Not All Hamstring Injuries Are the Same

Hamstring tears are one of the most common injuries sustained by artistic athletes, but they require special management.
By
Ashleigh Flanagan
February 17, 2026

The way you injure your hamstring really matters.

If you are a dancer, gymnast, aerialist or acrobat, it will not surprise you to learn that hamstring tears are one of the most common injuries sustained by artistic athletes (Nicholas et al., 2022; Scott et al., 2024). Hamstring injuries in this population are usually associated with splits, stretching and flexibility training (Nicholas et al., 2022; Scott et al., 2024).

Unfortunately, hamstring injuries linked to stretching appear to be understudied (and potentially under-reported). A 2022 systematic review of 34 studies on acute hamstring tears included only two that reported on stretching-related injuries, meaning that stretching-related injuries accounted for just 3% of hamstring injuries (Grange, 2022). Most studies on hamstring injuries have focused on running-based athletes, such as soccer and football players, a cohort at lower risk of stretching-related injuries, or do not classify the mechanism of injury.

Running-based athletes most commonly injure their biceps femoris (one of the three hamstring muscles) at the muscle belly during sprinting (Heet et al., 2019). The tear is usually the result of high muscle activation (Askling et al., 2011; Danielsson et al., 2020). The injury often affects walking and can result in dramatic bruising, depending on the degree of the tear. This is known as a type 1 hamstring injury (Grange, 2022).

In contrast, artistic athletes usually tear their semimembranosus (another hamstring muscle) at the musculotendinous junction during loaded lengthening of the muscle (Askling et al., 2011; Deleget, 2010). Unfortunately, the extent of muscle damage can be underestimated because walking may not be affected and bruising is often minimal or absent (Askling et al., 2011; Deleget, 2010). It is not uncommon for artistic athletes to continue training or performing following an injury, whereas running-based athletes may have to hobble off the field.

Despite initially appearing less severe, stretching-related hamstring injuries, known as type 2 hamstring injuries, take longer to heal than other hamstring tears and are more likely to become chronic (Askling et al., 2011; Deleget, 2010). Artistic athletes may also delay seeking treatment because the injury does not seem serious, as they can often continue training with modification. Similarly, health practitioners may underestimate the extent of tissue damage, as early functional recovery is common in this cohort.

I have spoken to many artistic athletes who tell me they “niggled” their hamstring while stretching years ago and, despite seeming to improve quickly at first, it has never been the same since. While they may have returned to training, they are often limited by pain and reduced flexibility. They are also worried about reinjuring the hamstring, so they can find themselves in a cycle of avoidance that leaves them with less capacity and tolerance for stretching.

Early rehabilitation is beneficial for all hamstring injuries (Bayer et al., 2017), especially those caused by stretching or flexibility training. Rapid early symptom improvement does not necessarily mean that the tear is minor or that the injury will resolve quickly. Ideally, have your injury assessed early by a health professional who is familiar with artistic athletes. Rehabilitation needs to include a graded return to split and flexibility training, not just a return to general training while avoiding splits.

Be assessed by physiotherapists experiences in managing flexibility related hamstring injuries: airspace.cliniko.com/bookings

References:
Askling, C. M., Malliaropoulos, N., & Karlsson, J. (2011). High-speed running type or stretching-type of hamstring injuries makes a difference to treatment and prognosis. British Journal of Sports Medicine, 46(2), 86–87. https://doi.org/10.1136/bjsports-2011-090534
Bayer, M. L., Magnusson, S. P., & Kjaer, M. (2017). Early versus Delayed Rehabilitation after Acute Muscle Injury. New England Journal of Medicine, 377(13), 1300–1301. https://doi.org/10.1056/nejmc1708134
Danielsson, A., Horvath, A., Senorski, C. et al. The mechanism of hamstring injuries – a systematic review. BMC Musculoskelet Disord 21, 641 (2020). https://doi.org/10.1186/s12891-020-03658-8
Deleget, A. (2010). Overview of Thigh Injuries in Dance. Journal of Dance Medicine & Science, 14(3), 97–102. https://doi.org/10.1177/1089313x1001400304
Grange, S., Reurink, G., Nguyen, A. Q., Riviera-Navarro, C., Foschia, C., Croisille, P., & Edouard, P. (2022). Location of Hamstring Injuries Based on Magnetic Resonance Imaging: A Systematic Review. Sports Health: A Multidisciplinary Approach, 15(1), 194173812110710. https://doi.org/10.1177/19417381211071010
Heer, S. T., Callander, J. W., Kraeutler, M. J., Mei-Dan, O., & Mulcahey, M. K. (2019). Hamstring Injuries. The Journal of Bone and Joint Surgery, 101(9), 843–853. https://doi.org/10.2106/jbjs.18.00261
Kuske, B., Hamilton, D. F., Pattle, S. B., & W. Simpson, H. R. (2016). Patterns of Hamstring Muscle Tears in the General Population: A Systematic Review. PLOS ONE, 11(5), e0152855. https://doi.org/10.1371/journal.pone.0152855
Nicholas, J., Weir, G., Alderson, J. A., Stubbe, J. H., van Rijn, R. M., Dimmock, J. A., Jackson, B., & Donnelly, C. J. (2022). Incidence, Mechanisms, and Characteristics of Injuries in Pole Dancers: A Prospective Cohort Study. Medical Problems of Performing Artists, 37(3), 151–164. https://doi.org/10.21091/mppa.2022.3022

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