Initial Management of Hamstring Strain
Apply cold therapy immediately for 20 minutes using an ice-water mixture wrapped in a damp cloth, repeat 3-4 times daily for the first 3-5 days, then begin supervised exercise therapy as soon as possible to optimize recovery. 1
Immediate Assessment and First Aid (First 3-5 Days)
What to Check For Initially
- Location and severity of pain - typically occurs at the myotendinous junction where force concentrates during eccentric muscle contraction 2
- Mechanism of injury - usually occurs during sprinting or jumping activities when the hamstring develops tension while lengthening 3
- Loss of function - assess ability to bear weight and perform knee flexion 2
- Local swelling and hemorrhage - indicates extent of tissue damage 2
- Rule out complete rupture - palpate for large defects at the ischial tuberosity origin or distal insertion, which would require surgical consultation 2
Initial Treatment Protocol
- Cold therapy: Apply ice-water mixture for 20-30 minutes per session, 3-4 times daily, always with a barrier (thin towel) between ice and skin to prevent cold injury 1
- Compression: Apply compression wrap to promote comfort, ensuring circulation is not compromised 1
- Elevation: Keep the injured leg elevated above heart level when possible 1
- Rest from painful activities: Avoid activities that reproduce pain, but do not immobilize beyond what is necessary for initial pain control 1
Pain Management
- NSAIDs may be used to reduce pain and swelling during the acute phase, though some inflammation is necessary for removing necrotic muscle fibers and optimal healing 1, 2
Critical Transition Point (After 3-5 Days)
Begin supervised exercise therapy immediately after the initial 3-5 day period - this has the strongest evidence (level 1) for optimal recovery 1
Early Mobilization Phase
- Flexibility exercises: Start with pain-free stretching focusing on the hamstring and surrounding muscle groups 1
- Strengthening progression: Begin with isometric exercises, then progress to isotonic and isokinetic exercises as tolerated 2
- Proprioception training: Include coordination exercises and functional movements 1
Monitoring Recovery
- Assess muscle strength imbalances - the hamstring-to-quadriceps ratio should reach 50-60% before return to sport 2
- Compare injured to uninjected leg - strength should be restored to within 10% of the unaffected leg 2
- Functional testing: Confirm adequate speed and agility before full return to activity 4
Common Pitfalls to Avoid
- Do not prolong immobilization beyond 3-5 days - this delays recovery and does not improve outcomes 1
- Never apply ice directly to skin - always use a barrier to prevent cold injury 1
- Do not delay exercise therapy - early supervised exercises have the strongest evidence for optimal recovery 1
- Avoid premature return to sport - reinjury rates are high with hamstring strains; ensure objective strength testing confirms readiness 2, 5