It’s no secret that a pulled hamstring can be a real pain in the butt. But can a pulled hamstring cause knee pain?

In this blog post, we will explore the relationship between pulled hamstrings and knee pain. We will also discuss how to treat this injury and prevent it from happening again.

Hamstring Anatomy

The hamstring is a muscle located in the back of the thigh. It runs from the hip to just below the knee joint and is responsible for flexing the leg. The hamstring is made up of three muscles: the biceps femoris, semitendinosus, and semimembranosus.

These muscles attach to the ischial tuberosity, a small bone that is part of the pelvis. The hamstring also consists of tendons and other soft tissues. Together, these structures allow the hamstring to perform its primary function of bending the leg at the knee joint.

Causes of Pulled Hamstring

Hamstring injuries are common in sports that involve sprinting, such as football, track and field, and soccer. Several other factors can contribute to a pulled hamstring, including muscle imbalance or overuse conditions like patellar tendonitis.

Muscle imbalance occurs when the muscles surrounding the hamstring are either too weak or too tight compared to other surrounding musculature. This can cause the hamstring to work harder than it physically can, leading to strain and injury.

Another common cause of a hamstring injury is trying to complete an explosive movement without the proper warm-up. Especially if you do not train greater ranges of motion for your hamstring, it is imperative that you adequately warm up.

An adequate warm-up usually consists of several active stretches building slowing in intensity until you can comfortably complete the explosive movement required for your sport.

In addition to the above, other causes of hamstring injuries include direct trauma, structural problems, and nerve problems. 

Can a Pulled Hamstring Cause Knee Pain?

Hamstring injuries are a common source of knee pain. The hamstring muscle group is located on the back of your thigh and connects the musculature (by attachment site) of the upper and lower leg surrounding and supporting the knee joint. When these muscles are tight or overworked, they can put a strain on the knee joint, leading to pain.

To add, the hamstrings also directly support the anterior cruciate ligament (ACL), because they not only flex the leg and extend the hip but also prevent anterior translation of the tibia. This is exactly what the ACL does, so the hamstrings are an important structural component of the knee joint. If the hamstrings are injured, it leaves the knee joint more susceptible to stresses that would usually be dealt with by the hamstring.

For these reasons, it is important to keep the hamstring muscles healthy and strong to avoid knee pain.

Types of Hamstring Injuries

Hamstring Sprains/Tears

A hamstring sprain or tear is a severe injury that can occur in any of the three hamstring muscles, although it is most common in the biceps femoris. A hamstring tear can occur when the muscle is stretched beyond its limits or when it is subjected to a sudden force, such as during a fall or a car accident.

There are three grades of this injury which are:

Grade I or strain: Hamstring strains are mild and common injuries, particularly among athletes who participate in running and jumping sports. A muscle strain occurs when one or more of these muscles is stretched beyond its limit, causing microscopic tears in the muscle tissue. Symptoms of a hamstring strain can range from a mild twinge of pain to severe discomfort that makes it impossible to walk.

Grade II or partial tear: A moderate injury in which there is more significant tearing of the muscle tissue. Symptoms include sharp pain and tenderness in the injured leg, along with swelling and bruising in the calf muscles. In some cases, there may also be a loss of range of motion at the knee. 

Grade III or avulsion injury: A severe injury in which the muscle is completely torn or ruptured. This complete tear can cause significant pain, swelling, and bruising, and the individual will not be able to walk without assistance.

Symptoms of a hamstring tear include pain, swelling, and bruising in the back of the thigh. In severe cases, the muscle may be completely torn away from the bone.

Hamstring Tendonitis

Hamstring tendonitis is a moderate hamstring injury that results when the tendons in the injured area become inflamed. This can be caused by overuse, sudden trauma, or poor stretching habits. Symptoms include pain and tenderness in the injured area, as well as stiffness and decreased range of motion.


How to Diagnose a Pulled Hamstring

Several methods can be used to diagnose a pulled hamstring. A physical examination will typically reveal tenderness and swelling in the affected area. In some cases, an MRI scan or magnetic resonance imaging (MRI) may be ordered to get a more detailed look at the injury.

How to Prevent a Pulled Hamstring

There are a few things you can do to prevent a pulled hamstring. First, gentle active stretches increasing in intensity before and after exercise can help to keep the muscles loose and less likely to be injured.

Second, staying hydrated by drinking plenty of water will help to keep the muscles healthy and strong.

Third, eating a balanced diet that includes all the essential nutrients will help the muscles repair and rebuild themselves.

Finally, train all ranges of motion for the hamstring. Personally, after persistent hamstring sprains and 4 knee surgeries, I realized stretching alone isn’t enough. Completing joint-centric training regimens that load lengthened positions of all muscles is the best way to prevent a sprain or strain.

How to Treat Hamstring Injuries

Physical Therapy

Hamstring injuries can range from mild to severe, but regardless of the extent of the injury, physical therapy is often an essential part of the recovery process. The first step in physical therapy is to improve the range of motion.

This may involve stretching exercises and/or massages. Once the range of motion has improved, the next step is to focus on strengthening the muscles. This usually entails a series of strengthening exercises that gradually increase in intensity.

It’s important to consult with a physical therapist throughout this process to ensure that you are doing the exercises correctly and not overexert yourself. With time and commitment, hamstring injuries can be effectively treated through physical therapy.


Anti-inflammatory Medications

Nonsurgical treatments like non-steroidal anti-inflammatory drugs (NSAIDs) can help to relieve the pain and swelling of a pulled hamstring. NSAIDs work by inhibiting the production of prostaglandins, which are hormones that promote inflammation.

NSAIDs can also help to reduce muscle spasms in the injured area. As a result, they can be an effective treatment for hamstring injuries. However, it is important to take NSAIDs as directed by a doctor to minimize the risk of side effects like gastrointestinal bleeding.


Treatment for a hamstring injury typically includes rest, ice, and compression. For best results, an ice pack should be applied for 20-30 minutes at a time. Cold packs can help to reduce inflammation and pain by decreasing swelling, which eventually aids in the healing process.

By following these simple steps, you can help to ensure a speedy recovery from a hamstring injury.

Be Consistent with Treatment

Consistency is key when recovering from a pulled hamstring or tendon tear. No two injuries are the same, so it’s important to trust the doctors and be patient with the recovery process. Depending on the severity of the injury, recovery can take anywhere from a few weeks to several months.

It’s important to stay consistent with the treatment plan and not try to push yourself too hard. Once you’re cleared by the doctor, you can slowly start to increase your activity level. With time and patience, you’ll be back to your old self in no time.

About the Author

Hi there! I’m Dr. Keagen Hadley, OTD, OTR/L. Straight out of the University of Mary, I’m all about blending my know-how in knee health, well-being, and medical technology. As a licensed occupational therapy doc, I’m here to translate complex concepts into clear, actionable insights – whether it’s knee care or groundbreaking healthcare tech.

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