Hamstring muscle injury rehabilitation in sports: a scoping review

To describe the methodological characteristics and content of published hamstring muscle injury (HMI) rehabilitation programmes in order to inform clinical practice and guide future research.

We searched the MEDLINE (PubMed), Scopus and Web of Science electronic databases, on October 2024, using key terms "hamstring" and "rehabilitation", with strategies refined after a preliminary search. Eligible studies included English-language publications involving non-surgically managed acute HMI in humans and reporting rehabilitation protocols.

We included 137 articles. Primary research (43.1%, n=59) included mostly cohort and randomised controlled trials (RCTs); secondary research articles (54.0%, n=74) were predominantly narrative reviews. Overall, 54.7% of studies had a low level of evidence. Only 44.2% of primary research focused on HMI rehabilitation programmes of which 47.8% were RCTs. Rehabilitation programme details were often missing. In the subacute/functional phases, strengthening (78.3%) and stretching (55.6%) were most frequently reported. Return-to-sport criteria were reported in only 43.5% of primary research, often based on pain resolution. Across both primary and secondary research, 40 different rehabilitation strategies were identified, with the most frequently reported being eccentric-based strengthening, flexibility exercises, progressive running and agility protocols. Key gaps included lack of standardisation, under-reporting of programme parameters and limited inclusion of diverse sporting populations.

Current scientific literature on HMI rehabilitation programmes shows wide variety, limited high-level evidence primary research and under-reporting of key clinical details. More rigorous and inclusive studies are needed to improve the standardisation and clinical applicability of rehabilitation strategies.