| Phase 1 |
| Goals |
- Protect scar development
- Minimize atrophy
|
| Protection |
| Avoid excessive active or passive lengthening of the hamstrings |
| Ice |
| 2 to 3 times per day |
| Therapeutic exercise (performed daily) |
- Stationary bike x 10 minutes
- Side-step x 10 meters, 3 x 1 minute, low to moderate intensity, pain-free speed and stride
- Grapevine x 10 meters, 3 x 1 minute, low to moderate intensity, pain-free speed and stride
- Fast feet stepping in place, 2 x 1 min
- Prone body bridge, 5 x 10 seconds
- Side body bridge, 5 x 10 seconds
- Supine bent knee bridge, 10 x 5 seconds
- Single-limb balance progressing from eyes open to closed, 4 x 20 seconds
|
| Criteria for progression to next phase |
- Normal walking stride without pain
- Very low-speed jog without pain
- Pain-free isometric contraction against submaximal (50-70 percent) resistance during prone knee flexion (90°) manual strength test
|
| Phase 2 |
| Goals |
- Regain pain-free hamstring strength, beginning in mid-range and progressing to a longer hamstring length
- Develop neuromuscular control of trunk and pelvis with progressive increase in movement speed
|
| Protection |
| Avoid end-range lengthening of hamstrings while hamstring weakness is present |
| Ice |
| Post-exercise, 10-15 minutes |
| Therapeutic exercise (performed 5-7 d/wk) |
- Stationary bike x 10 min
- Side-shuffle x 10 meters, 3 x 1 minute, moderate to high intensity, pain-free speed and stride
- Grapevine jog x 10 meters, 3 x 1 minute, moderate to high intensity, pain-free speed and stride
- Boxer shuffle x 10 meters, 2 x 1 minute, low to moderate intensity, pain-free speed and stride
- Rotating body bridge, 5 second hold each side, 2 x 10 reps
- Supine bent knee bridge with walk-outs, 3 x 10 reps
- Single-limb balance windmill touches without weight, 4 x 8 reps per arm each limb
- Lunge walk with trunk rotation, opposite hand-toe touch and T-lift, 2 x 10 steps per limb
- Single-limb balance with forward trunk lean and opposite hip extension, 5 x 10 seconds per limb
|
| Criteria for progression to next phase |
- Full strength (5/5) without pain during prone knee flexion (90°) manual strength test
- Pain-free forward and backward jog, moderate intensity
|
| Phase 3 |
| Goals |
- Symptom-free (eg, pain and tightness) during all activities
- Normal concentric and eccentric hamstring strength through full range of motion and speeds
- Improve neuromuscular control of trunk and pelvis
- Integrate postural control into sport-specific movements
|
| Protection |
| Avoid full intensity if pain/tightness/stiffness is present |
| Ice |
| Post-exercise, 10-15 minutes, as needed |
| Therapeutic exercise (performed 4-5 d/wk) |
- Stationary bike x 10 min
- Side-shuffle x 30 meters, 3 x 1 minute, moderate to high intensity, pain-free speed and stride
- Grapevine jog x 30 meters, 3 x 1 minute moderate to high intensity, pain-free speed and stride
- Boxer shuffle x 10 meters, 2 x 1 minute moderate to high intensity, pain-free speed and stride
- A and B skips, starting at low knee height and progressively increasing, pain-free
- a. A skip is a hop-step forward movement that alternates from leg to leg and couples with arm opposition (similar to running). During the hop, the opposite knee is lifted in a flexed position and then the knee and hip extend together to make the next step
- b. B skip is a progression of the A skip; however, the opposite knee extends prior to the hip extending recreating the terminal swing phase of running. The leg is then pulled backward in a pawing type action. The other components remain the same as the A skip.
- Forward-backward accelerations, 3 x 1 minute; start at 5 meters, progress to 10 m, then 20 m
- Rotating body bridge with dumbbells, 5 seconds hold each side, 2 x 10 reps
- Supine single-limb chair-bridge, 3 x 15 reps, slow to fast speed
- Single-limb balance windmill touches with dumbbells, 4 x 8 reps per arm for each leg
- Lunge walk with trunk rotation, opposite hand dumbbell toe touch and T-lift, 2 x 10 steps per limb
- Sport-specific drills that incorporate postural control and progressive speed
|
| Criteria for return to sport |
- Full strength without pain
- a. 4 consecutive repetitions of maximum effort manual strength test in each prone knee flexion position (90° and 15°)
- b. Less than 5 percent bilateral deficit in eccentric hamstrings (30°/second): concentric quadriceps (240°/second) ratio during isokinetic testing
- c. Bilateral symmetry in knee flexion angle of peak isokinetic concentric knee flexion torque at 60°/second
- Full range of motion without pain
- Replication of sport specific movements near maximal speed without pain (eg, incremental sprint test for running athletes)
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