Following Monday Night Football’s game between the Broncos and Chargers, reports came out that the Broncos’ star quarterback and prized offseason acquisition, Russell Wilson, had a “significant” hamstring injury. As our NY Jets prepare to go to Denver this weekend, I thought this would be a good opportunity to review hamstring injuries and timetable to return.

Why are hamstring injuries so common in athletes?

The “hamstrings” are the group of muscles in the posterior aspect of the thigh composed of the semitendinosus, semimembranosus, and the biceps femoris. The hamstrings are particularly susceptible to injury because they cross both the hip and knee joints, as well as one of the most important muscles with explosive movements. Sports like football, soccer, basketball, hockey, and sprinting require a lot of activity with this muscle group.

How do these injuries happen?

Typically, these injuries occur at the sudden take off phase of running. The muscle tears because it is rapidly stretched beyond its limit. The muscle typically tears at the myotendinous junction or where the muscle meets the tendon. This usually creates pain closer to the knee in the back of the thigh. Other times, the tendinous portion can tear off the bone near the proximal part of the thigh. This typically gives pain in the lower buttock/upper thigh region.

How do we manage these injuries?

Most hamstrings heal well with conservative management. RICE is common pneumonic we use that stands for Rest, Ice, Compression, and Elevation. This is typically applied during the first few days after injury. Once the pain has subsided, physical therapy is an excellent modality to help restore strength and range of motion. Muscle belly injuries do not require surgery. Surgery is reserved for injuries that involve tendon avulsion from the pelvis.

Platelet Rich Plasma is another modality for treatment of hamstring injuries. It requires using the patient’s own blood and spinning it down in a centrifuge to isolate the most potent growth factors. This is then injected into the site of injury. A study amongst NFL players injected with PRP with grade 2 hamstring injuries showed a faster return to play by 1 game (1 week).

Timetable for return?

This depends on the severity of the injury. Higher grade injuries may take up to 6 weeks to heal. More milder injuries can be expected in approximately 3-4 weeks.

Author: Nicholas Montemurro, MD – Total Orthopedics & Sports Medicine