Rehabilitation Guidelines for Proximal Hamstring Repair

Please note that these instructions are general guidelines to be followed; however, any written or verbal instructions provided by Dr. Verma or either Physician Assistant supersede the instructions below and should be followed.

Post-Operative Rehabilitation Guidelines for Proximal Hamstring Repair

1-6 Weeks: Period of protection

• Use axillary crutches for up to 6 weeks
  • Weeks 0-2: NWBAT with brace locked at 30 degrees flexion
  • Weeks 3-4: 25% – 50% weight bearing progression
  • Weeks 5-6: Weight bearing as tolerated with weaning from crutches
• Recommended exercises: Quad sets, Ankle pumps, Abdominal isometrics
• Passive knee range of motion (ROM) with no hip flexion during knee extension
  • Weeks 3-4: Begin pool walking drills (without hip flexion coupled with knee extension), hip abduction, hip extension, and balance exercises
  • Scar mobilizations

6-12 Weeks: Gait Training, Active Motion and Strengthening

• ROM – Daily Active Passive ROM exercises (increase ROM as tolerate)
• Non-impact balance and proprioceptive drills – beginning with double leg and gradually progressing to single leg
• 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
• Stationary bike for ROM, strengthening, and cardio
• Gait Training

12-18 Weeks:

• Advance strengthening as tolerated, continue closed chain exercises. Increase resistance on equipment.
• 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 jogging, running, sprinting drills

18-24 Weeks:

• Continue 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 leg bridge 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