STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To assess differences between a progressive agility and trunk stabilization (PATS) and a progressive running and eccentric strengthening (PRES) rehabilitation program on recovery characteristics following an acute hamstring injury, as measured via physical examination and magnetic resonance imaging (MRI). BACKGROUND: Determining the type of rehabilitation program that most effectively promotes muscle and functional recovery is essential to minimizing re-injury risk and optimizing athlete performance. METHODS: Individuals who sustained a recent hamstring strain injury were randomly assigned to 1 of 2 rehabilitation programs, PATS or PRES. MRI and physical examinations were conducted before and after completion of rehabilitation. RESULTS: Thirty-one subjects were enrolled, 29 began rehabilitation, and 25 completed rehabilitation. There were few differences in clinical or morphological outcome measures between rehabilitation groups across time, and re-injury rates were low for both rehabilitation groups after return-to-sport (4 of 29 subjects had re-injuries). Greater cranio-caudal length of injury, as measured on MRI before the start of rehabilitation, was positively correlated with longer return-to-sport time. At the time of return-to-sport, although all subjects showed a near complete resolution of pain and return of muscle strength, no subject showed complete resolution of injury as assessed on MRI. CONCLUSIONS: The 2 rehabilitation programs employed in this study yielded similar results with respect to hamstring muscle recovery and function at the time of return-to-sport. Evidence of continuing muscular healing is present after completion of rehabilitation, despite physical strength and function appearing normal on clinical exam. LEVEL OF EVIDENCE: Therapy, level 1b.

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