Hamstring Strain Injury Rehabilitation

Abstract

Hamstring strain injuries are common among athletes and often require rehabilitation to prepare players for a timely return to sport performance while also minimizing reinjury risk. Return to sport is typically achieved within weeks of the injury; however, subsequent athlete performance may be impaired, and reinjury rates are high. Improving these outcomes requires rehabilitation practitioners (eg, athletic trainers and physical therapists) to understand the causes and mechanisms of hamstring strain injury, know how to perform a thorough clinical examination, and progress loading to the site of injury safely and effectively. This narrative review discusses current clinical concepts related to these aspects of rehabilitation for hamstring strain injury, with the aim of helping practitioners improve athletes' outcomes. Collectively, this knowledge will inform the implementation of evidence-based rehabilitation interventions.

Figure 1

Active knee-extension tests performed with the athlete lying supine and holding the thigh at either A, 90° or B, maximal hip flexion. Range of motion can be assessed by placing an inclinometer on the anterior tibial border and instructing the athlete to extend the knee until the maximal tolerable stretch is achieved.

Figure 2

Isometric strength testing of the knee flexors in A, prone position at 0° of hip and 15° of knee flexion and B, supine position at 90° of hip and 90° of knee flexion and of the hip extensors in C, prone position at 0° of hip and 90° of knee flexion and D, supine position at 0° of hip and 0° of knee flexion.

Figure 3

Example of 3-stage progressive running protocol over 100 m, accounting for greater acceleration distances and more gradual-intensity increases at higher percentages of maximal velocity.

Figure 4

Example of progression of exercises targeting eccentric knee-flexion (white) and hip-extensor strength at long (black) and short (gray) hamstring muscle lengths. Abbreviation: ROM, range of motion.