How to treat a knot in the hamstring?

Treatment of a Hamstring Knot (Muscle Strain)

Immediately apply ice using an ice-water mixture for 20-30 minutes, 3-4 times daily, combined with relative rest and activity modification, followed by eccentric strengthening exercises once acute pain subsides. 1

Immediate Management (First 48-72 Hours)

The acute phase requires the PRICE protocol as recommended by the American College of Sports Medicine 1:

• Apply ice for 20-30 minutes, 3-4 times daily using a plastic bag or damp cloth filled with ice and water mixture (superior to ice alone or gel packs), with a thin towel barrier between ice and skin to prevent cold injury 2, 1
• Reduce activity immediately to prevent further damage and promote healing 2, 1
• Apply compression wraps to promote comfort while ensuring circulation is not compromised 1
• Elevate the injured limb to reduce swelling 1
• Protect the area from further injury through activity modification 1

Avoid heat application during the acute phase as cold application is superior to heat for soft tissue injuries 2

Pain Management

• NSAIDs (oral or topical) are recommended for short-term pain relief and may decrease recovery time, though they do not alter long-term outcomes 2, 1
• Topical NSAIDs are effective and may have fewer systemic side effects 2

Rehabilitation Phase (After Acute Symptoms Subside)

Eccentric strengthening exercises are the cornerstone of treatment and may reverse degenerative changes in the muscle-tendon unit 2:

• Begin progressive eccentric strengthening once acute pain subsides 1
• Continue until full return of muscle strength, endurance, and flexibility is achieved 3, 4
• Do not return to full activity until complete rehabilitation is achieved, as inadequate rehabilitation is the primary cause of recurrent hamstring injuries 3, 4

Supportive Measures

• Use semirigid or lace-up supports rather than elastic bandages for functional treatment 1
• Continue support devices during return to activity, especially with history of recurrent strains 1

Common Pitfalls to Avoid

• Do not apply heat during the acute phase - this is inferior to cold application 2
• Do not rush return to activity - premature return before full rehabilitation predisposes to reinjury, which is the most common complication of hamstring strains 3, 4, 5
• Do not use compression bandages for joint injuries as evidence for their benefit is unclear, though they are appropriate for muscle strains 2

When to Consider Advanced Evaluation

If symptoms persist beyond 6 months of conservative management, or if there is significant weakness or inability to bear weight, consider imaging (MRI is gold standard) to rule out complete rupture or avulsion injury that may require surgical intervention 6, 4

Most hamstring injuries (approximately 80%) fully recover within 3-6 months with appropriate conservative treatment 2