Hamstring Strains And Posterior Thigh Pain In Runners

Hamstring Strains And Posterior Thigh Pain In Runners

If you are a runner, you know how miserable tight hamstrings can be. In many cases, continuing to run with tight thigh muscles can result in muscle strains that can take months to heal. Here is a brief overview of hamstring strains that can result in posterior thigh pain and how you can prevent these injuries.

What Are Hamstrings

Your hamstrings are comprised of three muscles located in the posterior or back of your thigh. These muscles work in conjunction with the quadriceps muscles located in the front of your thigh, to control power when you are:

  • Running
  • Jumping
  • Walking

How To Hamstring Strains Occur?

You may have heard hamstring strains referred to as hamstring pulls. This is the same injury that occurs when the hamstring muscles are stretched suddenly. Injuries can occur anywhere along the muscle but are most common in the middle. Runners often develop hamstring strains due to improper stretching or over training.

Risk Factors

There are some things that place you at an increased risk of developing posterior thigh strains. These may include:

  • Wearing improper foot wear
  • Inadequate stretching before running
  • Hamstring weakness
  • Improper warm-up before exercise


Muscle strains produce symptoms that can vary in degree, depending on the severity of the injury. Here are the primary symptoms associated with posterior thigh strains:

  • Pain in the back of the thigh
  • Limited movement in the affected leg
  • Pain extending down the leg to the knee
  • Muscle swelling
  • Bruising on the back of the thigh


A variety of factors can contribute to these types of muscle injuries in runners. Below is a list of some of the most common causes of posterior thigh strains:

  • Poor form when running
  • Failure to warm-up properly
  • Running when muscles are fatigued
  • Inflexible hamstring muscles

Muscle strains can develop over the course of time. They are also more likely to occur if you begin to exercise too quickly after a previous muscle strain. You may experience sudden, sharp pain if you have an acute injury, as well.


Your doctor will ask you a series of questions to aid him in diagnosing your condition. Be sure to include any information such as the date of symptom onset, previous injuries and any medications you are taking. He will then examine your leg, palpating the thigh muscle to determine where you are tender. He may also have you perform a series of moves to determine your level of flexibility. While this may not be comfortable, it is an important part of the diagnostic process. In most cases, no further diagnostic tests are required. If your doctor is concerned about a complete muscle tear, he may order a CT scan or MRI.


Doctors typically follow the RICE theory for treatment of posterior thigh strains:

  • Rest
  • Ice
  • Compression
  • Elevation

Your doctor may also recommend alternating hot and cold packs to reduce pain and inflammation. If you have difficulty walking, he may provide crutches to help you for a few weeks. Anti-inflammatory medicines such as naproxen or ibuprofen may be prescribed to reduce pain. If pain persists, your doctor may order physical therapy. Therapists have modalities that can decrease pain and they can also teach you ways to prevent further running injuries including taping techniques. In very rare cases, surgery may be necessary to repair hamstring strains that damaged tendons or muscles.

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About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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