Hamstring Strain: First Steps to Treatment

Physical Therapy First for a Hamstring Strain

Woman stretching hamstrings
Gabrielle Lutze/Stocksy United

If you have a hamstring tear or strain, what should you do first to get started on the right treatment?

A hamstring strain can be a painful injury that limits your ability to walk or run normally. The pain from a hamstring strain can prevent you from walking up and downstairs normally, and it may hurt while you are sitting or trying to sleep.

Symptoms of a Hamstring Strain

What are the signs and symptoms of a hamstring strain?

Typically, a hamstring injury or tear occurs after a high-velocity movement that occurs with running or jumping. Signs and symptoms of a hamstring strain include:

  • pain in the back of your thigh, usually in the middle of the muscle bulk or near that hamstring attachment point near your buttocks.
  • pain while actively bending your knee.
  • Tenderness to palpation over your hamstrings
  • bruising and discoloration over the back of your thigh or behind your knee.
  • difficulty walking and running or climbing stairs.

If you have any of these symptoms, check in with your doctor right away to confirm your diagnosis and to get started on the best treatment for you.

Hamstring Strain: First Steps to Treatment

If you suspect you have a hamstring strain, there are some things you should do to get started on the right path to healing. Remember, everyone is different, and every hamstring strain should be treated with specialized care.

Your specific injury may require more or less care depending on several factors including the severity of the strain, the acuity of the injury, and your personal functional limitations that occur from the injury.

Here is a list of things you should do right away if you suspect you have a hamstring strain.

  1. See your doctor. If you suspect you have a hamstring strain or tear, you should make an appointment with your doctor to have it checked out. Your doctor may order special tests, like an MRI, to assess the severity of the injury and to make recommendations about treatment.
  2. Check in with your physical therapist. Did you know you can visit your physical therapist under direct access without seeing a doctor first? You can, and you should. Your physical therapist can assess your injury and get you started on the right treatment and exercise program to help guide you through the healing process.
  3. Use ice initially. When a hamstring strain first occurs, you may notice pain, swelling, and bruising in the back of your thigh where you hamstrings are. Using ice initially is recommended to help control your pain and limit the swelling around the injury. Apply ice for 15 to 20 minutes, several times each day. Use the CBAN method to ensure you are applying ice correctly. Ice should be applied daily for the first 24 to 48 hours after the injury.
  1. Use heat to improve muscular mobility. After a few days of rest and using ice, it may be time to apply heat to your hamstring injury. The heat helps to promote blood flow and can improve the overall extensibility of your hamstring. Apply heat for 10 to 20 minutes, taking care not to burn your skin. Heat can be used several times a day, and may be used just prior to performing gentle hamstring stretching exercises.
  2. Gently stretch your hamstrings. When a hamstring tear occurs, scar tissue will develop over the injury site. This tissue will one day become the healthy tissue of your hamstring muscle. While it is healing, it is a good idea to gently start to stretch it. Your physical therapist can show you the best hamstring stretches to perform for your particular injury. Take care not to stretch too vigorously or to perform high velocity, bouncing motions while stretching. This can disrupt the healing scar tissue and re-injure your hamstring.
  3. Start on gentle strengthening for your hamstrings. As your hamstrings are healing, you can begin gentle strengthening exercises for your hamstrings. You should start light, taking care not to disrupt the healing tissue in your hammies. Prone knee curls with no weight is a good place to start, and resistance can be added with resistance bands or cuff weights as your healing progresses. Your physical therapist can show you the best hamstring strengthening exercises for your particular injury.
  4. Focus on hip and core strength. Your hamstrings attach to the bottom of your pelvis on your SITS bones. Your hips and abdominal muscles also attach to various areas of your pelvis. Your core and hip muscles work in conjunction with your hammies to make sure that your pelvis is in the correct position while walking and running. Research shows that adding abdominal strengthening, like bridges and pelvic tilts, to your PT program, can help improve your hamstring rehab. Keeping your hips strong can also help stabilize your pelvic area and lessen stress upon your hamstrings. Your physical therapist can show you which exercises are best for you. 
  5. Learn how to prevent future hamstring problems. One of the most important components of any rehab program is to learn to prevent future problems. Even when you first start out on your hamstring rehab, you should be thinking about how to prevent future occurrences of the injury. You can do this by maintaining hamstring flexibility and mobility and by keeping your hamstrings strong. The Nordic Eccentric Hamstring Curl is proven to help elite athletes avoid hamstring strain injuries. Your physical therapist can help you determine the best exercise program to help you minimize the risk of future hamstring strains once your current injury has healed.

A hamstring strain can be a difficult injury to manage, and it can become a nagging problem that limits your ability to walk, run, or participate in sports. By doing the right things at the right time after your injury, you can be sure to rehab your injury properly, so you can quickly and safely get back to your normal activity level.


Sherry MA and Best TM. A Comparison of 2 rehabilitation programs for treating acute hamstring strains. JOSPT. 2004; 34(3):116-125

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