Here’s How Top Physios Assess Hamstring Injuries

Hamstring strains are among the most common muscle injuries in athletes, particularly those involved in sprinting, football, and other explosive sports that require high-speed running and rapid changes in direction.

These injuries can vary in severity, from mild strains that resolve quickly to more significant tears that require extended rehabilitation and careful management. A thorough assessment is integral, not only for an accurate diagnosis but also for understanding the extent of the injury, predicting the patient’s prognosis, and tailoring an effective rehabilitation plan.

In his Practical, expert physiotherapist Scott Hulm breaks down his structured approach to assessing hamstring strains, helping clinicians confidently identify key injury characteristics and make informed decisions about treatment. This blog highlights just some of the components he covers.

If you’d like to see exactly how expert physio Scott Hulm assesses hamstring injuries, watch his full Practical HERE. With Practicals, you can be a fly on the wall and see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster. Learn more HERE.

Palpation

Palpation is a fundamental part of hamstring strain assessment, helping clinicians pinpoint the exact location of the injury and determine its severity. A systematic and structured approach ensures that no key details are missed, allowing for a more accurate diagnosis and better-informed rehabilitation planning. Follow a few of these key steps:

• Patient positioning: Position the patient in prone with the knee slightly flexed to reduce tension.
• Systematic examination: Whether you begin palpating proximally or distally, it’s helpful to follow a standardised process. This ensures consistency and reduces the likelihood of overlooking important findings. Moving systematically along the muscle belly and tendons allows for a thorough evaluation.
• Pain and tenderness: Identifying areas of localised tenderness is crucial, as pain patterns can provide insight into the severity of the strain.
• Palpable defect: In more severe strains, a palpable gap or defect may be felt in the muscle belly, suggesting a higher-grade injury. This finding suggests a more significant injury that may require a longer rehabilitation process and, in some cases, surgical consultation.

Watch how Scott palpates the hamstrings in this short clip from his Practical:

Mobility assessment

Assessing mobility provides insight into tissue flexibility and patient pain response, as well as giving you a place to start and reassess throughout the patient’s rehab. A few options to assess your patient’s mobility include:

• Passive Straight Leg Raise (PSLR) test: Passively lift the patient’s leg while maintaining knee extension. Limited range or pain can indicate hamstring involvement. If possible, use an inclinometer to measure this for re-assessment.
• Max Hip Flexion Active Knee Extension (MHFAKE) test: This test is useful to assess hamstring mobility, as well as gain insight into the patient’s pain level.
• Modified Thomas Test: Useful to assess hamstring flexibility in conjunction with hip flexor tightness.
• Other mobility tests: hip flexion and and ankle dorsiflexion are weak risk factors for hamstring strains, so depending on the patient it may be useful to add these into a thorough assessment.

Combining multiple mobility tests provides a clearer picture of hamstring flexibility and potential restrictions. Since mobility limitations may persist even after strength has returned, regular reassessment can help track progress and guide rehabilitation interventions.

Strength testing

This will obviously be a key part of any assessment and reassessment for your patient. It’s important to reassess this throughout their rehab to see where they are at and make decisions about return to running and sport. Firstly, if you’re in a sporting environment, and need to quickly assess the severity of your athlete’s injury, Scott demonstrates a quick on-field test you can use in this video from his Practical:

If you’re seeing a patient in the clinic, tools such as a hand-held dynamometer and force plates can be used to measure strength and compare to the uninjured side, guiding decision-making. However, Scott notes strength can return quite quickly following hamstring injury, so this should not be the sole indicator of rehab progression!

Additionally, it’s important to assess not only knee flexion strength but also hip extension strength. Scott demonstrates how he does this in his Practical, watch the snippet below:

Lastly, for patients with recurrent hamstring strains, it may be beneficial to assess their apprehension. One way to do this is the H-test, which involves the patient rapidly flexing the hip in a supine position to assess confidence in movement.

Wrapping up

A comprehensive hamstring strain assessment is essential for guiding rehabilitation and return to running/sport. By incorporating palpation, mobility testing, and strength assessment, clinicians can gain a clearer picture of injury severity and functional deficits. As Scott Hulm demonstrates, a structured approach ensures nothing is overlooked and helps set you up for ongoing monitoring to ensure you understand the patient’s injury and progress to achieve optimal outcomes for them.

If you want to see exactly how an expert physio assesses hamstring strains, watch Scott Hulm’s full Practical for an in-depth breakdown of his process. Learn more HERE.