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Hamstring Injury Treatment & Management

  • Author: Herman Brad Ruiz, MD; Chief Editor: Craig C Young, MD  more...
Updated: Oct 22, 2015

Acute Phase

Rehabilitation Program

Physical Therapy

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.

Medical Issues/Complications

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.

Surgical Intervention

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.


Recovery Phase

Rehabilitation Program

Physical Therapy

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.

Medical Issues/Complications

Reinjury and delayed healing result if the therapy is too aggressive or if activity limitations are not followed.


Maintenance Phase

Rehabilitation Program

Physical Therapy

From 1 month postinjury onward, the patient continues stretching and strengthening exercises to maintain flexibility and an adequate hamstring-to-quadriceps strength ratio.

Contributor Information and Disclosures

Herman Brad Ruiz, MD Staff Physician, Department of Physical Medicine and Rehabilitation, Division of Orthopedics and Rehabilitation, Loyola University Medical School at Illinois

Herman Brad Ruiz, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Pain Society, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.

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