Written and medically reviewed by Dr. Carrie Jose, MSPT, DPT, cert. MDT · Updated October 21, 2026
Hamstring Pain is common – especially in active adults over 40.
But what’s less commonly talked about is how often a hamstring injury is misdiagnosed. If you’ve been stretching, foam rolling, and rehabbing your “hamstring strain” for weeks or months with little to no improvement – there’s a good chance your pain isn’t coming from your hamstring at all.
That’s because certain types of back problems can mimic hamstring pain almost perfectly. And if you don’t recognize the signs, you may end up chasing the wrong problem for far too long.
So how can you tell when your hamstring isn’t healing because it’s not really your hamstring?
Let’s take a look at what a true hamstring strain typically looks like – and then go over three clear signs that something else is actually going on.
What a true hamstring injury looks like:
A hamstring strain usually happens suddenly – often during an explosive movement like sprinting or lunging. You’ll feel a sharp pain in the back of your thigh, and possibly notice swelling, bruising, or tenderness. In the early stages, walking or bending your knee might be difficult. But with the right combination of rest, movement, and strengthening – most hamstring injuries heal well and don’t linger – especially when properly diagnosed and rehabbed.
If your pain doesn’t follow that pattern – or seems to be sticking around far longer than expected – there’s a good chance your spine is actually to blame.
Here are three key signs your “hamstring strain” might be something else entirely:
1. The pain never really goes away
A true muscle injury will hurt when it’s injured – but it heals. If your pain feels dull, achy, and persistent – especially after long periods of sitting or standing still – that’s a red flag.
This type of pain often stems from nerve irritation in the lower back, not muscle damage in your leg. It’s common for certain spinal problems to refer pain down the back of the thigh, which is why this gets misdiagnosed so often. But unlike a muscle strain, nerve-related pain doesn’t improve with time or basic rehab – and may even get worse with certain types of movement or exercise.
2. You notice tingling, numbness, or odd sensations
Muscles don’t cause tingling. Nerves do. In one small study of rugby players with repeat hamstring strains, more than half showed signs of nerve sensitivity on a nerve tension test, compared with none of the uninjured players[2]. So if your hamstring injury is accompanied by numbness, tingling, or an odd “buzzing” feeling in your butt or leg – it’s almost certainly a nerve issue. The sciatic nerve, which originates in your lower spine, travels right through the area where most people feel hamstring tightness. When that nerve gets irritated, it can create sensations that feel like they are coming from your hamstring – but aren’t.
If you’re experiencing these kinds of nerve symptoms – it’s a strong indicator that your spine (not your hamstring) is the real source of the problem – and it needs to be addressed.
Contact us to see how we can help relieve your pain.
3. Your pain travels below your knee
This one’s especially important. Your hamstrings attach just above and behind the knee – so pain you feel well below your knee is very unlikely to be coming from your hamstring.
If your discomfort travels down your calf or even into your heel, the likely culprit is your spine. In one study of 322 people with arm or leg pain, 43% turned out to have pain coming from the lower back or neck, the share was even higher for thigh and leg pain, and most of them had no back pain at the time[1]. So it’s very possible to have a perfectly healthy hamstring – but still feel pain there due to a nerve referral from your spine.
What to do next
If any of these signs sound familiar – don’t keep treating your hamstring like a muscle strain – it won’t help – and could even worsen your problem. Plus, the longer you focus on the wrong issue, the longer it will take to get better.
Instead, seek out a physical therapy specialist who understands how to properly screen and assess your spine. They’ll be able to figure out if your lingering hamstring pain is related to a problem in your lower back. And once you identify the true root of your pain – you can finally get the treatment you need – and get back to doing the activities you love.
Want more help with a hamstring that won’t heal? Download our free Back Pain Report or watch the Back Pain Masterclass replay.
Request a free Discovery Visit at CJ Physical Therapy
About Dr. Carrie Jose, MSPT, DPT, cert. MDT
Dr. Carrie Jose is the founder and owner of CJ Physical Therapy and Pilates in Portsmouth, NH, and has been helping people stay active, healthy, and mobile since 2002. She holds two degrees in physical therapy, is a comprehensively certified Pilates instructor, certified in Dry Needling, and holds a specialty certification in Mechanical Diagnosis and Treatment (McKenzie Method). She is also a physical therapy specialist and mechanical pain expert who writes for Seacoast Media Group. Carrie’s approach puts the person first, helping adults 40 and up move and feel better without pills, procedures, or surgery.
References
- Rosedale R, Rastogi R, Kidd J, Lynch G, Supp G, Robbins SM. A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS). J Man Manip Ther. 2020;28(4):222–230. doi:10.1080/10669817.2019.1661706
- Turl SE, George KP. Adverse neural tension: a factor in repetitive hamstring strain? J Orthop Sports Phys Ther. 1998;27(1):16–21. doi:10.2519/jospt.1998.27.1.16
