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Hamstring muscle injury in the athlete: state of the art
  1. Holly J Silvers-Granelli1,2,
  2. Moises Cohen3,
  3. João Espregueira-Mendes4,
  4. Bert Mandelbaum2,5
  1. 1Musculoskeletal Research Center, Velocity Physical Therapy, Santa Monica, California, USA
  2. 2Medical Assessment Research Committee, Major League Soccer, New York, New York, USA
  3. 3Orthopedic Department, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
  4. 4Dom Research Center, Clinica Espregueira Mendes, FIFA Medical Centre of Excellence, Porto, Portugal
  5. 5Sports Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Holly J Silvers-Granelli, Velocity Physical Therapy, Santa Monica, CA 90405, USA; hollysilverspt{at}


Hamstring injuries (HSI) are the source of significant impairment and disability for both professional and recreational athletes. The incidence and prevalence of HSIs has been well documented in the literature, as they are among the most common soft tissue injuries reported. The significant time loss due to injury and the inherent risk of reinjury pose a significant issue to the athlete, their career longevity and the success of their respective team. This review will deal predominantly with describing the prevalence and incidence of HSI in athletes, discuss risk factors and the mechanisms of injury for HSI, how to properly diagnose, image and prognosticate appropriate return to sport (RTS) for individuals who have sustained an HSI, prescribe treatment and prevention strategies and to discuss relevant options to decrease overall risk of primary and secondary recurrence of HSI.

Current treatments of acute HSI necessitate a thorough understanding of the mechanism of injury, identifying muscle imbalances and/or weakness, inclusion of eccentric and concentric hamstring (HS) and hip extension (HE) exercises, evaluation of pathokinematic movement patterns and use non-surgical methods to promote healing and RTS. This methodology can be used prospectively to mitigate the overall risk of HSI. Injection therapies for HSI, including ultrasound-guided platelet-rich plasma and corticosteroids, may impart some short-term benefit, but the existing literature is largely inconclusive with respect to long-term functional outcomes. Future directions should prioritise injury prevention, early diagnosis and targeted interventions that combine both non-surgical and minimally invasive orthobiological approaches and identifying biomechanical risk factors prospectively to mitigate risk.

  • lower extremity
  • epidemiology
  • practice management
  • evidence based medicine
  • muscle

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  • Contributors Each of the four authors on this manuscript made meaningful and substantial contributions. HJSG and BM conceived the design of the manuscript. HJSG acquired the references (literature review) and structured the manuscript. HJSG, MC and JEM drafted and extensively revised the manuscript. HJSG, BM, MC and JEM worked on the figures and added to the visual educational components of the manuscript. All authors approved the final manuscript and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.

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