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5 Step Hamstring Rehab
7th May

2019

Hamstring injuries are a common problem in sports where you have to decelerate, change direction or accelerate quickly.

Hamstring injuries, if left untreated, can cause problems for years, as the connective tissue that form your muscles and tendons needs to be remodelled. There is some evidence to suggest that connective tissue will only ever reach 95% of its native strength. This means that if you do not rehab (rebuild) your muscle properly, you could find it harder to manage tasks that were once simple, like cutting, weaving or bursting into open space.

The 5 Steps to Hamstring Rehab:

Step 1: Pain and ROM

When you initially injure yourself, the pain that is associated with it is a sign that your body is already planning your recovery. In the first 72 hours post injury, you will develop scar tissue in order to begin the remodelling process. Your job is to control the pain through icing and compression, and then begin the Range of Motion (ROM) activities. Once you have established a ROM that is 80% pre-injury, you can move forward. This could take anywhere from a week to 3 weeks depending on the injury. If your hamstring was torn off the bone (grade 3), you are likely going in for an operation, so chat with your doctor or physio about that one. 

Step 2: Strength- isomeric Single joint then double joint

Isometric strength exercises are where you contract the muscle but it does not change in length. This will help build neural pathways to the injured muscle and it will activate when engaged.  Initial exercises include prone SL Raise, SL DB RDL and SL Glute Bridge.

Once you have progressed to dynamic exercises, you can include Hamstring walkouts, BW squats, stationary lunges and . See our “hamstring strength” article for more specific hamstring exercises. Depending on how strong you were before you got injured, you need to build up our strength to 50-75% strength before moving to step 3. This can include regular strength exercises such as squats, lunges and step ups.

Begin with 3 x 6-8 reps without going to failure, then decrease reps for strength before you move to step 3. If you are in-season, 1-2 sessions per week will be good, but if it is your off-season, you can spread your load over 3-4 sessions in the week.

Step 3: Plyo’s + Running

Plyometrics do not start out with big bounding sessions or box jumps. Plyometrics simply starts out with low range squat jumps, then counter movement and broad jumps. Always start out with double leg exercise first, then progress to single leg exercises. In conjunction with your strength rehab, you could begin low level, straight line running. Then move to acceleration, weaving and deceleration. Week 3 could be change of direction and increasing speed with straight line running. Week 4 would be where you begin to recondition with progressions in fitness training.

A basic progression over 4 weeks is shown in the following table (again, this is for a low grade hamstring injury, a more serious injury, you would need to spend at least double the time at each stage).

Hamstring rehabilitation

When progressing your speed, tightness will be your limiting factor. Do not exceed a tempo that is faster than your tightness will allow. This will naturally occur as your strength, flexibility and fitness returns. After this, your training becomes sport specific and time of reconditioning is needed before return to play. Pain and recovery will be your indicator of adaptation. If you are still in pain or are not progression through each stage, go back one-step because the hamstring is not adapting correctly. Do not rush through this stage, you are better off building your running over 2 extra weeks, so that is can adapt to the load better. 

Step 4: Sport specific

By the time you get to this stage which could be anywhere from 4-8 weeks from the time of injury, you should be pain free with your training. Here is where you being to recondition your body through sport specific strength, fitness and skill training. Your confidence needs to high so that you believe you will not get hurt. This will come through hard training and testing yourself in all aspects of play. Key factors will be high-speed deceleration, change of direction, contact work, repeated accelerations and fatigue. See our range of programs to help rebuild your conditioning on and off the field. 

Step 5: Continued management

This is where you have to ensure that in your warm ups and strength training sessions, you spend extra work on your hamstring, such as mobility drills, prevention exercises and movement preparation activities. These range from beginning drills to high level. Check out our YouTube channel for exercise ideas to add into your warm up.

Throughout the entire period, you need to continue to work on your flexibility. In the initial phases, your basic, static stretching for all muscles in the hamstring  will benefit it. Then you need to progress to more intensive PNF and partner stretching. Ensure you complete mobility and dynamic stretches before exercise as well.

*Please note, the information in this article is general advice and you should see your medical professional and physiotherapist before following any type of exercise rehabilitation plan.

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