Hamstring Injuries. An Osteopathic Guide From Injury to Recovery


An Osteopathic Guide From Injury to Recovery!

Hamstring injuries are very common in high power and agility sports, such as AFL, tennis, or dancing.  The Hamstring is a group of 3 large muscles (Semitendinosus, Semimembranosus, Biceps Femoris)  that sit at the back of the thigh. The main action of the hamstring is to extend the leg and bend the knee – so very important in running, jumping or walking. hamstring strains

How Do Hamstring Injuries Occur?

Most hamstring injuries occur in the thick, central part of the muscle (the muscle belly), Often referred to as a Hamstring strain, they are caused by a rapid contraction or extensive stretch of the hamstring leading to microtears within the muscle belly in one or more of the hamstring muscles. Most commonly, this occurs in the biceps femoris portion of the hamstring. In severe cases, the muscle will partially or completely tear, known as a partial or full rupture, or the tendon may separate from the bone, known as an avulsion injury.

What Can I Do To Help My Hamstring Injury?

Advice surrounding the management of a hamstring strain, or any soft tissue injury for that matter, has changed in recent years from the traditionally known format of ‘RICER’ (Rest, Ice, Compression, Elevation and Referral). In 2019, the British Journal of Sports Medicine coined 2 new acronyms for the immediate and ongoing management of soft tissue injuries – PEACE (immediate management) & LOVE (subsequent management), see image below.

hamstring Injury

But, what does a typical hamstring strain assessment, treatment and rehabilitation protocol look like in conjunction with or after this immediate soft tissue management? More specifically, what does it look like with an osteopath?

Hamstring Injuries. Osteopathic Assessment and Diagnosis:

Osteopathic assessment is primarily used to determine the structure causing pain (in this case the hamstring), rule in or out other possible sources of pain differential diagnoses, such as an adductor/groin strain, referred pain from the low back lumbar spine, hamstring tendinopathy or hip bursitis. We also can help to , and to determine the severity (grade) of the injury. In severe cases (complete rupture), surgery may be required. So depending on the grade of injury, healing may take anywhere between 21 days to several months.

Typical Osteopathic Assessment of a Hamstring Injury Will Include:

  • Walking / Running gait assessment
  • Observation – of any bruising, swelling or deformity on the involved leg
  • Case history questionnaire – understanding the mechanism of injury, previous injury history and possible history of hamstring injuries, current functional capacity issues, general medical history and possible risk factors
  • Functional assessment – such as a sit-to-stand, squat, jump or hop
  • Range of motion testing – for the hip and knee, both actively and passively
  • Strength testing – of the hip and knee
  • Orthopedic testing – special tests to help rule in or out other possible causes of the pain differential diagnosis)
  • Palpation – of the posterior thigh to determine the specific portion of the muscle affected

If the hamstring injury is deemed severe and the practitioner requires further investigation, referral for medical imaging may be necessary


Early osteopathic treatment aims to reduce swelling, bleeding (bruising) and pain levels, improve hip and knee range of motion and increase muscular strength, in order to restore the patient’s normal function sooner rather than later.

  • Soft-tissue massage – the lower limb, including glutes, and low back musculature to improve blood flow and muscular tension
  • Joint mobilization – primarily of the hip and knee joints. If the patient is affected by an antalgic gait (a limp), mobilization of the ankle and lumbar spine (low back) may be required too
  • Muscle Energy Techniques (MET) – to increase muscle strength and improve mobility
  • Manipulation (HVLA) Techniques – if indicated, may be used to improve joint range of motion
  • Dry Needling – may be used to ease muscular tension during hamstring injuries.
  • Exercise prescription – should be used in conjunction with manual therapy to improve long-term outcomes.

Hamstring Injury: Return To Play Protocols:

Exercise rehabilitation programs are not only important in helping increase joint range of motion, muscular strength, endurance, proprioception, and power of the hamstring and surrounding muscles but also aims to reduce the risk of re-injury. Typical hamstring exercise progressions include:

  • Isometric exercises – contracting the hamstring without moving the leg.
  • Eccentric (lengthening) and concentric (contracting) exercises. A focus on glute, hip, hamstring and quadriceps strengthening.
  • Return to running & light training. Running prescription may include and progress through high knees, A-skips / B-skips, straight-line jogging, side-shuffling, forward-backward accelerations over increasing distances, change of direction drills and sprinting (ensuring pain-free at each stage before progressing)
  • Return to sport-specific training. Subjective symptoms between 0-3/10 or less, and no movement hesitations
  • Return to play. When range of motion, strength, functional abilities (i.e. jumping or running at near maximal speed) are restored without stiffness or pain, and muscular strength within 5-10% of the other leg

Some examples of exercises you may be prescribed when recovering from a hamstring injury may include:

  • Cycling on a stationary bike, swimming or walking
  • Glute and hamstring bridges, both single & double leg:

Nordic Hamstring Curls: 


Split Squats: 

At Equilibrium Sports and Spinal clinic, we thrive on helping our local community who need help with hamstring strains. Our Osteopaths service Malvern, Glen Iris, Ashburton, Hawthorn, Toorak, South Yarra, Camberwell, and Caulfield. Book online today, and let us help you turn your hamstring strain into a thing of the past!

We previously posted a blog about what hamstring strains look and/or feel like, and why you should seek treatment to avoid recurrence of injury – read that post here!

Any Questions?

Feel free to email us at [email protected] 




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