Professional Documents
Culture Documents
The Ultimate Guide To Hamstring Strain Rehabilitation - The Barbell Physio PDF
The Ultimate Guide To Hamstring Strain Rehabilitation - The Barbell Physio PDF
TO HAMSTRING STRAIN
REHABILITATION
Posted at 18:00h in Exercises, Lower Body, Physical Therapy, Running by zlongdpt
22 Likes
a d h k
1.5K 15 57 2
1.5K Facebook Twitter Pinterest LinkedIn
SHARES
A hamstring strain can be one of those stubborn injuries that far too often become recurring
injuries or a more chronic strain. Their high rate of recurrence is often due to a lack of careful
rehabilitation and training following the injury. If you are experiencing chronic hamstring
strains, there is a speci c and well-understood way to begin to exercise the injured body part
and progress back to full athletic participation.
ACUTE PHASE
CONSIDERATIONS: DID YOU
JUST INJURE YOUR
HAMSTRING OR IS IT
HAMSTRING, OR IS IT
CURRENTLY PAINFUL?
The rst step in rehabilitating insulted muscle tissue is to nd ways to use this muscle
without causing further injury. Isometric exercise is de ned as a muscular contraction where
the muscle length is not changing. In other words, the muscle is being exed, but it is not
creating any movement. An example of an isometric exercise is showing off your arm
muscles or exing your abs as hard as you can. Isometrics have been shown to help with
pain and are an effective initial way to start exercising after injury. The bridge position is a
good place to start with isometric hamstring exercise.
During rehab, there might be a session where you do the dynamic movement of one position,
and the isometric holds from the next most challenging position. This is how you can slowly
advance the di culty of rehab. Isometrics allow us to “feel out” new ranges of motion.
They’re helpful for teaching lifting for this same reason as for rehab. They are a useful
method of self-limiting progression to ensure we do not push ourselves too much and take a
step back as well. Isometrics builds the initial strength and comfort in each new range of
motion.
Start all new positions with isometric holds, then progress to reps and movement. Build from
2 sets x 5-8 reps to 3 x 10-12 before entering each new phase. Use pain and form as your
guide for progression.
If the phase 0 bridge is painful with your hamstring strain, there are a few ways to modify the
exercise and experiment with nding pain free movement. The range of motion can be
altered to reduce the strength of the contraction. Introducing extra isometric resistance in
other planes of movement can help to recruit varied musculature and signi cantly alter pain
sensation. Additionally, there are pelvic and core positioning cues and considerations that
can be used to nd pain free movement. A posteriorly tilted pelvis and exed spine
positioning can effectively shorten the length of the hamstrings and increase contraction
strength. This is one cue that can help to decrease sensitivity during the initial phase and
also train the core to prepare for proper positioning under load later on.
Stretching a muscle can create a temporary inhibitory effect on its bers, causing the tone of
the muscle to relax and thus allowing for more range of motion. Muscle length is a uid and
dynamic quality that changes based on the status of the nervous system and muscle bers
themselves. For example, if your hamstrings are extremely stiff after a killer deadlift workout,
their bers and cells are highly sensitive and do not want to be tugged on and stretched.
Therefore, your nervous system knows this and disallows intense stretching. Your muscles
did not physically shorten over night, and if worked back into range of motion properly, they
will return to a comfortable resting length once the soreness is resolved.
Here is a video of some gentle stretching techniques that can be used. Incorporating hip
rotation into stretches will ensure the entire hamstring group is stretched equally.
The goal is to continually add progressions and challenges to the exercises while being able
to distinguish between good pain, working muscles, stretch vs. pull, and bad pain. Good pain
during a hamstring rehab is a slight stretch or a very small pulling feeling that improves
throughout the exercise or set. Good pain is muscular soreness afterward. Bad pain is a
strong or painful pull, a tug, and any strength of contraction that would not be able to be
tolerated for a 5-10 second hold. If you are working with a patient, come up with some
mutually shared ways to communicate about stretch vs. pain vs. pull, good vs. bad pain, etc.
HAMSTRING STRAIN
EXERCISE PROGRESSIONS
FOR ATHLETES
UNILATERAL EXERCISES
Athletes require more advanced ways to increase the strength of their hamstrings and move
beyond the basic bridge and isometric progressions. Unilateral exercises can teach body
stiffness, core control, balance, and controlled eccentric lengthening along with reciprocal hip
movement. They can be bene cial for all athletes, including barbell lifters. Developing single-
leg strength is markedly different than lifting with both your feet on the ground, it will make
you stronger and more resilient. These exercises are sure to challenge even the healthiest of
hamstrings.
SINGLE-LEG DEADLIFT
The single-leg deadlift should be in everyone’s training program. It’s a key move for
combining hamstring mobility and strength into one movement. All of these exercises can be
progressed with speed as well as weight. Hamstrings are called up on to contract quickly and
need to be rehabbed accordingly.
Hamstring Rehab: Single Leg Deadlift Progressions
SLIDER LUNGES AND FALL OUTS
Lunges involve much more hamstring activity when they’re done with sliders. Like all of these
exercises, increasing the speed makes this signi cantly more challenging to the hamstrings.
BILATERAL EXERCISES
EXERCISE 1: NORDICS
Here is an example of an active Thomas test that you can do yourself to asses hip exor
mobility and control as well. Use a box or raised bench if you don’t have access to a table.
GLUTE STRENGTH
The glutes and hamstrings play synergistic roles as powerful extensors of the hip. It would
stand to reason that if one glute was weak, for whatever reason, that side hamstring might
have to take on more load. Training hip extension with both glute and hamstring dominant
movements is just as important as training knee exion in the rehab process.
To address glute strength: check out THIS ARTICLE for different exercises to throw into the
mix.
HIP FLEXION
HIP FLEXION
Lastly, one important test to help look at proper hip function and screen out for future
hamstring issues is the standing hip exion hurdle test. The hurdle test is part of a
movement screen that can be helpful for bringing to light hip pathology or movement de cits
in active exion that might impact gait and running mechanics.
The video below shows three common compensations: trunk side-bending, hip hiking, and
then hip rotation compensations. One thing to notice with the hip rotation de cits is the
concomitant compensations with foot eversion and inversion.
CORE STRENGTH
Often, we nd individuals with di culty controlling pelvic positions (core stability) will place
h l l l d d hl k
their pelvic in an anteriorly tilted position during athletic movements. Many times, working on
better controlling pelvic positioning can have a great effect on decreasing strain on the
hamstrings. Here are some of our favorites, but you can get creative here!
Psoas March and Variations are great to work the core and hip exor strength
simultaneously with a focus on controlling pelvic positioning.
Psoas March
Dead Bugs and Variations are a killer series of exercises to get your core seriously strong.
Dead Bugs
Band Pullover Straight Leg Raises are great to stabilize the core/pelvic while taking the
hamstring through its full range of motion.
RETURN TO RUNNING
RETURN TO RUNNING
Returning to jogging after a hamstring strain injury usually isn’t too bad. It’s the sprinting and
high-velocity work that is both challenging and daunting. This can be especially true for
athletes who injured their hamstrings running at full speed.
Both of these methods reduce stride length and maximum velocity for sprinting. They can
also be helpful for reviewing and teaching sprinting mechanics. An example of how a sled
drag progression might look is to gradually decrease the weight over 3-4 weeks to return
unweighted sprints. With hill sprints, the hill volume can gradually subbed in for at ground
sprinting until the sprinting volume is all on at ground.
RETURN TO RUNNING
Tempo running and a gradual return to running and practice drills are helpful. Often athletes
want to re-condition by jogging; they’ll go out and run 4 miles in 30 minutes and think they’re
helping their hamstring. Jogging is not su cient. That’s an 8mph pace. During a competitive
event, most high-level athletes (men & women) will be achieving speeds between 14 and 18
mph. Hamstring injuries happen during higher velocity running, and these conditions must be
re-created in rehabilitation to fully prepare the athlete.
During a tempo run, the athlete should be brie y hitting 10-12 mph and should strive for a full
cycling range of motion similar to max velocity running. By the time the athlete is returning to
practice and movement, they should be well-conditioned, extremely in touch with their body,
and constantly self-monitoring to avoid extreme fatigue and scenarios that can potentially
cause a re-injury. Returning from a muscle pull or tear requires self-limiting behavior and
discipline: pain is subjective, and the athlete is the only one that knows how they feel.
One nice way to do tempo runs is on a Woodway curve. The curve gives you a speed reading
and allows you to run as fast as you like and easily accelerate to 10 or 12 mph. If you don’t
have access to this kind of equipment, any eld or open area will do. A normal belt powered
treadmill is not ideal for tempo runs. Using a radar gun to gauge the athlete’s speed and
assign objective numbers is a helpful way to control tempo runs on the eld.
There are some other locomotive ways to challenge the hamstring strain in the last part of
There are some other locomotive ways to challenge the hamstring strain in the last part of
rehab. Bounding running, galloping, and running downhill or Overspeed running will increase
the stretch on the hamstring and potentially expose the injured area. During this last phase of
rehab, you need to expose the injury to ensure it’s strong enough for return to sport.