What is the treatment for a hamstring strain?

Hamstring Strain: Symptoms, Diagnosis, and Treatment

For a hamstring strain, immediately implement relative rest with ice application (10 minutes through a wet towel), avoid activities that cause pain, and begin eccentric strengthening exercises as soon as tolerable—most injuries heal within 4-6 weeks for mild-moderate strains, though severe injuries may require up to 75 days. 1

Clinical Presentation and Diagnosis

Symptoms to identify:

• Local pain in the posterior thigh occurring during eccentric exercise (when the muscle lengthens under tension) 2
• Loss of function and reduced strength 2
• Injury typically occurs at the myotendinous junction where force is concentrated 3
• Pain with stretching and resisted knee flexion 4

Physical examination findings:

• Palpable tenderness at the injury site 4
• Visible or palpable defect in severe cases 3
• Reduced range of motion 5

Imaging considerations:

• Diagnosis is usually clinical based on mechanism and examination 2
• MRI can pinpoint extent and location, which helps estimate recovery duration 4, 5
• Imaging is particularly valuable to rule out complete rupture at the ischial tuberosity (requiring longer immobilization) or avulsion injuries (requiring immediate surgery) 2

Immediate Treatment Protocol

First aid measures:

• Apply ice through a wet towel for 10-minute periods for acute pain relief 6, 1
• Implement relative rest—avoid activities that worsen pain but avoid complete immobilization to prevent atrophy 6, 1
• Compression wraps may provide comfort but do not improve recovery time 6

Pain management:

• NSAIDs effectively relieve pain and may reduce swelling 6
• Topical NSAIDs eliminate gastrointestinal hemorrhage risk associated with oral NSAIDs 6

Rehabilitation Timeline and Progression

Healing timeframes by severity:

• Grade 1-2 (mild-moderate): Complete healing typically within 50 days 1
• Grade 3-5 (severe): Approximately 75 days for complete healing 1
• 84% of patients show complete healing by 2-2.5 months regardless of severity 1
• Most injuries fully recover within 3-6 months 1

Critical rehabilitation components:

• Brief immobilization only: Less than 1 week even for severe strains to allow granulation tissue formation 3
• Early mobilization: Begin after brief rest period to properly align regenerating muscle fibers and limit connective tissue fibrosis 3
• Eccentric strengthening exercises: Start as soon as tolerable—these reverse degenerative changes and are essential for preventing reinjury 1, 5
• Concurrent stretching: Pain-free stretching exercises to regain flexibility 3
• Progressive strengthening: Advance from isometrics to isotonics to isokinetics 3

Return to Sport Criteria

Objective measures before clearance:

• Isokinetic testing showing hamstring strength restored to within 10% of uninjured leg 3
• Hamstring-to-quadriceps ratio of 50-60% (or minimum 0.55) 3, 7
• Peak torque reaching 95% of baseline 7
• Functional hop testing may be considered as one factor 6
• Typical return to competitive activities: 6-12 weeks depending on severity 1

Common pitfall: Premature return to sport based solely on symptom resolution rather than objective strength testing leads to nearly one-third of injuries recurring within the first year, often more severely 5

Surgical Indications

Surgery is indicated only for:

• Complete rupture at or near the ischial tuberosity origin 3
• Soft-tissue avulsion with large defect 3
• Bone avulsion with displacement ≥2 cm 3
• Cases resistant to conservative therapy where scar and adhesions prevent normal function 2

All other injuries should be managed conservatively as surgery is unnecessary for partial tears 3

Prevention Strategies

Key preventive measures:

• Pre-exercise stretching and adequate warm-up 2
• Baseline isokinetic testing to identify and correct strength deficits to hamstring-to-quadriceps ratio of 0.60 7
• Neuromuscular control exercises incorporated into training 5
• Recognition that previous mild injury or fatigue increases reinjury risk 2