Hamstring injuries. Proposed aetiological factors, prevention, and treatment.

Injuries to the hamstring muscles can be devastating to the athlete because these injuries frequently heal slowly and have a tendency to recur. It is thought that many of the recurrent injuries to the hamstring musculotendinous unit are the result of inadequate rehabilitation following the initial injury. The severity of hamstring injuries is usually of first or second degree, but occasionally third-degree injuries (complete rupture of the musculotendinous unit) do occur. Most hamstring strain injuries occur while running or sprinting. Several aetiological factors have been proposed as being related to injury of the hamstring musculotendinous unit. They include: poor flexibility, inadequate muscle strength and/or endurance, dyssynergic muscle contraction during running, insufficient warm-up and stretching prior to exercise, awkward running style, and a return to activity before complete rehabilitation following injury. Treatment for hamstring injuries includes rest and immobilisation immediately following injury and then a gradually increasing programme of mobilisation, strengthening, and activity. Permission to return to athletic competition should be withheld until full rehabilitation has been achieved (complete return of muscle strength, endurance, and flexibility in addition to a return of co-ordination and athletic agility). Failure to achieve full rehabilitation will only predispose the athlete to recurrent injury. The best treatment for hamstring injuries is prevention, which should include training to maintain and/or improve strength, flexibility, endurance, co-ordination, and agility.