Hamstrings Strains

Proper management during the first 24-48 hours is imperative to expedite return to participation after the injury as quickly and as safely as possible. Refer to the PEACE & LOVE Approach for acute care of the injury. If there is any noticeable deformity, seek out either Urgent Care or an Emergency Department, depending on severity (see Where Should You Go? page for more information). 

After any injury, follow up with your athletic trainer as soon as you can. 

Immediate Care:

A couple of key takeaways from "PEACE & LOVE": 

• Ice and cold treatments are not necessary and can disrupt inflammation, angiogenesis, and revascularisation, delay neutrophil and macrophage infiltration as well as increase immature myofibers, potentially leading to impaired tissue repair and redundant collagen synthesis and prolonging return to sport

• Only take Tylenol/Acetaminophen for the first 24-48 hours as needed to manage pain

• Swelling is good so avoid NSAIDs like Advil/Motrin/Ibuprofen, Aleve/Naproxen Sodium, etc. until at least 48-hours post-injury

• Limit walking and avoid testing range of motion for, at minimum, the first 24-48 hours post-injury

Exercises, starting as soon as you get home:

• Complete every hour using available Pain-free Range of Motion: 

  • Quad Sets 3×25: https://youtu.be/au62CidApd0?t=4 

    • Elevate the Knee above the head, if possible, for best results.

  • Heel slides using pain-free range of motion 3×20: https://youtu.be/rAMPY8lAbfY 

Subsequent Care: 

After waiting 24-48 hours after injury, complete the appropriate exercise stage provided you are pain-free or pushing yourself to a point of pain. Refrain from incorporating stretching into rehabilitation for the first 6-10 days, depending on injury severity, to avoid disruption of the healing callous. Although there isn’t any evidence on human models that this is true or that it will prolong recovery, it is just repeated in the literature to avoid stretching and only utilize it if a muscle length deficit remains after the first 2 weeks. If necessary, see the athletic trainer for more exercises or if exercises need to be modified. The descriptions of each phase are meant to be a guide and if the athlete is having difficulty or ease with completing the listed exercises, they can choose a different stage more appropriate.

Stretches (when appropriate) 4×/Day, 30 seconds each. Typically, wake-up, before practice, after practice, before sleep.

• Hamstrings Stretch: https://youtu.be/gYsa-sEGWiM

  • Use a stable object/surface between knee- and hip-height

  • Middle Finger on top of Middle Finger to keep the hands even

  • Reach as far down as you can while still being able to hold a static position

• Internal Rotation Hamstrings Stretch

  • Rotate the foot in and reach only with the contralateral (opposite-side) hand

• External Rotation Hamstrings Stretch

  • Rotate the foot out and reach only with the ipsilateral (same-side) hand

Stage 1 Exercises - 2×/Day - If not fully weight-bearing

1. Heel slides using pain-free range of motion 3×20: https://youtu.be/rAMPY8lAbfY 

2. 4-Way Straight Leg Raise 3×10 each direction using pain-free range of motion: https://youtu.be/-8MV0sX-C_k 

3. Prone Hamstring Curls using pain-free range of motion 3×20: https://youtu.be/x4aLje2kGKU 

4. Heel Digs (Hamstring Isometric Set) 3×20: https://youtu.be/DYzNacVSMaU 

Stage 2 Exercises - 2×/Day - If pain-free while fully weight-bearing completing activities of daily life

1. Glute Bridges 3×20: https://youtu.be/9NkNgFc_-Ys 

2. Bridge Walk Outs 3×5: https://youtu.be/PtAEesSYE1A (All the way up and down counts as 1 rep)

Stage 3 Exercises - 1×/Day - Once back participating in a modified capacity (pain-limiting activity)

1. Stability Ball Rollout 3×10: https://youtu.be/zeSD85M2t6c 

2. Single-Leg Glute Bridge 3×10: https://youtu.be/3NXv0Nany-Q 

3. Hamstring Rollout on Exercise Ball 3×10: https://youtu.be/-6ZeNRD_zOA 

   • If you don't have an Exercise Ball, do these, Hamstring Curl with Foam Roller 3×10: https://youtu.be/a8rPHLvWIfM

Stage 4 Exercises - 2×/Week - Once back participating without restrictions

1. Nordic Hamstring Curls 3×10: https://youtu.be/v_Egn_3CCsM 

2. Depth Jumps 3×10: https://youtu.be/AzPJZHOmGEg 

3. Lateral Bounds 3×10 each side: https://youtu.be/Rlf8hQ-Jzis 

Return to Participation: 

After the acute and subacute phase of the initial injury or reinjury, the athletic trainer will develop a plan for return to participation for the athlete. It is recommended that an athlete should return to athletics after a lower extremity injury without restrictions if the limb symmetry is at 90% of the contralateral (opposite-sided), unaffected limb, hop tests (single, triple, crossover, and side) for affected leg >95% of contralateral, unaffected limb’s result, and agility tests results are within normal ranges. These evaluations and tests should be completed under the supervision and direction of an athletic trainer or another appropriate healthcare provider. 

Taping/Bracing

If indicated, the Athletic Trainer can tape/wrap the injured area to expedite returning to participation. If the Athletic Trainer is wrapping you with an ACE wrap, please make sure to wash it in a washing machine and hang-dry it overnight. Usually ACE wraps can get 2 weeks worth of use before a new one is needed. 

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