What is the appropriate assessment and treatment for a hamstring injury?

From the Guidelines

Assessment and treatment of a hamstring injury should prioritize a comprehensive approach, including the RICE protocol, pain management, and a gradual rehabilitation process, as evidenced by the most recent and highest quality studies 1. The initial assessment of a hamstring injury should involve a thorough medical history and physical examination to determine the severity of the injury.

• The RICE protocol (Rest, Ice, Compression, and Elevation) should be initiated immediately to reduce inflammation and promote healing.
• Pain management typically involves over-the-counter medications like ibuprofen (400-600mg three times daily with food) or acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) 1. The rehabilitation process should progress gradually through three phases:
• Acute (first 3-5 days focusing on controlling inflammation and gentle range of motion)
• Subacute (1-3 weeks incorporating progressive stretching and light strengthening)
• Functional (3-6 weeks adding sport-specific exercises and eccentric strengthening) 1. Specific exercises should include gentle hamstring stretches, progressive resistance training with hamstring curls, and eventually eccentric exercises like Nordic hamstring lowers. Return to activity should be gradual and only when the patient can perform sport-specific movements without pain, typically taking 2-8 weeks depending on injury severity. Hamstring injuries occur when the muscle is overstretched or overloaded, often during sprinting or sudden direction changes, and proper rehabilitation is essential to prevent recurrence, which is common with inadequate recovery. In terms of imaging, MRI is highly sensitive and specific for detecting hamstring injuries, as well as other soft tissue abnormalities, and should be considered if the diagnosis is unclear or if the patient's symptoms persist despite adequate treatment 1.

From the Research

Assessment for Hamstring Injury

• The assessment of hamstring injuries typically involves a combination of clinical evaluation and imaging tests, such as Magnetic Resonance Imaging (MRI) and ultrasound (US) 2.
• Clinical measures, including palpation, swelling, and manual resistance, can be used to diagnose hamstring injuries, but their diagnostic accuracy is limited 3.
• Specific clinical tests, such as the active range-of-motion test and the taking-off-the-shoe test, have been investigated for their diagnostic accuracy, but further studies are needed to determine their clinical utility 3.
• Daily physical measures, including strength, flexibility, and palpation pain, can be useful in informing the progression of rehabilitation and perceived running effort 4.

Imaging Tests

• MRI is considered the gold standard for diagnosing hamstring injuries and can help guide treatment 5, 2.
• Ultrasound (US) is also a useful imaging modality for diagnosing hamstring injuries, particularly in the initial stages 2.
• MRI and US can provide complementary information on injury length, connective tissue involvement, and tear location, which can determine evolution, recovery strategies, and return to play 6.

Treatment

• Treatment for hamstring injuries is dictated by the specific tendon(s) injured, tear location, severity, and chronicity 5.
• Many hamstring injuries can be successfully managed with nonoperative measures, such as activity modification and physical therapy, while others may require operative treatment, such as endoscopic or open approaches 5.
• Adjuncts, such as platelet-rich plasma injections, are currently being investigated for the treatment of hamstring injuries 5.