Diagnosis and Management of Hamstring Muscle Injuries in Athletes

To provide an updated review of the clinical approach to hamstring muscle injuries in athletes, emphasizing diagnosis, classification systems, rehabilitation strategies, and novel procedural interventions. Advanced imaging, particularly MRI, plays a central role in accurate injury classification and prognostication, with systems like BAMIC and Barcelona Classification offering improved return-to-play (RTP) guidance. Rehabilitation remains the cornerstone of management, with growing evidence supporting eccentric training, neuromuscular control, and flexibility in reducing reinjury risk. Emerging non-surgical adjuncts such as blood flow restriction (BFR), extracorporeal shockwave therapy (ESWT), and injection options show promise but require further validation. Platelet-poor plasma (PPP) has shown superior return-to-play outcomes compared to PRP in early studies. Hamstring injuries require a multimodal, individualized approach that integrates clinical examination, advanced imaging, structured rehabilitation, and, when appropriate, novel adjunct therapies. While classification systems and imaging have improved prognostication, further prospective studies are needed to standardize procedural interventions and refine RTP decision-making.