Hamstring Injuries in Athletes: Evidence-Based Treatment

Justin W. Arner, MD; Michael P. McClincy, MD; James P. Bradley, MD


J Am Acad Orthop Surg. 2019;27(23):868-877. 

In This Article


Hamstring injuries are common in athletes and can cause notable disability. They can be separated based on proximal, muscle belly, and distal injuries, with proximal and distal injuries more commonly requiring surgical intervention. Most injuries do not require acute MRI; however, MRI is useful in proximal and distal injuries as well as muscle belly tears that fail to respond to nonsurgical treatment. Acute repair of proximal avulsions, both partial and complete, result in successful outcomes, whereas chronic complete repairs are more difficult and less reliable. Muscle belly injuries have predictable outcomes but recurrence is common. Nonsurgical treatments focus on eccentric strengthening with the possible addition of leukocyte-poor PRP, which may have the potential to hasten recovery and decrease re-rupture. Distal injuries are relatively rare but may require surgical intervention. Hamstring reinjury is common, making continuation of preventive therapies after return to sport essential. Future research with larger sample sizes are required to determine how to decrease injury and reinjury rates, to evaluate the efficacy of PRP, and to determine other treatments that may accelerate recovery after injury.