Hamstring Repair: Post-Operative Rehabilitation Protocol

Written By Bryn Gilbertson

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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

Bryn Gilbertson
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