The guidelines established by the New York State Workers Compensation Board are crafted to assist healthcare professionals in evaluating Hamstring and Hip Flexor Strains. These directives aim to support physicians and healthcare practitioners in determining the appropriate treatment for these conditions.
Healthcare professionals specializing in Hamstring and Hip Flexor Strains can rely on the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable level of care for their patients.
It is important to stress that these guidelines are not meant to replace clinical judgment or professional expertise. The ultimate decision regarding care should involve collaboration between the patient and their healthcare provider.
Hamstring and Hip Flexor Strains
Introduction
Hamstring and hip flexor strains are believed to be genuine muscular strains, involving disrupted myotendinous junctions. Examination findings typically include tenderness at either the muscle origin or insertion, accompanied by swelling or, in more severe cases, large ecchymoses (bruises). In instances where there are complete ruptures, surgical repair may be necessary. Clinical tests are generally not required for diagnosis. Treatment options may involve the use of NSAIDs, application of heat or cold, ace wraps, work limitations, therapy, and a progressive approach to agility and trunk stabilization.
Diagnostic Studies
Ultrasound:
Recommended:
- For diagnosing hamstring strains and tears and hip flexor strains.
Indications:
- Patients with hamstring strains, tears, and hip flexor strains, generally of at least moderate severity.
- Mild strains typically resolve with appropriate treatment without the need for diagnostic testing.
Frequency/Dose/Duration:
- Once.
Rationale:
- Ultrasound may be helpful in evaluating and confirming these diagnoses, making it a recommended diagnostic tool.
MRI:
Recommended:
- To diagnose hamstring or hip flexor strains in select more severe cases.
Indications:
- Severe and select cases of moderately-severe strains where there is consideration for surgical repair.
Rationale:
- MRI can assist in assessing the degree of severity in more severe cases, helping define eligibility for surgical intervention. Therefore, MRI is recommended in such cases.
Treatments
Cryotherapy/Heat – Hot or Cold or Ace Wrap Therapies:
Recommended:
- For the treatment of hamstring or hip flexor strains.
Indications:
- Most patients with sufficient pain from hamstring or hip flexor strains requiring treatment and medication, especially in the acute and peri-operative stages.
Frequency/Dose/Duration:
- Generally tailored according to severity and patient preferences.
Rehabilitation Therapy:
Rehabilitation required due to a work-related injury should focus on restoring functional ability needed for the patient’s daily and work activities, aiming to return them to their pre-injury status to the extent feasible.
- Active Therapy:
- Requires internal effort by the individual to complete specific exercises or tasks.
- Supervision from a therapist is needed, with verbal, visual, and/or tactile instructions.
- Therapists may assist in stabilization or guide movement patterns, but the patient predominantly executes the task.
- Patients should be instructed to continue active therapies at home to maintain improvement levels.
- Passive Interventions:
- Do not require exertion of effort from the patient but depend on modalities delivered by a therapist.
- Generally viewed as a means to facilitate progress in an active therapy program with concomitant attainment of objective functional gains.
- Assistive Devices:
- May be included as an adjunctive measure in the rehabilitation plan to facilitate functional gains.
Therapeutic Exercise
Physical or Occupational Therapy:
Recommended:
- For greater hamstring and hip flexor strains, particularly to address any strength deficits in the lateral hip musculature.
Frequency/Dose/Duration:
- Exercises are generally individualized and increased over time.
- Many therapists combine exercises with other treatment modalities.
- Stretching exercises are frequently included and progress to strengthening exercises.
- Frequency of visits is usually individualized based on the severity of the disorder, prior response to treatment, and job functions.
- Two to three visits per week for two weeks are often used to initiate an exercise program.
- Total numbers of visits may range from as few as 2 to 3 for mild patients to up to 12 to 15 with documentation of objective functional improvement.
- As part of the rehabilitation plan, patients should be instructed to continue both active and passive therapy at home as an extension of the treatment process to maintain improvement.
Indications for Discontinuation:
- Discontinuation is considered upon resolution of symptoms, post-operative healing, intolerance, lack of efficacy, or non-compliance.
Injection Therapy – Intraarticular Glucocorticosteroid Injections:
Recommended:
- For the treatment of hamstring or hip flexor strains.
Indications:
- For hamstring or hip flexor strains where control with NSAID(s), acetaminophen, weight loss, and exercise is unsatisfactory.
Frequency/Dose/Duration:
- A single injection should be administered, and the results evaluated.
Indications for Discontinuation:
- Generally, one injection is performed.
- A second injection may be considered if there is incomplete improvement (increased function and decreased pain).
Intraarticular Hip Viscosupplementation Injections:
Not Recommended:
- For the treatment of hamstring or hip flexor strains.
Intraarticular Platelet-Rich Plasma Injections:
Not Recommended:
- For the treatment of hamstring or hip flexor strains.
Prolotherapy Injections:
Not Recommended:
- For the treatment of hamstring or hip flexor strains.
Botulinum Injections:
Not Recommended:
- For hamstring or hip flexor strains.
Glucosamine Sulfate Intra-Muscular Injections:
Not Recommended:
- For the treatment of hamstring or hip flexor strains.
Glucosamine Sulfate Intra-Articular Injections:
Not Recommended:
- For the treatment of hamstring or hip flexor strains.
Surgical Repair:
Recommended:
- For the treatment of large or complete hamstring or hip flexor strains in select patients.
Indications/Rationale:
- Large or complete tears of the hamstrings or hip flexor strains with functional deficits deemed amenable to surgical treatment.
- Generally, large or complete hamstring tears require surgical repair to facilitate recovery.
Bed Rest:
Not Recommended:
- For the treatment of hamstring or hip flexor strains.
Walking Aid: Cane/Crutches/Walker:
Recommended:
- For select moderate to severe hamstring or hip flexor strains.
Indications:
- Disabling, moderate to severe hamstring or hip flexor strains where the risks of increasing debility are outweighed by device use that increases mobility.
Indications for Discontinuation:
- Resolution (e.g., post-operative recovery).
Rationale:
- For acute injuries, crutches and canes may be helpful during the recovery and/or rehabilitative phase to increase functional status (e.g., from wheelchair to walker to cane).
Electrical Therapies:
Not Recommended:
- For the treatment of hamstring or hip flexor strains.
Transcutaneous Electrical Stimulation (TENS):
Not Recommended:
- For hamstring or hip flexor strains.
