Hamstring Contusion

Injuries > Thigh > Hamstring Contusion

(Also known as Corked Thigh, Hamstring Bruise, Corky, Hamstring Haematoma, Charley Horse, Dead Leg)

What is a hamstring contusion?

A hamstring contusion is a condition characterized by a bruise or ‘corky’ to the back of the thigh, usually as a result of a direct impact. The group of muscles at the back of the thigh is commonly called the hamstrings (figure 1).

The hamstrings comprise of 3 muscles:

  • biceps femoris
  • semimembranosus
  • semitendinosus

These muscles originate from the pelvis and insert into the top of the lower leg bones (figure 1).

Hamstring Contusion Anatomy - The Hamstrings (click to enlarge)

Figure 1 – The Hamstrings (click on image to enlarge)

The hamstring muscles are responsible for bending the knee, straightening the hip and controlling knee and hip movements during activity. They are particularly active during running, jumping and kicking. The hamstrings also have a rich blood supply. Following a direct impact to the back of the thigh, damage to the muscle fibres, connective tissue and small blood vessels of the hamstrings may occur. This results in a ‘bruise’ and is known as a hamstring contusion.

Hamstring contusions range from minor contusions, resulting in minimal pain and allowing ongoing activity, to severe contusions, resulting in significant pain and loss of function.


Causes of a hamstring contusion

Hamstring contusions occur following a direct impact to the hamstring muscle from an object or person. This most commonly occurs due to a collision with another player during contact sports, such as football or rugby, or from an impact from a ball in sports such as hockey or cricket.


Signs and symptoms of a hamstring contusion

Patients with this condition usually feel a sudden pain in the muscle at the time of injury. In minor cases, pain may be minimal (or sometimes may go unnoticed) allowing continued activity. In more severe cases, patients may experience severe pain, muscle spasm, weakness and an inability to continue activity. Patients with a severe hamstring contusion may also be unable to walk without a limp.

Patients with a bruised hamstring usually experience pain during activities such as bending forwards, going up stairs, walking uphill, running, jumping, lunging or kicking. It is also common for patients to experience pain or stiffness after these activities with rest, especially upon waking in the morning. Swelling, tenderness and bruising may also be present in the hamstring muscle, along with an inability to stretch the injured leg as far as usual.

In severe cases a visible increase in size of the thigh may be detected due to bleeding and swelling. In these instances patients may be unable to sleep due to pain. Occasionally the swelling and bruising may track down to the knee joint or lower leg.


Diagnosis of a hamstring contusion

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a hamstring contusion. Further investigations such as an MRI scan or ultrasound may be required, in rare cases, to confirm diagnosis.


Treatment for a hamstring contusion

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Prognosis of a hamstring contusion

With appropriate management, patients with a minor hamstring bruise can usually recover in one to three weeks. With larger contusions, recovery may take four to eight weeks or longer, depending on the severity of injury. In rare cases, patients can sometimes develop myositis ossificans (i.e. bony growth, or calcification, inside the contusion). This condition is more common in severe contusions (especially those that are managed inappropriately) and may prolong recovery by weeks to months.


Physiotherapy for a hamstring contusion

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Other intervention for a hamstring contusion

Despite appropriate physiotherapy management, some patients with a bruised hamstring do not improve adequately. When this occurs, the treating physiotherapist or doctor can advise on the best course of management. This may include investigations such as an Xray (to assess for myositis ossificans), ultrasound, CT scan or MRI, pharmaceutical intervention, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition.


Exercises for a hamstring contusion

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.


Initial Exercises

Static Hamstring Contraction

Begin this exercise in sitting with your knee bent to about 45 degrees (figure 2). Press your heel into the floor tightening the back of your thigh (hamstrings). Hold for 5 seconds and repeat 10 times as hard as possible pain free.

Exercises for a Hamstring Contusion - Static Hamstring Contraction

Figure 2 – Static Hamstring Contraction (right leg)

Knee Bend to Straighten

Lying on your back, slowly bend and straighten your knee as far as possible without increasing your pain and provided you feel no more than a mild to moderate stretch (figure 3). Repeat 10 – 20 times.

Exercises for a Hamstring Contusion -  Knee Bend to Straighten

Figure 3 – Knee Bend to Straighten (right leg)


Intermediate Exercises

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Advanced Exercises

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Other Exercises

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Rehabilitation Protocol

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Physiotherapy Products for a hamstring contusion   Physiotherapy products for a hamstring contusion

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:

  1. Crutches
  2. Ice Packs
  3. Compression Bandages

Physiotherapy products that may be beneficial after the initial 72 hour period following injury and under guidance by the treating physiotherapist include:

  1. Heat Packs
  2. Resistance Band (for strengthening exercises)
  3. Swiss Balls (for strengthening exercises)
  4. Spikey Massage Balls (for self massage)
  5. Foam Rollers (for self massage)

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