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Updated: Jan 22, 2026

Muscle Imbalances: Testing and Training Functional Eccentric Hamstring Strength in Athletic Populations
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Hamstring Injuries in Athletes: Evidence-based Treatment.

Justin W Arner1, Michael P McClincy, James P Bradley

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Hamstring injuries in athletes can be proximal, muscle belly, or distal, often requiring surgery for proximal/distal types. Eccentric strengthening and platelet-rich plasma show potential for recovery and reduced re-rupture.

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Area of Science:

  • Sports Medicine
  • Orthopedic Surgery
  • Rehabilitation Science

Background:

  • Hamstring injuries are prevalent among athletes, causing significant disability.
  • Injuries are categorized as proximal, muscle belly, or distal, with proximal and distal types more frequently necessitating surgical intervention.

Purpose of the Study:

  • To review the classification, treatment, and outcomes of hamstring injuries in athletes.
  • To discuss the role of imaging, surgical versus nonsurgical management, and rehabilitation strategies.
  • To highlight the importance of preventive therapies and identify areas for future research.

Main Methods:

  • Literature review of hamstring injury management.
  • Analysis of treatment outcomes based on injury location (proximal, muscle belly, distal).
  • Evaluation of nonsurgical interventions including eccentric strengthening and platelet-rich plasma (PRP).

Main Results:

  • Acute repair of proximal avulsions yields successful outcomes; chronic repairs are less reliable.
  • Muscle belly injuries have predictable outcomes but high recurrence rates.
  • Nonsurgical treatment for muscle belly tears involves eccentric strengthening, potentially augmented by low-white blood cell platelet-rich plasma (PRP).
  • Distal hamstring injuries are rare but may require surgery.

Conclusions:

  • Hamstring injury management varies by location, with surgical intervention often needed for proximal and distal tears.
  • Eccentric strengthening and PRP show promise in recovery and re-rupture prevention.
  • Preventive therapies are crucial post-return to sport due to high reinjury rates.
  • Further research with larger cohorts is needed to optimize treatment and reduce injury/reinjury rates.