Recovering from Hamstring Strains: Rehabilitation Exercises and Progressions

Hamstring strains are a common injury among athletes and active individuals. They can be painful and debilitating, impacting the ability to perform simple daily tasks or participate in sports. At Twin Boro Physical Therapy, we specialize in treating hamstring strains, providing structured rehabilitation phases, exercises, and progressions designed to return patients to full activity safely and effectively.

Understanding Hamstring Strains

The hamstrings are a group of three muscles located at the back of the thigh, running from the hip to just below the knee. A hamstring strain occurs when one or more of these muscles are overstretched or torn. This injury is classified into three grades depending on severity:

• Grade I: Mild muscle strain or pull.
• Grade II: Partial muscle tear.
• Grade III: Complete muscle tear.

Symptoms of hamstring strains include a sudden sharp pain in the back of the thigh, swelling, and tenderness. In more severe cases, bruising and losing strength may be evident.

Initial Management

The first step in treating a hamstring strain is to follow the RICE protocol—Rest, Ice, Compression, and Elevation—during the first 24 to 48 hours post-injury. This approach helps reduce swelling and pain and is crucial for healing. Patients should avoid activities that cause pain to prevent further damage.

Phase 1: Pain Management and Mobilization

Once the initial pain and swelling have decreased, the first phase of rehabilitation at Twin Boro can begin, focusing on minimizing pain and gently mobilizing the affected area to preserve and gradually enhance the range of motion including:

• Pain Management: Modalities such as cold and heat therapy, electrical stimulation, and ultrasound can reduce swelling and aid in pain management.
• Gentle Mobilization: Mobilization exercises prevent stiffness and encourage movement, crucial for maintaining joint health and preparing the muscles for more active rehabilitation.
• Manual Therapy: Soft tissue massage helps reduce muscle tension and promote blood flow to the injured area, essential for delivering nutrients needed for tissue repair. Joint mobilizations improve joint function and gently increase the range of motion.
• Controlled Stretching: Stretching exercises maintain and improve muscle and tendon flexibility without straining the healing tissues. They are done carefully to ensure that they do not provoke pain or further damage to the hamstring.

Phase 1 Exercises

1. Static Hamstring Stretch: Lie on your back and raise your affected leg while keeping it straight. You can use a towel wrapped around your foot to gently pull the leg towards you until you feel a comfortable stretch.
2. Isometric Contractions: Sitting on the floor, stretch your legs out in front of you. Place a rolled-up towel under your knee and gently press against it without moving your leg.
3. Toe Touches: Standing, gently bend forward trying to reach your toes. Only go as far as comfortable without exacerbating pain. This helps maintain lower back and hamstring flexibility.

Phase 2: Strengthening

As patients progress past the initial recovery from a hamstring strain, the focus of physical therapy shifts towards regaining strength in the hamstring muscles. Twin Boro physical therapists emphasize a gradual approach to strengthening that aligns with each patient’s recovery stage and overall physical condition and includes:

• Progressive Resistance Training: These exercises rebuild muscle strength slowly, typically starting with light resistance and increasing in intensity as the patient’s tolerance improves.
• Eccentric Strengthening: Lengthening the hamstring muscles under load helps improve both strength and flexibility.
• Core Strengthening: Strong core muscles support the lower back and hips, reducing the load and stress on the hamstrings.
• Functional Exercises: Functional exercises are integrated during this phase to ensure that strength gains apply to daily activities.

Phase 2 Exercises

1. Lying Leg Curls: Lie on your stomach and slowly bend the knee of your injured leg as much as pain allows. As your strength improves, you can add light ankle weights.
2. Bridges: Lie on your back with your knees bent and feet flat on the ground. Lift your hips towards the ceiling, forming a straight line from your shoulders to your knees. Hold for a few seconds, then lower back down.
3. Nordic Hamstring Curls: Kneel with your feet secured. Slowly lean forward, using your hamstrings to resist the fall, then use your hands to push back up.

Phase 3: Neuromuscular Control and Advanced Strengthening

As the recovery progresses and the hamstrings gain strength, Phase 3 of the rehabilitation process at Twin Boro Physical Therapy focuses on enhancing neuromuscular control and advancing the strength of the hamstring muscles. This phase is critical for ensuring that the patient’s muscles recover their strength and ability to perform complex, coordinated movements necessary for daily activities and sports and involves:

• Neuromuscular Training: Designed to improve the coordination and efficiency of muscle responses, this training involves exercises integrating sensory feedback to improve motor output, enhancing the stability and coordination of the hamstrings and surrounding muscles.
• Balance and Stability Exercises: Exercises such as single-leg stands, Bosu ball squats, or using balance boards help train the body’s ability to maintain posture and control through dynamic and uneven loads.
• Proprioceptive Training: This includes activities that heighten body awareness, such as closed-eye exercises, varying surface textures during balance exercises, and agility drills that require quick changes in direction.
• Advanced Strengthening Techniques: In this phase, more complex and demanding exercises are introduced to ensure the hamstring is strong and capable of withstanding high loads and stress.

Phase 3 Exercises

1. Single-Leg Deadlifts: Stand on one leg with a slight bend in the knee. Slowly lean forward, extending your free leg behind you for balance. Lower as far as you can while maintaining balance and return to the starting position.
2. Walking Lunges: Engage the hamstrings dynamically as you step forward into a lunge, keeping your knees aligned and back straight.
3. Reverse Hyperextensions: Lie face down on a table or bed with your legs hanging off the edge. Lift your straight legs towards the ceiling, engaging your glutes and hamstrings.

Phase 4: Functional Training and Return to Sport

The final rehabilitation phase for hamstring strains focuses on preparing patients for a total return to sports or daily activities. This phase involves comprehensive training that ensures the hamstring is strong, resilient, and capable of handling the various stresses associated with specific activities.

• Integration of Functional Movements: Reintroducing movement patterns that patients will encounter daily, exercises are tailored to mimic the patient’s specific activity requirements, enhancing confidence and capability in performing those movements safely.
• Sport-Specific Exercises: For athletes, exercises are carefully selected to simulate the specific demands of their sports. This approach ensures that each athlete has the strength, endurance, and agility required to perform at competitive levels without risking re-injury.
• Stress Testing: Stress testing may be conducted to ensure readiness to return to sport or activity and involves putting the hamstring through the paces of high-load, high-intensity exercises that replicate the peak stresses it will need to endure.
• Maintenance Programs: Patients are provided with routines they can integrate into their regular fitness regime to maintain strength, flexibility, and hamstring endurance.

Phase 4 Exercises

1. Agility Drills: Include zig-zag running, sprints, and shuttle runs that replicate the movements of specific sports.
2. Plyometric Exercises: Perform jumping exercises such as box jumps and bounds to improve explosive power.
3. Speed Work: Gradually reintroduce speed elements into training with short sprints, emphasizing proper form to avoid strain.

Continuous Monitoring and Patient Education

Twin Boro physical therapists closely observe patient progress throughout each phase of recovery, adjusting treatments as needed to optimize healing and prevent re-injury. We also emphasize education, providing patients the knowledge to understand their recovery milestones, recognize potential setbacks, and implement best practices for hamstring health. This proactive approach ensures that patients are active participants in their recovery, equipped to maintain their well-being after recovery.

Recovering from Hamstring Strains with Twin Boro

Hamstring strains require a structured approach that gradually increases the demands on the injured muscle. At Twin Boro Physical Therapy, our expert physical therapists guide patients through each rehabilitation phase, ensuring they return to activities safely and effectively. For more information or to schedule an appointment, please find a Twin Boro location near you. We are committed to helping you achieve your best health and performance.