Abstract
Introduction: Delayed Onset Muscle Soreness (DOMS) is a common physiological response to eccentric exercise, but atypical or prolonged presentations in competitive athletes may mimic muscle strain. This report presents a novel case of prolonged hamstring DOMS in a track and field athlete, highlighting the clinical reasoning and outcome-based physiotherapy approach leading to full recovery. Methods: A 21-year-old male sprinter developed posterior thigh pain and stiffness 48 hours after an eccentric sprint and plyometric session. Clinical examination revealed diffuse tenderness over the biceps femoris without structural damage on ultrasound. Outcome measures included the Visual Analogue Scale (VAS) for pain, Active Knee Extension (AKE) for hamstring flexibility, and the Lower Extremity Functional Scale (LEFS) for functional ability. A 21-day progressive physiotherapy plan was followed. Phase 1 included cryotherapy, gentle stretching, and soft tissue release. Phase 2 emphasized eccentric reactivation, neuromuscular electrical stimulation, and proprioceptive training. Phase 3 focused on sport-specific sprint drills and functional reconditioning. Results: Initially, the athlete recorded a VAS score of 6/10, AKE of 125°, and LEFS of 56/80, indicating moderate pain and reduced flexibility and function. After one week, pain reduced to 3/10 with improved mobility. By the end of the second week, flexibility increased to 150°, and LEFS improved to 70/80. After three weeks, the athlete achieved full pain relief (VAS 0/10), complete flexibility (AKE 165°), and near-normal function (LEFS 78/80). He successfully returned to sprint training without recurrence at a four-week follow-up. Discussion: The prolonged DOMS presentation resembled a mild strain but was primarily neuromuscular and myofascial in origin. The use of functional and patient-specific outcome tools enabled precise monitoring of recovery and guided timely progression of exercises. Early eccentric reactivation and proprioceptive retraining were critical in preventing chronic dysfunction and facilitating an efficient return to sport. Conclusion: This case illustrates that atypical hamstring DOMS can mimic strain in high-performance athletes. Integrating pain, flexibility, and functional outcome measures with a structured, evidence-based rehabilitation approach ensures accurate diagnosis, optimal recovery, and safe return to sport