What is the treatment for a hamstring strain?

From the Guidelines

For treating a hamstring strain, the most effective approach is to follow the RICE protocol initially, which includes rest, applying ice for 20-30 minutes 3-4 times daily, using compression, and elevating the leg when possible, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The main goal of treatment is to reduce pain and swelling, and to promote healing of the injured muscle.

• Resting the injured leg and limiting its use is crucial to avoid worsening the injury.
• Applying cold therapy, such as an ice and water mixture, can help decrease pain and swelling, but it should not be applied directly to the skin and should be limited to 20-30 minutes, 3-4 times daily.
• Compression and elevation can also help reduce swelling and promote healing. After the acute phase, gentle stretching and progressive strengthening exercises can be started to promote recovery and prevent re-injury. It is also important to note that while relative rest is recommended, complete rest is not necessary, and patients should be encouraged to reduce activity to decrease repetitive loading of the damaged tendon 1. However, the most recent and highest quality study 1 provides the best guidance for treatment, and its recommendations should be prioritized.

From the Research

Treatment Options for Hamstring Strain

• The optimal management of hamstring muscle injuries is not yet defined, but various treatment options are being explored, including platelet-rich plasma (PRP) injections and rehabilitation programs 2.
• A study found that a single autologous PRP injection combined with a rehabilitation program was significantly more effective in treating hamstring injuries than a rehabilitation program alone, with patients in the PRP group achieving full recovery significantly earlier than controls 2.
• Another study found that PRP injection ± physical therapy reduced mean time to return to play or reinjury rates compared to no treatment or physical therapy alone for hamstring injuries, although the evidence was statistically nonsignificant 3.

Rehabilitation and Nonoperative Treatment

• Many hamstring injuries can be successfully managed with nonoperative measures such as activity modification and physical therapy, with adjuncts such as platelet-rich plasma injections being investigated 4.
• Rehabilitation exercises, including lengthening exercises, have been shown to be effective in reducing time to return to play, but had no difference in risk of re-injury 5.
• Progressive agility and trunk stability training may also reduce re-injury rates, although the evidence is limited 5.

Platelet-Rich Plasma Injections

• The effect of autologous platelet-rich plasma (PRP) therapy on the recovery of hamstring injuries is unclear, with some studies finding no significant difference in outcomes between PRP and control groups 3, 5.
• However, other studies have found that PRP injections can be effective in treating hamstring injuries, with patients in the PRP group achieving full recovery significantly earlier than controls 2.

Surgical Decision Making

• Operative treatment of proximal hamstring injuries is traditionally reserved for 2-tendon injuries with >2 cm of retraction, 3-tendon injuries, or injuries that do not improve with 6 months of nonoperative management 4.
• Acute surgical treatment of proximal hamstring injuries tends to be favorable, while distal hamstring injuries may initially be managed nonoperatively 4.