Hamstring Tear Protocol – Rehabilitation Guide


Individuals engaged in activities such as sprinting, climbing, jumping, or lunging are more susceptible to experiencing a distressing hamstring injury. The treatment approach encompasses a combination of rest, ice application, compression, elevation, and a gradual progression into gentle stretching and easy exercises. The majority of these treatment steps can be effectively administered within the comfort of one’s own home. A hamstring tear protocol can also be administered by a physician for non-operative injuries. The duration of healing can vary significantly, ranging from a few days to potentially extending over several months, contingent on the injury’s severity.

What is a proximal hamstring strain rehab protocol?

The aim of this protocol is to provide a comprehensive framework for healthcare professionals and patients to navigate the non-operative treatment of hamstring injuries. This protocol incorporates both time-based elements, contingent on tissue healing, and criteria-based elements, with significant variability based on the injury’s severity, strain grade, and its location within the muscle, myotendinous junction, or tendon.

The selection of specific interventions should be tailored to the unique requirements of each individual and take into account the findings from examinations and clinical judgment. For instance, the rehab protocol used for grade 2 hamstring tear is different from a grade 3 hamstring tear rehab protocol.

What are the differences between the grades of a hamstring injury?

When assessing your hamstring injury, it’s crucial to understand the grading system, which provides insight into the severity of your specific condition. Here’s an overview tailored to your situation:

  • Grade 1 Hamstring Injury (Mild Muscle Pull/Strain): At this level, you’re dealing with a relatively mild injury. It typically involves some overstretching or minor tearing of the hamstring muscle fibers. Symptoms might include slight discomfort, tenderness, and minimal impairment in your range of motion. Recovery for a Grade 1 injury often involves rest, gentle stretches, and basic strengthening exercises. You can generally expect a quicker return to your regular activities compared to more severe grades.
  • Grade 2 Hamstring Injury (Partial Muscle Tear): This grade signifies a more substantial injury, where there is a partial tear in your hamstring muscle. You’re likely to experience moderate to severe pain, swelling, and a noticeable reduction in your ability to move the affected leg. Recovery for a Grade 2 injury typically involves a more structured rehabilitation program, which may include physical therapy and exercises designed to regain strength and flexibility. Healing time can vary, but you should be prepared for a potentially longer recovery period than with a Grade 1 injury.
  • Grade 3 Hamstring Injury (Complete Muscle Tear): This is the most severe grade of hamstring injury. In a Grade 3 injury, your hamstring muscle has suffered a complete tear or rupture. The pain is intense, and you may have difficulty even bearing weight on the affected leg. Treatment often requires close medical attention, and you might need interventions like surgery to repair the torn muscle. Rehabilitation for a Grade 3 injury can be an extensive process, involving a gradual return to activity once the muscle has healed. Expect a more prolonged recovery period, which could extend for several months.
    Symptoms of hamstring injury by grade

The symptoms you experience can vary depending on the severity of your injury:

  • Grade 1: This is a strain. You might suddenly feel a radiating pain in the back of your thigh. Your strength won’t be significantly affected, but moving your leg may be challenging.
  • Grade 2: In a partial tear, the pain is more intense than in Grade 1. You may notice some swelling, bruising, and a loss of strength in your leg.
  • Grade 3: This is a severe tear. The pain is worse, and you might feel tenderness, notice more swelling and bruising. Some people even report feeling a popping sensation when the injury occurred.

Additional symptoms to watch for include a noticeable bump or knot in your thigh area, muscle spasms, and stiffness, especially after a period of rest or inactivity.

Considerations for the non-operative Hamstring injury

Several things affect how well your hamstring injury heals. These factors include:

  • How long you’ve had the injury: If it’s been a while, it might take longer to get better.
  • Where it hurts in your hamstring: Whether it’s near the top, middle, or bottom can impact your recovery.
  • How many muscles or tendons are involved: If it’s more than one, it could be a bit trickier to treat.
  • Your hip muscles’ strength before the injury: Strong hips can help your recovery.
  • If you have any problems with your sciatic nerve: This can make things more complicated.

It’s a good idea for your healthcare team to work together and talk to your doctor about all of these things. This way, you can get the best care for your hamstring injury.

Rehabilitation goals by Phase

  • Phase 1 (0-2 weeks after injury): Facilitate the recovery of damaged tissue by commencing early, protected range of motion exercises, safeguarding against muscle weakening, and reducing both pain and swelling.
  • Phase 2 (2-4 weeks after injury): Alleviate or eliminate pain and swelling, and aim for excellent motor control and pain-free functional movements.
  • Phase 3 (4-8 weeks after injury): Achieve a natural walking pattern, gradually advance to full range of motion, enhance neuromuscular coordination, boost muscle strength, and refine your sense of body position and movement awareness (proprioception and kinesthesia).
  • Phase 4 (8-12 weeks after injury): Achieve complete range of motion, enhance neuromuscular coordination, build strength, power, and endurance, and boost dynamic stability.
  • Phase 5 (12+ weeks after injury): Place importance on a gradual comeback to leisure activities, progressively ramping up your engagement to prepare for a full return to unrestricted function.

Hamstring tear protocol as guidance for treatment of hamstring injuries

If you’re dealing with a hamstring injury, it’s crucial to understand its severity and follow a tailored rehabilitation plan. Whether you’re in Phase 1, just starting your recovery, or in Phase 5, gearing up for a return to your favorite activities, the key is patience and persistence. Work closely with your healthcare team, follow the prescribed proximal hamstring strain rehab protocol, and don’t rush the process. Your path to full recovery may vary, but the goal remains the same: regain your strength, mobility, and confidence. Together with your medical professionals, you can navigate the phases of rehabilitation, ensuring a safe and successful return to your active lifestyle.

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