This is the treatment and healing part of our four strand hamstring strain rehabilitation Program devised by premiership football physiotherapist Neal Reynolds.
Healing and treatment of hamstring strains includes any treatment methods which are applied to aid the healing process including cold therapy, heat, electrotherapy and sports massage. It fits alongside the other elements which include stretching exercises, strengthening and maintaining fitness. Download a PDF overview of the program here.
Stage 1 - Acute stage
The acute stage of hamstring strain rehabilitation usually lasts 3 to 4 days depending on how bad or what grade the injury is. Complete rest is required during this stage. No running allowed and as little walking as possible.
Apply the PRICE principles of protection, rest, ice, compression and elevation. Apply cold therapy for 15 minutes every hour in the early stages and at least 3 or 4 times a day. Ice should not be applied directly to the skin as it may cause ice burns but wrap in a wet tea towel. Even better are commercially available cold packs and wraps which provide compression as well. Cold therapy will help stop any internal bleeding and reduce pain and swelling.
Use a compression bandage or thigh support to apply compression. This can be worn all the time during the acute stage to help reduce swelling and support the muscle. Elevating the limb as much as you can will help swelling and tissue fluids drain away from the site of injury.
The athlete is ready to move on to stage 2 when daily activities and normal walking is pain free. If this is not the case then continue with rest, ice and compression.
Stage 2 - Sub acute stage
Depending on severity the sub acute stage can last 1 to 10 days for a grade 1 hamstring strain, 2 to 3 weeks for a grade 2 hamstring strain and a severe grade 3 can last from 3 to 8 weeks or more and may require surgery.
At this stage hot and cold can be alternated. The pattern is 2 mins hot, 1 min cold. for 6 times (18 mins) twice a day. Use a hot water bottle or commercial gel pack which can be heated in hot water or carefully in the microwave oven to apply heat to the limb.
A professional therapist may use electrotherapy at this stage such a ultrasound, laser, pulse shortwave. This should be done daily if possible but this is not usually convenient for all but the professional sports person.
Sports Massage or soft tissue massage can be done at this stage but very light and superficial to begin with and gradually getting deeper. Start short and light. Massage can be applied daily initially if it is done lighter but later on as techniques need to be deeper more recovery time between sessions may be required.
The athlete is ready to move onto the third and final stage when massage is pain free, jogging can be done pain free for 5 minutes and they are at the dynamic stretching stage of the stretching exercise program.
Stage 3 - Final stage
In the final stage of the healing process deep tissue massage can be done every 3 days, Massage techniques will be deep and require longer recovery between sessions.
Heat can be applied for 20 minutes at a time once a day to really warm the muscle up and stimulate blood flow.
This should be continued until the athlete is back to full fitness and has completed the other 3 elements of hamstring rehab which are: