Hamstring and Groin Injuries in Sydney

What Are Hamstring and Groin Injuries?

Hamstring and groin injuries can cause pain, weakness and reduced confidence during walking, running, kicking or changing direction. They range from mild muscle strains to more significant tendon tears and persistent overload-related conditions. Although these injuries are particularly common in sport, they can also occur during work, exercise or everyday activity.

The hamstrings run along the back of the thigh, while the groin contains several muscles, tendons and other structures around the inner thigh, hip and pelvis. Because pain in these regions can have several possible causes, an accurate diagnosis is important before deciding on treatment. Many injuries can be managed without surgery through activity modification, progressive strengthening and physiotherapy for hip injuries.

This page explains the common types of hamstring and groin injuries, their symptoms, how they are diagnosed and the available treatment options. More significant injuries, including selected tendon avulsions or persistent structural problems, may require assessment by an orthopaedic surgeon.

The hamstrings are a group of three muscles located at the back of the thigh: the biceps femoris, semitendinosus and semimembranosus. These muscles begin near the lower part of the pelvis and extend towards the knee, helping to bend the knee, extend the hip and control the leg during walking, running, jumping and rapid changes of direction.

A hamstring injury may involve the muscle fibres, the junction between the muscle and tendon, or the tendon itself. Injuries near the pelvis are known as proximal hamstring injuries and can cause pain in the lower buttock, particularly during running, bending forward or prolonged sitting.

The groin is the region where the lower abdomen meets the inner thigh. It contains the adductor muscles, hip flexors, abdominal wall, inguinal structures, pubic region and parts of the hip joint. A groin strain most commonly affects the adductor muscles, which help draw the leg towards the body's midline and provide stability during walking, running and kicking.

Not all groin pain is caused by a strained muscle. Symptoms may also arise from the adductor tendons, iliopsoas tendon, pubic symphysis, abdominal or inguinal structures, hip joint or referred pain from the lumbar spine. Careful assessment may therefore be required to identify the underlying cause.

What Conditions Can Hamstring and Groin Injuries Include?

Hamstring muscle strain

A hamstring strain occurs when muscle fibres are overstretched or overloaded. It commonly develops during sprinting, acceleration, kicking or sudden stretching movements. Mild strains may cause localised discomfort, while larger injuries can result in bruising, swelling, weakness and difficulty walking or running.

Partial hamstring tear

A partial hamstring tear involves disruption of some, but not all, muscle or tendon fibres. Symptoms are often more severe than a mild strain and may include a sudden tearing sensation, weakness, bruising and pain when bending the knee or extending the hip.

Treatment depends on the size and location of the injury, the amount of weakness and the patient's work, recreational or sporting requirements.

Complete proximal hamstring avulsion

A proximal hamstring avulsion occurs when one or more hamstring tendons pull away from their attachment on the pelvis. This may occur during a forceful movement combining hip flexion with knee extension, such as slipping, waterskiing or an unexpected overstretching injury.

Patients may experience a sudden pop, severe buttock or posterior thigh pain, extensive bruising and marked weakness. Because complete tendon avulsions may require different treatment from routine muscle strains, early specialist assessment is often recommended.

Proximal hamstring tendinopathy

Proximal hamstring tendinopathy is a persistent tendon condition that develops gradually rather than following a single traumatic event. It commonly causes deep pain beneath the buttock during running, lunging, bending forward or sitting for prolonged periods.

Symptoms often fluctuate with activity and may continue if the tendon is repeatedly exposed to more load than it can currently tolerate.

Adductor strain

An adductor strain affects one or more of the muscles along the inner thigh. It frequently occurs during kicking, side-stepping, rapid changes of direction or slipping. Pain is usually felt within the groin or inner thigh and may worsen when squeezing the legs together or accelerating.

Adductor tendon injury

The adductor tendons connect the inner thigh muscles to the pelvis. Repetitive loading may contribute to tendon pain, while a sudden forceful movement can result in a partial or complete tendon tear.

Pain is often felt close to the pubic bone and may become worse during sprinting, kicking or resisted leg movements.

Sports groin injury

The term sports groin injury describes pain involving the adductor, inguinal, pubic or lower abdominal region. Terms such as athletic pubalgia or sports hernia may also be used, although they do not always refer to the same condition.

Careful examination can help determine which anatomical structure or combination of structures is contributing to the symptoms.

Hip-related or referred groin pain

Not all groin pain originates within the groin itself. Conditions such as femoroacetabular impingement, hip labral tears and hip osteoarthritis may produce pain in the groin.

Symptoms can also be referred from the lumbar spine or associated with nerve irritation, making an accurate diagnosis particularly important.

What Causes Hamstring and Groin Injuries?

Hamstring and groin injuries occur when the forces placed on muscles or tendons exceed their ability to tolerate load. While sporting activities commonly contribute, these injuries can also develop during work, recreational exercise or everyday activities.

Common contributing factors include:

• sprinting or rapid acceleration;
• sudden deceleration;
• kicking sports such as football or soccer;
• changing direction at speed;
• overstretching the hip or knee;
• slipping or falling into a split position;
• repeated running or high training loads;
• muscle fatigue;
• returning to activity before strength has recovered;
• a previous hamstring or groin injury;
• reduced conditioning; and
• sudden increases in training volume or intensity.

In many cases, more than one contributing factor is involved. Fatigue, previous injury, reduced tissue capacity and increasing training demands may all influence the likelihood of developing symptoms.

Symptoms of Hamstring and Groin Injuries

Symptoms depend on the structure involved, the location of the injury and its severity. Some injuries cause immediate pain, while tendon conditions may develop gradually over several weeks or months.

Symptoms of an acute injury

• sudden pain in the hamstring, buttock, groin or inner thigh;
• a pulling, tearing or popping sensation;
• swelling or bruising;
• weakness when walking or bending the knee;
• difficulty running, kicking or changing direction;
• limping; and
• a visible or palpable muscle defect in more severe injuries.

Symptoms of a gradual-onset condition

• pain that develops during or after activity;
• lower buttock pain while sitting;
• groin discomfort during running or kicking;
• morning stiffness;
• reduced strength; and
• recurring symptoms whenever activity levels increase.

When Should You Seek Medical Assessment?

Mild muscle soreness may settle with temporary activity modification. Medical assessment is recommended when pain is persistent, recurrent, worsening or affecting normal daily activities.

Prompt assessment may be appropriate if you experience:

• a sudden pop followed by significant pain or weakness;
• extensive bruising or swelling;
• difficulty walking or bearing weight;
• severe buttock pain following an overstretching injury;
• a suspected tendon rupture;
• numbness or tingling down the leg;
• pain following significant trauma; or
• symptoms that continue to worsen.

MRI

MRI provides detailed images of muscles, tendons and surrounding soft tissues. It may be recommended when a significant muscle tear, tendon avulsion or another structural injury is suspected, or when surgery is being considered.

Ultrasound

Musculoskeletal ultrasound may be useful for assessing selected muscle and tendon injuries, particularly superficial structures. Its usefulness depends on the location of the injury and the experience of the practitioner performing the scan.

X-rays

X-rays do not show muscle injuries directly but may be recommended when an avulsion fracture, hip condition or other bony abnormality is suspected.

Is imaging always required?

No. Many straightforward hamstring strains and groin injuries can be diagnosed clinically. Imaging is generally reserved for more significant injuries, persistent symptoms, uncertain diagnoses or situations where surgical management is being considered.

Non-Surgical Treatment Options

Most hamstring strains and many groin injuries improve with appropriate non-surgical treatment. The most suitable approach depends on the diagnosis, injury severity, symptoms, functional limitations and individual goals.

Activity modification

Activities that substantially aggravate symptoms may need to be reduced temporarily while maintaining comfortable movement wherever possible. Complete rest is rarely required, and prolonged inactivity may contribute to muscle weakness and delayed recovery.

Pain management

Simple pain-relieving medication may be appropriate for some patients. Medication should be discussed with a GP, pharmacist or treating clinician to ensure it is suitable for the patient's medical history and circumstances.

Physiotherapy

Physiotherapy commonly focuses on restoring movement, rebuilding hamstring or adductor strength and gradually increasing the amount of load the injured tissues can tolerate. Rehabilitation should be based on the specific diagnosis rather than using the same program for every injury.

Progressive strengthening

Strengthening may include isometric, concentric and eccentric exercises. Rehabilitation can then progress towards functional activities such as running, acceleration, kicking and change-of-direction drills as recovery allows.

Exercise physiology and conditioning

Once the injury has stabilised, exercise physiology rehabilitation may help restore strength, conditioning and confidence while supporting a safe return to work, recreation or sport.

Injections

Injections may be considered for selected persistent tendon conditions but are not routinely required for every hamstring or groin injury. Their role depends on the diagnosis and should be discussed with an appropriately qualified clinician.

When Might Surgical Assessment Be Considered?

Surgery is not commonly required for routine hamstring strains or most groin injuries. It may be considered when there is significant tendon damage, ongoing loss of function or persistent symptoms despite appropriate non-surgical treatment.

The decision is based on the diagnosis, examination findings, imaging results and the individual's activity goals rather than pain alone.

Situations where surgical assessment may be appropriate include:

• a complete proximal hamstring tendon avulsion;
• multiple hamstring tendons detached from the pelvis;
• significant tendon retraction shown on MRI;
• persistent weakness following a partial tendon tear;
• failure to improve after an appropriate rehabilitation program;
• selected structural groin conditions requiring surgical repair; or
• high work or sporting demands where restoring tendon function is particularly important.

The decision to proceed with surgery is individualised. Age, general health, activity level, tissue quality, the timing of the injury and rehabilitation goals all contribute to determining the most appropriate treatment.

Who May Be Suitable for Hamstring Tendon Surgery?

Patients being considered for proximal hamstring repair undergo a detailed assessment to determine whether surgery is likely to provide meaningful benefit. Imaging findings alone do not determine suitability, and treatment recommendations are made after considering the whole clinical picture.

Your surgeon may consider:

• the number of tendons involved;
• the degree of tendon retraction;
• whether the injury is recent or longstanding;
• the amount of weakness or functional limitation;
• whether sciatic nerve symptoms are present;
• the response to physiotherapy and rehabilitation;
• work, recreational and sporting requirements; and
• general health and the ability to participate in postoperative rehabilitation.

Patients with mild muscle strains or injuries that continue to improve through rehabilitation generally do not require surgery.

How Is Proximal Hamstring Repair Performed?

Before surgery

Before surgery, your surgeon reviews your symptoms, examination findings and imaging to confirm the diagnosis. The consultation also covers the expected benefits, potential risks, alternative treatment options and the rehabilitation process following surgery.

During surgery

Proximal hamstring repair is usually performed through an incision beneath the buttock. The surgeon identifies the torn tendon, protects nearby structures such as the sciatic nerve and prepares the tendon attachment site on the pelvis.

The tendon is then secured back to the bone using specialised anchors or another suitable fixation technique. Longstanding injuries can be more technically demanding because the tendon may have retracted and scar tissue may have developed.

After surgery

Following surgery, the repair requires protection while the tendon heals. Crutches, temporary movement restrictions or a brace may be recommended depending on the repair performed.

A structured rehabilitation program then progresses through several stages under the guidance of the treating team.

Benefits and Goals of Surgery

The primary aim of surgery is to restore tendon attachment and improve function where this is considered achievable and appropriate.

Potential goals may include:

• restoring the hamstring tendon attachment to the pelvis;
• improving hamstring strength and stability;
• reducing symptoms associated with a detached tendon;
• supporting return to work, recreation or sporting activities; and
• addressing nerve irritation where it is directly related to the injury.

Although many patients experience meaningful improvement, surgery cannot guarantee complete pain relief, full strength or return to previous sporting performance. Outcomes vary according to the injury pattern, timing of surgery, tissue quality, rehabilitation and individual health factors.

Risks and Considerations

All surgical procedures involve potential risks. Your surgeon will discuss those most relevant to your individual circumstances before any operation is undertaken.

Potential risks of proximal hamstring repair may include:

• infection;
• bleeding or haematoma;
• blood clots;
• delayed wound healing;
• sciatic nerve irritation or injury;
• numbness around the surgical site;
• persistent weakness;
• ongoing pain or sitting discomfort;
• re-tear or incomplete healing;
• stiffness;
• incomplete return to previous activity levels; and
• general risks associated with anaesthesia.

Older injuries may involve additional challenges because tendon retraction and scar tissue can make repair more complex.

Recovery and Rehabilitation

Recovery varies depending on whether the injury is treated non-surgically or surgically. The severity of the injury, tissue quality, general health, previous injuries and participation in rehabilitation can all influence progress.

Early recovery after a muscle injury

Most muscle strains are initially managed by reducing activities that aggravate symptoms while maintaining comfortable movement. Rehabilitation progresses gradually as pain settles and strength returns.

Recovery from hamstring tendinopathy

Hamstring tendinopathy generally improves through progressive strengthening rather than prolonged rest. Exercises are increased gradually according to symptom response and functional progress.

Early recovery after tendon repair

Following surgery, patients often require crutches and temporary restrictions to protect the repair. Sitting, stretching and certain hip movements may be limited during the early stages of healing.

Physiotherapy and rehabilitation

Rehabilitation usually progresses through several phases, beginning with gentle movement and muscle activation before advancing to strengthening, balance training, running drills and sport-specific exercises.

Progression is based on healing, strength and function rather than time alone.

Return to work

Return to work depends on the physical requirements of the occupation. Desk-based work may require temporary sitting modifications, while physically demanding roles often require a longer rehabilitation period before unrestricted duties can resume.

Return to sport or physical activity

Returning to sport requires more than waiting for pain to improve. Readiness is commonly assessed using strength, movement, running tolerance, sport-specific function and confidence with higher-speed activities.

A gradual return to training is generally recommended before returning to competition.

How Surgery Compares with Non-Surgical Treatment

Most hamstring strains, adductor strains and many tendon injuries respond well to structured rehabilitation without surgery. Non-surgical treatment avoids surgical risks while allowing muscles and tendons to recover through progressive loading.

Surgery is generally reserved for selected complete tendon avulsions, significantly retracted tendon tears or persistent structural injuries where restoring tendon attachment may improve function.

Even when surgery is performed, rehabilitation remains an essential part of recovery. The most appropriate treatment depends on the diagnosis rather than the severity of pain alone.

Reducing the Risk of Re-Injury

Although not every injury can be prevented, several measures may reduce the likelihood of future hamstring or groin injuries.

• restoring hamstring and adductor strength;
• improving hip and trunk stability;
• gradually increasing running speed and training load;
• including sprint and change-of-direction drills during rehabilitation;
• allowing adequate recovery between demanding training sessions;
• completing rehabilitation before returning to unrestricted sport;
• maintaining flexibility and an appropriate warm-up routine; and
• addressing previous movement or strength deficits.

Questions to Ask Your Surgeon

• What is causing my symptoms?
• Do I have a muscle injury or a tendon injury?
• Would additional imaging be helpful?
• Can my injury be managed without surgery?
• What are the advantages and disadvantages of surgery in my situation?
• How long is rehabilitation likely to take?
• When might I return to work?
• When could I safely return to sport?
• What risks should I be aware of?
• What may happen if I choose not to have surgery?

Specialist Assessment for Hamstring and Groin Injuries

Hamstring and groin injuries range from relatively minor muscle strains to complex tendon injuries and persistent causes of groin pain. While most patients improve with structured non-surgical treatment, an accurate diagnosis is important when selecting the most appropriate management plan.

If you have persistent pain, significant weakness, a suspected tendon rupture or symptoms that have not improved despite rehabilitation, specialist assessment may help clarify the diagnosis and determine whether continued conservative treatment or surgical management may be appropriate.

Book an assessment with MTP Health in Sydney to discuss your hamstring or groin symptoms, review any relevant imaging and consider the treatment options suitable for your circumstances.

Your Surgeon

Frequently asked questions