From the Guidelines
A pulled hamstring, or hamstring strain, should be treated with rest and limiting the use of the injured extremity, as well as cold application to decrease pain and swelling, for the first 48-72 hours, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The mainstay of treatment for strains, including hamstring strains, is rest and limiting the use of the injured extremity, which avoids worsening the injury 1.
- Cold application can acutely decrease pain and swelling in muscle strains, and the greatest tissue cooling is achieved by using a bag filled with ice and water surrounded by a damp cloth, with experts recommending limiting the duration of cold application to 20 to 30 minutes for 3 to 4 times daily 1.
- It is also recommended to avoid activities that cause pain and seek medical attention if the injury limits use of the extremity 1.
- Additionally, applying a compression wrap after an acute strain may promote comfort after an injury, as long as it does not compromise circulation 1.
- The treatment should prioritize reducing pain and swelling, while also promoting recovery and preventing further injury, with the goal of improving morbidity, mortality, and quality of life outcomes.
- Complete recovery typically takes 3-8 weeks depending on severity, and returning to activity too soon increases risk of reinjury, so patience during healing is essential.
- For severe strains, such as those with difficulty walking or severe pain, it is recommended to see a healthcare provider, as physical therapy may be necessary 1.
From the Research
Diagnosis of Pulled Hamstring
- A pulled hamstring, also known as a hamstring strain injury, can be diagnosed using imaging tests such as Magnetic Resonance Imaging (MRI) and ultrasound (US) 2.
- The diagnosis of a hamstring injury is crucial for planning a correct and individualised return to play (RTP) 2.
- A thorough clinical examination is necessary to determine the location and severity of the injury, which can help estimate the duration of the convalescent period 3.
Treatment and Rehabilitation of Pulled Hamstring
- Many hamstring injuries can be successfully managed with nonoperative measures such as activity modification and physical therapy 4.
- Adjuncts such as platelet-rich plasma injections are currently being investigated as a treatment option for hamstring injuries 4.
- Rehabilitation strategies that incorporate neuromuscular control exercises and eccentric strength training can help minimize the risk of reinjury 3.
- A clinical guide for the rehabilitation of acute hamstring injuries should include specific criteria for treatment progression and return to sport 3.
Return to Sport and Reinjury Prevention
- Return to sport is typically achieved within weeks of the injury, but subsequent athlete performance may be impaired, and reinjury rates are high 5.
- Improving outcomes requires rehabilitation practitioners to understand the causes and mechanisms of hamstring strain injury, know how to perform a thorough clinical examination, and progress loading to the site of injury safely and effectively 5.
- Objective measures to assess musculotendon recovery and readiness to return to sport can help minimize the risk of reinjury 3.