Hamstring Injury Treatment & Management
- Author: Herman Brad Ruiz, MD; Chief Editor: Craig C Young, MD more...
Treatment of hamstring injuries varies according to the severity of the injury. Patients with minor strains may progress quickly to strengthening exercises, whereas those with full-thickness ruptures require surgery. Up to 1 week after a minor injury, the focus of therapy is to limit pain, inflammation, and swelling. Rest, ice, compression, and elevation (RICE) are recommended. Elastic thigh bandages can be useful for compression. Icing for 20 minutes, 4 times per day, provides pain relief.
Most patients may begin active range of motion (AROM) exercises within their pain tolerance after 1-2 days. Individuals with more serious injuries benefit from immobilization in knee extension for 1-5 days to prevent contracture formation and further damage. Crutches enable ambulation while resting the injured leg.
After several days, most patients may begin pain-free submaximal isometrics, pool therapies, and upper-body exercises. Isometric exercises are performed at various knee angles in increments of 20°. Patients hold the contraction for 5-15 seconds, and perform 3 sets at each angle.
If patients return to their usual activities too soon, delayed healing or reinjury may result. In more serious injuries, compartment syndrome can result from an extending hematoma. The most common symptom of compartment syndrome is increasing pain.
Surgery is rarely performed for large hematomas; on the other hand, it is performed in more than 50% of cases of muscle belly tears, with consideration given to the patient's activity demands. However, surgery is generally indicated for bony avulsions only.
In cases of severe hamstring injuries, consultation with a sports medicine specialist or an orthopedic surgeon may be indicated. Physiatrists may be consulted to oversee rehabilitative therapies and to help prevent further injuries.
Generally, treatment 1-6 weeks postinjury focuses on patient strengthening, improving range of motion (ROM), and flexibility.
Passive static stretching may begin at this stage. Moist heat may be used to warm up the muscle tissues before stretching and exercising. Electrical stimulation may be used in conjunction with ice for added pain relief.
Being pain free throughout the entire ROM is not required before strengthening exercises may be initiated. The patient may exercise, preferably with a therapist, to strengthen the muscle within the available pain-free ROM.
Next, the patient begins isotonic exercises with resistance, increasing the program gradually as tolerated. As healing continues, high-speed, low-resistance isokinetic exercises are started. Resistance is increased gradually, while exercise speed is decreased. Over time, the patient progresses from concentric to eccentric strengthening exercises. Before the athlete returns to play, sports-specific training maximizes recovery and minimizes the chances for additional injury.
Reinjury and delayed healing result if the therapy is too aggressive or if activity limitations are not followed.
From 1 month postinjury onward, the patient continues stretching and strengthening exercises to maintain flexibility and an adequate hamstring-to-quadriceps strength ratio.
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