PROTECTION: • Excessive stretching of the hamstring should be avoided during this phase, as this can result in dense scar formation in the area of injury. • Restricted movement of the hamstring should be encouraged with the onset of pain used to define the range of motion. • Normal gait can be resumed when pain allows.

THERAPEUTIC EXERCISE:• The exercise and movement selected are designed to promote neuromuscular control within protective range of movement, to minimise the risk of damage to the remodeling phase. • The exercise should always be performed without pain, with the intensity of the exercise progressed from light to moderate as tolerated.

PROGRESSION CRITERIA:Progression to phase 2 can begin once the following criteria are met:1. Normal walking strides without pain2. Very low speed jogging without pain3. Pain free isometric contraction against sub-maximal (50-70%) resistance during prone knee flexion.

GENERAL INFORMATION FOR ATHLETES Phase 1: Early phase of injury 0-2 weeks

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PAGE 3EARLY

REHABILITATION EXERCISE PHASE 1 Exercise 1: Isometric knee extension

The athlete is required to perform 3 sets of 10 isometric knee extensions with a 3 to 5 second contraction on each repetition. The exercise should be stopped if pain occurs. Only gentle contraction should be performed.

Pic 1.• The athlete lays supine on the bed with their knee supported on a pillow and their leg and ankle relaxed.• The pillow is used to protect the injured hamstring from full extension during the isometric contraction.

Pic 2.• The movement starts with gentle and controlled contraction of the hamstring.• The athlete should apply downward pressure through the heel into the bed.

The athlete is required to perform 3 sets of 10 repetitions of active knee extension and flexion .The exercise should be stopped if pain occurs. Only gentle contraction should be performed during active extension and flexion. The aim of this exercise is to maintain the range of movement without overly stressing the injured hamstring.

REHABILITATION EXERCISE PHASE 1 Exercise 2: Active knee extension and flexion

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Pic 1.• The athlete should sit on the edge of the bed. The bed should be raised to allow clearance between athletes feet and the floor.• The athlete should position themselves to create a 90 degree angle at the knee.

Pic 2.• The movement starts with gentle and controlled knee extension.• The movement should be reversed back to the starting position at a slow tempo.

PAGE 5EARLY

REHABILITATION EXERCISE PHASE 1 Exercise 3: Active/assisted hamstring concentric contraction

The athlete is required to perform 3 sets of 10 repetitions of active / assisted contractions through pain free and non resisted range of motion. Eccentric contraction is assisted by a therapist so the patient is not intentionally contracting the injured muscle.

Pic 1.• The athlete should lay in the prone position on the bed.• The therapist should stand in the most comfortable position to provide assistance to the injured leg.

Pic 2.• The athlete will perform concentric contraction of the injured hamstring only through pain free range of motion.• The therapist will provide minimal assistance through the stage that pain occurs. The eccentric portion of the movement will be wholly assisted by the therapist.

REHABILITATION EXERCISE PHASE 2 Phase 2: Intermediate 1-4 Weeks

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PROTECTION: Full range of motion is enquired during this phase.Large lengthening of the hamstring should be avoided if weakness persists.

NSAIDS:( NSAIDs ) NON-steroidal anti-inflammatory medications are generally not used during this phase due to potential negative side effects associated with prolonged NSAID use. In addition, masking pain during rehabilitation may result in an overly aggressive progression of the rehabilitation exercise due to the patient being unable to accurately self-assess a potentially painful response.

THERAPEUTIC EXERCISE:Exercise employed in phase II promote a gradual increase in hamstring lengthening, compared to the limited range of motion allowed in phase 1. Emphasis on neuromuscular control, agility drills, and trunkstabilization ,exercise are performed with a progressive increase in speed and intensity. Sub-maximal eccentric exercise near mid-length of the muscle are initiated as part of functional movement.

PROGRESION:On the end of this phase athlete should be able to perform:- Resisted Flexion/Extension of the hamstring.- Forward and backward jogging in a straight line without pain.

PAGE 7 INTERMEDIATE

REHABILITATION EXERCISE PHASE 2 Exercise 5: Stool Scoots

Athlete is required to perform 3 to 4 sets of 10 repetitions of the hamstring contraction on the stool. The exercise should be stopped if pain occurs. Athlete should perform this movement in a slow tempo.

Pic1.• Movements begins with athlete sitting position on the stool, with their legs full extended and heel on the ground.• Athlete should maintain an upright posture.

Pic2.• Athlete plants heel into floor and uses hamstring to propel forward.• Movement should be performed in a slow and controlled tempo.• Athlete ends the movement by reversing back to the starting position.

REHABILITATION EXERCISE PHASE 2 Exercise 6: Body Bridge

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Athlete is required to perform 3 sets of 10 repetitions of the body bridge and to hold this position for 5 seconds. If pain or discomfort oc-curs, exercise should be stopped.

Pic1.• The athlete lies in a supine position with hips and knees flexed to allow their feet to sit flat on the bed.

Pic2.• The athlete should tighten abdominals to raise their hips from the floor. The hips should form a straight line through shoulders and knees.• Pressure should be applied and maintained through the heels.

PAGE 9 INTERMEDIATE

REHABILITATION EXERCISE PHASE 2 Exercise 7: Resisted hamstring curl

Athlete is required to perform 3 to 4 sets of 10 repetitions of the resisted hamstring curls. If pain or discomfort occurs, exercise should be stopped.

Pic1.• Athlete lays in prone position onthe bed.• The injured leg should not befully extended to avoid excessivestress to the hamstring muscle.• One end of the resistance bandis attached to a stable object and second end is placed around athletes ankle.

Pic 2.• The movement starts with concentric contraction of the hamstring muscle .• The direction of the contractionshould be towards the athletesbuttocks.• Contraction should be performedwith a controlled and slow tempo.

Athlete is required to perform 3 to 4 sets of 10 repetitions of partial body weight lunges using two objects to support themselves from excessive overload of the hamstring muscle. If pain or discomfort occurs, exercise should be stopped.

REHABILITATION EXERCISE PHASE 1 EXERCISE 9: Partial Body Weight Lunges

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Pic 1.• Athlete stands between two objects equally distributed to the left and right side.• Athlete should support themselves by holding onto the objects.• The aim of this exercise is workthrough the range of motion, but avoid overload of the injured muscle.

Pic 2.• Athlete should adopt the lungeposition (one leg forward secondleg stays in the starting position).• Athlete should maintain their back in the straight upright position.• Athlete will start with non injuredleg first to adapt the correct movement pattern, then perform slow and controlled repetitions on injured leg.

PAGE 11INTERMEDIATE

REHABILITATION EXERCISE PHASE 1 EXERCISE 9: Jog

Athlete is required to perform 5 sets of 10-15 meters slow and controlled straight line jog. If pain or discomfort occurs, exercise should be stopped.

Pic 1.• Athlete should start jogging in slow and controlled tempo and maintain correct gait.• Foot strikes should start with theheel and ground contact first, then middle foot and ball of the foot at the end of the stride.

Pic 2.• Athlete is required to jog at a slow tempo.• Dynamic turns and movementshould be avoided.• When changing the direction of run athlete should deaccelerate and slowly turn in to new running directions .

Pic 3.• When changing direction of jog, athlete should avoid rapid acceleration which could cause damage to the hamstring muscle.