Diagnosis, Rehabilitation, and Return to Sport after Athletic Hamstring Injury: An ICCUS Society Consensus Statement

Background Athletic hamstring injuries (AHSI) remain a persistent challenge because recurrence is common and clinical decisions often depend on incomplete evidence. This consensus statement is intended to give clinicians a practical, unified framework for classification, rehabilitation, and return to sport after athletic hamstring injury. The purpose of this study was to achieve expert consensus on the management of athletic hamstring injuries through a structured, scientific survey approach. Study Design Delphi Survey Methods A modified Delphi process, aligned with CREDES guidelines, was conducted with an expert panel of sports physical therapists identified as having specific expertise in AHSI from the ICCUS Society. Consensus was defined a priori as at least 80% agreement or disagreement on a 5-point Likert scale. Statements addressed three areas: AHSI examination and classification, rehabilitation and management, and return to sport (RTS) testing. Results Sixty statements were developed across three domains. Seventeen experienced clinicians completed the final round. Overall, 54 statements reached consensus, with a mean Likert score of 4.56 ± 0.37 out of 5 (strongly agree), and mean agreement of 89.88% ± 12.1%. Experts supported standardized terminology, MRI and the use of diagnostic ultrasound for diagnosis when appropriate, individualized and criterion-based rehabilitation, progressive tissue loading and length restoration, early neuromuscular control, gradual running and agility progression, progression to pain-free sprinting, objective strength assessment, sport-specific workloads, and athlete readiness as key RTS criteria. Discussion The findings emphasize active rehabilitation guided by measurable progress rather than reliance on fixed thresholds. Clinicians should combine injury classification, functional presentation, symptom response, objective testing, sport demands, and athlete confidence when advancing rehabilitation and making RTS decisions. Conclusion This ICCUS Society consensus statement offers a practical roadmap for managing AHSI: classify clearly, load progressively, monitor symptoms, test objectively, and return athletes only when sport-specific running, sprinting, strength, training tolerance, and readiness align. Level of Evidence 4