Treatment of Strained Hamstring and Glute Muscle
Immediately initiate the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) followed by early progressive rehabilitation with eccentric strengthening exercises once acute symptoms subside. 1
Acute Phase Management (First 24-72 Hours)
Apply ice for 20-30 minutes, 3-4 times daily using ice and water surrounded by a damp cloth without direct skin contact to prevent cold injury. 2, 1 This reduces acute pain and swelling, with improvements in pain scores at weeks 1,2, and 4 post-injury, though it does not improve function or time to recovery. 2, 3
- Use compression wraps to promote comfort while ensuring circulation is not compromised. 2, 1
- Elevate the injured limb to reduce swelling. 1, 4
- Protect the area from further injury by avoiding activities that cause pain, but do not completely immobilize the injury. 2, 1
- NSAIDs can be used to reduce swelling and pain, and may decrease recovery time. 1, 3
- Avoid heat application during the acute phase. 1
Critical Pitfall to Avoid
Do not immobilize for more than 10 days maximum, as complete immobilization causes muscular atrophy and deconditioning. 2, 3 Tensile loading of the muscle stimulates collagen production and guides normal alignment of newly formed collagen fibers. 2
Early Mobilization Phase (Days 3-7)
Begin pain-free range-of-motion exercises within 3-5 days to optimize recovery and prevent prolonged disability. 3, 4 Start exercise therapy as soon as possible to recover joint functionality, progressing gradually within pain limits. 3
- Continue compression support during this phase if needed for comfort. 1
- Focus on gentle stretching of the hamstring and glute muscles within pain tolerance. 4
Progressive Rehabilitation Phase (Week 1 Onward)
Incorporate eccentric strengthening exercises, which have proven beneficial for hamstring and lower extremity muscle injuries. 2, 1, 3 These exercises are critical for proper healing and reducing re-injury risk.
- Include proprioception training, coordination exercises, and functional movements in supervised settings. 3, 4
- Progress to strengthening exercises targeting the hamstring, glute, and surrounding muscle groups. 4
- Use semirigid or lace-up supports rather than elastic bandages for functional treatment during return to activity. 1
Special Consideration for Athletes
Neuromuscular training programs should be considered for athletes at risk of recurrent hamstring strains. 1 Continue support devices during return to activity, especially if there is a history of recurrent strains. 1
Medication Options
NSAIDs effectively relieve pain and may offer additional benefit in acute inflammatory conditions. 2, 1
Muscle relaxants (cyclobenzaprine) may be used as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions, but should only be used for short periods (up to two or three weeks). 5
Critical Pitfall: Corticosteroid Injections
Do not use corticosteroid injections into the muscle substance, as they may inhibit healing and reduce tensile strength, predisposing to rupture. 3 The role of corticosteroids in muscle strains remains controversial with potential deleterious effects. 2
When to Seek Advanced Medical Care
Seek immediate medical attention for any painful extremity injury that significantly limits use, or if symptoms worsen despite initial treatment. 2, 3 Consider imaging (MRI or ultrasound) if there is concern for complete rupture or avulsion injury, which may require surgical intervention. 6, 7