Pain-free versus pain-threshold rehabilitation following acute hamstring strain injury: A randomized controlled trial

Review written by Dr Teddy Willsey info

Key Points

  1. Young male athletes with acute hamstring injuries should use a progressive exercise rehabilitation program emphasizing eccentric knee flexor strength and exercises at long muscle lengths.
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Hamstring strain injuries (HSIs) represent the most prevalent cause of time lost across a wide range of sports (1). Conventional guidelines for hamstring strain rehabilitation recommend exercises be performed in complete absence of pain. It has been hypothesized that a lack of progressive load and challenging exercises during rehabilitation may delay restoration of two well-known HSI risk factors: knee flexion eccentric strength and biceps femoris long head (BFlh) fascicle length. The authors of this paper aimed to challenge traditional guidelines of “pain-free” exercise, while observing the efficacy of a simple and progressive eccentric focused rehabilitation and return to running protocol.

Two well-known hamstring injury risk factors include eccentric knee flexion strength and biceps femoris long head fascicle length.
This paper makes a strong case to not delay the introduction of challenging eccentric and long muscle length exercises due to the presence of pain or discomfort


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