What is the best treatment for a pulled hamstring in an adolescent?

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Elsevier ClinicalKey Derived Clinical Overview

• Rest, ice, compression, and elevation are early mainstays of treatment. • Initiate mobilization after brief period of rest to improve range of motion • Early mobilization in 1 to 3 days may reduce development of hematoma • Oral nonsteroidal antiinflammatory medications may be of benefit. • Formal Therapy • Acute period should focus on reduction of edema and hematoma • Advance to restoration of strength and range of motion • Restoring flexibility in the quadriceps and hamstring • Core strengthening for proper pelvic mechanics when return to sport • Late therapy should focus on functional activities. • Patient can return to sport when strength is restored and they are able to perform functional activities without pain. • There have been some reports of using corticosteroid or platelet-rich plasma injections early after injury to reduce secondary injury and shorten return to play, but there is no definitive research to support these treatments at this time.

• Hamstring muscle injuries can be difficult to treat, and the recovery time varies considerably on a case-by-case basis. • Keep in mind the nature and level of activity the patient will be returning to. • They must be pain free with activity prior to return to sport. • If surgical intervention is necessary, counsel the patient on the risk of neurologic injury.

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Elsevier ClinicalKey Derived Clinical Overview

• Determination of the cause if there is one • Maintain flexibility with stretching as possible • Shoe modifications or foot orthosis if symptomatic

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Elsevier ClinicalKey Clinical Overview

Treatment Regardless of age, asymptomatic hypermobile persons would benefit from regular physical activity, instruction of proper ergonomics, and avoidance of extreme contorting. Symptomatic joint hypermobility, instability, and periarticular pain should be addressed whether syndromic or nonsyndromic and regardless of how many or few joints are affected. Physical and occupational therapy is the mainstay of management. Although high-quality evidence is still lacking, the general approach typically includes techniques to: Reduce spasm Relaxation Massage Hydrotherapy Stretching and low-resistance/low-impact exercise designed to increase: Tone Stability Endurance Hypermobile joints often need neuromuscular reeducation, activating some muscle groups and addressing other dominant, tense muscles. Knee hypermobility is usually accompanied by quadriceps weakness and hamstring tightness. Exercising the quads and stretching the hamstrings helps to provide better muscular balance and control, often lessening the pain. Therapists should be free to address other compensatory mechanisms that are evident, such as: Lumbar hyperlordosis, which often accompanies the tight hamstrings Flexible flat foot, which often loads the knee asymmetrically Instruction and exercises to maintain proper posture and ergonomics are helpful, and repetitive activities, including activities of daily living, also often need to be addressed. A home exercise plan is important for long-term management and may include almost any desired physical activity, such as dancing or playing a sport. Bracing and orthotics may play a role in joint support or protection and are used in conjunction with the therapy programs. Prolonged bracing may predispose to muscular weakness and atrophy if not paired with ongoing exercise but may be necessary, and is appropriate if used to enable routine activity, in the setting of injury, or when excessive strain is to be applied. Shoe orthotics are commonly ordered for flexible flat feet with heel valgus ( Fig. 2 ).

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Elsevier ClinicalKey Clinical Overview

Treatment Early and appropriate management of back pain helps to optimize functional outcome and minimize complications Symptoms for benign mechanical back pain usually resolve within 2 to 4 weeks of conservative care, such as rest, ice, and PT Back pain in children not improving within 2 weeks of conservative care requires in-depth assessment, including complex imaging, laboratory studies, and consultative services as indicated Treatment for benign back pain typically includes relative rest, activity modification, limited use of NSAIDs, and close follow-up PT (physical therapy) is typically recommended with stressed adherence to a prescribed home exercise program PT focus includes: Core strengthening and stabilization Mobility Stretching, including hamstrings and hip flexors, biomechanics, posture assessment, and myofascial release techniques if appropriate Functional progression of therapy and activity may occur as biomechanics improve and comfort levels increase Modalities such as superficial ice or heat may be recommended Therapeutic ultrasound over an open growth plate or physis is contraindicated, and its use is restricted in skeletally immature patients Bedrest should be avoided Psychological support through cognitive behavioral therapy can address any psychosocial components associated with pain often absent but not excluded with benign mechanical type