Hamstring muscle injury rehabilitation in sports: a scoping review
BMJ open sport & exercise medicine · 2026
A scoping review finds hamstring rehab research is a mess of under-reported protocols and pain-based return-to-sport calls, not a source of new treatment guidance.
The paper
Scoping review, n=137 articles, on rehabilitation programmes for non-surgically managed acute hamstring muscle injury in sport.
What they found
Of 137 included articles, 54.7% had a low level of evidence, only 44.2% of primary research actually described a rehabilitation programme (47.8% of those RCTs), and return-to-sport criteria were reported in just 43.5% of primary research, often based only on pain resolution. Strengthening (78.3%) and stretching (55.6%) were the most common subacute/functional-phase components, with 40 different rehab strategies identified overall.
Study design
Scoping review of primary and secondary literature (137 articles: 43.1% primary, mostly cohort/RCT; 54.0% secondary, mostly narrative reviews) mapping methodological characteristics and content of hamstring injury rehab programmes, not a review of clinical outcomes.
Methodology
Three databases (MEDLINE, Scopus, Web of Science) were searched to October 2024 in English only, which is a reasonable scoping-review approach but leaves grey literature and non-English trials out, a real source of selection bias given how much S&C practice sits outside indexed journals. Scoping reviews by design don't grade evidence with GRADE or pool an effect size, so the 54.7% 'low level of evidence' figure is a descriptive classification, not a bias-adjusted quality score, a clinician can't take it as a verdict on any single programme's efficacy. There is no outcome synthesis (no re-injury rates, return-to-sport time pooled), so this paper cannot tell you whether any given rehab approach works better than another, only how inconsistently the field reports what it does.
The appraisal
This is a mapping exercise, not an efficacy study, so there is no effect size to weigh for clinical significance. Its real value is exposing a field-wide reporting problem: under half of primary studies even describe their rehab programme in enough detail to replicate, and return-to-sport decisions are still commonly pain-based rather than criteria-based, which matters practically even though the review itself makes no comparative claim.
The gap
The review cannot tell you which of the 40 identified strategies actually reduces re-injury or speeds safe return to sport, that requires outcome-focused systematic reviews and adequately powered RCTs with standardised, non-pain-based RTS criteria.
Landmark context
This sits downstream of two decades of hamstring return-to-sport research, from Askling-type eccentric/lengthening protocols to the push for criteria-based rather than pain-based RTS decisions. What this scoping review adds is a reality check on how little of that conceptual progress has reached standard practice, most published protocols in the literature still under-report programme detail and lean on pain resolution rather than validated RTS criteria.
What to do Monday
No, it doesn't hand clinicians a new protocol to adopt, but it is a useful prompt to audit your own hamstring rehab documentation and RTS criteria against something more rigorous than pain resolution alone, and to be skeptical of any single published 'protocol' claiming superiority without outcome data.
In practice
This applies to any athlete recovering from an acute hamstring strain, sprinters and field-sport players especially, where RTS calls get made under time and selection pressure. In the clinic, don't let 'pain-free' be your sign-off, baseline a Single Leg Hamstring Bridge test on the affected versus unaffected side at initial assessment and re-test before clearing for sport, so the decision rests on a number rather than a feeling. On the S&C floor, this is a prompt to document your eccentric strengthening and progressive running phases properly, sets, reps, velocity, distance, because the review shows most published programmes don't even specify that, so lifting someone else's 'protocol' wholesale usually means borrowing an under-described one. Caveat: this review tells you what's missing from the evidence, not which loading scheme wins, so it should sharpen your own criteria-based practice rather than send you looking for a new template to copy.
The five papers that matter — every week, free.
We read the whole sports-medicine, rehab & performance literature and appraise the papers worth your time.
Get the free weekly issueRelated appraisals
Read in your language: English · Français · Deutsch · Español · Italiano · Nederlands · Dansk · Svenska