My name is Nick, I am owner of Physio For Surgery and on my blog I offer free advice to help you recover from different injuries. Today I am writing a rehabilitation protocol for hamstring injuries. It typically follows a structured approach to allow the muscle to heal properly while gradually restoring strength, flexibility, and function. Here’s a detailed protocol broken down into phases based on severity and recovery time. This protocol assumes a grade 1 or grade 2 strain (mild to moderate injury). For more severe injuries (grade 3 tears), extended rest and a slower progression will be required, often with medical intervention.Enter your text here...
Phase 1: Acute Phase (1-5 days)
Goal: Minimize pain, inflammation, and swelling; protect the injured muscle from further damage.
1. Rest
- Avoid activities that may stress the hamstring (running, jumping, etc.).
- Use crutches if necessary to reduce strain during walking.
2. Ice
- Apply ice to the injured area for 15-20 minutes every 2-3 hours to reduce swelling and pain.
3. Compression
- Use a compression bandage or wrap to control swelling and provide support to the injured muscle.
4. Elevation
- Keep the leg elevated above heart level when you can to reduce swelling.
5. Pain Management
- Ice and potential use of NSAIDs (e.g., ibuprofen) can be taken to control pain and inflammation, under a doctor's guidance and prescription.
6. Gentle Movement
- Begin gentle range-of-motion exercises (heel slides, ankle pumps) to avoid stiffness without straining the muscle.
Phase 2: Subacute Phase (5-14 days)
Goal: Improve range of motion (ROM), begin gentle strengthening, and reduce pain.
1. Stretching
Hamstring stretching (gentle): Begin with light, pain-free stretches (hold for 15-20 seconds, 3-4 times daily).
- Lying hamstring stretch (on back, one leg straight, pulling the injured leg gently towards the chest).
- Standing hamstring stretch (one foot on a low surface, lean forward gently).
2. Low-load Strengthening:
- Isometric contractions: Contract the hamstring without movement. Hold for 5 seconds, then relax. Start with 10 repetitions.
- Glute bridges: Focus on engaging the glutes and hamstrings. Start with 2 sets of 10-15 repetitions.
- Stationary biking or pool walking: If pain-free, low-impact cardiovascular exercises like biking or pool walking can help maintain fitness.
3. Manual Therapy:
- Soft tissue mobilization or manual therapy (from a physiotherapist) can help reduce scar tissue formation and improve flexibility.
Phase 3: Early Strengthening (2-4 weeks)
Goal: Improve range of motion (ROM), begin gentle strengthening, and reduce pain.
1. Strengthening Exercises:
- Eccentric hamstring exercises: Focus on the lengthening phase of the muscle (e.g., Nordic hamstring curls). Start with low resistance and gradually increase.
- Leg curls: Begin with light weights or resistance bands, progressing as tolerated.
- Single-leg balance and stability work: Single-leg deadlifts, single-leg glute bridges.
- Bodyweight squats and lunges: Ensure proper form, avoiding sharp pain.
2. Functional Mobility:
- Dynamic stretching: Incorporate gentle leg swings and walking lunges to maintain flexibility and mobility.
- Low-impact cardiovascular work: Continue stationary biking, elliptical, or swimming, gradually increasing intensity.
Phase 4: Advanced Strengthening and Functional Movement (4-6 weeks)
Goal: Build strength, speed, and functional capacity to return to sport or activity.
1. Plyometrics and Agility Drills:
- Start with low-intensity agility drills (side shuffles, ladder drills).
- Progress to more dynamic exercises such as bounding, jumping, and short sprints.
- Incorporate eccentric hamstring exercises, focusing on controlling the muscle during lengthening phases (e.g., lowering into a deadlift position slowly).
2. Strength Training:
- Continue progressing with eccentric hamstring curls (Nordic curls) and weighted leg curls.
- Add weight to squats, deadlifts, and lunges, focusing on proper form and gradual progression.
- Step-ups: Add dumbbells for additional resistance.
3. Sports-Specific Drills (if applicable):
- Start incorporating movements and drills specific to your sport or activity (e.g., cutting, changing direction, acceleration).
Phase 5: Return to Sport/Full Activity (6-8+ weeks)
Goal: Return to pre-injury activity levels with full strength, flexibility, and agility.
1. Full-Speed Agility and Plyometrics:
- Incorporate sprinting, acceleration/deceleration drills, cutting, and multi-directional movements at game speed.
- Jumping drills (box jumps, squat jumps) can also be included if applicable.
2. Sports-Specific Reconditioning:
- Engage in more intensive sports-specific drills with quick direction changes, jumping, or sprinting based on the demands of your activity.
3. Monitoring and Prevention:
- Continue to monitor for signs of pain or stiffness.
- Maintain a regular stretching and strengthening routine to avoid re-injury.
- Warm-up thoroughly before activities with dynamic stretching and mobility work.
Criteria for Return to Sport/Activity:
- Full range of motion of the hamstring.
- Strength within 90% of the uninjured leg.
- Ability to complete sports-specific drills without pain or compensation.
- Cleared by a healthcare provider or physiotherapist.
Notes:
- Always progress exercises and activities based on pain tolerance. If pain or swelling increases, reduce the intensity and rest.
- For severe hamstring injuries (grade 3), this timeline may need to be extended, and medical or surgical intervention may be necessary.
If you or someone you know is struggling to return from a hamstring injury feel free to shoot me an email nick@physioforsurgery.ca and we'll set up a free call to see how we can help!
