Hamstring strengthening exercises are usually progressed from isometric to isotonic and then eccentric contraction modes based on the alleviation of pain and/or between-leg deficits in isometric knee flexor strength. In addition, exercise is typically only performed and progressed in the complete absence of pain during hamstring strain injury rehabilitation. Despite these principles being conventional clinical practice, there is a lack of evidence to support their relevance. This lecture presents an alternative exercise-specific approach to exercise progression and pain during hamstring strain injury rehabilitation. The key learning points are:

- There is no need to completely avoid pain during hamstring strain injury rehabilitation

- Allowing exercise to be performed and progressed up to a pain-threshold rated 4/10 results in greater strength improvements during rehabilitation compared to remaining pain-free

- Exercise-specific progression criteria can safely accelerate to progression of eccentric loading during hamstring strain injury rehabilitation compared to basing this decision of isometric knee flexor strength tests

Learning objectives

> You should be able to discuss the benefits of the alternative exercise-specific approach to exercise progression and pain during hamstring strain injury rehabilitation presented in this lecture. 

> You should be able to defend why pain shouldn't be completely avoided during hamstring strain injury rehabilitation.