Hamstring Injury Physiotherapy in Sydney CBD

Whether it went with a loud pop mid-sprint or has been a slow, nagging ache at the sitting bone that won’t shift — hamstring injuries are one of the most common and most poorly rehabbed conditions in sport and active populations. Getting the diagnosis right determines everything that follows.

Types of Hamstring Injury

Acute Hamstring Muscle Tears

The hamstrings — biceps femoris, semimembranosus, and semitendinosus — are a group of muscles running from the sitting bone (ischial tuberosity) down the back of the thigh to the knee. Acute tears most commonly occur during high-speed running or sudden eccentric loading — the muscle is forcefully lengthening while contracting, and something gives.

Tears are graded by severity:

Grade 1 — a minor strain with minimal fibre disruption. Pain with activity, minimal swelling, walking largely unaffected.

Grade 2 — a partial tear with significant pain, swelling, bruising, and difficulty walking normally. This is the most common presentation we see.

Grade 3 — a complete rupture. Significant pain, bruising, swelling, and a palpable defect. Relatively rare but requires careful management — sometimes surgical.

Early and accurate assessment is important to determine the grade, identify whether the proximal tendon is involved, and establish the right rehabilitation timeline. Returning too soon after a hamstring tear is one of the most common causes of re-injury — and re-injury rates in sport are alarmingly high when rehabilitation is rushed or incomplete.

Proximal Hamstring Tendinopathy

Proximal hamstring tendinopathy is chronic pain at the tendon attachment on the sitting bone, driven by compressive tendon loading rather than acute tearing. It is common in runners, cyclists, and active people who spend significant time sitting — and it is frequently misdiagnosed or undertreated.

The pain is typically:

Located at the sitting bone (ischial tuberosity) — deep, aching, and sometimes sharp
Worse with running — particularly at pace or up hills
Aggravated by prolonged sitting, especially on hard surfaces
Reproduced by forward bending of the trunk with straight legs

Like all tendinopathies, proximal hamstring tendinopathy does not respond well to rest alone, aggressive stretching, or passive treatment. It requires progressive tendon loading — and the right kind of loading, at the right stage.

How We Assess Hamstring Injuries

At City Physio & Pilates, hamstring assessment covers:

Detailed injury history — mechanism, timeline, previous episodes, and what’s been tried
Clinical grading of the injury — muscle vs tendon involvement, grade of tear if acute
Neural assessment — sciatic nerve involvement can mimic or accompany hamstring injury
Lumbar spine screening — referred pain from the lower back is a common confounding factor in posterior thigh pain
Strength and flexibility testing — bilateral comparison
Functional movement assessment — relevant to your specific sport or activity demands
Imaging review where available

Treatment for Hamstring Injuries

Acute tears:

Early load management — relative rest from provocative activity while maintaining movement and circulation
Manual therapy — soft tissue work and neural mobilisation where indicated
Progressive strengthening — from isometric through isotonic to eccentric loading, with clear criteria-based progression at each stage
Sport-specific rehabilitation — speed, power, and agility work before return to full training
Return-to-sport testing — strength symmetry, speed, and confidence criteria before clearance

Proximal hamstring tendinopathy:

Compressive load management — modifying sitting postures, running mechanics, and forward-bend patterns
Progressive tendon loading programme — isometric → isotonic → running-specific loading
Strength training — progressive Nordic hamstring curls, Romanian deadlifts, and hip hinge patterns
Running retraining — pace, gradient, and volume management

Both presentations benefit from a structured, criteria-based rehabilitation plan rather than time-based milestones. The question is not “how many weeks has it been” but “what can this structure currently tolerate and what does it need to progress.”

Frequently Asked Questions

How long does a hamstring tear take to heal? Grade 1 strains typically resolve in 1–3 weeks with appropriate management. Grade 2 tears require 4–8 weeks minimum before return to full sport, with proper rehabilitation. Grade 3 tears and proximal tendon avulsions take significantly longer and may require surgical assessment.

Can I still train with a hamstring injury? Usually yes — with modification. Complete rest is rarely optimal. Your physiotherapist will prescribe appropriate alternative training to maintain fitness while the hamstring rehabilitates.

Why does my hamstring keep re-tearing? The most common reason is returning to full training before the muscle has regained full eccentric strength and neuromuscular control. Strength deficits of as little as 10–15% between sides significantly increase re-injury risk. Criteria-based return to sport — not a calendar — is what prevents this.

Is proximal hamstring tendinopathy the same as a hamstring strain? No. The management is quite different. Tendinopathy responds to progressive loading and compressive load management. A muscle strain responds to graded tissue healing and progressive strengthening. Getting this distinction right at assessment avoids weeks of inappropriate treatment.

Book a Hamstring Injury Assessment

City Physio & Pilates | 25 Martin Place, Sydney CBD | Steps from Martin Place Metro and Wynyard

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Hamstring Tear