Exercise is as good as surgery for a hip injury.

Acute injuries to the back of the thigh can occur due to slipping accidents, but also when skiing or snowboarding, for example. The injury is also called a hamstring strain.

Hip injuries are usually treated with surgery, but there is no scientific evidence that surgery is the best option. Now, a new study suggests that exercise may be just as effective.

– In Sweden, there were large local differences in the choice of treatment. Our results show that exercise, i.e. non-surgical treatment, can be as good an alternative as surgery. This could mean a lower risk of complications, faster rehabilitation and a good quality of life for most patients, says Kenneth Jönsson, chief physician at the University Hospital and professor of orthopedics at Uppsala University.

More common in countries that practice winter sports.

The hamstring muscles are located at the back of the thigh. These muscles flex the knee joint and extend the hip joint. A so-called proximal hamstring tear means that the tendon attachment on the sit bone of the hamstring muscles has been torn.

– It is a relatively uncommon injury that usually occurs during an uncontrolled splitting movement when the hip joint is flexed at the same time as the knee is extended. The popularity of cross-country skiing and long-distance skiing in Sweden and Norway means that this injury is relatively more common in this part of the world. In the acute phase, the injury causes, among other things, severe pain and decreased function when extending the hip and trying to flex the knee, says Kenneth Johnson.

Equivalent training results

The study included patients who were randomized to surgery or non-surgical treatment. During the procedure, the tendon stem was reattached to the sit bone using wires fixed in the sit bone. Patients in the second group were recommended a rehabilitation program with the support of a physiotherapist.

At follow-up, participants had to rate pain, activity, and mobility.

– After two years, the results showed that the differences between the two treatments were small, and that they produced equivalent outcomes in terms of function and recovery, says Kenneth Johnson.

He believes that nonsurgical treatment could be a safe and effective alternative to surgery for this type of hip injury.

– It opens the door to new guidelines in healthcare and could change how hamstring injuries are treated in the future.

The study was conducted in Sweden and Norway during the period 2017-2022. More than 100 patients aged 30 to 70 years participated in it.

Scientific study:

Surgical vs. nonsurgical treatment for proximal hamstring strainsNajim guide.