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Addressing a Need

Hamstring injuries are an incredibly common part of sport, with some incident rates reported at 3 to 4.1 per 1000 competition hours. There are multiple risk factors that can predispose an athlete to hamstring injury or re-injury. For this reason, the rehabilitative strategy needs to be multi-factorial. Currently, many physical therapists treat hamstring injuries as they would any other muscle strain in the body, failing to appreciate the incredibly dynamic and rigorous stress placed on the hamstring during athletic activity. This can result in return to sport too early, diminished performance, and even re-injury. The purpose of this project was to synthesize the available literature pertaining to hamstring injury, risk factors, rehabilitation, and return to sport considerations. Using that information, a standardized protocol was established to assist physical therapists with hamstring rehabilitation, including recommendations for useful metrics/outcome measures and evidence-based interventions.



Hamstring Strain Rehab Protocol

Literature Review


Health Literacy

An important component of this project was creating educational resources that could effectively communicate my findings. My approach to this was two-fold: (1) ensuring that clinicians understood the evidence regarding hamstring strain rehabilitation which was accomplished by a formal voice-over presentation and (2) a concise and informative handout to be given to patients with this injury that accommodates varying levels of health literacy. Those two products are linked below.

Patient Education

VoiceThread Narration



All the deliverable products were shared with multiple colleagues including current students, physical therapists, and athletic trainers. The following form was attached to prompt more subjective feedback about these deliverables:

Feedback Form



This project gave me an excellent excuse to take a deep dive into the literature around hamstring injury, running biomechanics, exercise prescription, and return to sport considerations. This interest was sparked by my time working with collegiate track & field athletes who were frequently sidelined by hamstring injuries. I never felt like I had a good grasp of what an effective rehabilitation looked like with these higher level movers. At first, I was overwhelmed by the potential scope for this topic. The body of evidence is immense, and I had difficulty synthesizing and condensing the information I was finding. For that reason, I had some late nights leading up to various deadlines to make sure I kept pace throughout the semester. I acknowledge that my literature review is not even close to comprehensive, and any one of my subheadings would have made for a Capstone on its own. In spite of that, I feel like I was able to create several deliverable products that have real merit clinically. My protocol goes into greater detail than most others, and the exercise recommendations are thoughtful and supported in the literature. I am very excited to put it into practice and appreciate that this project has given me yet another tool to use in the years to come.



To Louise Thoma, PT, DPT, PhD, thank you for advising me these past 3 years and for agreeing to serve as the fearless leader of my committee in spite of how busy of a season this has been for you. I really valued your expertise in sport and orthopedics.

To Jonathon Hacke, PT, DPT, ATC-Ret, your witty comments on my various drafts helped me through some of the more grueling moments in this process. You have impacted me and this program in ways you probably don’t even realize.

To Joshua Torrey, PT, DPT, thank you for the quick feedback and agreeing to assist me in this endeavor, even though I never had the chance to meet you in person. Here’s to crossing paths one day!

One Response to “Advanced management of hamstring muscle strains in athletes with return to sport considerations”

  1. Louise Thoma

    Josh – This was a great project and learning experience. Developing strong and effective (implementable) clinical guidelines is HARD and nearly always a team effort – and also an important skillset to develop in promoting evidence based practice. I’m confident that these products, and the experiences that you had to develop them, will be useful in the future! It was evident how diving deeper into some of these topics gave new appreciation on the intricacies and nuance of the evidence from the perspective of making recommendations. I’m excited to see how you build on this in the future. Congratulations!


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