Pain guide · Leg pain
A hamstring strain is a sudden pain at the back of the thigh, usually while sprinting or stretching hard. This guide takes you from the first days to sprinting, using the exercises with the best trial results.
It also covers high hamstring tendinopathy: a deep ache low in the buttock, worse with sitting and running, which needs a slower plan.
Exercise is for pain that has been checked or is clearly mild and settling.
A strain starts suddenly, during a sprint or a stretch. High (proximal) hamstring tendinopathy builds gradually: localised lower buttock pain with tasks such as running and sitting. Strains that involve the tendon high up took longer to recover in trials, whatever the rehab.
In two trials from the same Swedish group, a rehab program built on three lengthening exercises (Askling's L-protocol: the Extender, the Diver and the Glider) returned elite footballers to full training in 28 days rather than 51, and elite sprinters and jumpers in 49 days rather than 86, compared with conventional exercises.
This plan uses the 90/90 hamstring move for the Extender and a bodyweight single-leg Romanian deadlift as the closest move to the Diver. The exercise details come from a secondary description of the protocol.
In a trial of 43 men, rehab that allowed pain up to a tolerable level returned players as fast as strictly pain-free rehab, and recovered more knee-bending strength and longer muscle fibres in the biceps femoris.
Source 4
Starting rehabilitation 2 days after a thigh or calf strain rather than 9 returned recreational athletes to sport almost 3 weeks sooner, with no difference in later healing or strength.
Programmes that include the Nordic hamstring exercise roughly halved hamstring injuries in a review of 15 studies and 8,459 athletes. In a trial in amateur footballers, 25 sessions over 13 weeks cut injuries from 0.8 to 0.25 per 1,000 hours, though not their severity. It prevents injuries; it is a late-stage exercise after one.
A 2016 review found no randomised trials of rehabilitation and suggested principles from other tendon problems apply. Since then, individualised physiotherapy and shockwave did equally well in a 100-person trial, isometric and isotonic exercise had the same short-term effect on pain and strength, and a review suggests progressive loading at increasing hip bend.
Mild to moderate discomfort that you find tolerable is fine during exercise; in a trial, working that way did no harm and recovered more strength. In the lengthening exercises (the Extender and the Diver), stop just before pain. Sharp pain, or a limp afterwards, means back off for a session or two.
For high hamstring tendinopathy, use a tendon rule instead: pain up to about 5 out of 10, settled by the next morning. That borrows the rule tested in Achilles tendon pain; it has not been tested in the hamstring.
Start at the first stage. Each move opens a full guide with a 3D demo.
Days 1 to 7. Walk as you are able.
3D demoGlute bridgeBeginner · No equipment5 holds of 20 to 30 s, both legs · This site's suggested start
Easier: Pelvic tilt into bridge · Harder: Glute kickback (quadruped hip extension)
3D demo90/90 HamstringBeginner · No equipment3 sets of 12 each side, twice a day · Askling's Extender: hold the thigh still and straighten the knee slowly to just before pain
3D demoMachine leg curlBeginner · Strength machine2 sets of 12, light, comfortable range
Harder: Slider hamstring curl
Move on when: You can walk briskly without pain, and the Extender reaches nearly full knee straightening.
Weeks 1 to 3.
3D demoSingle-leg Romanian deadliftAdvanced · A dumbbell3 sets of 6 each leg, bodyweight, every other day · Like Askling's Diver: reach the arms forward and stop just before pain
Easier: Dumbbell Romanian deadlift · Harder: Full Nordic curl
3D demoSlider hamstring curlIntermediate · No equipment3 sets of 8
Easier: Machine leg curl · Harder: Full Nordic curl
3D demoDumbbell Romanian deadliftIntermediate · A dumbbell3 sets of 8 · Once the hinge practice is easy
Easier: Hip-hinge practice · Harder: Single-leg Romanian deadlift
Move on when: These are pain-free at a moderate speed.
Weeks 3 to 6 and on. The hamstring flexibility routine suits this stage.
3D demoNordic curlAdvanced · An anchor point2 to 3 sets of 4 to 6 · Keep it in your weekly routine afterwards to prevent the next strain
Easier: Slider hamstring curl · Harder: Full Nordic curl
3D demoSingle-leg glute bridgeIntermediate · No equipment3 sets of 10 each side
Easier: Glute bridge · Harder: Alternate-leg bounding
3D demoTreadmill joggingIntermediate · Cardio machineEasy runs, building time
Easier: Treadmill walking · Harder: Sprint intervals
3D demoSprint intervalsAdvanced · No equipmentShort efforts at 60 to 70% effort to start · Build speed over several sessions
Easier: Treadmill jogging
Move on when: Sprinting at full effort is pain-free.
Ease the pressure on the tendon: sit on a cushion and break up long spells of sitting (this site's suggestion). Then load the tendon progressively, starting with little hip bend and moving toward more. The doses are this site's starting points.
Not hard, early on. The lengthening exercises that did best in trials move the muscle actively to just before pain rather than holding a deep stretch.
When brisk walking and the lengthening exercises are pain-free at a moderate speed. Start with skipping and easy jogging, then build sprint speed over several sessions.
It varies. In the trials, elite footballers returned in about 4 weeks with lengthening exercises and sprinters and jumpers in about 7, and strains involving the tendon high up took longer.
Keep the Nordic curl in your weekly routine. Programmes that include it roughly halve hamstring injuries.
Deep pain low in the buttock that is worse with sitting and running suggests high hamstring tendinopathy. Break up long sitting and follow the slower loading plan on this page.
A strain starts suddenly during activity and is tender in the muscle. Pain that spreads below the knee, or comes with tingling or numbness, points to the back: see the sciatica guide.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
