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Grade One Hamstring Strain

Days 1 to 5

RICE protocol - rest, ice, compression and elevation (never apply ice directly to the skin). The Hamstring should be rested in an elevated position with an Ice Pack applied for twenty minutes every two hours, if practical (never apply ice directly to the skin). A Compression Bandage should be applied to limit bleeding and swelling in the tissues. After the early stages have been spent resting, more active rehabilitation can be started.


Days 6 to 10

Gentle Hamstring stretching can begin, sitting on a Gym Mat and slowly bending forward, sliding the hands down the thighs. The patient should stop when the tension of a stretch in the Hamstring begins to be felt - the position should then be held for thirty seconds. Repetitions x 3.

This should be pain-free.

Gentle resistance exercises can begin under the supervision of a qualified therapist. Early, gentle, pain free stretching and strengthening against light force provided by the therapist can help to align the scar tissue, which is forming to heal the muscle tear. This ultimately produces a stronger scar.


Days 11 to 14

Free exercises to strengthen the hamstring muscles can begin.

The patient starts by sitting on the Gym Mat and sliding the heel up to the bottom. Repetitions x 20, 3 times each day. If this can be done without pain, progress to the next position can be made.

The patient lies on their front and brings the heel up to the bottom. Repetitions x 20, 3 times each day. If this can be done without pain, progress to the next position can be made.

Standing, the patient brings the heel up to the bottom. Repetitions x 20, 3 times each day.

Hamstring stretches are also continued.


Days 15 to 17

Intermittent jogging and walking can begin.

5 minutes at first, then build up in 5 minute increments. Once the patient can do 15 minutes they should build up to to half pace running.

Squats can begin - repetitions x 20, 3 times daily.

Hamstring curls using a resistance weight machine can also begin.

Everything should be pain-free.


Day 18+

Backward running can begin.

If pain-free, the patient progresses to full pace forward running.

The patient continues stretching and strengthening exercises.

The patient begins sports specific activities.

Grade Two Hamstring Strain

Days 1 to 5

RICE protocol - rest, ice, compression and elevation (never apply ice directly to the skin). This is aimed at reducing the bleeding and damage within the muscle tissue.


Days 6 to 11

Gentle Hamstring stretching can begin, sitting on a Gym Mat and slowly bending forward, sliding the hands down the thighs. The patient should stop when the tension of a stretch in the Hamstring begins to be felt - the position should then be held for thirty seconds. Repetitions x 3.

This should be pain-free.

Each day the patient should be able to stretch a little further.

Gentle resistance exercises can begin under the supervision of a qualified therapist. Early, gentle, pain free stretching and strengthening against light force provided by the therapist can help to align the scar tissue, which is forming to heal the muscle tear. This ultimately produces a stronger scar.


Days 12 to 19

Free exercises to strengthen the hamstring muscles can begin.

The patient starts by sitting on the gym mat and sliding the heel up to the bottom. Repetitions x 20, 3 times each day. If this can be done without pain, progress to the next position can be made.

The patient lies on their front and brings the heel up to the bottom. Repetitions x 20, 3 times each day. If this can be done without pain, progress to the next position can be made.

Standing, the patient brings the heel up to the bottom. Repetitions x 20, 3 times each day.

Hamstring stretches are also continued.


Days 20 to 26

Intermittent jogging and walking can begin.

5 minutes at first, then build up in 5 minute increments. Once the patient can do 15 minutes they should build up to to half pace running.

Squats can begin - repetitions x 20, 3 times daily.

Hamstring curls using a resistance weight machine can also begin.

Everything should be pain-free.


Day 27+

Backward running can begin.

If pain-free, the patient progresses to full pace forward running.

The patient continues stretching and strengthening exercises.

The patient begins sports specific activities.

Grade 3 Hamstring Strain (Complete Rupture)

Follow the advice of an orthopaedic consultant.

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