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Condition/Disorder Synonyms

  • Pulled hamstring

ICD-9-CM Code

  • 848.9 Unspecified site of sprain and strain

ICD-10-CM Code

  • T14.9 Dislocation, sprain, and strain of unspecified body region

Key Features


  • Stretch injury to biceps femoris or semimembranosus resulting in disruption of muscular or musculotendinous units

    • Grade I: mild

    • Grade II: moderate

    • Grader III: severe to complete tear or rupture

Essentials of Diagnosis

  • Diagnosis made with patient history and clinical findings or with imaging

  • Pain with resistance

  • Location of Lesion May Influence Prognosis

General Considerations

  • Mechanisms of injury1

    • Deceleration during swing phase while running

      • Typically occurs during high-speed running

      • Involves intramuscular tendon or aponeurosis of biceps femoris (long head), semitendinosus (secondary injury)

    • Excessive stretch while dancing or kicking

      • Typically during extreme hip flexion with full knee extension

      • Injury at proximal tendon of semimembranosus


  • Previous hamstring injury is a strong predictor of recurrence

  • Athletes in high-speed-demand sports (e.g., football, track, rugby, soccer)

  • Athletes in sports/competition involving kicking or extreme hip flexion and knee extension (e.g., dancing, water-skiing)

Clinical Findings

Signs and Symptoms

  • Acute-onset pain at proximal hamstring during high-speed running, often with audible pop, typically early or late in athletic event

  • Pain at ischial tuberosity with sitting

  • Decreased range of motion (ROM) in knee and hip

  • Decreased strength with knee flexion and hip extension

  • Tenderness to palpation (possible palpable lesion) at proximal tendon or musculotendinous junction

  • Tenderness may occur along muscle belly proximal to ischial tuberosity

Functional Implications

  • Inability to run or sprint

  • Inability to sit without limitation from pain

  • Inability to flex hip with knee fully extended

Possible Contributing Causes

  • Previous history of hamstring injury

  • Explosion activity without proper warm-up

  • Muscle imbalance between quadriceps and hamstring

Differential Diagnosis

  • Adverse neural tension

  • Adductor muscle strain

  • Avulsion fractures at ischial tuberosity

  • Lumbar radiculopathy

  • Sacroiliac dysfunction

  • Sciatica

Means of Confirmation or Diagnosis


  • MRI for soft tissue

Findings and Interpretation

  • MRI can reveal area of fluid accumulation and location of lesion



  • NSAIDs

Medical Procedures

  • Surgery to repair grade-III strain or avulsion


  • To hospital for imaging (MRI)

  • Surgery (if grade-III strain)


  • Inability to run or sprint

  • Inability to sit without limitation from pain

  • Inability to flex hip with knee fully extended

Tests and Measures


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