Non-Operative — Hamstring Strain (Non-Operative)

University of Delaware Physical Therapy · UDPT Clinical Team

Weight-Bearing

Full WB; assistive device if antalgic gait in acute phase; ice in lengthened position 4-5x/day acutely

Key Restrictions

Pain monitoring model throughout: ≤5/10 during and after exercises (must return to baseline by next morning); isotonic loading only when pain < 5/10 (isometrics if > 5/10); NSAIDs no sooner than 2-4 days post injury; hamstring index > 90% before initiating sprint training; no progression of baseline pain week to week

Timeline & Phases

Phase I (Acute 0-2 days: rest, ice, compression, elevation; progress when non-antalgic gait and > 48 hours post injury); Phase II (Sub-acute > 48 hrs: progressive strengthening, running, agility; progress when hamstring index > 90% and symmetrical length); Phase III (Return to sport: full sprint progression, sport-specific movements at > 90% speed); median return to play 15-58 days

Notes

University of Delaware PT Clinic; non-operative; primarily biceps femoris long head; October 2023; 3-stage strengthening progression (early: bilateral bridge/hip extension/eccentric slider; middle: unilateral bridge/hip extension/Nordic/SL RDL; late: add resistance/speed); 8-level road/treadmill running progression; 9-stage field/court running progression (Hickey et al); 3-stage criteria-based sprint progression (50%/75%/90-100% intensity); agility from day 3 if pain 1-2/10; proximal injuries bias hip extension over knee flexion; return to sport criteria: no palpation tenderness, pain-free symmetrical ROM, hamstring index > 90-100% (HHD/MVIC at 30°), single straight-leg bridge, active knee extension test, H-test, sport-specific movement at maximum intensity without apprehension

Surgeon / Author

UDPT Clinical Team

Published

October 2023