Conditioning: Phase 1

The following is the first of four phases that will guide you from hamstring strain toward healthy running. Progress from each phase as instructed, applying rehabilitation modalities such as taping where needed.

Duration: 1 Week (at least)
Goal: Reduce pain through unloading
Frequency of Exercises: Phases 1a & 1b are twice per day. Phase 1c is once per day. Conditioning should be done with minimal pain. Begin with one of the phases below based on your pain scale.

a. HIGH PAIN

START HERE if pain is >7/10 with squatting, lunge, and/or double leg bridge
Goal: Reduce Inflammation. Do not run.

Supine Heel Slides (With Towel): 3 x 10 reps. Sitting with a towel underneath your foot, bring your heel toward your body, back out, and then repeat. Purpose: improve circulation and stimulate healing.
Supine Hamstring Contractions (Isometric). 2 x 10 reps (5 second holds). On your back with your knees bent, gradually dig your heel in the ground to contract your hamstring. Do this gently, as you want to keep pain minimal. Purpose: decrease inflammation and increase circulation in the hamstring for healing.
Soft Tissue Massage: 3-5 minutes. Gently massage soft tissue around the area to reduce pain, relax the muscle, decrease inflammatory fluid.
Walking: If minimal or no pain, walk throughout the day in 5-10 minute intervals on a flat surface. Purpose: maintain some loading of the knee.
Ice: 10 minutes. Place on injured tissue to reduce pain and inflammation.

b. MODERATE PAIN

START HERE if pain is 4-6/10 with squatting, lunge and/or bridging
Goal: Continue to reduce pain. Can work into very mild pain (<2/10). Do not run.

Prone Knee Bends: 2 x 20 reps. On your stomach, support your affected foot on a high pillow. Bring your foot off the pillow and back down. This will contract your hamstring in a shortened range. You should be able to do this with minimal discomfort (<2/10 pain). If this is too difficult then place a pillow under your ankles for increased support. Purpose: decrease inflammation and stimulate healing.
Supine Heel Slides: 2 x 20 reps (mild pain okay). On your back with your injured knee bent, bring your leg back towards you. If that is too painful, you can use a towel under your foot on a smoother surface. Pushing your heel down will add more resistance. Purpose: improve circulation and stimulate healing.
Supine Hamstring Contractions (Isometric). 2 x 10 reps (5 second holds). On your back with your knees bent, gradually dig your heel in the ground to contract your hamstring. Do this gently, as you want to keep pain minimal. Purpose: decrease inflammation and increase circulation in the hamstring for healing.
Walking: If minimal or no pain, walk throughout the day in 5-10 minute intervals on a flat surface. Purpose: maintain some loading of the hamstring.
Soft Tissue Massage: 3-5 minutes. Gently massage the soft tissue around the strained area to reduce pain, relax the muscle, and decrease inflammatory fluid.
Ice: 10 minutes. Place on injured tissue to reduce pain and inflammation.

c. MILD PAIN

START HERE if pain is <3/10 with squatting, lunge and/or double leg bridges
Goal: Continue to reduce pain. Do not run.

Prone Knee Bends: 2 x 20 reps. On your stomach, with your legs straight, bring your foot off the ground and back down. This will contract your hamstring in a shortened range. You should be able to do this with minimal discomfort (<2/10 pain). Purpose: decrease inflammation and stimulate healing.
Offset Bridges: 3 x 10 reps. Place your injured leg’s foot closer to the body. This will decrease load on the affected hamstring. Bring your hips up and down. If it is too painful on the injured hamstring, then put more pressure on the other foot. You should feel your hip, hamstring and thigh muscles working with pain <3/10. Purpose: To improve circulation, reduce pain, stimulate healing, and load to tissue.
Supine Hamstring Contractions (Isometric). 2 x 10 reps (5 second holds). On your back with your knees bent, gradually dig your heel in the ground to contract your hamstring. Do this gently, as you want to keep pain minimal. Purpose: decrease inflammation and increase circulation in the hamstring for healing.
Squats: 3 x 8-10 reps. With knees shoulder width apart, slowly come down into mild pain (3/10 most), and come back up. If able, place a Resistance Band around your knees to recruit your glutes with the squat. Purpose: increase load capacity of the hamstring.
Single Leg Balance: 3 x 30 seconds (each leg). Ideally, complete this in front of a mirror. Stand with both hands on your hips while your feet are directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Hold that position. Purpose: improve hip, knee, and ankle joints stability.

Walking: If minimal or no pain, walk throughout the day in 5-10 minute intervals on a flat surface. Purpose: maintain some loading of the hamstring.
Soft Tissue Massage: 3-5 minutes. Gently massage soft tissue around the area to reduce pain, relax the muscle, decrease inflammatory fluid.
Kneeling Hip Flexor Stretch: In the kneeling position with arms supported on the wall, engage your abdominals by doing a posterior pelvic tilt (i.e. low back is flattened with a limited curve). This posterior tilt will stretch the hip flexor muscles and decrease strain on the hamstring. Engage your glutes on your kneeling side and keep your body as a unit until you feel a stretch in the front of your hip. You may increase your stretch by leaning away from the side. Purpose: decrease anterior tilt to decrease strain on hamstring.
Ice: 10 minutes. Place on injured tissue to reduce pain and inflammation.

TO GRADUATE TO PHASE 2

Required: Can complete a squat and/or double leg bridge x 10 reps with minimal pain (<3/10) for three consecutive exercise sessions
Required: Can sleep without waking up from pain in the hamstring
Required: Minimal tenderness from hamstring palpation (touch)
Note: If you begin at Phase 1.a., before graduating to Phase 2, be sure to progress in turn through Phases 1.b. and 1.c.

Principles of Hamstring Strain: A Review

CAUSE – abrupt overload of the muscle/tendon, usually with an explosive activity like sprinting
NEED – offload hamstring and reduce pain
PLAN – avoid overstretching the hamstring as it recovers (2-3 weeks), massage to decrease muscle scar tissue, and progressively load the tissue to improve strength

Still Need Help?

You are welcome to meet virtually with our PT for additional feedback and assessment. Otherwise, continue to the next step to learn how best to manage the pain from your injury.