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Running Injuries Series: Hamstring pain

Hamstring strains are one of the most common injuries in sports which demand repetitive sprint efforts such as football and rugby. If not well managed, they can cause long term issues with a high rate of recurrence. We are also exploring other causes of pain in the back of thigh which can be mistaken for a muscle injury and require a different approach to treatment.

Pain in the back of thigh can be caused by an injury to the hamstring muscle.


The hamstrings are a group of three muscles which run from their origin at the back of the pelvis to cross down the back of the thigh and attach to the back of the knee in several locations. It is the key muscle group in both force production when sprinting, but also in decelerating the leg during high-speed running. In the deceleration phase the hamstring is working maximally in an eccentric contraction and this is the time at which they tend to be injured, as the muscle contracts in a more lengthened position. You can also injure your hamstring from a sudden overstretch movement, though this tends to be a less common mechanism of injury.


Hamstring muscle strains and tears injury usually cause a sharp pain in the back of thigh when sprinting, and you’re likely to have localised tenderness and sometimes bruising as well as pain when walking and stretching the muscle. The average return to play time in professional footballers is around three weeks, though in the general population it will often be longer depending on what part of the muscle and tendon unit is injured. The time it takes to return to sport will be affected by other factors such as age and fitness level. If you tear your hamstring it’s essential you complete a comprehensive rehabilitation programme with progressive strengthening exercise as well as high speed running programming to regain normal muscle function and get back to sport.


The hamstring muscles: Biceps Femoris, Semimembranosus and Semitendinosus

As hamstring injuries have a relatively high recurrence rate, the risk of injuring your hamstring increases significantly if you’d had the same problem in the past. Other factors which increase your risk of hamstring muscle injury include a lack of strength and your age. Age, of course we can’t do much about, but strength is a fundamental component to make a full recovery and reduce the risk of having hamstring problems in the future.


However, not all pain in the back of thigh is necessarily from an injury to the hamstring muscle itself. There are other causes of pain in the back of thigh which can masquerade as a hamstring muscle injury and it’s important to recognise these as the treatment and recovery for these problems is significantly different to the conventional management of a muscle injury.


The Nordic exercise is an key component of hamstring rehabilitation

Nerve tissue which runs from the lumbar spine down the back of the leg can become irritable and can often cause tightness in the back of the thigh; sometimes this can develop suddenly, but more often you will notice a tightness in the thigh that comes on more gradually. Although it may be aggravated by running, other activities may also be painful, such as driving or sitting for long periods. There are specific treatment and exercises to improve the mobility of the nerve which can resolve the issue. This neural component can sometimes be present in conjunction with a muscle injury and needs to be addressed as part of your treatment.


Tightness in the gluteal or buttock muscles can also cause pain to be referred to the back of the leg and this sort of pain is commonly mistaken for an injury to the hamstring muscle, often most noticeable during or after exercise and is painful with stretching the hamstring. These symptoms can be resolved by stretching and using techniques to free-up the gluteal muscles. Similarly, low back problems can cause referred pain into the back of the leg and respond well to treatment and exercise for the back rather than the hamstring.


If you’re struggling with thigh pain and want some clarity on your diagnosis and the right treatment and rehabilitation, it’s worth seeking professional advice to ensure you get back to sport and minimise the risk of having problems in the future. Get in touch here for more information.

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