Hamstring Tendinopathy Rehabilitation Program

Hamstring strain exercises

Hamstring/Biceps femoris tendinopathy is an overuse injury causing pain at the back of the knee. The following example rehab program is for information. We recommend getting professional advice.


Whether the injury is inflammation of the tendon, degeneration, a strain or partial rupture, the basic aims of rehabilitation remain the same:

  • Decrease pain and inflammation.
  • Stretch and the muscles and restore mobility and flexibility.
  • Strengthen the knee.
  • Gradual return to full fitness.
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Decreasing Pain and Inflammation

  • Rest from aggravating exercises. Avoid any form of exercise that may make the injury worse. If you are on your feet a lot at work then this will not help. You should rest until the acute stage has passed. This is usually 48 hours if you look after it. If you continue to use the tendon then it may remain acute for longer. If you can contract the hamstring muscles (bend the knee) without pain then the acute stage may have passed.
  • Apply ice/cold therapy. At least 3 times a day for 15 minutes.
  • NSAID (Non-Steroidal Anti-inflammatory Drugs) e.g. Ibuprofen may help reduce inflammation in the early stages. Always consult your doctor before taking medication. Ibuprofen should not be taken if you have asthma.
  • Wear a knee support or heat retainer. Heat may be applied after the acute stage but up until then, apply cold therapy.

Stretching and Restoring Flexibility

Bent leg hamstring stretching
  • Hamstring stretches can be done from day one so long as they are not painful. If stretching produces pain then rest until stretching can be done without pain.
  • Hold stretches for 30 seconds and repeat the stretch 5 times.
  • Stretch every day (if it is pain-free).
  • Stretching exercises should be done with the leg rotated inwards and again with the leg rotated outwards….more.
  • Sports massage can play an important part in restoring flexibility and enhancing the healing process. Massage can begin after the initial acute stage – usually after the first 48 hours. If bending the knee is painful then avoid massage therapy until it is not.

Strengthening Exercises

Hamstring leg catches
  • Strengthening exercises should be done to gradually and progressively increase the load through the tendon. This is important to prevent your injury recurring. Simply going straight back to normal training levels as soon as you are free of pain is not a good idea.
  • Strengthening exercises can begin as soon as they can be done without pain. This may be after the first 48 hours or it may be up to a week before strengthening can begin.
  • There should be a gradual progression. Once you can cope with the easy exercises without pain during, after or the following day, then move onto a more difficult exercise.
  • Strengthening exercises should continue long after you feel the injury has recovered.

Running & returning to fitness

  • As soon as you are confident of pain-free stretching and strengthening exercises it may be possible to begin more sports specific training. This may be within a few days or up to a couple of weeks or longer depending on severity.
  • This should be a gradual process. Start with a gentle jogging programme as shown below:
Day 1:walk 4 minutesjog 2 minutesrepeat 4 times
Day 2:rest  
Day 3:walk 4 minutesjog 3 minutesrepeat 3 times
Day 4:rest  
Day 5:walk 3 minutesjog 4 minutesrepeat 4 times
Day 6:rest  
Day 7:walk 2 minutesjog 6 minutesrepeat 4 times
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  • Continue this gradual progression until you can confidently run and resume normal training.
  • Gradually increase the duration of your runs. No more than 10 % per week is usually recommended. If your sport demands sprinting then gradually increase the speed of each training session so long as there are no adverse effects. Start at 50% of maximum speed and increase by about 10% per session.
  • Continue with specific strengthening and stretching exercises.
  • Each session should begin with a warm-up and stretch and end with a cool down and stretch.
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