Premiership Physiotherapist Neal Reynolds has devised a hamstring stretching program which is used by professional players as part of rehabilitation.
The step by step routine is used in conjunction with healing, strengthening and maintaining aerobic fitness. As every injury is different and every athlete is different it is impossible to put timescales on when certain exercises should be done. This step by step approach means the athlete only moves onto the next stage when ready.
Stage 1 - Acute stage
During the acute stage immediately following a hamstring strain injury no stretching should be done at all, only rest. How long this stage lasts for will depend on the severity or what grade the injury is but is usually 2 to 4 days.
Move on to the next stretching stage when daily activities such as normal walking are pain free. If at any time you suffer a setback then simply move back a stage or two and start again.
Straight leg hamstring stretch
Straight leg hamstring stretch in standing can begin. Place the foot on a table or similar and lean into the stretch keeping the leg straight and chest up. Take the stretch as far as is comfortable and hold relaxing into the stretch. Aim to stretch forward from the hip rather than the shoulders. A gentle stretch should be felt at the back of the leg but it should not be painful. Perform 3 set of 10 seconds once or twice a day. The aim is to get a little bit of elasticity to the healing tissue, not increase flexibility. This can also be done sitting down.
Bent leg hamstring stretch
Bent leg hamstring stretch on the back targets the muscle fibres closer to the hip whereas the straight leg hamstring stretch targets the fibres nearer the knee. Lie on your back and pull the leg over keeping the knee very slightly bent until a gentle stretch is felt at the back of the leg. Again this should not be painful. Perform 3 sets of 10 seconds once or twice a day.
You are ready to move on when you have repeated the above pain free for a minimum of 3 days.
Stage 3 is similar to to stage 2 but the aim is to try and get the same range of motion and flexibility in the injured leg as the non injured leg. straight leg standing hamstring stretch should be continued as before with 3 x 10 seconds in the pain free range once or twice a day. Likewise with the bent leg stretch on the back. The athlete is ready to move on when both legs have similar levels of flexibility. Again the purpose of stage 2 is to get a little bit of elasticity to the healing tissue.
Dynamic hamstring stretching
Begin gentle dynamic stretching. Dynamic stretching involves gently swinging the leg into a stretched position. Ensure the leg is relaxed at all times and the stretch is not forced. Perform 3 x 10 reps gently swinging the straight leg as high as is comfortable. It may help to put the free hand over the swinging leg as a target and to possibly trick the brain into thinking it is safe to swing the leg.
Active straight leg raise
Begin active straight leg raises from lying on the floor. The athlete lifts the injured leg up as far as it will go within the pain free range then lowers again. Perform 3 sets of 10 reps once or twice a day. Try to get a more dynamic movement with this exercise and aim to gradually straighten the knee as flexiblity allows.
Cycling upside down
Cycling exercise lying on the floor. The athlete lies on their back and supports their hips up in the air with their hands whilst performing a cycling action with the legs.
The athlete is ready to move on when stage 4 exercises can be done for 2 days pain free.
Stage 5 is the same as stage 4 but with the aim of working towards equal flexibility on both legs. Dynamic hamstring stretches, active stretches and cycling should all be done pain free. When both legs feel the same with equal flexibility then the athlete is ready to move onto stage 6.
Dynamic walks can begin which involve the athlete walking forwards whilst kicking the straight leg up in front each step to get a dynamic stretch in the muscle. The leg swings should be controlled and not forced, always within the pain free range of motion. Perform 3 sets of 10 repetitions once a day. This exercise should be done for at least 2 days without any pain. The athlete has completed all hamstring stretching stages when this exercise and others previously done are pain free with equal flexibility in both legs.