A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. The role of stretching in rehabilitation of hamstring injuries: 80 athletes follow-up.
Prospective randomized comparison of 2 rehabilitation programs.
                The objectives of this study were to compare the effectiveness of 2 rehabilitation programs for acute hamstring strain by evaluating time needed to return to sports and reinjury rate during the first 2 weeks and the first year after return to sport. A third objective was to investigate the relationship between functional testing performance and time to return to sports and reinjury rates after return to sport.
                Hamstring muscle strains are common in sports and often result in chronic pain, recurrent hamstring strains, and reduced sports performance. Current rehabilitation programs are primarily developed anecdotally and lack support from prospective, randomized research.
                Twenty-four athletes with an acute hamstring strain were randomly assigned to 1 of 2 rehabilitation groups. Eleven athletes were assigned to a protocol consisting of static stretching, isolated progressive hamstring resistance exercise, and icing (STST group). Thirteen athletes were assigned to a program consisting of progressive agility and trunk stabilization exercises and icing (PATS group). The number of days for full return to sports, injury recurrence within the first 2 weeks, injury recurrence within the first year of returning to sports, and lower-extremity functional evaluations were collected for all subjects and compared between groups.
                The average (+/- SD) time required to return to sports for athletes in the STST group was 37.4 +/- 27.6 days, while the average time for athletes in the PATS group was 22.2 +/- 8.3 days. This difference was not statistically significant (P = .2455). In the first 2 weeks after return to sports, reinjury rate was significantly greater (P = .00343, Fisher's exact test) in the STST group, where 6 of 11 athletes (54.5%) suffered a recurrent hamstring strain after completing the stretching and strengthening program, as compared to none of the 13 athletes (0%) in the PATS group. After 1 year of return to sports, reinjury rate was significantly greater (P = .0059, Fisher's exact test) in the STST group. Seven of 10 athletes (70%) who completed the hamstring stretching and strengthening program, as compared to only 1 of the 13 athletes (7.7%) who completed the progressive agility and trunk stabilization program, suffered a recurrent hamstring strain during that 1-year period.
                A rehabilitation program consisting of progressive agility and trunk stabilization exercises is more effective than a program emphasizing isolated hamstring stretching and strengthening in promoting return to sports and preventing injury recurrence in athletes suffering an acute hamstring strain. Future randomized clinical trials should investigate the potential for progressive agility and trunk stabilization programs in the prevention of hamstring strain injury during sports. For years, stretching has been an integral part of fitness, practice, and rehabilitation programs to decrease muscle stiffness and relieve pain associated with it. The increased joint range of motion (ROM), indicating the degree of muscle flexibility, has a benefit of stretching proven for healthy tissues.
                The objective of our study was the assessment of the effects of stretching in the rehabilitation of hamstring injuries.
                We followed up 80 Greek athletes, of average age 20.5 yr, with "second-degree" strain of the hamstring muscles. The athletes were divided into two groups, A and B. For both groups, we estimated the time required for the rehabilitation of the decreased knee ROM and the total time before the athletes could return to a full training program.
                Group B, which carried out a more intensive stretching program, was found to have a statistically significant shorter time of regaining normal ROM (5.57 +/- 0.71 d) and rehabilitation period (13.27 +/- 0.71 d) in comparison with group A (7.32 +/- 0.525 d and 15.05 +/- 0.81 d, respectively).
                Our results suggest that stretching is of great importance in treating muscle strain injuries in that it improves the effectiveness of the rest rehabilitation program.
Most proposed physiotherapy techniques for rehabilitation of hamstring injuries have not been assessed using randomised trials. Those that have only have single studies with a limited range of participants and outcomes. There is limited evidence to suggest that time to recovery for elite athletes can be reduced with an increased daily frequency of hamstring stretching exercises. There is preliminary evidence from another small study of mixed ability athletes to suggest that exercise to correct movement dysfunction could reduce time to return to full activity and the risk of re-injury. Further studies are required to check these findings. Until further evidence is available, current practice and widely published rehabilitation protocols cannot either be supported or refuted.