Proximal Hamstring Repair Rehab Protocol

Therapist reference

Physical Therapy Protocols · From Dr. Allred · Transcribed from the printed sheet · 6 sections

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If you have questions about a protocol or a specific patient, call the clinic where the surgery was performed.

After hours & emergency numbers → Weekdays, business hours.

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Phase 1 · Weeks 0–6 (Protect the Repair)

Precautions: touch down-weight-bearing with crutches (foot can rest on ground but not support weight) for 6 weeks; no active hamstring contraction; no hip flexion with the knee extended; no active knee flexion against gravity; knee extension limited per intra-operative repair tension and the brace.

  • Pelvic tilts; quad sets; ankle pumps; isometric hip abduction/adduction/ER.
  • NMES with short-arc quads (half-bolster, hip flexion <20°).
  • Week 2: begin passive knee/hip ROM — do not exceed 45° hip flexion; respect knee-extension limits.
  • Week 4: gentle active knee/hip ROM within the same limits; no active knee flexion against gravity.
  • Incision desensitization and scar massage; silicone patch if keloid is a concern.

Phase 2 · Weeks 6–9 (Restore Gait)

Precautions: no hamstring strengthening or stretching.

  • Progress to full weight bearing as tolerated; restore a normal gait and pain-free ADLs.
  • Begin active knee flexion against gravity (concentric); weight shifts; SLR / SAQ into SLR; gentle quadruped rocking.
  • Gentle stool stretches (hip flexion/adduction); gluteus medius isotonics (side-lying clamshells).

Phase 3 · Months 3–4 (Strengthen)

  • Goal: unrestricted ADLs; begin hamstring flexibility and strengthening.
  • Hamstring curls standing (hip neutral), high-rep/pain-free, add resistance gradually → progress to machine curls.
  • Total leg/hip: quarter squats and heel raises (bilateral → unilateral); glute max (prone → supine bridging); glute med (hip hiking, multi-hip); light unilateral knee extension/leg press.
  • Balance and proprioception (balance board → foam → Dynadisc).

Phase 4 · Months 5–9 (Return to Function & Sport)

  • Advanced proprioception; closed-chain hamstring work (step-downs, Swiss-ball curls, Romanian deadlifts, squat progression with resistance).
  • Low-level plyometrics (jump rope, multidirectional lunges → walking lunges); begin a light jogging progression.
  • Return to sport is typically allowed at 6–9 months, based on testing.

Return-to-Sport Criteria

  • No pain with normal daily activities; community mobility without pain.
  • Hip and knee range of motion within functional limits.
  • Hamstring strength ≥75% of the other side (concentric and eccentric).
  • Passes a hop-test battery (single, triple, and crossover hop).

References

  • Proximal Hamstring Ruptures: Treatment, Rehabilitation, and Return to Play. PMC.
  • Management of Proximal Hamstring Injuries: Non-operative and Operative Treatment. PMC.
Questions about this sheet? Call the clinic where the surgery was performed. I'm happy to talk through the plan. Numbers are at the top of this page, and every after-hours line is on the emergency numbers page.