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Ask Dr. Rick – February 2011

February 7, 2011

Hamstring Injuries

I dreaded writing this article on hamstring injuries because it has been the bane of my sports medicine existence. A substantial portion of my practice involves the care, treatment and training of world-class track athletes and in return in my 25 years of taking care of Olympic athletes, I have been faced with the care and treatment of hamstring injuries.

The hamstring is a large muscle that originates from the pelvis and inserts into the tibia. It is a commonly injured muscle tendon unit in many, many sports. It is injured in baseball, injured in basketball and very commonly injured in track and field. The most common hamstring injury is a musculotendinous injury of the biceps femoris when in reality hamstring injuries can be a tendon injury, a muscle injury or a combination of the two. If the muscle is injured, it is diagnosed clinically as Grade I through Grade III with Grade I being mild and Grade III being a complete muscle tear with gapping of the muscle. In a tendinous injury, the injury likewise can be created as I through III with III being the worst and I being the mildest of tendon injuries.

Once the hamstring musculotendinous unit is injured, care and treatment consists initially of rest and the standard PRICE protocol. This stands for: protection, rest, ice, compression and elevation. It is very important to not stretch the hamstring after it has been injured. It is very important to rest the musculotendinous unit once it has been injured and it is very, very important to have prophylactics against reinjury. Prophylactics against reinjury include physical therapy, aggressive strengthening and biomechanical re-education so that the musculotendinous unit is not stretched to failure.

We recommend against anti-inflammatory medications because they limit healing and we aggressively treat these injuries acutely with either PRP (platelet rich plasma) injections or Chondro cell injections. We do not recommend cortisone injections and we do not recommend stretching of the hamstring until the healing process is well under way.

It is important to see your physician after a hamstring injury to make the correct diagnosis and it is important once the hamstring has healed to be on an aggressive hamstring exercise program, core strengthening exercise program and biomechanical re-education program.

Ask Dr. Rick


“I read your article last month and have a question about ankle sprains. Typically how long can I expect it to take for my ankle sprain to heal? Thank you.”
– Keyshawn J., Wildwood, MO

Thank you for your question, Keyshawn. This is a great question because there is really no answer. Some ankle sprains can heal as quickly as 7-to-10 days and some ankle sprains can take up to six weeks. It depends on how severe the tear is and how aggressive you treat them. In general, you can expect an ankle sprain to resolve in four to six weeks to return to full, unrestricted activity. As stated before, I believe it is important to see a physician and undergo appropriate treatment so that this does not become a recurring problem with an unstable ankle.


“My doctor has told me that I have weak ankles and I am not sure exactly what she means by this. I play high school basketball and would like to play in college. Could you please give me some direction?”
– Allison Z., Town & Country, MO

Dear Allison: In general, when athletes are told they have weak ankles, this means that there is looseness in the ligament construct and generalized laxity or instability in the ankles. It is very important to prophylactically treat any laxity in the ligamentous structure of the ankles and this would consist of you wearing a brace or taping at all times while on the court and being on a preventative strengthening program consisting of lower leg strengthening, proprioceptive exercises and balance training to avoid recurrent ankle sprains. If you continue to have instability after going through a significant therapy regimen, you should see an orthopedic surgeon and consider care and treatment. This is a great question and I really appreciate your input.

Dr. Rick’s Pearl of the Day: Athletes need to stay away from sugary replacement drinks that lead to empty calories.

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