Article Text

Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis
  1. Haiko IMFL Pas1,2,
  2. Gustaaf Reurink1,3,4,
  3. Johannes L Tol1,5,6,
  4. Adam Weir4,
  5. Marinus Winters7,
  6. Maarten H Moen1,8
  1. 1The Sports Physician Group, Department of Sports Medicine, St Lucas Andreas Hospital, Amsterdam, The Netherlands
  2. 2Department of Cardiology, Alrijne Hospital Leiden, Leiden, The Netherlands
  3. 3Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
  4. 4Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands
  5. 5Aspetar, Orthopedic and Sports Medicine Hospital, Doha, Qatar
  6. 6Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
  7. 7Department of Rehabilitation, Nursing Science & Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
  8. 8Bergman Clinics, Naarden, The Netherlands
  1. Correspondence to Haiko IMFL Pas, The Sports Physician Group, Department of Sports Medicine, St Lucas Andreas Hospital, mailbox 9243, Amsterdam 1006 AE, The Netherlands; pas.haiko{at}


Background Our 2012 review on therapeutic interventions for acute hamstring injuries found a lack of high-quality studies. The publication of new studies warranted an update.

Objectives To update and reanalyse the efficacy of conservative treatments for hamstring injury.

Data sources PubMed, EMBASE, Web of Science, Cochrane library, CINAHL and SPORTDiscus were searched till mid-February 2015.

Study eligibility criteria Randomised controlled trials (RCTs) on the effect of conservative interventions versus a control group or other intervention for hamstring injuries (HI) were included.

Data analysis The search results were screened independently by two authors. Risk of bias assessment was performed using a modified Downs and Black scale with a maximum score of 28. Meta-analysis was performed, where possible.

Main results 10 RCTs (526 participants), including 6 new RCTs, were identified. Two RCTs were of good/excellent quality, the rest were fair or poor (median Downs and Black score 16 (IQR 9)). Meta-analysis of two studies on rehabilitation (lengthening) exercises showed a significantly reduced time to return to play (HR 3.22 (95% CI 2.17 to 4.77), p<0.0001) but no difference in risk of re-injury. Meta-analysis of three studies investigating platelet-rich plasma (PRP) showed no effect when compared to control (HR 1.03 (95% CI 0.87 to 1.22), p=0.73). Limited evidence was found that progressive agility and trunk stability training may reduce re-injury rates.

Conclusions Meta-analysis showed superior efficacy for rehabilitation exercises. PRP injection had no effect on acute hamstring injury. Limited evidence was found that agility and trunk stabilisation may reduce re-injury rates. The limitations identified in the majority of RCTs should improve the design of new hamstring RCTs.

  • Hamstring
  • Injuries
  • Platelet-Rich Plasma
  • Physiotherapy
  • Review

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Linked Articles