Diagnosis and Prognosis of Hamstring Injury



In practice, three clinical scenarios can be distinguished in hamstring injuries: (1) acute hamstring injury, (2) hamstring injury sequela (repeated episodes of injury and/or pain) and (3) hamstring tendinopathy.

An acute hamstring injury is usually not hard to recognise, and with a relatively simple clinical examination, prognostic information can be obtained, although prediction of the recovery time for the individual athlete just after injury remains inaccurate. A postponed clinical evaluation 1 week after injury seems to be more appropriate for prediction of injury duration. Additional imaging with MRI or sonography may complement the clinical assessment of hamstring muscle injury, but the value for injury prognosis is limited.

Managing hamstring injury sequela is often challenging as scientific knowledge is limited. The diagnostic workup should be aimed at exploring the differential diagnosis of other causes of posterior thigh pain and evaluating (risk) factors that affect persistent or repeated hamstring symptoms.

Presentation of hamstring tendinopathy differs from acute injury and is characterised by well-localised pain at the tendon insertion to bone, generally provoked with prolonged sitting, cycling or lunging, squatting or change of direction activity. Clinical examination should seek to reproduce the patient’s pain by provocation testing including resistance testing and combined passive stretch and compression tests. Additional (MRI) imaging only has value in clinical decision-making if aligned with physical examination, as imaging abnormalities are frequently observed in asymptomatic individuals.


Diagnosis Prognosis Clinical examination Imaging 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Academic Centre of Evidence-Based Sports MedicineAmsterdam University Medical Centers, AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Orthopaedics and Sports MedicineErasmus MC University Medical CentreRotterdamThe Netherlands
  3. 3.Physiotherapy DepartmentUniversity of CanberraBruceAustralia
  4. 4.Institute of Sport, Exercise and HealthLondonUK
  5. 5.High Performance Sport NZMillennium Institute of Sport and HealthAucklandNew Zealand
  6. 6.Department of Orthopedic Surgery, Sports Orthopedic Research Center—Copenhagen (SORC-C)Amager-Hvidovre Hospital, Copenhagen UniversityCopenhagenDenmark

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