Torn hamstring, pulled hamstring, biceps femoris strain: how long it takes to heal depends on which muscle is involved, where the injury is and how large it is. This page gives you indicative recovery times for each type of injury, what to do in the first days, how to read your scan report and how to return to sport while lowering the risk of re-injury.
This page expands on the guide to muscle injuries.
"Torn biceps femoris" or "pulled hamstring" are the names people often give to any injury at the back of the thigh. In fact the hamstrings, so called because they bend the knee, are three muscles: the biceps femoris on the outer side, made of a long head and a short head; and the semitendinosus and semimembranosus on the inner side.
They start from the ischial tuberosity, the part of the pelvis you sit on, except the short head, which starts from the femur. The long head of the biceps femoris and the semitendinosus share a tendon, the conjoint tendon; the semimembranosus has its own long, flat tendon that runs deeper. Further down, the biceps femoris attaches to the head of the fibula on the outer side of the knee, and the semitendinosus and semimembranosus to the inner side of the tibia1.
They are the most common muscle injuries in sport: in professional football they account for about one injury in five, and their share has grown in recent seasons2. The biceps femoris is involved in over 8 injuries out of 10, the semimembranosus in about 1 in 10, the semitendinosus less often3.
With a tear, the pain is sudden and localised, starts at a moment you remember, sometimes with a sharp "stab" or a pop, and gets worse when you contract or stretch the muscle. With muscle tightness (contracture) the pain is more diffuse, builds gradually or appears the day after exercise, and the muscle feels tense but no fibres are torn6. Symptoms alone cannot tell them apart with certainty: an ultrasound scan can.
These can be signs of the tendon pulling off the bone. It is rare but needs to be recognised early7: when surgery is needed, results are better if it is done within about 4 weeks8,9.
Strain, tear, pull and injury are different words for the same thing: damage to the muscle fibres. Muscle tightness (contracture), instead, is a muscle problem without torn fibres, and that is why it heals faster; the international consensus on terminology keeps it apart from true injuries6.
To estimate recovery time, how the injury is classified matters. The most widely used system, the British Athletics Muscle Injury Classification (BAMIC), is based on MRI and describes two things10:
Many reports still use a simpler scale from 1 to 3: grade 1 with few fibres involved, grade 2 with a partial tear, grade 3 with a complete tear of the muscle or tendon12. This is why "grade 1, 2 or 3" alone is not enough to predict recovery time: you also need to know where the injury is. See the recovery time table →
You may also hear low-grade, mid-grade or high-grade hamstring injury. These are everyday expressions, not an official classification: they usually mean a mild injury (grade 1, old classification), a moderate one (grade 2) and an extensive or complete one (grade 3). Even at a low grade, if the injury involves the tendon, recovery takes longer.
These ranges come from studies of athletes followed by medical staff and refer to the return to full training or competition. They are indicative: the estimate for your case is made after the examination and ultrasound, and you return to sport when the criteria are met, not when the weeks run out.
| Type of injury | Indicative time | Notes |
|---|---|---|
| Muscle tightness: pain without torn fibres (grade 0) | About 1 week | Tests show no torn fibres12. |
| Mild muscle injury (grade 1, old classification; "low-grade") | 2–3 weeks | The most common case3,12. |
| Moderate injury at the muscle–tendon junction of the long head (grade 2, old classification; "mid-grade") | 3–6 weeks, on average 3–4 | The tendon stays intact3,13. |
| Biceps femoris T-junction | 4–6 weeks, sometimes over 2 months | At the interface between the short and long heads of the biceps femoris. High risk of recurrence14,15. |
| Injury involving the tendon: inside the muscle or full-thickness conjoint tendon | 2–3 months | Tendon heals more slowly than muscle11,13. |
| Complete muscle rupture (grade 3, old classification; "high-grade") | About 10 weeks, highly variable | Rare: about 3 injuries in 10012. |
| Proximal semimembranosus tendon, stretch-type injury | Many months, on average about a year to return to the previous level | Early symptoms are often mild, recovery is long16. |
| Complete tendon avulsion from the bone | Case by case; after surgery on average about 6 months | Rare. Surgery gives better results if done within about 4 weeks8,9. |
Going back to training does not mean going straight back to full level: in elite sprinters, returning to the previous performance took on average several months, longer when the injury was close to the ischial tuberosity and involved the tendon17.
Close to the buttock, this is the tendon shared by the long head of the biceps femoris and the semitendinosus to attach to the ischial tuberosity. The pull of two different muscles is concentrated here: when the injury involves it, especially full-thickness, recovery is clearly longer than for a muscle-only injury13.
It starts from the ischial tuberosity next to the conjoint tendon and runs deep, under the semitendinosus1. It is injured mostly by slow, wide stretching, less so in sprinting. It is the most insidious injury: it hurts little at first, but returning to the previous level can take many months16.
In the lower thigh, on the outer side, where the long and short heads join before the tendon that goes to the fibula. It is a complex structure, with a superficial tendon part and a deeper connective tissue part that varies from person to person. Injuries here have a high risk of recurrence, and recovery is longer when the damage involves the tendon part or extends deep between the two heads14,15.
The diagnosis starts with the consultation: how it happened, where it hurts, how much pain contraction and stretching cause, how much strength is missing compared with the other leg. Ultrasound, ideally 48 hours after the injury, shows which muscle is injured, where and how large the tear is, and lets us follow healing over time18.
MRI is more sensitive, so it can identify even low-severity injuries; but this does not change the rehabilitation pathway, which depends on the functional tests20,21.
MRI is useful in selected cases: deep injuries close to the ischial tuberosity, suspected major involvement of the proximal tendon or avulsion of the tendon from the bone, before any surgery7,20.
Consultation and ultrasound are done in the same session. Based in Modena, Italy; for people living elsewhere, see the online consultation below.
The most common phrases in reports of a biceps femoris injury, explained simply.
The report should always be read together with the examination: the same word can describe different situations. If you live far away, I can review your report and images by video call: online consultation →
Recovery is based on progressive loading, adapted to the location of the injury: tendon injuries need a slower progression than muscle-only injuries21. You return to sport when the tests are passed: no pain, strength and flexibility similar to the other side, running at top speed and the movements of your sport.
The risk of re-injury is higher for the biceps femoris and for tendon injuries3,11. To prevent it, complete the strengthening even after the pain has gone: the Nordic hamstring exercise roughly halves hamstring injuries22.
This is the treatment with the most evidence. Starting early and increasing the load step by step shortens the return to sport5,23.
Useful for pain in the first days, without overdoing it; it does not speed up healing4.
There is no evidence that they speed up healing or reduce re-injury23. Therapeutic ultrasound should not be confused with ultrasound imaging, which is used for diagnosis.
Apart from extremely rare cases, there is no point in using them. In the most authoritative study they gave no advantage over a saline injection24; reviews find at most about one week less, with low-quality evidence and no reduction in re-injury23,25,26.
Recovery time
It depends on the location and size of the injury. Typical times: 2–3 weeks for a grade 1 injury, 3–4 weeks for grade 2 (old classification) at the junction between muscle and tendon, 2–3 months when the tendon is involved, about 10 weeks for a complete muscle rupture. The estimate for your case is made after the examination and ultrasound. See the recovery time table →
"Pulled" or "strained" does not mean a milder injury: it is just another name for a muscle tear. If the damage is small and limited to the muscle, expect on average 2–3 weeks; for a grade 2 injury (old classification) at the muscle–tendon junction 3–4 weeks; if the tendon is involved 2–3 months. See the recovery time table →
Tear, strain and injury are the same thing, so times are the same: on average 2–3 weeks for grade 1, 3–4 weeks for grade 2, about 10 weeks for grade 3, a complete muscle rupture (old classification); 2–3 months if the tendon is involved. What makes the difference is where the injury is and how large it is, which ultrasound shows. See the recovery time table →
With the old 1 to 3 classification, in professional football average time out was about 1 week for grade 0 (tightness), 2–3 weeks for grade 1, about 3 weeks for grade 2 and about 10 weeks for grade 3, a complete rupture. At the same grade, location matters a lot: an injury that enters the tendon takes longer and recurs more often. See the recovery time table →
These are everyday expressions, not an official classification. "Low-grade" usually means a mild injury (grade 1, old classification): on average 2–3 weeks. "Mid-grade" a moderate one (grade 2): on average 3–4 weeks. "High-grade" an extensive injury or a complete muscle rupture (grade 3): about 10 weeks. If the injury involves the tendon, 2–3 months are needed, even at a low grade. See the recovery time table →
About a week on average. Muscle tightness is muscle pain without torn fibres: that is why it heals faster than a strain or tear, which are true injuries. If the pain has not improved after 7–10 days, an ultrasound scan is worth having to rule out an injury. See the recovery time table →
Easy running restarts when walking and daily life no longer hurt, and speed is increased step by step. Sprinting at top speed is one of the last steps: you go back when it doesn't hurt, strength is similar to the other leg and the specific tests are passed, not on a fixed date. See the recovery time table →
The most common causes are tendon involvement not recognised at the start, a return to activity that was too quick, or a new injury close to the previous one. The semimembranosus tendon, injured by wide stretching, also has very long recovery times despite causing few symptoms. A repeat ultrasound helps understand what is going on. See the recovery time table →
First days
Stop and don't carry on playing. In the first 2–3 days protect the leg by avoiding movements that hurt, use an elastic bandage and keep the leg raised; ice can help with pain, without overdoing it. Avoid routine anti-inflammatory drugs, stretching and deep massage. As soon as walking doesn't hurt, start gentle exercises: starting early shortens recovery. Read more →
In the first days ice can help with pain, but should not be overused; it is better to put heat off. Stretching and deep massage on the area should be avoided in the first days: stretching a freshly injured muscle hurts and does not speed up healing. Stretching comes back into the programme later, gradually and without pain.
Yes, if walking doesn't hurt: complete rest is not needed and slows recovery. In a leading study, starting rehabilitation 2 days after the injury instead of 9 brought forward the return to sport by about 3 weeks. If instead you struggle to walk or bend the knee, get seen within a few days.
Usually not: the bruise often appears after 1–3 days and tracks down towards the knee because of gravity. On its own it does not tell you how severe the injury is. It becomes a warning sign if it is very extensive and comes with a pop near the buttock, difficulty walking or strong pain when sitting: in these cases you need to be seen within a few days.
With a tear, the pain is sudden, localised, starts at a precise moment, sometimes with a stab or pop, and gets worse when you contract or stretch the muscle. With muscle tightness the pain is more diffuse and builds gradually or the day after exercise. Symptoms alone are not enough: an ultrasound scan tells them apart with certainty. Read more →
A clear pop near the buttock, often when slipping into a split or bending suddenly forward with the knee straight, extensive bruising at the back of the thigh, difficulty walking and strong pain when sitting can indicate the tendon pulling off the bone. It is rare but must be recognised early: when surgery is needed, results are better if it is done within about 4 weeks. Read more →
Anatomy, diagnosis and report
No. The hamstrings are three muscles at the back of the thigh: biceps femoris, semitendinosus and semimembranosus. The biceps femoris is involved in over 8 injuries out of 10, which is why its name is used for any tear at the back of the thigh. Read more →
In most cases ultrasound, ideally 48 hours after the injury. In recent tears it shows the injury as well as MRI, it is done during the consultation together with the functional tests that tell how severe the injury is, it lets muscles and tendons be seen in movement and it is easy to repeat at follow-up. MRI is for selected cases, such as injuries close to the pelvic bone or suspected tendon avulsion. Read more →
It means the injury is at the point where the muscle fibres join the tendon, the myotendinous junction. This is the most frequent location, more than half of cases. If the tendon stays intact, typical times are 2–3 weeks for grade 1 and 3–4 for grade 2 (old classification); if the injury enters the tendon, 2–3 months are needed. See the recovery time table →
They are the British classification of muscle injuries, found in diagnostic test reports. The number is the extent, from 0 (no visible damage) to 4 (complete rupture); the letter is the location: "a" at the edge of the muscle, "b" at the junction between muscle and tendon, "c" inside the tendon. For example 2b is a moderate injury at the junction, 3c an extensive one that enters the tendon, with longer recovery and more recurrences. Read more →
Recovery, prevention and treatments
By completing the strengthening even after the pain has gone, and returning to sport only when the criteria are met. Programmes that include the Nordic hamstring exercise roughly halve hamstring injuries. Read more →
Apart from extremely rare cases, no. In the most authoritative study, platelet-rich plasma (PRP) injections did not bring forward the return to sport or reduce re-injury compared with a saline injection; reviews find at most about one week of advantage, with low-quality evidence. Recovery is based on exercise with progressive loading. Read more →
No: there is no evidence that they speed up healing or reduce re-injury. The treatment with the most evidence is therapeutic exercise, started early with a load that increases step by step; ice can help only with pain in the first days. Read more →
In most cases yes, generally within the first year27,28. The new tendon does not rebuild the original anatomy, though: the muscle stays shorter and smaller and attaches at a different point28. The result is less strength in bending the knee, especially when it is well flexed, which can last for years and which the other hamstrings only partly compensate27,29. This is why hamstring strengthening is part of the return to sport after ACL surgery.
Yes. By video call I go through how it happened and your symptoms, review any reports and scans you already have, and prepare a rehabilitation plan tailored to you, to follow with a physiotherapist near you or through telerehabilitation. Online consultation →
The content of this page is based on the scientific literature cited below. Tap an entry to see the full citation.
You can have the assessment by telemedicine, by video call even from the office, and receive a rehabilitation plan tailored to you. Online consultation and telerehabilitation →
Video consultation in English, with a rehabilitation plan built around your injury included, to follow with a physiotherapist near you or through telerehabilitation. Near Modena or Lisbon, also in person, with examination and ultrasound in the same session.
Request an online consultation Guide to muscle injuries →