Sports Medicine

, Volume 47, Issue 6, pp 1123–1144 | Cite as

Can Clinical Evaluation Predict Return to Sport after Acute Hamstring Injuries? A Systematic Review

  • Lotte Schut
  • Arnlaug WangensteenEmail author
  • Jolanda Maaskant
  • Johannes L. Tol
  • Roald Bahr
  • Maarten Moen
Systematic Review



The current literature on the value of clinical evaluation for predicting time to return to sport (RTS) after acute hamstring injuries has not been systematically summarised.


The aim of this study was to systematically review the literature on the prognostic value of clinical findings (patient history and physical examination) for time to RTS after acute hamstring injuries in athletes.

Data Sources

The databases PubMed, EMBASE, SPORTDiscus and Cochrane Library were searched between October 2014 and August 2015.

Study Eligibility Criteria

Studies evaluating patient history and/or physical assessment findings as possible predictors for time to RTS (described in days or weeks) following acute hamstring injuries in athletes were eligible for inclusion.

Data Analysis

Two authors independently screened the search results and assessed risk of bias using the modified Quality in Prognosis Studies (QUIPS) tool for quality appraisal of prognosis studies. We used a best-evidence synthesis to determine the level of evidence.


Sixteen studies were included, of which one study had a low risk of bias and 15 had a high risk of bias. Moderate evidence for an association with time to RTS was found for three clinical findings (visual analogue scale; pain at time of injury, self-predicted time to RTS and clinician predicted time to RTS). There was limited evidence for an association with time to RTS for seven clinical findings (muscle pain during everyday activities, popping sound at injury, forced to stop within 5 min, visual bruising at the site of injury, width (cm) of tenderness to palpation, pain on trunk flexion and pain on active knee flexion initially after injury). The remaining clinical findings revealed either conflicting evidence or limited evidence for an association with time to RTS.


There is at present no strong evidence that any clinical finding at baseline provides a valuable prognosis for time to RTS after an acute hamstring injury. There is moderate evidence that visual analogue scale pain at time of injury and predictions for time to RTS by the patient and the clinician are associated with time to RTS. The methodological quality of the current literature is characterised by a substantial risk of bias and reporting of RTS definitions and criteria for RTS were inconsistent. We provide recommendations that can guide the design of future studies.


Knee Flexion Magnetic Resonance Imaging Finding Electronic Supplementary Material Table Physical Assessment Ischial Tuberosity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Author contributions

Lotte Schut and Arnlaug Wangensteen contributed equally to this manuscript.

Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Lotte Schut, Arnlaug Wangensteen, Jolanda Maaskant, Johannes L. Tol, Roald Bahr and Maarten Moen declare that they have no conflicts of interest relevant to the content of this review.

Supplementary material

40279_2016_639_MOESM1_ESM.docx (37 kb)
Supplementary material 1 (DOCX 36 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Lotte Schut
    • 1
  • Arnlaug Wangensteen
    • 2
    • 3
    Email author
  • Jolanda Maaskant
    • 4
    • 5
  • Johannes L. Tol
    • 2
    • 6
    • 7
  • Roald Bahr
    • 2
    • 3
  • Maarten Moen
    • 7
    • 8
  1. 1.Medicort Specialists in Physical TherapyNaardenThe Netherlands
  2. 2.Aspetar Orthopaedic and Sports Medicine HospitalDohaQatar
  3. 3.Department of Sports Medicine, Oslo Sports Trauma Research CenterNorwegian School of Sports ScienceOsloNorway
  4. 4.Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical FacultyAcademic Medical Center and University of AmsterdamAmsterdamThe Netherlands
  5. 5.ACHIEVE Centre of Applied Research, Faculty of HealthAmsterdam University of Applied SciencesAmsterdamThe Netherlands
  6. 6.Academic Center for Evidence Sports Medicine, Academic Medical CenterAmsterdamThe Netherlands
  7. 7.The Sports Physician Group, OLVG WestAmsterdamThe Netherlands
  8. 8.Department of Sports MedicineBergman ClinicsNaardenThe Netherlands

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