From the Guidelines
Management of a grade 2 hamstring injury should prioritize a progressive rehabilitation approach, focusing on the RICE protocol, pain management, and gradual strengthening exercises, as outlined in the most recent guidelines 1. The initial 48-72 hours are crucial in reducing pain and swelling, and the application of ice is recommended to achieve this, with the most effective method being a bag filled with ice and water surrounded by a damp cloth, applied for 20 to 30 minutes, 3 to 4 times daily 1. Key aspects of the rehabilitation approach include:
- Rest and limiting the use of the injured extremity to avoid worsening the injury
- Cold application to decrease pain and swelling
- Gentle stretching and progressive strengthening exercises, starting with isometric contractions and advancing to eccentric exercises as tolerated
- Gradually increasing activity levels based on pain response
- Return to sports only when full strength, flexibility, and functional movement are restored
- Physical therapy to guide the progression and prevent premature return to activity, which significantly increases reinjury risk 1. It is essential to note that while cold application can decrease pain and swelling, it has not been demonstrated to improve function or time to recovery, emphasizing the need for a comprehensive rehabilitation approach 1.
From the Research
Management of Grade 2 Hamstring Injuries
The management of grade 2 hamstring injuries can be complex and may involve various treatment options. Some of the key considerations include:
- Nonoperative measures such as activity modification and physical therapy 2
- Adjuncts such as platelet-rich plasma (PRP) injections, which have shown promise in treating hamstring injuries 3, 4
- The use of PRP injections has been shown to be more effective than rehabilitation programs alone in treating grade 2 hamstring injuries, with patients achieving full recovery significantly earlier than controls 3
- PRP injections have also been shown to provide better short-term pain relief compared to steroid injections 4
Treatment Options
Some of the treatment options for grade 2 hamstring injuries include:
- Platelet-rich plasma (PRP) injections, which have been shown to be effective in treating hamstring injuries 3, 4, 5
- Rehabilitation programs, which can be used alone or in combination with PRP injections 3, 2
- Electrophysical therapy and various soft-tissue-based and exercise-based techniques, which have been traditionally used to treat hamstring injuries 6
- Surgical treatment, which may be reserved for more severe injuries or those that do not respond to nonoperative management 2
Considerations for Treatment
When considering treatment options for grade 2 hamstring injuries, some of the key factors to consider include:
- The severity of the injury, with more severe injuries potentially requiring more aggressive treatment 2
- The location of the injury, with proximal hamstring injuries potentially requiring different treatment approaches than distal hamstring injuries 2
- The patient's overall health and medical history, which can impact the effectiveness of different treatment options 2
- The patient's goals and expectations, with athletes potentially requiring more aggressive treatment to return to play as quickly as possible 3, 4, 5