Hamstring Strain Injury in Athletes

This guideline, from APTA Orthopedics and the American Academy of Sports Physical Therapy, covers how physical therapists should diagnose, examine, treat and return athletes to sport after a hamstring strain, and how to prevent one.

It describes a hamstring strain as sudden pain at the back of the thigh during activity, reproduced by stretching or contracting the muscle, with tenderness and loss of function. For estimating return to play it points to hamstring strength, pain at the time of injury, days until pain-free walking and the area of tenderness, and it recommends measuring knee-flexor strength with a dynamometer and hamstring length with an inclinometer.

For prevention, it gives its strongest recommendation to including the Nordic hamstring exercise in a program with warm-up, strengthening and high-speed running. After injury, it recommends eccentric training to tolerance alongside stretching, strengthening, stabilization and progressive running to speed return, and agility and trunk stabilization work to lower reinjury. A previous hamstring strain is a risk factor, so return-to-play decisions should be cautious for anyone who has not completed a progressed program that included eccentric training.