Proximal Hamstring Repair — Endoscopic Proximal Hamstring Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

FFWB with crutches/walker 0-2 wks with T-Scope brace locked in neutral (unlocked only for sitting to eat/toilet/bathe/ride in car with knee kept flexed); PWB 25% progressing to 50% at wk 2 with brace locked; WBAT with bilateral crutches/walker at wk 4; WBAT with unilateral AD progressing to FWB with brace unlocked at wk 6 (D/C brace once FWB tolerated)

Key Restrictions

No hamstring stretching x6 wks; ROM limits: PROM hip flexion 45 deg at wk 2, 60 deg with SLR limit 30 deg at wk 4, 90 deg at wk 6; no forced/aggressive stretching; no contact activities through Phase II; avoid terminal ROM in Phase III; do not push through pain

Timeline & Phases

Phase I, Immediate Rehabilitation: protect repaired tissue, restore ROM within guidelines, prevent muscular inhibition/gait abnormalities, diminish pain/inflammation; wks 1-6: ankle pumps, glute sets, quad sets, transverse abs isometrics, sub-max hip abduction isometrics, NWB ankle strengthening, passive calf stretch at 0 deg hip flexion, clams added wks 2-3 (hip flexion precaution), wks 4-5 add gentle AROM hip, supine SLR to 30 deg max, SAQ below 30 deg hip flexion, side-lying hip abduction, prone quad strengthening, lumbopelvic stabilization, single/double-limb balance, scar massage/STM; Phase II, Intermediate Rehabilitation (wks 6-10, criteria: FWB achieved with low pain and minimal gait deviation): protect repaired tissue, restore full hip ROM before strengthening, progressive hip/pelvis/LE strengthening, restore normal gait and cardiovascular endurance; D/C brace at wk 6, stationary bike at wk 6 if 90 deg hip flexion achieved, supine SLR to 45 deg max, sub-max multi-angle hamstring isometrics, standing calf raises, resistance band TKEs, treadmill gait training wk 6; wks 7-8 isotonic strength progression, dynamic/isokinetic training; wks 9-12 (if LE strength >=4/5) clamshells, physio ball bridge with hamstring curl, closed chain progressions, resisted lateral walking, hamstring strengthening in lengthened position, elliptical/Stairmaster; wk 12 eccentric hamstring strengthening; Phase III, Advanced Rehabilitation/Return to Sport (wks 12-18, criteria: symmetrical AROM, normalized gait, hip flexor strength >4/5, hip abd/add/ext/ER/IR strength >4+/5, SLS 30 sec, medial tap down without valgus collapse): full symmetrical muscular strength, restore pre-op cardiovascular endurance; squat progression (double leg press/squat to single leg to unstable surface), jump progression (double leg on total gym/trampoline/hard surface to tuck jump to depth/box jumps), hop progression (single leg in place to distance to triple hop to consecutive hops), jog progression via ladder drills/carioca/slide board/elliptical then walk-to-run program (5 phases, 2 days each, run 1-5 min increments); no contact activities throughout; use clinical judgment for jump/hop/jog appropriateness

Notes

OSMS Rehabilitation Guidelines; protocol adopted with permission from Dr. Jovan Laskovski; walk-to-run progression sourced from OSU Sports Medicine (2012); T-Scope brace required throughout Phase I; avoid combined hip flexion with knee extension (hamstring lengthened position) throughout early phases