RESEARCH SUMMARY: Hamstring strain rehabilitation and re-injury risk (Hickey et al., 2021)

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Original research title: ‘Current clinical concepts: hamstring strain injury rehabilitation’ (Hickey et al., 2021)

Authors: Hickey, J., Opar, D., Weiss, L., Heiderscheit, B

Year: 2021


Whilst many practitioners prioritise the rehabilitation element of an athlete’s return to play, choosing the best rehabilitation is not a strong enough focus. Consequently, many athletes return to play with an increased risk of re-aggravating their injury.

This narrative explores the current clinical concepts on acute hamstring injuries (HSI). The aim is to inform practitioners on how to best promote athletes’ early return to play whilst minimising risk of re-injury.


Athletic trainers and physiotherapists need to have a solid understanding of the currently limited evidence - based information regarding HSI and HSI rehabilitation, so athletes have the greatest opportunity for a full recovery.

In the situation of heavy time constraints, practitioners need to use sound clinical reasoning and prioritise rehabilitation interventions that actively promote the highest treatment outcomes.  

Ultimately, a return to play process for HSI should involve a shared decision amongst the athlete, team medical staff (including rehabilitation practitioners) and strength and performance staffs.   

Key findings

  • HSI involve a mixture of high muscle-tendon unit forces, extensive hamstring lengthening beyond normal and high velocity movements. 
  • Given its fundamental nature, returning to high-speed running is one of the main aspects of HSI rehabilitation.
  • Eccentric hamstring and hip extensor strengthening exercises are recommended as part of HSI rehabilitation to best manage strength and structural deficits as well as preparing athletes for the demands of high-speed running. 

To read the full research paper, see here.

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