Conditioning: Phase 3

The following is the third of four phases that will guide you from hamstring strain toward healthy running. Progress from each phase as instructed.

Duration: 4 Weeks (at least)
Goal: Progressive Loading and Mechanics
Frequency of Exercises: 3 x per week (day off in between)
Warm Up: For at least 5 minutes before activity (e.g. Pre-Run Warm up)

Single Leg Romanian Dead Lifts: 3 x 10 reps (each side). Standing on one leg, bring your chest forward while keeping the other leg off the ground in line with your body. Lean forward without losing balance, and come back up. You should feel the muscles of the hamstring, glutes, and calf work. Purpose: increase demand on glute and hamstring eccentrically.
Split Squats: 3 x 8 reps (slowly: 3 second down, 3 second up) – okay to experience mild pain (<3/10). Standing with one leg forward and the other leg back, come slowly straight down towards the ground by bending your knees. Your body should not lunge forward during the movement. Come slowly back up and repeat movement. Purpose: increase load on hamstring for improved resilience.
Step Ups: 3 x 10 reps each leg. On a step, bring affected leg up on step and step up, and then back down. Very mild pain is okay. Add weight if too easy. Purpose: increase load on the hamstring.
Side Planks (Leg Up): 3 x 30 seconds (each side, or until fatigue). With your elbow aligned with your shoulders, come up on your side. Keep your body straight throughout. Purpose: improve hip strength and core stability to reduce risk of knee caving in.
Front Plank: 3 x 30 seconds or until fatigue. On your elbows and knees, bring your knees off the ground and hold. Try to keep your body level throughout this exercises by keeping your hips level and engaging your abdominals and glutes. Keep your elbow below your shoulders and push up to engage your scapular muscles. Purpose: strengthen core and glutes for running form stability.

Single Leg Glute Bridges: 3 x 10 reps. On your back with one knee up, bring your hips up and down slowly. You should feel your hamstrings work, and mild pain is okay. If too easy, complete more reps, add weight, or bring your leg away from your body. Purpose: increase glute strength and hamstring strength.
Single Leg Balance (Running Man): 3 x 30 seconds (each leg). Standing on one limb with your knee slightly bent, perform a running motion by bringing your lifted leg in a backward-forward motion along with an arm swing motion. You can start off with minimal movement, and as you progress increase the range of motion and speed. Purpose: improve postural balance and stability.

Stretching:
- 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.
- Kneeling Hamstring Stretch: 10 sec holds x 10 reps. In the kneeling position, bring your affected foot forward until you feel a pull in your hamstring. Next, bring your hips back while keeping your core neutral. You should feel a stretch in the hamstring. Hold for 10 seconds then relax.
Run/Walk Progression (initially avoid hills)

TO GRADUATE TO PHASE 4

Required: No pain with split squats x 10 reps, step ups x 10 reps, single leg glute bridges x 10 reps, and jogging for six consecutive exercise sessions
Ideal: improved hip flexor mobility

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.