Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Hamstring Strain Physical Therapy Guide

What Is A Hamstring Strain?

Strains and sprains are most commonly caused by excessive overstretching of tissues, strenuous contractions and/or repetitive microtrauma. They are very common, and often resolve after following a course of rehabilitation within a few days to a few months depending on the type of strain. Muscle strains are graded into 3 different categories:

  1. Grade 1: a strain or damage of up to 25% of the muscle fibres. This is the most common type of strain and normally resolves within a couple of weeks with rest, ice and exercise.
  2. Grade 2: a strain or damage of up to 50% of the muscle fibres, normally accompanied by swelling and bruising. They normally resolves within 3-5 weeks with a more intensive Physical Therapy programme.
  3. Grade 3: a strain or damage of up to 75% of the muscle fibres, with severe swelling and bruising. These injuries typically take up to 3 months to make a full recovery.

What Causes it?

Hamstring strains are very common, especially in sport. In the English Premier League, hamstring injuries make up 12% of all injuries throughout a season! They are normally caused by excessive running and sprinting, or in rapid acceleration / deceleration changes. The pain is felt immediately in the back of the thigh and you’ll often have to stop what sport / activity you are performing immediately as you are unable to continue. The main cause of any muscular injury is muscular overload. Muscle overload is the main cause of a hamstring muscle strain. This happens when the muscle is stretched beyond its capacity or challenged with a sudden load.

Hamstring Strain Risk Factors

  • Age: a number of studies have shown that older sportspeople are at an increased risk of an acute hamstring strain. Players aged 23 and over are approximately 4 time as likely to sustain a hamstring injury.
  • Previous hamstring injury: A prior history of hamstring strain is a huge risk factor for future injury, likely caused by the scar tissue in the muscle fibres. This is why it is imperative to complete a full rehab programme.
  • Hamstring weakness: Reduced hamstring strength increases the risk of the muscle being susceptible to an overload injury.
  • Fatigue: Performing or competing whilst your muscles have been overworked and have not fully recovered increases your risk of injury.

What Are The Symptoms?

  • Sudden and severe pain during exercise, occasionally with a snapping or popping feeling/sound.
  • Pain in the back of the thigh and lower buttock when walking, straightening the leg, or bending over.
  • Tenderness in the back of the thigh.
  • Bruising and swelling.
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Foam Rollers!

Deep massage of affected muscle groups is a treatment intended to speed up the recovery process of injuries like hamstring strains, which is often used by Physical Therapists, but can be performed by the patients themselves. The purpose of deep massage is to improve the mobility of the muscular tissue and prevent adherent scars forming. The massage is deep and quite painful for people suffering from a hamstring strain, however the movement encourages realignment and lengthening of the muscle fibres and will improve your recovery time.

You can buy our favourite roller here!

What Are My Treatment Options?

There are many treatment options available to people who suffer from a strained Hamstring! Your rehabilitation programme and recovery time depend entirely on how severe the hamstring strain is. Make sure you get a full assessment from your health care professional.

Rest & Time

Initially, you need to stop doing the activities that caused the hamstring injury in the first place and prevent agitating it further. Immediately following the hamstring strain you can commence the RICE protocols:

  • Rest. Rest, relax and protect your hamstring. Stop, change, or take a break from any activity that may be increasing your pain.
  • Ice. Cold packs will reduce pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Do no place ice directly on to skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!
  • Compression. Wrapping the thigh with a compression sleeve will help decrease swelling and improve recovery time. You can find our favourite hamstring compression sleeve here!
  • Elevation. Elevate your feet to reduce swelling and bruising in your thigh.

Physical Therapy

Although rest is a vital component of the recovery process, it doesn’t mean the affected leg has to be completely immobilised for long periods. In fact,  the muscle fibres need to be placed under tensile loads to grow and stay healthy.  The easiest way to grow your hamstrings? Exercise! 

Hamstring Strain Exercises

1) Prone Knee Bends

A basic exercise to maintain hamstring mobility and start your strength training. It can also be progressed and made more difficulty by using ankle weights.

How to do it:

  • Lie on your front with a weight wrapped around your ankle.
  • Slowly bend your knee, bringing your heel up towards your bottom.
  • Slowly allow the ankle to fall back down towards the floor.

Repeat 12 reps, 3 times per day.

2) Hamstring Bridge Walkout

This exercise is also known as a “modified glute bridge”. Remember to briefly hold each position before slowly progressing to the next position. Focus on tensing your hamstring muscles to keep yourself upright!

How to do it:

  • Lying flat on the floor, bend both of your knees to 90° with your feet flat on the floor.
  • Start the exercise by extending your hips, driving your hips from the floor to perform a glute bridge.
  • At the top of the motion, begin taking short, alternating steps away from you. Continue until your legs are fully extended and your weight is supported only on your heels, slowly return to your starting position.

Repeat 5 times, three times throughout the day.

3) Chair Drags

This is a novel exercise that can easily be done at the office if you have a sitting based job. Pulling yourself along by bending at your knees creates a great contraction in your hamstrings and will progress your rehabilitation.

How to do it:

  • Sit on a office chair (with wheels)
  • Pull yourself along digging in your heels as opposed to pushing off the floor.
  • Build up to 10 repetitions traveling 10 metres each time.

4) Nordic Hamstring Curls

The nordic hamstring curl is a very advanced exercise that should be done towards the end stage of your rehab. It is an eccentric strengthening exercise which lengthens and strengthens the hamstring tendons. It is easiest completed with a partner!

How to do it:

  • Kneel down on a padded yoga mat and have your partner hold down your ankles.
  • Slowly allow your weight to fall forward, try and maintain the fall by tensing your hamstring muscles.
  • Allow yourself to fall to the floor if you feel your muscles fatiguing.
  • Push yourself back up and repeat the process.

Repeat 10 reps, 3 times per day.

5) Lunges

A brilliant functional exercise which strengthens your hamstrings (and other hip muscles) whilst improving co-ordination and prepares you for returning to sport.

How to do it:

  • Keep your upper body straight, with a decent posture. Try to engage your core muscles.
  • Step forward with your injured leg, lowering your hips until both knees are bent to a 90-degree angle
  • Slowly reverse back to your starting position.
  • To progress you can use weights, or lunge in varying directions.

Repeat for 12 reps, 3 sets,  twice a day.

6) Dynamic Hamstring Stretch

Dynamic hamstring stretches involve gentle swings of the affected leg forwards and backwards gradually getting higher and higher each time. There is no set number of swings to achieve, aim to do more than 20. It is a great exercise to get the blood pumping to your hamstring and to lengthen the muscle fibres and tendons.

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