Hamstring Repair: Post-Operative Rehabilitation Protocol
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Phase 1 (Week 1-6): Protect Repaired Tendon and Control Pain
Weight Bearing
50% Partial Weight Bearing for 3 weeks then Weight Bearing as tolerated with Axillary Crutches
Brace
A hinged knee brace is used for the first 3 weeks to prevent knee extension beyond 30 degrees
Precautions
Avoid hip flexion coupled with knee extension
Avoid unsafe surfaces and environments
Suggested Exercises
Quad sets
Ankle pumps
Abdominal isometrics
Passive knee range of motion (ROM) with no hip flexion during knee extension
Post-operative weeks 3-4: May begin pool walking drills (without hip flexion coupled with knee extension), hip abduction, hip extension, and balance exercises
Upper body Ergo cardiovascular training
Phase 2 (Week 6-12): Gait Retraining and Limb Control
Aims
Good control and no pain with functional movements, including step up/down, squat, partial lunge (do not exceed 60° of knee flexion)
Precautions
Avoid dynamic stretching
Avoid loading the hip at deep flexion angles
No impact or running
Suggested Exercises
Non-impact balance and proprioceptive drills – beginning with double leg and gradually progressing to single leg
Stationary bike
Gait training
Begin hamstring strengthening – start by avoidance of lengthened hamstring position (hip flexion combined with knee extension) by working hip extension and knee flexion moments separately; begin with isometric and concentric strengthening with hamstring sets, heel slides, double leg bridge, standing leg extensions, and physioball curls
Hip and core strengthening
Progression Criteria
Normal gait
Single leg balance >15secs
Normal (5/5) hamstring strength in prone with the knee in a position of at least 90° knee flexion
Phase 3 (Week 12 +)
Aims
Painfree work and sport specific exercises, including impact
Precautions
Painfree during strength training
Post activity soreness should resolve within 24hrs
Suggested Exercises
Continue hamstring strengthening – progress toward strengthening in lengthened hamstring positions; begin to incorporate eccentric strengthening with single leg forward leans, single leg bridge lowering, prone foot catches, and assisted Nordic curls
Hip and core strengthening
Impact control exercises beginning 2 feet to 2 feet, progressing from 1 foot to the other and then 1 foot to same foot
Movement control exercise beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities
Initiate running drills, but no sprinting until Phase IV
Biking, elliptical, stairmaster, deep water running, swimming
Progression Criteria
Dynamic neuromuscular control with multi-plane activities at low to medium velocity without pain or swelling
Less than 25% deficit for side to side hamstring comparison
Phase 4 (4-5 Months): Advanced Retraining
Aims
Good control and no pain with work and sport specific requirements
Precautions
Painfree during strength training
Post activity soreness should resolve within 24hrs
Suggested Exercises
Continue hamstring strengthening – progress toward higher velocity strengthening and reaction in lengthened positions, including eccentric strengthening with single leg forward leans with medicine ball, single leg dead lifts with dumbbells, single legbridge curls on physioball, resisted running foot catches, and Nordic curls
Running and sprinting mechanics and drills
Hip and core strengthening
Impact control exercises beginning 2 feet to 2 feet, progressing from 1 foot to other and then 1 foot to same foot
Movement control exercise beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities
Sport/work specific balance and proprioceptive drills
Stretching for patient specific muscle imbalances Continue hamstring strengthening – progress toward strengthening
Return to Work/Sport Criteria
Dynamic neuromuscular control with multi-plane activities at high velocity without pain or swelling
Less than 10% deficit for side to side hamstring comparison on Biodex testing at 60° and 240° per second
Less than 10% deficit on functional testing profile Work on sport specific training and drills