Hamstring strain exercises should form part of a comprehensive rehabilitation program and include stretching, strengthening and sports specific hamstring exercises. Physiotherapy Consultant Neal Reynolds has devised a step by step program as might be used by professional footballers
- Stretching exercises
- Strengthening exercises
- Maintaining aerobic fitness
Introduction to hamstring strain rehabilitation
Expert interview (play video): 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.
Progress through the stretching exercises only moving onto the next level when the milestones have been reached.
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
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
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 stage 2 but the aim is to try and get the same range of motion and flexibility in the injured leg as the
Dynamic hamstring stretching (play video)
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
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
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
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
The following strengthening exercises (play video) for the rehabilitation of hamstring injuries should be done progressively as part of our hamstring strain rehab program. This is for information purposes only. We recommend seeking professional advice. Below are a number of progressively more difficult hamstring exercises. They should always be done
The athlete lies on their front in the prone position. The partner or therapist provides resistance as the athlete contracts the hamstring muscles,
Standing knee flexion
The athlete stands on one leg and bends the other one using gravity as resistance. This can be done gently and slowly to start with as an early stage exercise. Aim for 3 sets of 10 repetitions once a day building to 4 sets of 20 reps. Ankle weights can be used to increase the load further. As the athlete returns to running this exercise can be performed more explosively.
The leg is allowed to fall and the hamstring muscle catches the leg before it falls to the horizontal. It may take a while to get used to this one. The athlete must stay relaxed as the leg falls under the influence of gravity and only contracts the hamstring muscles to prevent the foot landing. This starts to work the muscles eccentrically with a very light dynamic training effect.
This should be done
The athlete lies on their back, knees bent and pushes the hips upwards to work the
Single leg bridges are done in the same way ensuring you squeeze the gluteal muscles and aim to maintain a straight line from the shoulder on the ground to the knee at the top point of the exercise. Again, begin with 3 x 8 reps and build up.
Seated hamstring curl
This is a deceptively difficult exercise which works the hamstring muscles specifically in a very contracted close range of movement
Single leg hip extensions
This is a more advanced version of a bridge. Using a step or box the athlete rests on their elbows and alternates each leg putting the heel down on the floor maintaining good core stability. It is important to keep the hips and shoulders still. As the heel touches the ground the gluteal muscles and hamstrings have to work isometrically to keep the body stable. This also works the hamstring muscles in a similar position as they are in when sprinting or accelerating.
Single leg ball pick up
This is another deceptively difficult hamstring exercise which looks easy at first glance.
The athlete places on foot in front of the other and bends down to pick up the medicine ball. They then repeat the movement to put the ball back down. Repeat this 5 to 10 times.
Lunge with ball
A basic lunge is performed while holding a ball to aid balance. This exercise strengthens the glutes, hamstring muscles and quadriceps muscles. The athlete stands with the injured leg a wide stance in front of the other. Holding a medicine ball close to the chest the weight is shifted onto the front leg and back knee bent dropping it down to the floor.
Another deceptively difficult exercise which looks easy but checking the level of muscle soreness the next day is important before doing
Norwegian leg curl
One of the most advanced hamstring exercises. The athlete kneels down while the therapist holds the ankles. They then slowly lean forwards as far as they can under control using the hamstrings to resist the
Being injured doesn't have to mean training stops. This step by step aerobic fitness program to be used when recovering from hamstring strains and is designed to be used in conjunction with a full hamstring strain rehab program consisting of healing, strengthening and stretching exercises. The athlete will only move onto the next stage if the current stage can comfortably be completed
Stage 1 (acute stage): This is the painful stage immediately after
When daily activities such as walking up stairs, getting in and out of a car
Stage 2: Use a rowing machine if pain allows. Row at a steady pace and low resistance for 5 minutes upwards. A time of 20 minutes a day should be enough to help maintain fitness. You may find it easier to break this into 5 or 10 minutes intervals with a couple of minutes walk recovery to monitor the effect on the hamstring muscle.
Stage 3: Stationary cycling
Stage 4: Arm only swimming
Stage 5: Stepper
Stage 6: Cross Trainer
Stage 7: Slow jogging – up to 2 x 10 minutes with a short rest in between. Move on when the above is
Stage 8: Slow jogging – up to 25mins continuous. Move on when
Stage 9: Half pace running. 6 x 50m strides. Move on when
- 100m shuttles at
30s(3 x 6mins) with short rest.
- 100m shuttles at 27s (3 x 6mins) with short rest.
- 100m shuttles at 24s (3 x 5 minutes) with longer rest.
- 100m shuttles at
20s(3 x 4 mins) with longer rest as required.
Stage 11: (final