Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention

Abstract

Synopsis: Hamstring strain injuries remain a challenge for both athletes and clinicians, given their high incidence rate, slow healing, and persistent symptoms. Moreover, nearly one third of these injuries recur within the first year following a return to sport, with subsequent injuries often being more severe than the original. This high reinjury rate suggests that commonly utilized rehabilitation programs may be inadequate at resolving possible muscular weakness, reduced tissue extensibility, and/or altered movement patterns associated with the injury. Further, the traditional criteria used to determine the readiness of the athlete to return to sport may be insensitive to these persistent deficits, resulting in a premature return. There is mounting evidence that the risk of reinjury can be minimized by utilizing rehabilitation strategies that incorporate neuromuscular control exercises and eccentric strength training, combined with objective measures to assess musculotendon recovery and readiness to return to sport. In this paper, we first describe the diagnostic examination of an acute hamstring strain injury, including discussion of the value of determining injury location in estimating the duration of the convalescent period. Based on the current available evidence, we then propose a clinical guide for the rehabilitation of acute hamstring injuries, including specific criteria for treatment progression and return to sport. Finally, we describe directions for future research, including injury-specific rehabilitation programs, objective measures to assess reinjury risk, and strategies to prevent injury occurrence. Level of Evidence: Diagnosis/therapy/prevention, level 5. J Orthop Sports Phys Ther 2010;40(2):67–81. doi:10.2519/jospt.2010.3047

Evaluation and Imaging of an Untreated Grade III Hamstring Tear: A Case Report

“…3 of these injuries recur within the first year after a return to sports, with subsequent injuries being more severe than the original injury [16]. Our patient at 1 year after injury had no recurrence despite participating at the same level of sport.…”

“…Nonsurgical management is the standard of care for myotendinous injuries [29], although the required rehabilitation can be protracted from 6 to 50 months [16]. Tests that measure strength, ROM, and pain can provide a reasonable estimate of rehabilitation duration in injuries involving the intramuscular tendon and adjacent muscle fibers [39,43].…”

“…Tests that measure strength, ROM, and pain can provide a reasonable estimate of rehabilitation duration in injuries involving the intramuscular tendon and adjacent muscle fibers [39,43]. However, for injuries to the proximal free tendon, the amount of impairment identified from these tests does not predict the recovery time needed to return to preinjury level [16].…”

Complications of muscle injuries

“…Extrinsic factors are premature return-to-play, inadequate training, muscle strength imbalances, decreased flexibility, increasing age, and history of prior injury. Intrinsic factors are persistent weakness in the injured muscle, reduced extensibility of the musculo-tendon unit due to residual scar tissue and adaptive changes in the biomechanics and motor patterns of sporting movements following the original injury [11,13].…”

The Effects of a Closed-Chain, Eccentric Training Program on Hamstring Injuries of a Professional Football Cheerleading Team

“…In 1 study, biceps femoris strain injuries accounted for 80% of the total 170 hamstring injuries analyzed [7,8]. To understand the effects of hamstring injuries and to find ways to treat and prevent it, researchers have examined various exercise interventions that focus on closed-chain and eccentric mechanisms.…”