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1 · SNAPSHOT

Hamstring Strain body chart — Illustrative, not diagnostic. Canva body chart for Hamstring Strain.

Who: Sprinting and kicking athletes. Recurrent in athletes with poor trunk or glute control.
What: Acute muscle strain, most often biceps femoris.
How it behaves: Sudden posterior thigh pain during sprinting or an overstretch. Sharp or grabbing, and it stops them. Eased by rest, compression, and gentle mobility.

The one thing to take from this page:

There is a real JOSPT clinical practice guideline for this, and a Journal of Physiotherapy appraisal of it. Read both. And know the uncomfortable headline: hamstring injury rates in professional football have been reported as rising across recent seasons, after a decade in which everyone did Nordics.

The honest headline

What we've been told	What the literature says
"Eccentric control is the gold standard"	The effects of eccentric training and the Nordic hamstring exercise are heterogeneous, and the prevention literature has been critically revisited
"Nordics prevent hamstring injuries"	Rates in professional football have been reported as having increased
"Test Nordic strength pre-season to find who's at risk"	That has been examined directly. Read the result before you build a screening programme around it

Eccentrics stay. The certainty goes.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages. Acute and traumatic reorders to main problem → body chart → history → behaviour.

MAIN PROBLEM

"I was at top speed and something grabbed."
"I went for the ball, over-reached, and felt it tear."
"I've done this before. Same leg."

BODY CHART

Posterior thigh. Get them to point. High and lateral, mid-belly, or right up at the ischium?
Mark how far up. Proximal and near the ischial tuberosity behaves differently and is a longer conversation.
Any pain below the knee, into the calf or foot? Any pins and needles? That's a lumbar and neural question, not a muscle one.

HISTORY — and this is the best pearl on the pattern

Ask what they were doing at the moment it went. Clinical pearl: sprint-type versus stretch-type differ in healing.

	Sprint-type	Stretch-type
Mechanism	Top-speed running, terminal swing	Over-lengthening — high kick, slide tackle, split
Usual muscle	Biceps femoris	Semimembranosus, often near the origin
Site	Higher and lateral	Higher and medial
Time loss	Often less	Often more. Say so early

Read further: mechanisms from video analysis in professional players [1].

Previous hamstring injury? Which leg, when, how long out, and did they finish the rehab?
Where in the season? Load, fixture congestion, recent return from another injury.
Sprint exposure. Have they been sprinting regularly, or only in matches?

BEHAVIOUR

Aggs: sprinting, accelerating, lengthening, hills, sitting on it, stretching it.
Eases: rest, compression, gentle mobility.
Severity: VAS 0–10 at best / at worst / right now.
Irritability: resting symptoms + vigour of the provoking activity + time to settle.
Walking, stairs, driving, sitting tolerance — the practical measures for the first fortnight.

SPECIAL / SCREENING QUESTIONS

Any back pain, or history of it?
Any calf pain, swelling, or warmth? DVT.
Night pain, rest pain, fever, weight loss?
A sudden pop with a big bruise high in the thigh and difficulty walking? Think proximal avulsion.

Assessing this region? Download the Knee assessment template →

3 · HYPOTHESIS RANKING

Competing pattern	The one discriminating feature
Proximal hamstring tendinopathy	Gradual onset, ache at the ischial tuberosity, worse with SITTING and uphill running. Not a sudden grab at speed.
Lumbar radicular / sciatic referral	Neural-type pain, positive SLR or slump, possible back history, and neuro findings. Clear this.
Deep gluteal syndrome	Deep buttock, worse sitting and in hip flexion/adduction/IR.
Adductor magnus strain	More medial, provoked by adduction as well as extension.
Ischial apophyseal avulsion	Adolescent, sudden, at the ischium. A different injury entirely.
Proximal hamstring avulsion	A pop, a large bruise, marked weakness, difficulty walking. Surgical conversation.
Referred from the SIJ or lumbar spine	Reproduced by spinal or pelvic provocation, not by resisted knee flexion.

The ones that outrank the table

DVT. Calf pain, swelling, warmth, immobility, recent travel or surgery.
Proximal avulsion. Refer.
Anything with night pain, systemic features, or no mechanism.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated.

Finding	What it suggests	What you do
Calf pain, swelling, warmth, or asymmetry	DVT	Urgent medical review. Do not massage the leg
Recent immobilisation, long travel, surgery, oral contraceptive, malignancy	DVT risk profile	Raise your threshold
A pop with a large proximal bruise, marked weakness, difficulty walking	Proximal hamstring avulsion	Urgent orthopaedic / sports medicine review
Adolescent with sudden ischial pain	Apophyseal avulsion	Imaging and medical review
Progressive neurological symptoms, foot drop	Lumbar	URGENT
Saddle change	Cauda equina syndrome	EMERGENCY
Night pain, rest pain, fever, weight loss	Infection, tumour	Urgent medical review
Massive swelling, tense compartment, disproportionate pain	Compartment syndrome, large haematoma	EMERGENCY
No mechanism at all	Not a strain	Reassess

The rule: a hamstring strain has a moment. If there is no moment, or the leg is swollen, warm and tender in the calf, you are not looking at a muscle.

Cross-links: Proximal hamstring tendinopathy · Lumbar radicular pain · Quadriceps strain · Septic arthritis / DVT / tumour

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Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.

Guideline anchor

No Australian guideline. But there is a real physiotherapy clinical practice guideline — Hamstring Strain Injury in Athletes, JOSPT (Martin et al. 2022, PMID 35164536) — and it has been appraised in Journal of Physiotherapy (Zadro et al. 2023, PMID 36914523).

Read them together. Treatment and management have also been systematically reviewed (Poursalehian et al. 2023, PMID 37983561) and the prevention and rehabilitation literature critically revisited (Afonso et al. 2024, PMID 38071509).

PubMed Source

The guideline is American and physiotherapy-specific. Read the Journal of Physiotherapy appraisal alongside it — that is exactly what the appraisal exists for. And note that the underlying literature is overwhelmingly male professional football; the female athlete has had to be written about separately.

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The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 20

Show

Every source on this page resolves and title-verifies against PubMed. Newest first.

2023Jokela et al. (2023). Mechanisms of Hamstring Injury in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 33(3), 217-224. https://doi.org/10.1097/JSM.0000000000001109
2024Mendiguchia et al. (2024). Anterior pelvic tilt increases hamstring strain and is a key factor to target for injury prevention and rehabilitation. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 32(3), 573-582. https://doi.org/10.1002/ksa.12045
2024Bramah et al. (2024). Exploring the Role of Sprint Biomechanics in Hamstring Strain Injuries: A Current Opinion on Existing Concepts and Evidence. Sports medicine (Auckland, N.Z.), 54(4), 783-793. https://doi.org/10.1007/s40279-023-01925-x
2024Day et al. (2024). Correlation of Player and Imaging Characteristics With Severity and Missed Time in National Football League Professional Athletes With Hamstring Strain Injury: A Retrospective Review. The American journal of sports medicine, 52(11), 2709-2717. https://doi.org/10.1177/03635465241270281
2022Martin et al. (2022). Hamstring Strain Injury in Athletes. The Journal of orthopaedic and sports physical therapy, 52(3), CPG1-CPG44. https://doi.org/10.2519/jospt.2022.0301
2023Zadro (2023). Appraisal of Clinical Practice Guideline: Clinical Practice Guideline for hamstring strain injury in athletes. Journal of physiotherapy, 69(2), 128. https://doi.org/10.1016/j.jphys.2023.02.010
2023Poursalehian et al. (2023). Hamstring Injury Treatments and Management in Athletes: A Systematic Review of the Current Literature. JBJS reviews, 11(11), e23.00161. https://doi.org/10.2106/JBJS.RVW.23.00161
2025Giakoumis et al. (2025). Clinical Presentation and Rehabilitation Progression Following Hamstring Injury Assessed by BAMIC in Elite Track and Field. Scandinavian journal of medicine & science in sports, 35(10), e70136. https://doi.org/10.1111/sms.70136
2021Yagiz et al. (2021). Heterogeneous effects of eccentric training and nordic hamstring exercise on the biceps femoris fascicle length based on ultrasound assessment and extrapolation methods: A systematic review of randomised controlled trials with meta-analyses. PloS one, 16(11), e0259821. https://doi.org/10.1371/journal.pone.0259821
2021Opar et al. (2021). Is Pre-season Eccentric Strength Testing During the Nordic Hamstring Exercise Associated with Future Hamstring Strain Injury? A Systematic Review and Meta-analysis. Sports medicine (Auckland, N.Z.), 51(9), 1935-1945. https://doi.org/10.1007/s40279-021-01474-1
2024Afonso et al. (2024). Revisiting the hamstring injury prevention and rehabilitation literature: filling the gaps!. British journal of sports medicine, 58(5), 243-244. https://doi.org/10.1136/bjsports-2023-106878
2023Ekstrand et al. (2023). Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men's professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22. British journal of sports medicine, 57(5), 292-298. https://doi.org/10.1136/bjsports-2021-105407
2022Gronwald et al. (2022). Hamstring injury patterns in professional male football (soccer): a systematic video analysis of 52 cases. British journal of sports medicine, 56(3), 165-171. https://doi.org/10.1136/bjsports-2021-104769
2022Vermeulen et al. (2022). Early versus delayed lengthening exercises for acute hamstring injury in male athletes: a randomised controlled clinical trial. British journal of sports medicine, 56(14), 792-800. https://doi.org/10.1136/bjsports-2020-103405
2022Hickey et al. (2022). Early introduction of high-intensity eccentric loading into hamstring strain injury rehabilitation. Journal of science and medicine in sport, 25(9), 732-736. https://doi.org/10.1016/j.jsams.2022.06.002
2022Hickey et al. (2022). Hamstring Strain Injury Rehabilitation. Journal of athletic training, 57(2), 125-135. https://doi.org/10.4085/1062-6050-0707.20
2022O'Sullivan et al. (2022). Hamstring Injury Rehabilitation and Prevention in the Female Athlete. International journal of sports physical therapy, 17(6), 1184-1193. https://doi.org/10.26603/001c.38254
2021Pieters et al. (2021). Return to Play After a Hamstring Strain Injury: It is Time to Consider Natural Healing. Sports medicine (Auckland, N.Z.), 51(10), 2067-2077. https://doi.org/10.1007/s40279-021-01494-x
2024Gendron et al. (2024). Prognosticating Return-To-Play Time Following a Hamstring Strain Injury Using Early Flexibility Asymmetry and Musculoskeletal Ultrasound Imaging Outcomes: An Exploratory Study Among Canadian University Football Players. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 34(5), 436-443. https://doi.org/10.1097/JSM.0000000000001230
2026Bru-Ruiz et al. (2026). Establishing weighted criteria for return to play after hamstring injury: a systematic review and methodological quality analysis. BMC musculoskeletal disorders. https://doi.org/10.1186/s12891-026-10072-z

Mapped to this pattern

LEFS
Lower Extremity Functional Scale
lower limb function · 20 items · 5 min

Generic measures that also apply

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