Proximal Hamstring Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

TTWB 0-2 wks; 15-40% WB progression 2-6 wks; gait initiated Phase II; progressing through Phase III-IV

Key Restrictions

Hinged knee brace locked at 45 deg at all times until wk 6; avoid hip flexion coupled with knee extension throughout; avoid unsafe surfaces/environments; avoid dynamic stretching and loading hip at deep flexion angles Phase II; no impact or running Phase II

Timeline & Phases

Phase I (surgery-6 wks): protect repaired tissue integrity, restore ROM within restrictions, reduce pain/inflammation, prevent muscular inhibition, hinged knee brace locked 45 deg at all times until wk 6, avoid hip flexion coupled with knee extension, avoid unsafe surfaces, TTWB 0-2 wks then 15-40% WB progression 2-6 wks, passive knee ROM with no hip flexion during knee extension, quad sets, ankle pumps, abdominal isometrics, scar mobilization, after wk 3 pool walking drills/hip abduction/hip extension/balance exercises (avoiding hip flexion with knee extension), UE circuit training/ergometer, progress to Phase II if minimal pain with Phase I exercises; Phase II (usually 6-12 wks): protect repair integrity, restore full ROM, initiate limited gait, progressively increase strength, avoid dynamic stretching and deep hip flexion loading, no impact/running, PROM hip flexion progresses past 90 deg, non-impact balance/proprioceptive drills (double to single leg), gait training, hip/core strengthening, begin hamstring strengthening with hip extension and knee flexion moments trained separately (avoiding lengthened hamstring position), isometric/concentric strengthening (hamstring sets, heel slides, double leg bridge, standing leg extension, physio ball curls), stationary bike/UE ergometer, aqua therapy, progress to Phase III with normal gait on all surfaces, SL balance >15 sec, 5/5 hamstring strength in prone at >=90 deg knee flexion, functional movements without unloading affected leg; Phase III (usually 12-16 wks): restore muscular strength/endurance, initiate impact exercise, restore cardiovascular endurance, optimize neuromuscular control/balance/proprioception, no pain during strength training, progress hamstring strengthening toward lengthened positions with eccentric work (single leg forward leans, single leg bridge lowering, prone foot catches, assisted Nordic curls), hip/core strengthening, impact control exercises (two feet to two feet progressing to one foot to same foot), movement control low-to-high velocity/single-to-multi-plane, initiate running drills (no sprinting), stationary bike/elliptical/Stairmaster/swimming including deep water running, progress to Phase IV with dynamic neuromuscular control at low/medium velocity pain-free and surgical hamstring strength >75% of unaffected leg on Biodex at 60/240 deg/sec; Phase IV (usually 16+ wks): no pain during strength training, restore muscular strength/endurance, optimize neuromuscular control/balance/proprioception, progress hamstring strengthening to higher velocity and lengthened-position work (single leg forward leans with medicine ball, single leg deadlifts with dumbbells, single leg bridge curls on physioball, resisted running foot catches, Nordic curls), running/sprinting mechanics and drills, hip/core strengthening, impact and movement control progression, sport-specific balance/proprioceptive drills, patient-specific stretching; return to sport MD-directed, >12 wks, requiring high-velocity multi-plane control pain-free, hamstring strength >90% of uninvolved side on Biodex at 60/240 deg/sec, and functional testing >90%

Notes

OSMS Rehabilitation Guidelines; distinct from OSMS's Endoscopic Proximal Hamstring Repair protocol — this version uses a hinged knee brace (locked 45 deg x6 wks) and TTWB/15-40% WB progression rather than the T-Scope hip brace and FFWB approach of the endoscopic protocol, suggesting a different (open or alternative) surgical technique; references Biodex isokinetic testing at 60/240 deg/sec for return-to-sport criteria