One of the most common injuries to the lower extremities, a hamstring pull is more than likely to be encountered in a massage therapist’s practice. Since today’s medical climate often makes it easier for most people to schedule an appointment with a massage therapist than with an orthopedist, there is an increased need for bodyworkers to have the skills for evaluating common injuries. When massage therapists can assess the origin of a client’s pain, they are better prepared to formulate an effective massage plan.


The group of muscles located on the posterior side of the upper thigh, the hamstring muscles consists of the:

  1. Semimembranosus
  2. Semitendinosus
  3. Biceps femoris

While the hamstring muscles all originate from the ischial tuberosity of the pelvis, the biceps femoris has a second portion that originates from the lower outer portion of the femur bone itself. The hamstrings primary function is to extend the hip and flex the knee.


Hamstring strain could result from any activity, but is caused most often by those involving sprinting, due to the high force loads on the hamstrings. The hamstrings are particularly susceptible to strain injury because of their structure and function.

Otherwise known as a hamstring strain, a pulled hamstring is a tear in one or more of the hamstring muscles. A common source of injury and chronic pain in athletes, injuries to the hamstring muscles primarily occur proximally and laterally – usually involving the biceps femoris. Symptoms of a pulled hamstring generally include:

  • A sudden sharp pain at the back of the leg during exercise.
  • Spasms of the hamstring muscles usually associated with pain on stretch and contraction.
  • Swelling and bruising.
  • If the rupture is severe, a gap in the muscle may be felt.
  • Due to the tensile loads on the muscle-tendon unit, it is common for the person to report hearing a loud pop or snap when the injury occurred.


The severity of injury to the hamstring muscles is classified according to the following three grades:

  • Grade 1 – is a mild strain with a few torn muscle fibers. This injury is likely accompanied by tightness in the posterior thigh, some discomfort and minimal swelling. Lying prone and trying to bend the knee against resistance likely will not illicit much pain.
  • Grade 2 – is a moderate strain accompanied by a definite loss in strength. This more severe injury often disrupts the gait, is associated with sudden twinges of pain upon activity and is painful with applied pressure. Flexing the knee against resistance will cause pain and the client may not be able to fully straighten his/her knee.
  • Grade 3 – is a complete tear of the hamstrings. This most severe of hamstring injuries will definitely affect a person’s ability to walk, causes immediate and noticeable swelling and is associated with severe pain – especially during knee flexion. Severe third-degree strains may involve an avulsion fracture, where the tendon is torn away from its attachment pulling a small chunk of bone with it. Regardless of the possibility of an avulsion fracture, a suspected third-degree sprain should be referred to a physician.


According to Ben Benjamin, Ph.D., a hamstring strain may be confused with a low back injury if pain is referred to the lower buttock. Benjamin advises orthopedic testing to differentiate between these two types of injuries. Since resisted flexion of the knee at 90 degrees places the greatest stress on the upper hamstring tendon, it will cause pain if that structure is injured.

Additionally, Benjamin suggests differentiating between these two injuries by palpating the hamstrings on both the right and left sides. If the hamstring on the painful side is more tender, you can conclude that muscle is contributing to the pain. If not, you know the pain is being referred from another location.

Since massage therapists are often recruited for pain relief prior to other medical professionals, the skills to evaluate this common injury are crucial. Therapists who can identify a hamstring strain and determine its severity can better administer massage that will deliver safe, targeted, pain relief.

Recommended Study:

Advanced Anatomy and Physiology
Advanced Anatomy for Professionals
Sports Massage