Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2015

01-08-2015 | Sports Medicine

Clinical principles in the management of hamstring injuries

Authors: Lasse Lempainen, Ingo J. Banke, Kristian Johansson, Peter U. Brucker, Janne Sarimo, Sakari Orava, Andreas B. Imhoff

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2015

Login to get access

Abstract

Purpose

Hamstring injuries are among the most common muscle injuries seen in sports clinical practice. This narrative review covers essential knowledge of hamstring injuries, ranging from strains to total proximal three-tendon ruptures. The primary aim is to provide basic information for clinicians and sports medicine therapists dealing with hamstring problems.

Methods

In this review, existing literature of hamstring injuries was taken together. Emphasis was given to subjects less well covered in previous reviews, such as preventive measures, as well as the most relevant information needed in the treatment of these injuries.

Results

Occasionally, symptoms remain after hamstring injuries which can be successfully treated with surgery. Knowledge of the effectiveness of preventive measures and nonsurgical and surgical treatment is limited by small studies of low evidence level.

Conclusions

Evidence-based treatment algorithms are not available. Larger studies of better quality with more concrete grading of hamstring tears are needed to improve knowledge in prevention and treatment of hamstring injuries.

Level of evidence

IV.
Literature
1.
Aggen PD, Reuteman P (2010) Conservative rehabilitation of sciatic nerve injury following hamstring tear. N Am J Sports Phys Ther 5:143–154PubMedCentralPubMed
2.
Alioto RJ, Browne JE, Barnthouse CD et al (1997) Complete rupture of the distal semimembranosus complex in a professional athlete. Clin Orthop Relat Res 336:162–165PubMedCrossRef
3.
Arnason A, Andersen TE, Holme I et al (2008) Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports 18:40–48PubMedCrossRef
4.
Arnason A, Sigurdsson SB, Gudmundsson A et al (2004) Risk factors for injuries in football. Am J Sports Med 32:5S–16SPubMedCrossRef
5.
Askling C, Karlsson J, Thorstensson A (2003) Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scand J Med Sci Sports 13:244–250PubMedCrossRef
6.
Askling CM, Kolouris G, Saartok T, Werner S, Best TM (2013) Total proximal hamstring ruptures: clinical and MRI aspects including guidelines for postoperative rehabilitation. Knee Surg Sports Traumatol Arthrosc 21:515–533PubMedCrossRef
7.
Askling CM, Nilsson J, Thorstensson A (2010) A new hamstring test to complement the common clinical examination before return to sport after injury. Knee Surg Sports Traumatol Arthrosc 18:1798–1803PubMedCrossRef
8.
Beiner JM, Jokl P, Cholewick J et al (1999) The effect of anabolic steroids and corticosteroids on healing of muscle contusion injury. Am J Sports Med 27:2–9PubMed
9.
Bencardino JT, Mellado JM (2005) Hamstring injuries of the hip. Review. Magn Reson Imaging Clin N Am 10:677–690CrossRef
10.
Birmingham P, Muller M, Wickiewicz T et al (2011) Functional outcome after repair of proximal hamstring avulsions. J Bone Joint Surg Am 93:1819–1826PubMedCrossRef
11.
Brooks JH, Fuller CW, Kemp SP et al (2005) Epidemiology of injuries in english professional rugby union: part 2 training injuries. Br J Sports Med 39:767–775PubMedCentralPubMedCrossRef
12.
Brucker PU, Imhoff AB (2005) Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 13:411–418PubMedCrossRef
13.
Clanton TO, Coupe KJ (1998) Hamstring strains in athletes: diagnosis and treatment. Rev J Am Acad Orthop Surg 6:237–248
14.
Copland ST, Tipton JS, Fields KB (2009) Evidence-based treatment of hamstring tears. Curr Sports Med Rep 8:308–314PubMedCrossRef
15.
Davis KW (2008) Imaging of the hamstrings. Rev Semin Musculoskelet Radiol 12:28–41CrossRef
16.
De Paulis F, Cacchio A, Michelini O et al (2008) Sports injuries in the pelvis and hip: diagnostic imaging. Eur J Radiol 27:S49–S59CrossRef
17.
De Smet AA, Best TM (2000) MR imaging of the distribution and location of acute hamstring injuries in athletes. AJR 174:393–399PubMedCrossRef
18.
de Visser HM, Reijman M, Heijboer MP et al (2012) Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med 46:124–130PubMedCrossRef
19.
Devlin L (2000) Recurrent posterior thigh symptoms detrimental to performance in rugby union: predisposing factors. Sports Med 29:273–287PubMedCrossRef
20.
Drezner JA (2003) Practical management: hamstring muscle injuries. Rev Clin J Sport Med 13:48–52CrossRef
21.
Elliott MC, Zarins B, Powell JW et al (2011) Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med 39:843–850PubMedCrossRef
22.
Emery CA, Rose MS, McAllister JR et al (2007) A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial. Clin J Sport Med 17:17–24PubMedCrossRef
23.
Engebretsen AH, Myklebust G, Holme I et al (2008) Prevention of injuries among male soccer players: a prospective, randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med 36:1052–1060PubMedCrossRef
24.
Engebretsen AH, Myklebust G, Holme I et al (2010) Intrinsic risk factors for hamstring injuries among male soccer players: a prospective cohort study. Am J Sports Med 38:1147–1153PubMedCrossRef
25.
Folsom GJ, Larson CM (2008) Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 36:104–109PubMedCrossRef
26.
Gabbe BJ, Bennell KL, Finch CF et al (2006) Predictors of hamstring injury at the elite level of Australian football. Scand J Med Sci Sports 16:7–13PubMedCrossRef
27.
Gabbe BJ, Branson R, Bennel KL (2006) A pilot randomised controlled trial of eccentric exercise to prevent hamstring injuries in community-level Australian Football. J Sci Med Sport 9:103–109PubMedCrossRef
28.
Garrett WE Jr (1996) Muscle strain injuries. Rev Am J Sports Med 24:S2–S8CrossRef
29.
Gibbs NJ, Cross TM, Cameron M et al (2004) The accuracy of MRI in predicting recovery and recurrence of acute grade one hamstring muscle strains within the same season in Australian Rules football players. J Sci Med Sport 7:248–258PubMedCrossRef
30.
Goldman EF, Jones DE (2010) Interventions for preventing hamstring injuries. Cochrane Database Syst Rev 1:CD006782PubMed
31.
Harris JD, Griesser MJ, Best TM et al (2011) Treatment of proximal hamstring ruptures—a systematic review. Int J Sports Med 32:490–495PubMedCrossRef
32.
Hartig DE, Henderson JM (1999) Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees. Am J Sports Med 27:173–176PubMed
33.
Hernesman SC, Hoch AZ, Vetter CS et al (2003) Foot drop in a marathon runner from chronic complete hamstring tear. Clin J Sport Med 13:365–368PubMedCrossRef
34.
Järvinen TA, Järvinen TL, Kääriäinen M et al (2007) Muscle injuries: optimizing recovery. Best Pract Res Clin Rheumatol 21:317–331PubMedCrossRef
35.
Kalimo H, Rantanen J, Järvinen M (1997) Muscle injuries in sports. Bailliere’s Clin Orthop. 375:324–337
36.
Koulouris G, Connell D (2003) Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 32:582–589PubMedCrossRef
37.
Koulouris G, Connell D (2005) Hamstring muscle complex: an imaging review. Rev Radiogr 25:571–586
38.
Koulouris G, Connell DA, Brukner P et al (2007) Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med 35:1500–1506PubMedCrossRef
39.
Kraemer R, Knobloch K (2009) A soccer-specific balance training program for hamstring muscle and patellar and achilles tendon injuries: an intervention study in premier league female soccer. Am J Sports Med 37:1384–1393PubMedCrossRef
40.
Kujala UM, Orava S, Järvinen M (1997) Hamstring injuries. Current trends in treatment and prevention. Sports Med 23:397–404PubMedCrossRef
41.
Kujala UM, Orava S, Karpakka J et al (1997) Ischial tuberosity apophysitis and avulsion among athletes. Int J Sports Med 18:149–155PubMedCrossRef
42.
Lempainen L, Sarimo J, Heikkilä J et al (2006) Surgical treatment of partial tears of the proximal origin of the hamstring muscles. Br J Sports Med 40:688–691PubMedCentralPubMedCrossRef
43.
Lempainen L, Sarimo J, Mattila K et al (2007) Distal tears of the hamstring muscles: review of the literature and our results of surgical treatment. Br J Sports Med 41:80–83PubMedCentralPubMedCrossRef
44.
Lempainen L, Sarimo J, Orava S (2007) Recurrent and chronic complete ruptures of the proximal origin of the hamstring muscles repaired with fascia lata autograft augmentation. Arthroscopy 23:441–445PubMedCrossRef
45.
Levine WN, Bergfeld JA, Tessendorf W et al (2000) Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League. Am J Sports Med 28:297–300PubMed
46.
Malliaropoulos N, Isinkaye T, Tsitas K et al (2011) Reinjury after acute posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med 39:304–310PubMedCrossRef
47.
Mann G, Shabat S, Friedman A et al (2007) Hamstring injuries. Review. Orthopedics 30:536–540PubMed
48.
Mendiguchia J, Alentorn-Geli E, Brughelli M (2012) Hamstring strain injuries: are we heading in the right direction? Review. Br J Sports Med 46:81–85PubMedCrossRef
49.
Murray PJ, Lowe WR (2009) Achilles allograft reconstruction of a chronic complete proximal hamstring rupture. Knee Surg Sports Traumatol Arthrosc 17:1360–1363PubMedCrossRef
50.
Orava S, Rantanen J, Kujala UM (1998) Fasciotomy of the posterior femoral muscle compartment in athletes. Int J Sports Med 19:71–75PubMedCrossRef
51.
Orchard J, Best TM (2002) The management of muscle strain injuries: an early return versus the risk of recurrence. Clin J Sport Med 12:3–5PubMedCrossRef
52.
53.
54.
55.
Petersen J, Thorborg K, Nielsen MB et al (2011) Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. Am J Sports Med 39:2296–2303PubMedCrossRef
56.
Rahusen FT, Weinhold PS, Almekinders LC (2004) Nonsteroidal anti-inflammatory drugs and acetaminophen in the treatment of an acute muscle injury. Am J Sports Med 32:1856–1859PubMedCrossRef
57.
Rettig A, Meyer S, Bhadra A (2009) Evaluation of hamstring injuries: the role of magnetic resonance imaging. Oper Tech Sports Med 17:215–218CrossRef
58.
Sallay P (2009) Diagnosis, classification, and management of acute proximal hamstring avulsion injuries. Oper Tech Sports Med 17:196–204CrossRef
59.
Sarimo J, Lempainen L, Mattila K et al (2008) Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 36:1110–1115PubMedCrossRef
60.
Sarimo J, Lempainen L, Mattila K et al (2009) Diagnosis and surgical treatment of partial (one- and two-tendon) proximal hamstring avulsions. Oper Tech Sports Med 17:229–233CrossRef
61.
Schilders E, Bismil Q, Sidhom S et al (2006) Partial rupture of the distal semitendinosus tendon treated by tenotomy—a previously undescribed entity. Knee 13:45–47PubMedCrossRef
62.
Sebastianelli WJ, Hanks GA, Kalenak A (1990) Isolated avulsion of the biceps femoris insertion. A case report. Clin Orthop Relat Res 259:200–203PubMed
63.
Silder A, Heiderscheit BC, Thelen DG et al (2008) MR observations of long-term musculo tendon remodeling following a hamstring strain injury. Skeletal Radiol 37:1101–1109PubMedCentralPubMedCrossRef
64.
Söderman K, Werner S, Pietilä T et al (2000) Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surg Sports Traumatol Arthrosc 8:356–363PubMedCrossRef
65.
Street CC, Burks RT (2000) Chronic complete hamstring avulsion causing foot drop. A case report. Am J Sports Med 28:574–576PubMed
66.
van Mechelen W, Hlobil H, Kemper HC et al (1993) Prevention of running injuries by warm-up, cool-down, and stretching exercises. Am J Sports Med 21:711–719PubMedCrossRef
67.
Verrall GM, Slavotinek JP, Barnes PG et al (2006) Assessment of physical examination and magnetic resonance imaging findings of hamstring injury as predictors for recurrent injury. J Orthop Sports Phys Ther 36:215–224PubMedCrossRef
68.
Volpi P, Melegati G, Tornese D et al (2004) Muscle strains in soccer: a five-year survey of an Italian major league team. Knee Surg Sports Traumatol Arthrosc 12:482–485PubMedCrossRef
69.
Woodley SJ, Mercer SR (2005) Hamstring muscles: architecture and innervation. Cells Tissues Organs 179:125–141PubMedCrossRef
70.
Woods C, Hawkins RD, Maltby S et al (2004) The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of hamstring injuries. Br J Sports Med 38:36–41PubMedCentralPubMedCrossRef
71.
Worrell TW (1994) Factors associated with hamstring injuries. An approach to treatment and preventative measures. Rev Sports Med 17:338–345CrossRef
Metadata
Title
Clinical principles in the management of hamstring injuries
Authors
Lasse Lempainen
Ingo J. Banke
Kristian Johansson
Peter U. Brucker
Janne Sarimo
Sakari Orava
Andreas B. Imhoff
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-2912-x

Other articles of this Issue 8/2015

Knee Surgery, Sports Traumatology, Arthroscopy 8/2015 Go to the issue

Ankle

Outcome of subtalar instability reconstruction using the semitendinosus allograft tendon and biotenodesis screws

Ankle

Safety and efficiency of posterior arthroscopic ankle arthrodesis

Knee

In vitro comparison between cortical and cortico-cancellous femoral suspension devices for anterior cruciate ligament reconstruction: implications for mobilization

Sports Medicine

In vivo monitoring of angiogenesis during tendon repair: a novel MRI-based technique in a rat patellar tendon model

Knee

Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT

Ankle

Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events