What is the treatment for a hamstring muscle tear?

Treatment for Hamstring Muscle Tear

Initial treatment should consist of relative rest, cryotherapy (ice through a wet towel for 10-minute periods), NSAIDs for pain relief, followed by eccentric strengthening exercises starting after the acute phase, with most injuries healing within 4-6 weeks for mild-moderate tears and 75 days for severe tears. 1

Immediate Management (First 48-72 Hours)

• Apply ice through a wet towel for 10-minute periods to provide acute pain relief and reduce swelling 2, 1
• Implement relative rest by reducing activity to decrease repetitive loading of the damaged tendon, but avoid complete immobilization to prevent muscle atrophy 2, 1
• Use compression and elevation as part of the RICE protocol 3
• Prescribe NSAIDs for short-term pain relief, with topical NSAIDs being preferable to eliminate the risk of gastrointestinal hemorrhage associated with oral NSAIDs 2, 1

Rehabilitation Phase (After Acute Phase)

• Begin eccentric strengthening exercises as soon as tolerated, as these have been shown to reverse degenerative changes and stimulate collagen production 2, 1
• Incorporate stretching exercises to maintain and improve flexibility, which is critical for preventing recurrent injury 4
• Gradually increase activity while monitoring pain response, ensuring the scar tissue can bear pulling forces without re-rupture 5
• Perform functional hop testing and isokinetic testing to assess hamstring-to-quadriceps ratio before clearing for return to sport 1

Expected Healing Timeline

• Grade 1-2 (mild-moderate) injuries: Complete healing typically occurs within 50 days, with return to sport at 4-6 weeks 1
• Grade 3-5 (severe) injuries: Complete healing takes approximately 75 days 1
• 84% of patients show complete healing by 2-2.5 months regardless of severity 1
• Most patients fully recover within 3-6 months with appropriate conservative treatment 1

Surgical Indications

Surgery should be considered for:

• Proximal hamstring injuries with 2-tendon tears and >2 cm retraction 6
• All 3-tendon injuries 6
• Complete ruptures with loss of function, particularly avulsions from the ischial tuberosity 5
• Distal biceps femoris injuries in high-level athletes, where surgical treatment may allow faster return to sport 6, 7
• Injuries that fail to improve after 6 months of well-managed conservative treatment 6

Surgical results are generally excellent, with 14 of 18 patients in one series returning to their former level of sport after an average of 4 months 7.

Critical Pitfalls to Avoid

• Do not allow return to sport before achieving full rehabilitation (complete return of muscle strength, endurance, flexibility, coordination, and athletic agility), as inadequate rehabilitation is the primary cause of recurrent hamstring injuries 4, 5
• Avoid prolonged immobilization beyond what is necessary for the specific grade of injury, as this leads to muscle atrophy and loss of strength 5
• Do not use corticosteroid injections, as they may inhibit healing and reduce tensile strength of the tissue, potentially predisposing to rupture 2
• Ensure adequate warm-up and pre-exercise stretching to prevent initial and recurrent injuries 5

Adjunctive Nutritional Support

• Consider vitamin C-enriched dietary gelatin and collagen peptides to support tendon repair and augment tendon hypertrophy during rehabilitation 8
• Maintain adequate protein intake (≥1.6 g/kg body mass) during rehabilitation to prevent muscle loss and support tendon healing 8