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Grade 1 - A sensation of a cramp or tightness and a slight feeling of pain when the muscles are stretched or contracted. Grade 2 - With a grade two hamstring strain there is immediate pain which is more severe than the pain of a grade one injury. It is confirmed by pain during stretch and contraction of the muscle. It can be also felt with a ping feeling, like elastic in the muscle. Grade 3 - Bruising due to strained hamstring, horizontal lines show where bandage was. A grade three hamstring strain is a severe injury. There is an immediate burning or stabbing pain and the athlete is unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is. After a few days with grade two and three injuries a large bruise may appear below the injury site caused by the bleeding within the tissues.
Recommended treatment for this injury consists of the RICE protocol - rest, ice, Compression - Use an elastic bandage to avoid swelling, and elevation. The RICE method is primarily used to reduce bleeding and damage within the muscle tissue. Lower grade strains can easily become worse if the hamstring is not rested properly. Grade one hamstrings should be rested from sporting activity for approximately three weeks, and grade two injuries typically require four to six weeks for recovery. Complete ruptures require surgical repair and rehabilitation for approximately three months. Initial treatment of the injury, regardless of the severity of the strain, is the same. Within the first five days, the hamstring is rested in an elevated position with an ice pack applied for 20 minutes every two hours. A compression bandage is applied to limit bleeding and swelling in the tissues. After five days of rest, active rehabilitation begins. Given that rest is such a crucial factor in recovery, crutches may be necessary for long distance travel. For short distances, crutches are unnecessary; however, use of crutches during travel may prevent worsening the grade of the strain.