The primary aim was to report clinical features at initial assessment after hamstring injury, and the association of these with the mechanism of injury, BAMIC, and time to return to full training (TRFT). A secondary aim was to monitor functional milestones during rehabilitation and assess these relative to BAMIC and TRFT. Hamstring injuries in elite track and field athletes were eligible for inclusion. Clinical markers and the time to reach functional milestones in rehabilitation and TRFT were recorded. Low back pain and hamstring cramping/tightness in the week prior to acute injury were, independently, present in 30% of injuries. A reduction in Maximal Hip Flexion Active Knee Extension (MHFAKE) (p = 0.04), greater MHFAKE asymmetry (p = 0.01), increased Visual Analogue Scale (VAS) pain on walking (p = 0.001) and resisted hamstring contraction (p = 0.01) were associated with TRFT. BAMIC c injuries had a higher VAS pain score on walking and hamstring contraction, took longer to jog, and for passive knee extension to be pain free (p = 0.04). Time to return to pain-free jogging, pain-free and full power on manual muscle testing, Askling H-test negative, and full passive ROM were associated with TRFT. Pain-free palpation (p = 0.69) was not associated with TRFT. Class c injuries are challenging to detect clinically, but a higher VAS pain score and prolonged restriction in range may be clinical associations. MHFAKE and VAS on walking and hamstring contraction may be helpful in prognostication. Low back pain and hamstring tightness/cramping are common symptoms prior to acute hamstring injury.
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