Physical Therapy for Hamstring Strains

The hamstring muscle group consists of three muscles in the posterior thigh: the semitendinosus, semimembranosus and biceps femoris. The long head of the biceps femoris muscle is the most commonly involved hamstring muscle in both first-time and recurrent injuries. The normal healing process of a hamstring injury is similar to other biological tissues and progresses through stages of inflammation, proliferation, and remodeling. The remodeling phase can last up to 2 years. Early hip and knee range of motion may contribute to less disorganized scar formation and a lower reinjury rate. Early and accurate clinical diagnosis of a hamstring injury is important for providing appropriate treatment, deciding on return to play, and preventing reinjury.

Recent Clinical Practice Guidelines were made after researching best intervention for hamstring injuries. While clinicians measure intervention effectiveness in many ways (eg, strength, range of motion and pain levels), the ultimate success of the rehabilitation process is determined by the athlete’s ability to return to prior level of activity/play. It is recommended clinicians should use eccentric (muscle is contracting while it lengthens) strengthening in combination with stretching, stabilization, and other strengthening and progressive running programs to improve return to play time. To reduce reinjury rate after hamstring injuries, rehabilitation should use:

• Progressive agility and trunk stabilization exercises
• Stretching
• Strengthening 
• Functional exercises that simulate patient’s activity/sport

Experts use modalities to control pain & swelling and clinicians should perform neural tissue mobilizations to reduce adhesions to surrounding tissue. Modalities should occur in conjunction with eccentric and progressive strengthening. Length of recovery time will be dependent on many factors including the degree and location of strain.