What is the treatment for a pulled hamstring with pain in the middle posterior thigh?

Treatment for Pulled Hamstring with Pain in the Middle Posterior Thigh

The most effective initial treatment for a pulled hamstring with pain in the middle posterior thigh is a combination of rest, ice, compression, and elevation (RICE), followed by a progressive rehabilitation program focused on eccentric strengthening exercises and gradual return to activity. 1, 2

Acute Phase Treatment (First 24-72 hours)

• Apply the RICE protocol immediately after injury to reduce pain and swelling:

  • Rest: Reduce activities that cause pain to prevent ongoing damage 3
  • Ice: Apply for 15-20 minutes every 2-3 hours to reduce tissue metabolism and blunt inflammatory response 3, 2
  • Compression: Use elastic bandage to limit swelling 2
  • Elevation: Keep the leg elevated when possible to reduce swelling 2

• NSAIDs (oral or topical) can be used for short-term pain relief, with topical NSAIDs having fewer systemic side effects 3, 2

• MRI is the gold standard imaging modality for hamstring injuries if imaging is needed, with 100% detection rate for proximal hamstring avulsion injuries compared to only 58.3% with ultrasound 4

Rehabilitation Phase (After Acute Phase)

• Begin a progressive rehabilitation program that includes:

  • Eccentric strengthening exercises to promote tendon healing and collagen alignment 3, 5
  • Stretching exercises for the hamstring complex to improve flexibility and reduce tension 3, 2
  • Gradually increasing program of mobilization, strengthening, and activity 1, 2

• Rehabilitation should address key factors that contribute to hamstring injuries:

  • Poor flexibility 1, 6
  • Inadequate muscle strength and/or endurance 1, 5
  • Dyssynergic muscle contraction during running 1
  • Insufficient warm-up prior to exercise 1, 2

Return to Activity Guidelines

• Return to full activity should be withheld until complete rehabilitation has been achieved 1, 2:

  • Complete return of muscle strength and endurance 1
  • Full restoration of flexibility 1, 5
  • Return of coordination and athletic agility 1
  • Pain-free function during sport-specific movements 5, 2

• Premature return to activity significantly increases the risk of reinjury, which is a major problem with hamstring strains 5, 2

Special Considerations

• For proximal hamstring avulsion injuries (complete tears with >2cm retraction), surgical repair may be indicated, particularly in young active patients 7

• Conservative treatment is appropriate for most partial tears and tears with minimal retraction (≤2 cm) 7

• The severity of hamstring injuries is usually first or second degree (partial tears), but occasionally third-degree injuries (complete rupture) do occur 1

• A short period of immobilization may be beneficial for more severe injuries to accelerate formation of granulation tissue, but should be optimized to avoid muscle atrophy 2

Pitfalls to Avoid

• Inadequate rehabilitation following the initial injury is thought to be responsible for many recurrent hamstring injuries 1, 5

• Returning to activity before complete rehabilitation will predispose the athlete to recurrent injury 1, 2

• Prolonged immobilization should be avoided as it can lead to muscle atrophy and loss of strength and extensibility 2

• Corticosteroid injections should be avoided as they may inhibit healing and reduce tensile strength, predisposing to spontaneous rupture (based on similar tendinopathy guidance) 3