Hamstring strains can be extremely debilitating and difficult to properly recover from if not rehabbed correctly.
The time it takes for return to prior level of activity after a hamstring strain is anywhere from 1-12 weeks and the success and speed of this return can be greatly enhanced with proper rehabilitation. What does "proper rehabilitation" look like?
To find this answer Askling et al conducted a study comparing a conventional rehab routine to one that emphasized lengthening exercises.
What they found was shocking. The group that performed lengthening exercises returned to their sport in nearly half the time.
This finding makes sense if we understand that hamstring injuries typically occur during high speed running when the hamstring is being rapidly lengthened under large loads. Therefore, to optimize recover from the injury we must build the resiliency of the musculature to handle the forces placed on it during high speed running or the next time the athlete runs another strain will occur.
The rehab exercises they utilized are pictured and described below.
The Protocol
The Extender
The Diver
The Glider
The Extender - Restore Flexibility
Begin by lying on your back, bring your knee to your chest put both hands behind the knee and slowly extend the knee to a point just before pain.
3 sets of 12 repetitions
2 times per day until full range of motion has returned.
The Diver - Hamstring Strength and Trunk Stabilization
While standing on the injured leg with a knee bend of 10-20 degrees, flex the knee of the uninjured leg up to 90 degrees. Now bring the arms forward as you bend at the hip to 90 degrees and keep the uninjured knee bent at 90 while attempting maximal hip extension of the lifted leg. Owing to its complexity, perform slowly in the beginning.
3 sets of 6-8 repetitions
Every Other Day
The Glider - Specific Eccentric Strengthening
Begin in an upright position while holding onto a supportive surface. Bend the knee of the injured leg to 10-20 degrees and put all body weight over the heel of the injured leg. The motion is started by slowly gliding the uninjured leg backwards leaving the injured leg to lengthen out in front, stop before you feel pain. Utilize a furniture slider or towel on a smooth surface to achieve the posterior gliding motion. Bring yourself back to the starting position using your arms and NOT your injured leg. Progression can be achieved by increasing the posterior glide distance, increasing speed or using more of the injured leg to assist you back to the starting position.
3 sets of 4-6 repetitions
Every Other Day
Weekly Routine Example
Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday |
Extender 3x12 Diver 3x8 Glider 3x4 | Extender 3x12 | Extender 3x12 Diver 3x8 Glider 3x4 | Extender 3x12 | Extender 3x12 Diver 3x8 Glider 3x4 | Extender 3x12 | Extender 3x12 |
The above routine is a great place to start after a hamstring injury. However, this routine is not all inclusive and knowing when it is safe to return to jogging, sprinting, jumping and sport participation can be greatly enhanced by the guidance of a Doctor of Physical Therapy.
Thanks for Reading,
Dr. Dylan Webster, PT, DPT, OCS, XPS
References:
1. Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols
British Journal of Sports Medicine 2013;47:953-959.
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