Hamstring muscle injuries in athletics

Hamstring muscle injuries (HMI) are a common and recurrent issue in the sport of athletics, particularly in sprinting and jumping disciplines. This review summarises the latest literature on hamstring muscle injuries in athletics from a clinical perspective. The considerable heterogeneity in injury definitions and reporting methodologies among studies still needs to be addressed for greater clarity. Expert teams have recently developed evidenced-based muscle injury classification systems whose application could guide clinical decision-making; however, no system has been adopted universally in clinical practice, yet.

The most common risk factor for HMI is a previously sustained injury, particularly early after return-to-sport. Other modifiable (e.g., weakness of thigh muscles, high-speed running exposure) and non-modifiable (e.g., older age) risk factors have limited evidence linking them to injury. Reducing injury may be achieved through exercise-based programmes, but their specific components and their practical applicability remain unclear.

Post-injury management follows similar recommendations to other soft tissue injuries, with a graded progression through stages of rehabilitation to full return to training and then competition, based on symptoms and clinical signs to guide the individual speed of the recovery journey. Evidence favouring surgical repair is conflicting and limited to specific injury sub-types (e.g., proximal avulsions). Further research is needed on specific rehabilitation components and progression criteria, where more individualised approaches could address the high rates of recurrent HMI. Prognostically, a combination of physical examination and magnetic resonance imaging (MRI) seems superior to imaging alone when predicting “recovery duration”, particularly at the individual level.