Management

Imaging

• Ultrasound and CT are useful in assessing the injury howver the gold standard for assessing these injuries is MRI. This is particularly useful in minor hamstring injuries or where the diagnosis is unclear
  
  

Rehabilitation

• injury occurrence and re-injury rates have not improved over the last three decades (1)
  
  
• during the initial stage of injury (I.e. first week) It is important that RICE is applied. (Rest Ice Compression Elevation
  • helps to minimise inflammation and reduce swelling
  • stretching and rest are advised following this as a measure of preventing the muscle fibres shortening during the healing phase
  • unfortunately hamstrings do frequently heal slowly so patience is required
    
    
• the next phase involves stretching which initially is done passively and through a limited range of movement. Early strength work can be started as tolerated with specific exercises including hamstring curls, bridges, flicks and dead lifts
  
  
• finally, straight-line running is encouraged gradually working up to more intense acceleration and deceleration drills. Sports specific training can then occur and when ready the athlete can return to his or her chosen sport however some injuries can take much longer than the average muscle strain which will resolve over a 2-3 week period

Corticosteroid injection

• use of steroids is also controversial for fear of poor healing, rupture or infection. The vast majority of sports medicine practitioners do not advocate the use of corticosteroid injection in the management of these injuries

Ultrasound

• although frequently used, the role of ultrasound in treating specific hamstring injuries is poorly supported by solid evidence
• thought that low frequency ultrasound increases the tensile strength of healing bone following fracture, healing tendon and soft tissue
• ultrasound is thought to act by causing a localised increase in temperature. This results in an increase in protein synthesis and membrane permeability and also increases fibroblast activity

Surgery

• surgical intervention although rarely indicated in the management of these injuries does have a role where there has been complete avulsion of the proximal hamstrings. This is a soft tissue injury with avulsion from the lateral aspect of the ischium. Occasionally a bony avulsion of the ischium occurs and this may require internal fixation

Reference:

• 1) Mendiguchia J, Alentorn-Geli E, Brughelli M. Hamstring strain injuries: are we heading in the right direction? Br J Sports Med. 2011 Jun 15.