What is the treatment for a torn hamstring?

Treatment for a Torn Hamstring

The treatment for a torn hamstring should include immediate application of cold therapy (ice-water mixture) for 20 minutes to reduce hemorrhage, edema, pain, and disability, followed by a progressive rehabilitation program focused on strength and flexibility restoration. 1

Initial Management (First 24-72 hours)

• Apply cold therapy using an ice-water mixture (more effective than ice alone or gel packs) for periods of 20 minutes, with a thin barrier between the cold container and skin 1
• Rest the injured area to prevent further damage 2
• Use compression to limit swelling 2
• Elevate the leg to reduce edema 2
• Avoid heat application to the injured area as it is not as effective as cold therapy 1
• Limit weight-bearing on the affected leg until advised by a healthcare professional 1

Diagnostic Evaluation

• MRI is the gold standard for diagnosis of hamstring injuries, allowing classification of location, extent, degree (partial vs. complete), and chronicity 1
• MRI is particularly useful for evaluating acute proximal hamstring tendon avulsions, with 100% detection rate compared to only 58.3% for ultrasound 1
• Clinical assessment should determine severity: first degree (mild strain), second degree (partial tear), or third degree (complete rupture) 2

Treatment Based on Injury Severity

Mild to Moderate Tears (Grade 1-2)

• Conservative management is the standard approach for partial tears 3
• Short period of immobilization to accelerate formation of granulation tissue matrix 4
• Progressive mobilization to prevent muscle atrophy and maintain strength and extensibility 4
• Gradually increasing program of strengthening, flexibility, and activity 2

Complete Tears (Grade 3)

• Surgical intervention is recommended for:
  • Two-tendon injuries with >2 cm of retraction 3
  • Three-tendon injuries 3
  • Injuries that do not improve after 6 months of conservative management 3
• Acute surgical treatment of proximal hamstring injuries tends to have favorable outcomes 3

Rehabilitation Protocol

• Begin with isometric strengthening exercises as soon as tolerable 1
• Progress to concentric and eccentric exercises in closed kinetic chain 1
• Incorporate neuromuscular and motor control re-education exercises 1
• Gradually increase activity level based on healing progress 2
• Return to sports should be withheld until full rehabilitation has been achieved, including:
  • Complete return of muscle strength
  • Restoration of endurance and flexibility
  • Return of coordination and athletic agility 2

Prevention of Recurrence

• Hamstring injuries have a high rate of recurrence, often due to inadequate rehabilitation 2
• Preventive measures include:
  • Maintaining and improving strength, flexibility, and endurance 2
  • Proper warm-up and stretching before exercise 4
  • Addressing any muscle imbalances 5
  • Progressive return to activity 2

Special Considerations

• Proximal hamstring avulsions may require surgical reattachment to the ischial tuberosity 6
• Distal hamstring injuries are less common and often associated with other knee injuries 6
• Functional bracing is not recommended for routine use as it confers no clinical benefit 1

Return to Activity

• Functional evaluation should be used to determine readiness for return to sport 1
• Permission to return to athletic competition should be withheld until full rehabilitation has been achieved to prevent recurrent injury 2
• Failure to achieve complete rehabilitation will predispose the athlete to recurrent injury 2