Hamstring Injuries: What To Do, What To Expect, What’s On The Horizon
By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
• Hamstring injuries can take a long time to fully heal, ranging from 3 to 8 weeks for most young athletes
• See a physician soon after injury if you heard or felt a “pop”
• Full recovery is needed before return to sports in order to lower your chance of reinjury
Hamstring injuries are common in any sport involving sprinting, jumping, or rapid change of direction. In young growing athletes hamstring injuries can involve pulling the bone off the pelvis (an “avulsion”). Once growth slows down or stops hamstring injuries are more often found in the muscle, or in the tendon at the upper or lower end. These injuries generally have a high rate of return to play, but can often take a long time to recover and also have a risk of reinjury. Some new treatments are on the horizon which have the chance to improve healing times and lower reinjury rates.
What’s The Story?
Athletes with hamstring injuries will typically have a sudden onset of pain in the back of the thigh during a sprint. This often causes them to stop the run, putting their hand on the back of the thigh.
If you heard or felt a “pop” at the time of the initial injury I would strongly recommend that you see a sports medicine physician for early evaluation and treatment. The dreaded “pop” may mean that you had a bone injury in the pelvis, or it could mean a serious tear in the hamstring muscle or tendon.
Fortunately, most injuries involve the hamstring muscle rather than the bone or tendon. The reason that’s a good thing is that the muscle has a very good blood supply and that is essential for healing any injury. The blood carries cells and other repair factors to the injury and will allow the body to heal the injury.
Everyone will respond differently, so discuss your particular situation with your doctor. In general, hamstring injuries in young athletes will not require surgery. An exception could be a bone avulsion that is significantly pulled away from the bone. Most often, the initial treatment is rest from sports, ice, an Ace wrap for compression, anti-inflammatory medication, and physical therapy. Crutches might be needed early on for pain relief. In teenagers and young adults a cortisone injection is sometimes done, and has been shown to shorten return to play times in specific circumstances. Discuss this carefully with your doctor.
Proper rehabilitation is incredibly important. Before returning to practice or competition, the athlete will need to go through a gradual rehabilitation program involving range of motion, strength, agility, power, and speed. A physical therapist is skilled in these techniques and can greatly improve the chances for successful recovery. Very important: you want to be completely recovered before returning to play. If you are not completely recovered you have a high chance of getting another (and often more severe) injury.
On the horizon: new treatments
Keep an eye on the news for use of “platelet rich plasma” or “PRP” during the upcoming NFL season with hamstring injuries. This is a safe treatment involving an injection of concentrated products from the athlete’s own blood. PRP has the potential to accelerate healing and without any illegal substances used. I would predict that PRP will become common for most athletes over the coming years, once we gather widespread evidence of its benefits. Other treatments further down the line would include implantation of stem cells with the potential to truly heal the injury with normal tissue. Stem cell research for muscle injuries is progressing, but in the very early stages.
When Can I Return To Play?
Once again, everyone is different so you’ll want to get individual guidance from your doctor and physical therapist. But in general, I will typically see young athletes take about 3 weeks to return to play after a mild injury, and about 8 weeks to return after a more significant injury. It takes a surprisingly long time! Bone avulsions are a completely different story, often taking several months for successful return. Whatever the injury severity, make sure you are fully recovered before you attempt a return to play.