Introduction

Despite a variety of injury prevention programmes and a rapid increase in research over the past decade, the incidence of hamstring muscle injuries (HSI) in many competitive sports has not decreased.1 Risk factors are multifactorial and may include anthropometry, game volume and intensity, competitive timetabling (congestion), length of career, international travel and duties and of course a history of prior injury and compliance to adequate rehabilitation. While some risk factors are not modifiable, inappropriate decision-making and/or non-adherence to rehabilitation practices may partially explain the increased incidence (and reoccurrence of HSI).2 Clinicians managing athletes with HSI require the best available evidence to support their management in optimising return to play. Unfortunately, evidence in key areas remains weak. For example, criteria used to guide return to full sprinting do not encompass the differing roles of each hamstring muscle in sprinting. Furthermore, agreement is lacking on when to consider surgical intervention to restore connective tissue architecture, tension and reduce reinjury risk in severe HSI. Given the increasing incidence and burden of HSI, together with what appears to be suboptimal injury prevention and rehabilitation evidence, the sports and …