Phased Hamstring Rehab With Running Progression and Return to Play

Trials show that low-grade concentric curls and stretching give slower recovery and higher reinjury rates. Better programs include eccentric loading, progressive running and lumbopelvic control, described in a 2010 JOSPT paper and a recent Journal of Athletic Training commentary. Phase one protects the forming scar and limits atrophy with side stepping, grapevine, fast feet and bridges, avoiding long muscle lengths and allowing pain up to about 4/10 rather than demanding pain-free work. Normal walking, slow jogging and a pain-free 50% isometric at 90 degrees move the athlete on. Phase two adds boxer shuffles, rotating planks, bridge walk-outs and windmills with limited range while weakness remains, until moderate jogging is pain free and strength is 5/5 at 90 degrees. Phase three moves to full range and speed with A and B skips, accelerations, single-leg chair bridges, loaded windmills and lunges, physio curls and Nordic curls, with sprint speed raised in steps. Return to play measures include palpation pain length, long-length knee flexion strength, active knee extension and apprehension. None of the trials tested eccentric strength.