The Dreaded Hamstring Strain
Few moments in sports cause fans and fantasy managers to hold their breath quite like a star player pulling up without contact. During the Chicago Bears' Week 2 matchup against the Minnesota Vikings, quarterback Caleb Williams scrambled to his left, pulled up in visible distress, and went down on the turf. The eventual diagnosis: a right hamstring injury.
Photo Credit: Getty Images: Todd Rosenberg “The Sun”
For a dynamic, off-script playmaker like Williams, a hamstring strain is a major obstacle. But what actually happens when a hamstring pulls, why are elite dual-threat quarterbacks vulnerable to them, and what does the path to recovery look like?
What Is a Hamstring Strain?
The hamstrings are a group of three muscles running down the back of your thigh—the biceps femoris, semitendinosus, and semimembranosus. Their main job is to flex the knee and extend the hip.
A hamstring strain occurs when these muscle fibers are stretched beyond their capacity during a powerful contraction. This frequently happens during eccentric loading, when the muscle is forced to lengthen while trying to contract. In football, this typically occurs right as a sprinter’s foot is about to hit the ground, when the hamstring is acting like a brake to decelerate the leg. This can occur during normal sprinting, when a player overextends trying to regain their balance, or when the field/grass gives way during a breaking maneuver causing a quick response in an already loaded position.
Hamstring strains break down into 3 categories:
Grade 1: Mild in nature (1-3 weeks)
Grade 2: Partial tearing of the muscle (4-8 weeks)
Grade 3: Complete tearing of the muscle or when tendon avulsion occurs from the bone. (3 - 6 months)
Seems simple right?
Unfortunately, this isn’t always the case. Between each grade is a layer of mystery and tissue tolerance that we can’t tell just by looking at a player standing or walking. Take Caleb Williams as an example. He was carted off the field, but was later seen walking with minimal limp out of the locker room. Is this a Grade 2 hamstring strain hiding in disguise? At the time of this blog post, the answer is still unknown. Initial testing for Caleb shows good signs, but an MRI is being provided today which will give us a good indication of grade level.
Why having the right physical therapist makes all the difference?
Rushing back from a hamstring injury is a trap. Soft-tissue injuries often feel fully healed long before the tissue has regained its original tensile strength. Re-injury rates for hamstrings are notoriously high, usually occurring within the first few weeks of returning to play.
A professional rehabilitation protocol focuses on four critical criteria before an athlete gets clearance:
Rest and Protection (Early Phase): Managing initial inflammation using ice, compression, and short-term rest to allow early fiber repair.
Eccentric Strengthening (Mid Phase): Exercises like Nordic hamstring curls force the muscle to lengthen under load, restoring structural strength where it failed.
High-Speed Running Exposure (Late Phase): Sub-maximal jogging isn't enough. The athlete must prove they can reach 100% top-end sprinting without pain or apprehension.
Dynamic Mobility: Restoring full range of motion in the hips and lower back so the hamstrings aren't forced to overcompensate for tight kinetic chain neighbors.
Through each phase of recovery comes challenges along the way. In the early phase patients will start to feel better and might push themselves too hard, causing soreness and minor set back. Or in the mid to late phase when all the initial exercises are going well, minimal soreness, and light plyometrics or jogging isn’t painful an athlete might be ready to sprint or return to practice in full it is still advised that we take is slow. Set backs will occur when the process is rushed or the progression isn’t handled correctly.
A physical therapist who understands sports and rehabilitation protocols will be able to help you navigate these phases of recovery and provide you with the confidence to return to the field without issues. At Ignite Physical Therapy in West Chester PA, we understand how to get you back to sports because we’re athletes ourselves.
The demands a sport puts on the body isn’t understood by everyone, and neither is the effort and time it takes to rehab it correctly. Hamstring strains aren’t always season ending and athletes can recover quickly from them with the proper help and knowledge.
Written by:
Dr. Jared Bonacquisti, PT, DPT
Co-Founder of Ignite Physical Therapy and Physical Therapist