Return to Play
A common threshold for return to play is when the strength of the injured hamstring has at least 90% of the strength of the unaffected hamstring and when the patient has full ROM. At least a 50-60% hamstring-to-quadriceps ratio is desired before allowing the athlete to return to play.
Strength testing is performed using isokinetic exercise equipment. In addition, it is also important to ensure the return of normal flexibility and endurance before the patient returns to play; reinjury is most often due to lack of both.
Therapy that incorporates sports-specific activities can help minimize the risk of reinjury.
Complications
Returning to play too early is a common factor leading to chronic hamstring pain and injury. Reinjury rates as high as 77% may be related to areas of calcification and inflammation in the hamstring after injury. Scar formation may impinge the sciatic nerve, resulting in hamstring syndrome. Surgery has rarely been used to break up painful scar tissue.
Prevention
The implementation of proper warm-up and maintenance of flexibility and adequate strength are needed to prevent future injuries. The patient should be aware that as fatigue sets in, the risk of injury increases. With improved form and by emphasizing knee flexion during activities, the risk of further injuries is minimized.[2, 7, 8, 13, 14, 15]
Fifty Danish male professional and amateur soccer teams (942 players) were studied in a randomized controlled trial that compared a 10-week progressive eccentric training program followed by a weekly maintenance program. The overall results showed a significant reduction in hamstring injuries. The program was especially useful in prevention of recurrent injuries (number need to prevent 3), and to a lesser effect, the program was able to aid in the prevention of new injuries (number needed to treat 25).[16]
Prognosis
With minor activity limitations and proper rehabilitation, the prognosis is good for hamstring strains and even partial tears. Complete tears also heal but require a significantly longer and more intensive rehabilitation program.
Davis KW. Imaging of the hamstrings. Semin Musculoskelet Radiol. Mar 2008;12(1):28-41. [Medline].
Reid DC. Soft tissue injuries of the thigh. Sports Injury Assessment and Rehabilitation. Philadelphia, Pa: Churchill Livingstone; 1992:551-71.
Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med. Jun 2008;36(6):1110-5. [Medline].
Sallay PI, Friedman RL, Coogan PG, Garrett WE. Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med. Mar-Apr 1996;24(2):130-6. [Medline].
Askling CM, Tengvar M, Saartok T, Thorstensson A. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med. Apr 30 2008;epub ahead of print. [Medline].
Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med. Apr 30 2008;epub ahead of print. [Medline].
Clark RA. Hamstring injuries: risk assessment and injury prevention. Ann Acad Med Singapore. Apr 2008;37(4):341-6. [Medline]. [Full Text].
Clanton TO, Coupe KJ. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg. Jul-Aug 1998;6(4):237-48. [Medline].
Hoskins W, Pollard H. The management of hamstring injury-- part 1: issues in diagnosis. Man Ther. May 2005;10(2):96-107. [Medline].
Levine WN, Bergfeld JA, Tessendorf W, Moorman CT 3rd. Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League. Am J Sports Med. May-Jun 2000;28(3):297-300. [Medline].
Elliott MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med. Apr 2011;39(4):843-50. [Medline].
Malliaropoulos N, Isinkaye T, Tsitas K, Maffulli N. Reinjury after acute posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med. Feb 2011;39(2):304-10. [Medline].
Kujala UM, Orava S, Järvinen M. Hamstring injuries. Current trends in treatment and prevention. Sports Med. Jun 1997;23(6):397-404. [Medline].
Unger CL, Unger DA. Preventing and rehabilitating hamstring injuries. Athl Ther Today. May 1997;44-9.
Worrell TW. Factors associated with hamstring injuries. An approach to treatment and preventative measures. Sports Med. May 1994;17(5):338-45. [Medline].
Petersen J, Thorborg K, Nielsen MB, Budtz-Jørgensen E, Hölmich P. Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men's Soccer: A Cluster-Randomized Controlled Trial. Am J Sports Med. Nov 2011;39(11):2296-303. [Medline].
Print
