Acute and Chronic Hamstring Injury Treatments

Marc Darrow, MD., JD

We see many people with problems of the hamstring. Usually they are people who participate in a physically demanding sport where accelerating, kicking, jumping, cuts and stops, or endurance is required. These would be the runners, the marathoners, the triathletes, the soccer players.

Most people with hamstring tendonitis report that have have had this “nagging injury” for some time. After trying to remedy their situation on their own with rest, ice / heat, wraps, braces and tapes, over the counter pain killers and anti-inflammatories and lots of stretching they seek medical care. Sometimes these people will get stronger doses of medications they are already taking or they will eventually be told to consider a cortisone injection because of continued inflammation.

Grade I Hamstring Injury

  • Discomfort and muscle soreness
  • Some swelling
  • You can still bend your knee
  • You can still walk and run but with pain.

Grade II Hamstring Injury

  • Walking and stride are effected.
  • Decreased range of motion. Pain when bending knee.
  • Discomfort and muscle soreness. Acute sharp pains.
  • Swelling is apparent.
  • Bruising is apparent.

Grade III Hamstring Injury

  • Difficulty walking. Use of cane or other walking devices may be needed.
  • Throbbing pain, severe pain with movement.
  • Obvious swelling and bruising.

Back of the leg or back of the knee pain

You have probably done enough research up until this point to know that the hamstrings are muscles at the back of the thigh. These are the semitendinosus muscle, semimembranosus muscle and the long and short head of the biceps femoris. These muscles with the exception of the short head of the biceps femoris attach to the pelvis at the ischial tuberosity or “sit bones.” These muscles are also often referred to as the Proximal (center) hamstrings.

The hamstrings are involved all almost all motions of the leg. Rest, therefore, is generally a difficult treatment course to follow.

Hamstring injury treatments

The obvious goal of hamstring injury treatments is to heal the injury and get the person back to their sport or activities as soon as possible. There are many people we see that were a little overzealous in their desire to get back to their sport and reinjured their hamstring and for some, made their situation worse. It is hard to sit an active person down and the average recovery time of one to five months depending on the injury is usually more than he/she is ready for.

Ischial tuberosity 02-1 posterior view

The red area is the Ischial tuberosity where the hamstrings attach and the area of the ischial bursa. Cortisone injections may be beneficial for some patients in cases where bursitis is suspected.

PRP treatments for acute hamstring injuries

PRP (Platelet Rich Plasma) treatments are injections made from your blood. What is injected is not the blood but the blood’s platelets which are spun out of the blood by centrifuge. PRP is considered an effective and reliable treatment option to cortisone and surgery.

A January 2022 study (1) reported on the effect of platelet-rich plasma (PRP) treatment on recovery in acute hamstring injuries, In this stuyd athletes with acute hamstring inkjury were treated with  a combination of hematoma aspiration and muscle strain PRP injection in partial hamstring muscle tears (grade 2 strains) in athletes.

This is how the study was conducted and its results:

  • Fifty-five athletes (28 treated conservatively, 27 with hematoma aspiration/PRP injection) were included.
    • Average return-to-play time was 32.4 days in the conservative group and 23.5 days in the aspiration/PRP group.
    • Recurrence rate of the hamstring strain was 28.6% (8/28) in the conservative treatment group and less than 4% (1/27) in the aspiration/PRP group.

The researchers concluded: “Athletes with grade 2 hamstring strains treated with a combination of hematoma aspiration and PRP injection had a significantly shorter return-to-play and a lower recurrence rate compared with athletes receiving conservative treatment.”

An April 2020 study (2) speculated that the addition of PRP injections to nonoperative treatment for acute partial musculotendinous hamstring injuries will lead to a shortened return to play in National Football League (NFL) players.

When divided into two groups, those players who had PRP and those players who did not, the doctors noted:

  • Average time missed in those treated with PRP injections was 22.5 days, 18.2 practices, and 1.3 games.
  • In those who did not receive PRP injections, time missed was 25.7 days (3 more days), 22.8 practices (missed four more practices) and 2.9 games (missed almost 2 more games).

Ultrasound-Guided Needle Tenotomy

When a patient does not respond to any treatments they may be recommended to Ultrasound-Guided Needle Tenotomy. Here the doctor will purposefully damage the tendon with an ultrasound guided needle with the hopes that this newe injury will stimulate an overall healing of the hamstring tendons.

Surgery for acute rupture verses chronic hamstring problems.

When there is a complete rupture of the hamstring tendon, injections and conservative care cannot put the hamstring back together again. But when people have chronic hamstring problems, is surgery an answer?

A November 2021 editorial in the journal Arthroscopy (3) writes: “While surgical treatment of acute proximal hamstring ruptures is well understood to be the best treatment option for many patients, treatment of chronic proximal hamstring pathology has lagged, with most management consisting of conservative options: rest, ice, physical therapy, nonsteroidal anti-inflammatory drugs, shock-wave therapy, and injections such as corticosteroids and platelet-rich plasma. However, recent research shows that endoscopic repair of chronic proximal hamstring pathology is safe and effective for treating this pathology at short-term follow-up, with high rates of return to activity and patient satisfaction.”

 

 

1 Trunz LM, Landy JE, Dodson CC, Cohen SB, Zoga AC, Roedl JB. Effectiveness of Hematoma Aspiration and Platelet-rich Plasma Muscle Injections for the Treatment of Hamstring Strains in Athletes. Medicine and science in sports and exercise. 2022 Jan 1;54(1):12-7.
2 Bradley JP, Lawyer TJ, Ruef S, Towers JD, Arner JW. Platelet-rich plasma shortens return to play in National Football League players with acute hamstring injuries. Orthopaedic journal of sports medicine. 2020 Apr 17;8(4):2325967120911731.
3 Shore B. Editorial Commentary: Endoscopic Proximal Hamstring Repair Is Safe and Effective for Refractory Tendinosis and Partial Tears:“Pain in the Butt” Has an Endoscopic Solution!. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021 Nov 1;37(11):3286-7.


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