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From Strain to Gain: A Physio's Approach to Hamstring Recovery

Hamstring injuries are a common woe for athletes and fitness enthusiasts alike. Whether you're a weekend warrior, a seasoned athlete, or simply someone who enjoys staying active, a hamstring strain can be a real setback. However, the good news is that surgery isn't always the only option for recovery. In fact, with the right approach, many hamstring injuries can be effectively managed and rehabilitated without the need for invasive procedures.



As physiotherapists, we've seen our fair share of hamstring strains,so here are some insights into how we can turn the tables from strain to gain using an evidence based approach to recovery.


Understanding a hamstring strain:

Before delving into the recovery process, it's crucial to understand what exactly happens when you sustain a hamstring strain. The hamstring muscles, which run along the back of your thigh, are responsible for bending your knee and extending your hip. When these muscles are stretched beyond their limit or overloaded, they can become strained, resulting in pain, stiffness, and limited mobility.


Hamstring strains are typically classified into three grades:

  1. Grade 1: Mild strain with minimal tissue damage.

  2. Grade 2: Moderate strain involving partial tearing of the muscle fibres.

  3. Grade 3: Severe strain with complete tearing of the muscle fibres.


Regardless of the grade, proper management is essential for optimal recovery and to prevent future injuries.


  1. PEACE: early acute management we use the acronym PEACE: Protect, Elevate, Avoid anti-inflammatory modalities, Compress, Educate

  2. LOVE: continued sub acute management we use the acronym LOVE: Load, Optimism, Vascularisation, Exercise

  3. Pain management: Over-the-counter pain relievers such as ibuprofen or acetaminophen may be recommended to manage pain and discomfort. Soft tissue work and heat can also modulate pain. However, it's important not to rely on medication or passive modalities as a long-term solution and to focus on addressing the root cause of the injury.

  4. Gradual mobilisation: As the acute phase subsides, gentle mobilisation exercises can be introduced to improve flexibility and range of motion. However, it's crucial to progress gradually and avoid overstretching the injured muscle. The exercises we use here are from the Askling protocol and include the Extender, the Diver and the Glider.

  5. Strength training: Once irritable pain has subsided, a tailored strength training program focusing on the hamstring muscles and surrounding stabilisers can help rebuild strength and endurance. We may start with heavy long lever isometrics, and progress to heavy slow resistance and then incorporate high load eccentric movements. The main focus is on lengthening the hamstring under load.

  6. Functional rehabilitation: Most research shows us that the mechanism of injury in 57%–78% of hamstring strain injury cases in field-based sports is cited as high-speed running, indicating high demands and a potential for injury. It suggests that gradual exposure to high speed running may also be protective of hamstring strain injury and this can be accomplished with load management considerations.


In conclusion, while hamstring strains can be a frustrating setback, they don't have to spell the end of your active lifestyle. By utilising a best evidence approach to recovery and addressing the underlying factors contributing to the injury, you can bounce back stronger than ever. Surgery may not always be necessary, but it's essential to seek guidance from a qualified physiotherapist to develop a personalised rehabilitation plan tailored to your specific needs and goals.


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