How long does a pulled hamstring take to heal?

What is a hamstring strain?

The hamstrings are three muscles at the back of the thigh that bend the knee and extend the hip. A strain, or pulled hamstring, happens when muscle fibres are overstretched or torn, most often during sprinting, when the muscle is working hard while lengthening, or during movements such as high kicking or splits.

A sudden sharp pain at the back of the thigh during activity is typical, sometimes with a popping sensation, followed by tenderness, swelling and bruising. Walking may be painful, and bending the knee against resistance usually hurts.

How long does recovery take?

Recovery time varies with the size and location of the injury. In a randomised trial of 56 Swedish elite sprinters and jumpers with MRI-confirmed acute hamstring injuries, the mean time to return to full training was 49 days with a lengthening-exercise protocol and 86 days with a conventional protocol 1.

In the same trial, injuries involving the free tendon near the buttock took longer. With the lengthening protocol, the mean return time was 73 days for tendon-involved injuries and 31 days for injuries not involving the tendon 1. Recreational athletes with mild strains often return sooner.

What happens in the first days?

In the first few days, protecting the leg from painful stretching and sprinting, while walking within comfort, helps limit further damage. Ice and compression may ease pain and swelling. Gentle, pain-free movement usually begins within days.

Complete rest for long periods is not needed and may slow recovery by allowing the muscle to weaken and stiffen.

What does hamstring rehabilitation involve?

Rehabilitation progresses through stages: restoring pain-free walking and range of motion, strengthening the hamstrings and surrounding muscles, then running progression and sport-specific drills such as acceleration, sprinting and change of direction.

Lengthening-type exercises, in which the hamstring works while it lengthens under control, such as the extender and diver exercises used in the trial, form a key part of modern programmes 1. Strengthening of the buttock and trunk muscles supports the hamstrings during sprinting.

How can hamstring injuries be prevented?

Hamstring injuries often recur, particularly in the first weeks after returning to sport. In a randomised trial in 579 male amateur football players from 40 teams, a programme of 25 Nordic hamstring exercise sessions over 13 weeks reduced hamstring injury incidence from 0.8 to 0.25 injuries per 1,000 player hours 2.

The Nordic hamstring exercise involves kneeling with the ankles held and slowly lowering the body forwards under hamstring control. Continuing prevention exercises during the season, gradual increases in sprinting load and adequate warm-ups all help.

How are hamstring injuries graded?

Hamstring strains are often described by severity. Mild strains involve overstretching with minimal fibre damage and little loss of strength. Moderate strains involve partial tearing with more pain and weakness. Severe injuries involve extensive tearing or tendon involvement, sometimes with bruising and a palpable gap.

Clinicians may use MRI to assess the size and location of the injury, especially in athletes or when a tendon injury is suspected. Location matters, as injuries involving the tendon usually take longer to return from.

When should a hamstring injury be scanned or seen by a specialist?

Seek assessment for a large area of bruising, a gap felt in the muscle, significant weakness when bending the knee, pain high up near the buttock bone after a forceful stretch, or inability to walk normally. These may suggest a severe injury or a tendon avulsion, which sometimes needs surgical repair.

Numbness or tingling down the leg, or pain that does not improve over a couple of weeks, should also be reviewed.

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