Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2012 Dec 12;12(12):CD004575.
doi: 10.1002/14651858.CD004575.pub3.

Rehabilitation for hamstring injuries

Duncan L Mason  1 , Victoria A Dickens, Andy Vail
Affiliations
Meta-Analysis

Rehabilitation for hamstring injuries

Duncan L Mason et al. Cochrane Database Syst Rev. .

Abstract

Background: Hamstring injuries are a common musculoskeletal disorder, particularly amongst athletes. Many factors have been associated with these injuries, including motor control and strength, soft tissue length and postural alignment. Well-established rehabilitation protocols are commonly used in the treatment of this condition, but their effectiveness remains questionable. This is an update of a Cochrane review first published in 2007.

Objectives: To evaluate the effectiveness of all rehabilitation strategies employed to promote the return to full strength, range of movement and function of those individuals presenting with all forms of hamstring injury, regardless of site, severity, onset or level of chronicity.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to September 2011), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2011 Issue 3), MEDLINE (including in-process & other non-indexed citations: 1966 to August 2011), EMBASE (1980 to September 2011), PEDro (2006 to June 2012), CINAHL (1937 to September 2011), AMED (1985 to September 2011), SPORTDiscus (1859 to February 2006), and the World Health Organisation International Clinical Trials Registry platform (April 2012).

Selection criteria: Randomised clinical trials investigating the effect of at least one rehabilitation strategy, in isolation or combination with another, compared with another strategy or control, performed on individuals presenting with hamstring injuries.

Data collection and analysis: Two review authors performed study selection. All review authors performed data extraction and assessed risk of bias. Any disagreement was resolved by discussion.

Main results: Two trials were included in the review, totaling 104 participants. One trial assessed additional (four times a day) versus once daily stretching and the other assessed exercise for movement dysfunction versus stretching and strengthening. The first trial, involving 80 elite athletes, suggested additional stretching could reduce time to return to full activity (mean difference (MD) -1.8 days, 95% confidence interval (CI) -2.1 to -1.5, P < 0.001). The second trial, involving 24 participants from a diverse sporting background, did not find conclusive evidence of a difference (MD -14.5 days, 95% CI -30.64 to 1.64, P = 0.08). It did, however, report reduced re-injury rates using exercise for movement dysfunction of 8% versus 64% (odds ratio (OR) 0.05, 95% CI 0.00 to 0.52, P = 0.01). No other outcomes relevant to this review were reported by either study: most notably pain and participant satisfaction.

Authors' conclusions: Most proposed physiotherapy techniques for rehabilitation of hamstring injuries have not been assessed using randomised trials. Those that have only have single studies with a limited range of participants and outcomes. There is limited evidence to suggest that time to recovery for elite athletes can be reduced with an increased daily frequency of hamstring stretching exercises. There is preliminary evidence from another small study of mixed ability athletes to suggest that exercise to correct movement dysfunction could reduce time to return to full activity and the risk of re-injury. Further studies are required to check these findings. Until further evidence is available, current practice and widely published rehabilitation protocols cannot either be supported or refuted.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Specific targeted intervention versus alternative intervention, outcome: 1.1 Return to full function [Days].
4
4
Forest plot of comparison: 1 Specific targeted intervention versus alternative intervention, outcome: 1.2 Exacerbation or re‐injury within 12 months.
1.1
1.1. Analysis
Comparison 1 Specific targeted intervention versus alternative intervention, Outcome 1 Return to full function.
1.2
1.2. Analysis
Comparison 1 Specific targeted intervention versus alternative intervention, Outcome 2 Exacerbation or re‐injury within 12 months.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Malliaropoulos 2004 {published and unpublished data}
    1. Malliaropoulos N, Papalexandris S, Papalada A, Papacostas E. The role of stretching in rehabilitation of hamstring injuries: 80 athletes follow‐up. Medicine and Science in Sports and Exercise 2004;36(5):756‐9. - PubMed
Sherry 2004 {published data only}
    1. Sherry MA, Best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. Journal of Orthopaedic & Sports Physical Therapy 2004;34(3):116‐25. - PubMed

References to studies excluded from this review

Askling 2003 {published data only}
    1. Askling C, Karlsson J, Thorstensson A. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scandinavian Journal of Medicine and Science in Sports 2003;13(4):244‐50. - PubMed
Chan 2001 {published data only}
    1. Chan SP, Hong Y, Robinson PD. Flexibility and passive resistance of hamstrings of young adults using two different static stretching protocols. Scandinavian Journal of Medicine and Science in Sports 2001;11(2):81‐6. - PubMed
Cibulka 1986 {published data only}
    1. Cibulka MT, Rose SJ, Delitto A, Sinacore DR. Hamstring muscle strain treated by mobilizing the sacroiliac joint. Physical Therapy 1986;66(8):1220‐3. - PubMed
Heiser 1984 {published data only}
    1. Heiser TM, Weber J, Sullivan G, Clare P, Jacobs RR. Prophylaxis and management of hamstring injuries in intercollegiate football players. American Journal of Sports Medicine 1984;12(5):368‐70. - PubMed
Kiminski 1998 {published data only}
    1. Kiminski TW, Wabbersen CV, Murphy RM. Concentric versus enhanced eccentric hamstring strength training:clinical implications. Journal of Athletic Training 1998;33(3):216‐21. - PMC - PubMed
Kornberg 1989 {published data only}
    1. Kornberg C, Lew P. The effect of stretching neural structures on grade one hamstring injuries. Journal of Orthopaedic and Sports Physical Therapy 1989;10(12):481‐7. - PubMed
Levine 2000 {published data only}
    1. Levine WN, Bergfeld JA, Tessendorf W, Moorman CT 3rd. Intramuscular corticosteroid injection for hamstring injuries. A 13‐year experience in the National Football League. American Journal of Sports Medicine 2000;28(3):297‐300. - PubMed
McGrath 2003 {published and unpublished data}
    1. McGrath E. personal communication March 23 2005.
    1. McGrath E. Hamstring strength profile after transversus abdominus training. Physiotherapy Ireland 2003;24(2):19.
Reynolds 1995 {published data only}
    1. Reynolds JF, Noakes TD, Schwellnus MP, Windt A, Bowerbank P. Non‐steroidal anti‐inflammatory drugs fail to enhance healing of acute hamstring injuries treated with physiotherapy. Suid‐Afrikaanse Tydskrif Vir Geneeskunde [South African Medical Journal] 1995;85(6):517‐22. - PubMed
Turl 1998 {published data only}
    1. Turl SE, George KP. Adverse neural tension: a factor in repetitive hamstring strain?. Journal of Orthopaedic and Sports Physical Therapy 1998;27(1):16‐21. [MEDLINE: ] - PubMed
Upton 1996 {published data only}
    1. Upton PA, Noakes TD, Juritz JM. Thermal pants may reduce the risk of recurrent hamstring injuries in rugby players. British Journal of Sports Medicine 1996;30(1):57‐60. [MEDLINE: ] - PMC - PubMed

Additional references

ACPSM 1998
    1. Association of Chartered Physiotherapists in Sports Medicine. Guidelines for the management of soft tissue (musculoskeletal) injury with Protection, Rest, Ice, Compression and Elevation (PRICE) during the first 72 hours. Chartered Society of Physiotherapy Guidelines 1998.
Brosseau 2002
    1. Brosseau L, Casimiro L, Milne S, Welch V, Shea B, Tugwell P, Wells GA. Deep transverse friction massage for treating tendinitis. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD003528] - DOI - PubMed
Croisier 2002
    1. Croisier JL, Forthomme B, Namurois MH, Vanderthommen M, Crielaard JM. Hamstring muscle strain recurrence and strength performance disorders. American Journal of Sports Medicine 2002;30(2):199‐203. - PubMed
Garrett 1984
    1. Garrett W, Califf J, Bassett F. Histochemical correlates of hamstring injuries. American Journal of Sports Medicine 1984;12(2):98‐103. - PubMed
Goldman 2010
    1. Goldman EF, Jones DE. Interventions for preventing hamstring injuries. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD006782.pub2] - DOI - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hunter 1998
    1. Hunter G. Specific soft tissue mobilization in the management of soft tissue dysfunction. Manual Therapy 1998;3(1):2‐11. - PubMed
Kellett 1986
    1. Kellett, J. Acute soft tissue injuries ‐ a review of the literature. Medicine and Science in Sports and Exercise 1986;18(5):489‐500. - PubMed
Kroll 1997
    1. Kroll PG, Raya MA. Hamstring muscles: An overview of anatomy, biomechanics and function, injury etiology, treatment and prevention. Critical Reviews in Physical & Rehabilitation Medicine 1997;9(3‐4):191‐203.
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6.4.11: Search filters. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Orchard 2002
    1. Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997‐2000. British Journal of Sports Medicine 2002;36(1):39‐44. - PMC - PubMed
Pomeranz 1993
    1. Pomeranz SJ, Heidt RS. MR imaging in prognostication of hamstring injury. Work in progress. Radiology 1993;189:897‐900. - PubMed
Van der Windt 1999
    1. Windt DA, Heijden GJ, Berg SG, Ter Riet G, Winter AF, Bouter LM. Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain 1999;81(3):257‐71. - PubMed
Woodley 2005
    1. Woodley SJ, Mercer SR. Hamstring muscles: architecture and innervation. Cells Tissues Organs 2005;179(3):125‐41. - PubMed
Worrell 1994
    1. Worrell TW. Factors associated with hamstring injuries: an approach to treatment and preventative measures. Sports Medicine 1994;17(5):338‐45. - PubMed

References to other published versions of this review

Mason 2007
    1. Mason DL, Dickens VA, Vail A. Rehabilitation for hamstring injuries. Cochrane Database of Systematic Reviews 2007, Issue 1. [DOI: 10.1002/14651858.CD004575.pub2] - DOI - PubMed

Publication types

MeSH terms