Physical Therapy Exercises After Hamstring Strain

Imagine a big clump of balled up slop at the site where your hamstring muscle was torn. That tissue is collagen and is called scar tissue. It is the product of the normal healing process after a hamstring strain. The best way to remodel this tissue is with gentle, progressive stretching.4 (Your PT may also choose to do scar tissue massage with you to help get rid of that lump of tissue near your injury site.)

There are various ways to start to stretch your hamstrings after a hamstring strain. Start slowly and gently increase the intensity of each stretch over the course of four to six weeks.

Different hamstring stretches that your PT may prescribe for you may include:

• The hurdler stretch5
• The towel hamstring stretch
• The amazing standing hamstring stretch

Each stretch can be held for 15 to 30 seconds, and you can do three to five repetitions. Hamstring stretches should be continued several weeks during your rehab, and you may wish to keep flexible by stretching your hammies several times a week even after you are fully healed.

Another part of your rehab should be focused on hamstring strengthening.2 Your PT can show you the best exercises to strengthen your hamstrings. Some ideas may include:

• Prone knee curls (start with only gravity as your resistance, and then make things more challenging by adding cuff weights)
• Standing hamstring curls6
• Ball bridges with knee flexion
• Seated hamstring curls with a resistance band
• Good morning exercises
• The Nordic eccentric hamstring curl7

Remember, start out slowly and then progress by increasing the number of repetitions of each exercise or by adding resistance with cuff weights or resistance bands.

Make sure you perform each strengthening exercise slowly and focus on the eccentric portion of the contraction. Eccentric contractions occur as your hamstring is lengthening.8 So, if you are doing a hamstring curl, controlling the motion slowly as your knee is straightening is the eccentric portion of the contraction. Some studies indicate that eccentric contractions may have a protective effect against hamstring injuries.

Remember, your hamstrings cross your knee joint in the back. Guess what? Your calf muscles cross there too, so don’t ignore them while rehabbing a hamstring injury. Your calf and hamstring work together to help support your knee, so performing calf strengthening exercises can help support your entire lower extremity.

Exercises to strengthen your calves may include:

• Calf raises9
• Theraband strengthening exercises
• Alfredson protocol for Achilles strength10

Each different exercise should be done for 10 to 15 repetitions several times per week. Stop if any calf exercise starts to increase pain in your injured hamstring.

Your hip muscles, like the gluteus medius, help control the position of your leg as you are walking and running. If your hips are weak, your lower leg may rotate inwards and place excessive stress on your knee and the muscles around it. Keeping your hips strong can help alleviate this excessive stress on your hamstring muscles, which may help protect them from further injury after a hamstring strain.11

Straight leg raises are a great way to start your hip strengthening exercises. Once your hips get stronger and your hamstring has healed, you can start more advanced hip strengthening, like hip hikers.

Your quadriceps muscles are on the front of your thigh, just opposite your hammies. Keeping these muscles strong can help support your entire lower extremity and create balance between all the muscles of your leg. Short arc quad exercises or mini squats can help keep your quads working well while you rehab your hamstrings.

Exercises for your hips and quads should be done for 10 to 15 repetitions, 3 to 4 times per week.

Your abdominal and core muscles attach to the top of your pelvis, and your hamstrings originate from the bottom of your pelvis. Therefore, keeping your core strong can affect pelvic position, and a pelvis that is not in optimal position may place increased stress and strain on your hamstring muscles. It makes sense that your physical therapist may have you work on core stability exercises as part of your hamstring strain exercise program. Research indicates that hamstring rehab programs that include core exercises may yield effective results.12

Abdominal and core strengthening exercises that your PT may prescribe include:

• The pelvic tilt
• Bridges13
• Stability ball bridges
• Planks14
• Quadruped exercises

Your physical therapist may have you work on balance and proprioception exercises as part of your hamstring strain rehab program. Poor balance and instability can make your leg muscles, like your hamstrings, work extra hard during high-intensity athletics like running or jumping.15 This may place excessive stress on your hamstrings, leading to a strain.

Balance exercises may include:

• Single leg stance16
• The T-stance
• The BAPS board (typically done in the PT clinic)
• Using a wobble board while standing on one foot
• Medicine ball balance exercises

One important caveat with balance exercises: be safe. To effectively improve your balance, you must create situations that challenge your balance, and this may place you in a situation where you can fall. Be sure you remain safe while performing your balance exercises by keeping something nearby that you can hold onto to stabilize yourself.

As your hamstring strain physical therapy program progresses, your PT may have you work on high-intensity jumping exercises, called plyometrics. Exercises may include:

• Drop-jump exercises17
• Single leg hop exercises
• Box jumping

All of these exercises have one thing in common: they place high amounts of stress on your lower extremity muscles and joints.18 They should be done under the close supervision of your physical therapist and are reserved for the latter stages of your hamstring strain rehab when significant healing has taken place.

Your physical therapist can also perform functional mobility testing to determine when (and if) it is safe for you to return to high-intensity athletics. These tests are designed to challenge your leg muscles, like the hamstrings, and can help your PT determine if you can get back to sports.

Once your hamstring has healed and you are ready to move on from the physical therapy clinic and back to normal activity, your PT can work with you to devise a home exercise program to help you maintain optimal flexibility, strength, balance, and jumping ability to help you minimize your risk of future hamstring strains.

Keep in mind that everyone is different, and everybody heals at different rates. Plus, every injury is not the same, and your hamstring recovery may be quick, or it may take a bit longer than you would like. The best way to understand what exercises you should do for your hamstring rehab is to work closely with your doctor and physical therapist.

If you have had a hamstring strain, your PT will likely progress you through exercises, similar to this program, to help you fully recover. Check in with your physical therapist to start on your own personalized rehab program for your hamstring strain so you can get back to optimal functional mobility quickly and safely.