From the Guidelines
The best management for a grade 3c hamstring injury involves a comprehensive rehabilitation approach, prioritizing eccentric training, such as flywheel resistance training, to stimulate specific neuromuscular and morphological adaptations, reducing the likelihood of re-injury and promoting optimal recovery. This approach is based on the most recent evidence from 2024, which highlights the benefits of flywheel resistance training in reducing the likelihood of muscular injuries, including hamstring injuries 1. The rehabilitation process should start with the POLICE protocol (Protection, Optimal Loading, Ice, Compression, Elevation) during the acute phase, followed by a gradual progression of physical therapy, including:
- Gentle range of motion exercises and isometric contractions in the early phase
- Progressive strengthening with eccentric exercises, such as Nordic hamstring curls, Romanian deadlifts, and bridge variations, gradually increasing in intensity
- Sport-specific training to ensure a safe return to sports activities Pain management with NSAIDs, such as ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily), and acetaminophen (1000mg four times daily) if needed, should be considered for 5-7 days. Complete rest from sports activities is essential for 4-6 weeks, and surgical consultation may be necessary if there is complete tendon avulsion or a significant gap between torn ends on imaging. Return to sport typically takes 3-6 months and should only occur when the patient has regained at least 90% strength compared to the uninjured side, has full pain-free range of motion, and can complete sport-specific movements without compensation, as supported by the latest research on flywheel resistance training 1.
From the Research
Management of Grade 3c Hamstring Injury
- The management of grade 3c hamstring injuries is a complex process, and the optimal treatment approach is still being researched and debated 2, 3, 4, 5, 6.
- Nonoperative measures such as activity modification and physical therapy are often used to manage hamstring injuries, with adjuncts like platelet-rich plasma (PRP) injections being investigated as potential treatments 3.
- PRP injections have shown promise in reducing recovery time and improving outcomes for hamstring injuries, but the evidence is not yet conclusive, with some studies showing benefits and others showing no significant difference compared to rehabilitation alone 2, 4, 5, 6.
- A systematic review and meta-analysis found that PRP injection plus physical therapy may reduce mean time to return to play and reinjury rates compared to physical therapy alone, but the evidence was not statistically significant 6.
- The use of PRP injections for hamstring injuries is still being researched, and more high-quality studies are needed to fully understand its effectiveness and potential benefits 2, 6.
- Operative treatment, such as endoscopic or open approaches, may be considered for proximal hamstring injuries with significant retraction or for injuries that do not improve with nonoperative management 3.
- The treatment approach for grade 3c hamstring injuries should be individualized and based on the specific injury pattern, severity, and patient presentation, with a comprehensive rehabilitation program being a crucial component of the treatment plan 3, 4, 5.