return to sport: 2–3 weeks

Grade 2: Partial Hamstring Tear

Symptoms

• Sudden sharp pain during activity
• Pain when walking, especially upstairs
• Bruising and swelling within 24–48 hours
• Difficulty bending the knee against resistance
• Palpable tenderness along the muscle belly
• Limping or altered gait

Treatment Plan

In-clinic physiotherapy:

• Soft tissue mobilisation and massage to reduce swelling and improve healing
• Progressive isometric to eccentric loading to remodel muscle fibres
• Gait retraining
• Taping or neuromuscular electrical stimulation (NMES) if indicated

Example Exercise Program:

• Week 1–2:
  • Isometric single-leg bridge hold (pain-free range):
    3 sets of 10 reps, 10-sec holds
  • Seated hamstring curls with resistance band (gentle range):
    3 sets of 12 reps
• Week 3–5:
  • Romanian Deadlifts (RDLs) with no weight:
    3 sets of 8–10 reps
  • Bridge walkouts (on mat or ball):
    3 sets of 6 reps
• Week 6+:
  • Nordic hamstring curls (eccentric focus): 3 sets of 5 reps
  • Agility drills (ladder, cone drills, light sprint mechanics)

Progression Criteria:

• Equal strength (within 90%) compared to the uninjured leg
• Pain-free high-speed running drills
• Good hamstring control with dynamic exercises

Expected return to sport: 4–8 weeks

Grade 3: Complete Tear or Rupture

Symptoms

• Sudden, severe pain — often described as a “pop”
• Inability to continue the activity at the time of injury
• Rapid bruising and significant swelling. Black and blue bruising.
• Noticeable muscle deformity or dent in the back of the thigh
• Unable to walk or bear weight properly
• Tenderness extending up to the buttock if tendon is involved
• Sometimes no pain when trying to perform hamstring curls

Treatment Plan

Grade 3 tears may require a referral for imaging (MRI) and in some cases surgical repair, especially if the hamstring tendon has retracted from the bone.

In-clinic physiotherapy (non-surgical or post-op):

• Early rehab includes gentle range of motion exercises and isometric contractions
• Later stages focus on progressive strength, neuromuscular control, balance, and return-to-sport training
• Scar tissue management and soft tissue therapy
• Biomechanical assessments to prevent future injury

Example Exercise Program:

• Week 1–3 (non-weight bearing or partial weight-bearing):
  • Passive range of motion (e.g., assisted knee bends):
    3–4 sets of 10 gentle reps
  • Isometric quads and glute squeezes:
    3 sets of 10 reps, 5-sec holds
• Week 4–8:
  • Isometric hamstring curls (light band):
    3 sets of 12 reps
  • Double-leg bridge with slow lowering:
    3 sets of 10 reps
• Week 8–12+:
  • Weighted RDLs or deadlifts (as tolerated): 3 sets of 6–8 reps
  • Functional drills (e.g. single-leg hopping, skipping, change of direction)

Progression Criteria:

• Restored muscle length and strength
• Good trunk and pelvic control
• Clearance from surgeon or consultant (if post-op)

Expected return to sport: 3–6+ months

Why Does Rehab Matter So Much?

A proper rehab program significantly reduces the risk of re-injury, which is unfortunately common with hamstring tears. Studies have shown that eccentric strengthening exercises, such as the Nordic hamstring curl, can cut recurrence rates dramatically.

Our goal as physiotherapists is to:

• Help you recover safely and fully
• Build strength, flexibility, and control
• Restore confidence and performance
• Prevent future injuries

Get physio for a hamstring injury in Egham (servicing the Staines and Virginia Water areas) and Woking

If you’ve pulled your hamstring, whether mildly or severely, getting it assessed early can make a big difference. At our clinics, we provide evidence-based, hands-on care with structured rehab tailored to your specific tear. Book in Egham or Book in Woking.