What is the treatment for a hamstring tear?

Treatment for Hamstring Tears

The treatment for hamstring tears should begin with rest, ice, compression, and elevation (RICE) in the acute phase, followed by progressive rehabilitation including stretching and strengthening exercises, with surgical intervention reserved only for complete tears with significant retraction or cases that fail conservative management after 6 months. 1

Initial Assessment and Classification

• Hamstring tears typically occur during eccentric contraction (when the muscle develops tension while lengthening) 2
• Location of tears can be:
  • Proximal (at the ischial tuberosity)
  • Mid-substance (muscle belly)
  • Distal (insertion on tibia or fibula)
• MRI is the gold standard for diagnosis and helps guide treatment decisions 1

Conservative Management (First-Line Treatment)

Acute Phase (First 24-72 hours)

1. RICE Protocol:

   • Rest: Avoid activities that cause pain
   • Ice: Apply for 15-20 minutes every 2-3 hours
   • Compression: Use elastic bandage to reduce swelling
   • Elevation: Keep the injured area elevated when possible

2. Pain Management:

   • NSAIDs may be used for pain relief, though evidence for their effectiveness specifically in hamstring tears is limited 3

Early Rehabilitation Phase (Days 3-14)

1. Short period of relative immobilization to accelerate formation of granulation tissue matrix 2

   • Duration depends on tear severity

2. Gentle Range of Motion Exercises:

   • Begin as pain allows
   • Avoid excessive stretching that could disrupt healing tissue

Progressive Rehabilitation Phase (Weeks 2-8)

1. Progressive Stretching:

   • Gradually increase hamstring flexibility
   • Avoid overstretching

2. Strengthening Exercises:

   • Begin with isometric exercises
   • Progress to concentric and eccentric exercises
   • Focus on both hamstrings and quadriceps for balanced strength

3. Neuromuscular Training:

   • Proprioception exercises
   • Balance training

Return to Activity Phase (Typically 4-12 weeks)

1. Sport-Specific Training:
   • Gradual return to running, sprinting, and sport-specific movements
   • Functional testing before full return

Surgical Management

Surgery is indicated for:

• Two-tendon proximal injuries with >2 cm retraction
• Three-tendon proximal injuries
• Complete ruptures with loss of function
• Injuries that fail to improve after 6 months of conservative management 1, 2

Surgical outcomes:

• Most athletes (14 of 18 in one study) can return to pre-injury level of sport after surgical repair of distal hamstring tears 4
• Return to sport typically occurs around 4 months post-surgery (range 2-6 months) 4

Prevention Strategies

• Pre-exercise stretching and adequate warm-up are important preventive measures 2
• Address risk factors:
  • Previous mild injuries
  • Fatigue
  • Muscle imbalances

Common Pitfalls to Avoid

1. Premature return to sports - increases risk of re-injury
2. Inadequate rehabilitation - complete rehabilitation is essential to prevent recurrence
3. Missing complete ruptures - these require surgical intervention
4. Overlooking avulsion injuries - these may require longer immobilization or surgery

Special Considerations

• Distal hamstring injuries are less common but may require different management approaches:
  • Biceps femoris injuries often require surgical management
  • Semitendinosus injuries in high-level athletes may benefit from early excision or tendon stripping 1
• Reinjury is a significant concern with hamstring tears and should be addressed through comprehensive rehabilitation 5

The treatment approach should be guided by the specific tendon(s) injured, tear location, severity, and chronicity, with most hamstring injuries responding well to appropriate conservative management 1, 6.