Study shows: Exercise can replace surgery for hamstring injuries

– Traditionally, surgery has been the standard treatment for acute hamstring injuries, although there is no scientific evidence that this treatment would be best for this injury. In Sweden, there were large regional 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, MD, professor of orthopedics at Akademiska sjukhuset/Uppsala University, who was the lead researcher of the current study.

The hamstrings are muscles located at the back of the thigh that flex the knee joint and extend the hip joint. A proximal hamstring tendon rupture means that the tendon on the sit bone of the hamstring muscles has torn. Injuries often occur in slip-and-fall accidents, but also in connection with sports such as water and cross-country skiing or snowboarding accidents.

– 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, explains Kenneth Johnson.

The study was conducted in Sweden and Norway between 2017-2022. Patients aged 30-70 at ten hospitals were randomised to either surgery or non-surgical treatment. During surgery, the tendon stem is reattached to the sit bone using wires fixed to the sit bone. In the case of non-surgical treatment, the patient is recommended a rehabilitation programme supported by a physiotherapist. Patients were followed using a number of parameters, including a patient-reported tool called the Perth Hamstring Assessment Tool (PHAT) developed in Australia, which assesses pain, activity and movement.

– After two years, the results showed that the differences between the two treatment methods were minimal, and that they gave equivalent results in terms of function and recovery. The study shows that non-surgical treatment can be a safe and effective alternative to surgery for patients with proximal hamstring contractures. Kenneth Johnson concludes that it opens up new guidelines in healthcare and could change how hamstring injuries are treated in the future.