Background Hamstring muscle injuries are notoriously found among the most common causes of abstinence and delayed return to sport, in a variety of track, field and other high level athletes. In this respect we present our experience of conservative treatment of total proximal, non-avulsed hamstring rupture in high-level track, field and other athletes and application of an integrated rehabilitation protocol.

Methods Eleven high level athletes, nine men and two women, were diagnosed with sub/ total proximal, non-avulsed, hamstring rupture (grade III or IV strain). All of the patients were treated conservatively over a time scheme of twelve weeks.Then the athletes were ready to return to their complete sport–specific training.

Results All the athletes were treated conservatively. All of them made a full return to their sport .Mean follow up time was from six months to two years. One male track athlete had a multiple reinjury history after his primary hamstring rupture (over 18 months of follow up).All the other athletes fully returned to their sports with no recurrent hamstring injuries during the follow up.

Conclusions Indications that have been proposed for operative treatment of total proximal hamstring ruptures are most clear and widely acceptable when a bone avulsion is present off the ischial tuberosity.¹ However when it comes to total proximal, non avulsed ,hamstring rupture (grade III or IV strain) the operative indications may be relative and there still may be a place for integrated conservative treatment.²

Conservative treatment has to be based on the correct classification of the injury, the right clinical assessment at the acute phase as well as along the whole length of treatment.

Surgical treatment has an important role to play in complete proximal hamstring ruptures bearing in mind the right indications such as acute bone avulsions from the muscles’ origin.³