How to Rehab a Pulled Hamstring Muscles

Pulled hamstrings (or hamstring strains) are common injuries in sports that require high-speed running, agility and explosive power.

In this article, I’ll show you a few effective concepts to help you rehab pulled hamstring muscles and return to your favorite physical activity safely.

Early Rehabilitation Phase of Hamstring Strains – Protection and Minimization of Atrophy

The primary goals are to protect the healing tissue, minimize atrophy and strength loss of hamstrings, quadriceps, hip stabilators, and prevent loss of knee motion.

Optimal exercises for this phase include:

Stationary Bike: Low-intensity cycling helps maintain cardiovascular fitness without placing excessive stress on the hamstring. It can aid in circulation, which is beneficial for healing, and helps minimize atrophy without risking further injury.
Submaximal Isometric Contractions at Multiple Angles: Performing isometric holds at 30°, 60°, and 90° of knee flexion helps to maintain hamstring strength without causing muscle lengthening that might disrupt the healing process. This controlled activation encourages muscle engagement and neural stimulation while protecting the injury site.
Single Leg Balance: This exercise helps maintain proprioception and neuromuscular control, which are critical for preventing future injuries. Balancing on the uninjured leg initially, and gradually incorporating the injured leg as healing progresses, helps retrain balance and stability mechanisms without excessive load on the hamstrings.
Progressive hip strengthening: With emphasize on the gluteus muscles to help ensure the proper one-leg stability.

Avoid painful movements at this stage.

Criteria for the next stage:

1. Normal walking stride without pain

2. Pain-free isometric contraction against submaximal (50%-75%) resistance during prone knee flexion (90°) manual strength test

Intermediate Rehabilitation Phase – Regaining Strength and Improving Neuromuscular Control

The focus shifts to regaining pain-free hamstring strength through the full range of motion and developing neuromuscular control of the trunk and pelvis. Optimal exercises for this phase include:

Single-Leg Exercise: Reaches and similar one-leg exercises using the hamstrings to control the movement while developing eccentric strength in the hamstrings, are crucial for preventing re-injury.
Hamstring Curls on a Swiss Ball: Lying on the back with heels placed on a Swiss ball, lift the hips off the ground and curl the ball towards the body by bending the knees. This exercise targets both the hamstrings and the core, promoting improved neuromuscular control.
Walking Lunges: This dynamic movement helps regain functional strength and improves coordination. It involves stepping forward into a lunge position and then stepping into the next lunge, mimicking walking. This exercise integrates the strength and stability of the entire lower body and core, which is vital for sports-specific movements.

Avoid end-range lengthening of hamstrings if painful.

Criteria for the next stage:

1. Full strength (5/5) without pain during prone knee flexion (90°) manual strength test

2. Pain-free forward and backward jog, moderate intensity

3. Strength deficit less than 20% compared against uninjured limb

4. Pain free max eccentric in a non-lengthened state

Advanced Rehabilitation Phase: Sport-Specific Training and Prevention of Re-Injury

In the final phase, the rehabilitation focuses on restoring the athlete’s ability to perform sport-specific movements without limitations, incorporating lengthened state eccentric training to enhance end-range strength. Optimal exercises for this phase include:

High-Intensity Running Drills: Gradual reintroduction to running at increasing speeds and intensities helps restore the functional capacity needed for sports. Including drills that emphasize acceleration, deceleration, and change of direction challenges the hamstrings in a controlled, progressive manner.
Plyometric Training: Exercises such as jump squats, box jumps, and bounding drills improve power, agility, and neuromuscular control, which are essential for sports performance. These high-intensity movements also test the hamstrings’ resilience in explosive, dynamic scenarios.
Sport-Specific Drills: Integrating drills that replicate the specific demands of the athlete’s sport helps ensure that the rehabilitation process is tailored to their unique needs. This could include dribbling drills for soccer players, sprinting drills for track athletes, or cutting drills for football players, focusing on agility, speed, and hamstring strength at extended lengths.

These exercises are designed to progressively load the hamstring from initial healing through to return-to-play readiness, emphasizing protection, strength building, and functional integration at each stage. Always consult with a healthcare professional or a physical therapist to tailor the rehabilitation program to the individual’s specific needs, injury severity, and sport requirements.

Why Do Hamstrings Get Injured?

Here are some of the most common causes of a pulled hamstring injury:

High Speed Running: The hamstring muscles are particularly vulnerable during high-speed running. This is due to their role in decelerating the lower leg in the swing phase and then rapidly contracting to generate force for the push-off. This combination of eccentric (lengthening under tension) and concentric (shortening under tension) actions at high speeds places a significant strain on the muscle fibers.
Eccentric Strength Deficit: Athletes who have sustained a previous hamstring strain often exhibit a deficit in eccentric strength when the muscle is elongated. The lack of strength in this lengthened state increases the risk of injury when the muscle is stretched under load, such as during sprinting or high kicking.
Poor Flexibility and Muscle Imbalances: Decreased flexibility and imbalances between the muscle groups of the legs, such as stronger quadriceps relative to the hamstrings, can increase the risk of hamstring injuries. These imbalances may alter normal movement patterns and increase stress on the hamstrings.
Fatigue: Muscle fatigue can lead to a decrease in the hamstrings’ ability to absorb and generate force, making them more susceptible to injury during prolonged activities or at the end of sporting events.
Inadequate Warm-Up: Failing to properly warm up before activity can leave the muscles stiff and more prone to injury. A warm-up should include dynamic stretching and exercises that gradually increase heart rate and blood flow to the muscles.
Previous Injury: A history of hamstring strains is a significant risk factor for future hamstring injuries. This may be due to incomplete rehabilitation, resulting in persistent strength deficits, scar tissue formation, or changes in muscle tissue properties that make it more susceptible to injury.

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Resource:PMC3362981

Author

My name is Trivo. I'm a physiotherapist and I enjoy exercising, learning new stuff in physio and fitness world, and sharing my knowledge and point of view in this field.