Tenderness to palpation predicts return to sport following acute hamstring strain

A recent study sought to determine whether you could predict return to sport following acute hamstring strain based on tenderness to palpation. Pretty interesting, right?

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STUDY: Mapping Tenderness To Palpation Predicts Return To Play Following Acute Hamstring Strain – Schmitt et al. May 2020

Study reviewed by Dr Teddy Willsey

Key points from the study

  1. Prognostication for return to sport following hamstring injuries is oftentimes imprecise and impractical.
  2. Hamstring tenderness mapping appears to be a promising clinical examination procedure to predict hamstring injury return to sport time.
  3. There is a need for more objective measures to help inform clinicians as they formulate plans of care and inform patients on return to sport timelines.

Okay, let’s dive into the rest of this review.

Background and objective

Hamstring strains are extremely common in sports that involve high velocity sprinting. Time to return to sport (RTS) is quite variable following hamstring strains, with early estimations oftentimes being imprecise and impractical.

Little evidence exists supporting the utility of tests and measures to determine hamstring strain RTS. The authors of this study sought to investigate the predictive value of measuring the area and location of tenderness to palpation (TTP) following acute hamstring strain.


19 male athletes who sustained an acute hamstring strain underwent hamstring tenderness mapping during their initial evaluation and twice more throughout the rehabilitation process.

Tenderness mapping begins with identifying the point of peak tenderness, and then determining the proximal-distal and medial-lateral borders of the tenderness. Length, width, and total area of tenderness is palpated for, mapped, and calculated as percentages of the total thigh.


Return to sport time was most strongly correlated with length of tenderness. RTS was correlated with total area of tenderness and age to a lesser degree. RTS was not shown to be correlated with width of tenderness or location of peak tenderness. There was no difference in RTS time observed between proximal and distal or medial and lateral hamstring injuries.


Given the small sample size, it is important that this protocol is repeated on a much larger scale prior to clinical adoption.

One secondary limitation is the conservative rehabilitation protocol used. The average RTS time in this paper was 43.5 days. Although shown to be effective at reducing re-injury rates, longer RTS timelines are not realistic in team sports settings.

Clinical implications

The results of this study are exciting. It appears that palpating for tenderness may provide clinicians with valuable information regarding the severity of an injury and the rehabilitation timeline. Clinicians should work to develop a level of comfort with palpating for soft tissue injuries, establishing a baseline level of comfort on non-injured tissue, and communicating with the patients regarding pain levels.


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Here’s the topics for the 11 other studies we’ve reviewed in our September issue, just published:

  • Workplace Resistance Training for Neck Pain
  • ACL Injury Mechanisms in Football (Soccer)
  • Predicting Rotator Cuff Tears in Non-traumatic Shoulder Pain
  • Contextual Effects of Treatment for Knee OA Pain
  • Red Flags for Serious Spinal Pathologies
  • Chronic Exertional Compartment Syndrome Treatment
  • Inflammatory Response of Cartilage to FAI
  • Hop Tests for Return to Sport after ACL Reconstruction
  • Advice for Patients Living with Subacromial Pain
  • Eccentric Hamstring Training at Long Muscle Lengths
  • Theories of Physical Activity Behaviour Change


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