How to rehab your Hamstring injury

by Michael
HELP! I’ve done my hammy (again)
So you have fallen victim to the most common injury in a variety of sports such as Aussie Rules (AFL) and soccer. This could be the first, or one of many. You’re nervous, frustrated, anxious and unsure of what to do from here. 
All you want to do is return to what you love doing. 
I know this all too well too. I regularly see hamstring strains and have experienced them myself, so I understand the feelings, emotions and thoughts someone would be experiencing. Although they may seem minor, they are definitely not without their own trials and tribulations. 
That’s why we are here to help! Here’s a Q&A to answer some of the most commonly asked questions. If you scroll down, I’ve also added video’s of some of my most favourite hamstring rehab exercises.  
And just for extra credit I am summarising the key points right at the beginning, so if you don’t like reading, or you’re time poor, these are my key takeaways: 
• It takes roughly 3-5 weeks for MOST hamstring injuries to recover 

• You need to STRENGTHEN your hammy’s

• You need to CONDITION your hammy’s (do high speed running) 

• BEFORE BEING READY TO PLAY you should have; no pain to touch or press on your hammy, completed 3-4 sessions of high speed work, full recovery of strength and range of motion and completion of 2 full training sessions. This a good way to determine readiness for return to play 

• It’s important to ADDRESS RISK FACTORS such as pelvic control, range of motion, strength and conditioning, sprint technique and load management which are vital aspects of recovery.  

• There is a LARGE RISK returning too early, make sure you have great rehab. 


How does a hamstring injury occur?  

I can confirm it is definitely not a sniper hiding in the grass. 
Most likely you have done it running and most importantly doing high speed running. It can also happen with kicking, landing from a jump, or change of direction
Essentially, we like to break it up into 2 distinct categories that we treat differently. A sprint mechanism, and a stretch mechanism
In both these circumstances the hamstrings are placed under a lot of stress. 

How severe is my hamstring injury? 

The easiest way to determine the severity or grading of your injury would be to have it assessed by a physio. 
The second best way would be the following key criteria: 
• How long before you began walking pain free? 

• Was there a presence or absence of bruising? 

• How much pain is there when you stretch your hammy?

• How much pain is there when you try a strength exercise? (e.g a single leg hamstring bridge) 

• Was it gradual or an immediate onset of pain?

Typically, to determine the severity of a Hamstring strain someone would experience – 
Walking pain lasting less than 5 days and is less intense, no bruising, only a slight decrease in strength and range of motion = GRADE 1-2 (low grade on the old grading scale). 
Walking pain that lasts greater than 5 days and is quite intense, along with bruising, plus a reduction in strength and range of motion = GRADE 2-3 (high grade on the old grading scale).
You should assess these things at the 3 and 5 day mark to determine the severity of your hamstring strain. 

How long do Hamstring injuries take to recover?

We could open up a huge can of worms here but we will aim to provide a really easy rule of thumb for MOST, not all hamstring strains. 
Typically, with great rehab most GRADE 1-2 Hamstring Strains will recover within 21 days. 
GRADE 3 Hamstring Strains or strains that involve the Hamstring Tendon are a different story and they can look more like 6 – 8 weeks, or more depending on the area of tendon injured. 
DISCLAIMER: this is not a perfect rule, poor rehab will lead to delays and each person is different.

Is there a risk of returning from a Hamstring injury too early? 

YES. Big risk. 
Hamstrings are notorious for feeling good, but if you haven’t done appropriate rehab you will be exposing yourself to risk and probably chasing your tail with niggles, and the dreaded “hamstring awareness” we all see. 

How do I stop my Hamstring injury from happening again?

It is a really simple answer – Good rehab. It’s non-negotiable.
What this includes is making sure you have addressed your risk factors. Specifically ones that can be changed. Unfortunately, we can’t change your age and we can’t reverse time to stop your previous strains or other injuries. 
However, one of the biggest risk factors is decreased hamstring strength.  Having a lack of strength, and most importantly eccentric strength, is a HUGE risk factor. You need to get stuck into a variety of exercises to help provide the hammy’s with enough resilience to withstand the large stress they are put under. 
Here is a great example of a strength exercise – The nordic curl – aim for 2 sets of 6 repetitions to begin with.

Another factor is lack of exposure to high speed running. This is a no brainer. To help prepare for sprinting we need GRADUAL and SAFE exposure to high speed running. This includes appropriate progression and regression within the program where needed. 
The last factors I will talk about is range of motion and pelvic control. Range of motion is linked to increased risk, so it is definitely worth putting time and effort into making sure you have good hip and hamstring mobility. It is also very important to ensure that you have good pelvic control. 
Here is a nice mobility exercise you can do – The hammy slider – aim for 3 sets of 15 reps!


What the heck is pelvic control? 

Basically, the ability to not stick your bum out when running or exercising, not arching your back, not swaying side to side when running, and overall having complete control over what your hips are doing. 
A physio can help with identifying if you have any of these things and provide exercises and resources to help retrain these things. This could be specific exercises tailored for you, mobility work or some manual therapy. 

What about my running technique? Could that be a factor? 

Absolutely. Running and sprinting technique can definitely be a factor, not as impactful as strength and high speed running exposure, but definitely a factor. 
We can address this as part of our rehab process. We do this by identifying how you run, and the underlying reason why. 
Changing someone’s technique is not always needed, but to know if it is we would first need to see how you run.

What are key markers to return to activity or sport following a Hamstring injury? 

Number One: It is not sore AT ALL to press on. 
Number Two: You have full strength and full range of motion in your hamstrings. Also, you can complete 3×12 of hammy Sliders and 2×6 of Nordics without pain and PERFECT form. 
Try some single leg hammy sliders! Aim for 3 sets of 12 reps.

Number Three: You have completed at least 3 sessions of HIGH SPEED RUNNING and completed at least 2 full training sessions
Number Four: You have addressed your main RISK FACTORS, such as pelvic control or sprinting technique. 
Lunge sliders are a great way to control your pelvic position and encourage flexibility

Number Five: You have respected tissue healing time and feel CONFIDENT in a safe return. 

What’s the summary?

Put into practice some of the tips and advice which has been given today! There is no reason why you shouldn’t be able to get a headstart towards developing the hamstrings of your dreams, namely, ones that don’t “twang”. 
Lastly, I have included some videos of exercises that you can do to help strengthen up those hammy’s, lengthen up those hammy’s, and improve your running technique. 
However I do have to say, it is best to get a hammy checked by a health professional as this will give you the best chance of a safe return to play, and also a great rehab. 
Let us say NO MORE to hamstring strains keeping us out of what we love. 
Hammy jumps are a great power and endurance exercise, aim for 3 sets of 12 reps. 

To book a Physio appointment to have your Hamstring strain assessed, click HERE