Hamstring rehabilitation

Seek guidance from one of our experienced Richmond Physiotherapy Clinic physiotherapists regarding the expected and safe progression through any rehabilitation programme.

Hamstring rehabilitation

An expert physiotherapy assessment is required to ascertain the contribution of any source of referred pain to an injured hamstring, for example referred pain or tension from the low back, sacro-iliac joint, the gluteals or any form of adverse neural tension.

Some examples of hamstring rehabilitation programs are provided however they require the guidance of an experienced physiotherapist prior to undertaking. These are examples utilised by several of Australia’s better sports physiotherapists. They vary as no one has the proven gold standard in preventing hamstring recurrence or injury in the first place, plus they need to be tailored to individual athletes.

More sophisticated hamstring rehabilitation programs may be obtained by contacting us.


The information contained in this site is not intended as a substitute for advice from a qualified health care professional. Always obtain advice from a qualified health care professional before starting any exercise, stretching or health care program. The author and everyone involved in the production of this site disclaim any liability for any adverse effects resulting from the use of the information presented.


Hamstring strain

Is it a hamstring strain or referred pain (from the back, gluteals or hip) in the back of the thigh?

Hamstring strain

If unsure please consult one our experienced Richmond Physiotherapy Clinic physios for an expert clinical assessment. For physiotherapy guidelines in assessing hamstring strains a more specific estimation of severity may be seen in hamstring strains assessment of severity and grading of hamstring strains.

The following guidelines result from many years of treating hundreds of elite athletes, AFL funded research of AFL hamstring injured athletes and liaison with AFL and elite sports physiotherapists and physicians;


How many weeks until it is safe to return to play after a hamstring strain?

A previous strain in the prior 12 months or so almost always dictates that 3 weeks of rehabilitation is required before it is “safe to return to play”.

An inability to walk at normal pace on level ground within 24 hours almost always means that a 3 week period of training is required before it is “safe to return to play”.

A combination of both these parameters strengthens the requirement of a 3 week of rehab interval.

The consensus among AFL clubs is that a full week of 100% pace training should be undertaken prior to return to play.


What are the indicators of risk for potential recurrence for a hamstring strain?

Previous hamstring injury is primary predictor of recurrence. In addition taking anti-inflammatory medication and having a painful active knee extension stretch test of greater than 10 degrees are factors also associated with being at risk of suffering a recurrence of the hamstring strain.

Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers (Published in the British Journal of Sports Medicine, 2008).


Is a hamstring MRI or ultrasound necessary for a hamstring strain?

An MRI or Ultrasound is not required for diagnosis or estimating the duration of rehabilitation of an acute minor or moderate hamstring injury – the physiotherapy examination is more accurate than MRI or US.

A Comparison Between Clinical Assessment and Magnetic Resonance Imaging of Acute Hamstring Injuries


Does the rehabilitation influence the risk of recurrence in hamstring strains?

Training consisting of running drills and specific hamstring strengthening should be engaged in every second day, particularly in players thought to be at risk of re-injury. Players should stretch two to three times per day and engage in three full training sessions before returning to play. Not taking NSAID’s in the post-acute period following a hamstring strain may be associated with a greater chance of successful return to competition.

The influence of rehabilitation factors on recurrence of hamstring injury in elite Australian footballers


Hamstring injury prevention

Every full pace running or acceleration sport participant should engage in full pace running and acceleration during the preseason period and, in addition, perform 2 sessions of hamstring strengthening, including one eccentric emphasis hamstring exercise, as part of preseason training.

Eccentric emphasis hamstring exercise should include the only scientifically proven (2013) beneficial exercise; Nordic lowers.


Hamstring rehabilitation

Full attention to detail should be applied to rehab if you are at risk of recurrence. See our hamstring rehabilitation page for the indicators of risk and detailed rehabilitation programs.


Hamstring research

Several new and previously unquantified parameters should be included in a clinical assessment to aid in prognosis; time to walk pain-free and previous hamstring injury are predictors of time to return to competition and recurrence, respectively. See our hamstring strain assessment and prevention research


The information contained in this site is not intended as a substitute for advice from a qualified health care professional. Always obtain advice from a qualified health care professional before starting any exercise, stretching or health care program. The author and everyone involved in the production of this site disclaim any liability for any adverse effects resulting from the use of the information presented.


Hamstring stretches

Hamstring muscles are restored tooptimal length with a variety of stretching exercises including a variety of knee flexion angles and a variety of hold times.

Hamstring stretch standing

See one our physiotherapists at Richmond Physiotherapy Clinic for a tailored program to suit your specific rehabilitation needs.

“Dynamic Stretching” is, according to most of the hamstring experts in the world, more effective than static or sustained stretching. Maintaining the spine neutral or flat is preferred to loading the back in flexed (or bent forward) positions.

The role of stretching in hamstring rehabilitation as described by Malliaropoulos in 2004 is recognized as a scientifically sound (Reurink, 2012), further information can be found in Price Warrens research.

When recovering from a hamstring strain you should stretch 2-4 times per day (Malliaropoulos, 2004, Warren, 2008). Further rehab considerations include seeing a physiotherapist at Richmond Physiotherapy Clinic and (ref; Heiderscheit, and Sherry 2010);

  • Start walking and running as a pain free progression
  • Restore mobility
  • Restore balanced and symmetrical strength (with an emphasis on agility and plyometric exercise)
  • Balanced and symmetrical strength
  • Balance and motor control restoration
  • Lumbar Spine and gluteal referred pain/tension treatment
  • Lumbopelvic and hip mechanics strength
  • Gait analysis
  • Orthotics
  • Treatment should not be limited to only one of these components, combination of strengthening exercises and movement re-education

Hamstring stretching progressions


The information contained in this site is not intended as a substitute for advice from a qualified health care professional. Always obtain advice from a qualified health care professional before starting any exercise, stretching or health care program. The author and everyone involved in the production of this site disclaim any liability for any adverse effects resulting from the use of the information presented.


Hamstring strengthening and prevention of injury

Muscles strengthen optimally with a variety of strengthening exercise, isometric, concentric and eccentric, with a variety of angles and progressively loaded and progressed in a pain free manner to fatigue. In response to pain free strengthening muscles get stronger.

Hamstring strengthening and prevention of injury

See one our physiotherapists at Richmond Physiotherapy Clinic for a tailored program to suit your specific rehabilitation needs.

Nordic lowers are the only lower limb exercise to have scientifically proven benefit (Peterson et al, 2011) and should be included in any hamstring exercise program whether you are an amateur footballer or playing for Australia.

Some of the Hamstring Nordic Lower exercises include;

Nordic Lower stabilized with Price Warren’s body weight transmitted through straight arms
Nordic Lower stabilized with Price Warren’s body weight transmitted through his thighs
Nordic Lower performed on Lat Pull apparatus
Price Warren’s modified end range Nordic Lower performed on Swiss Ball
Price Warren’s modified end range Nordic Lower performed on bosu
Physio ball rollouts. Double leg progress to single leg with hands across chest.

Further variations on some of Richmond Physiotherapy Clinic’s favourite hamstring rehabilitation exercises;

Foot catch exercise simulates swing phase of running. Quick quads contraction then attempts to catch or stop the lower leg before reaching full knee extension by a hamstring contraction
Hamstring strengthening seat or bench lifts, progress to drop and catch and hands across chest
Hamstring Windmill Touches plus progress angles, speed, width of reach and weight
Romanian Dead lifts – care with lumbar spine preparation and activation of stability

When recovering from a hamstring strain you should engage in a running and strengthening routine session every second day (Warren, 2008).

Further rehab considerations include seeing a physiotherapist at Richmond Physiotherapy Clinic and;

  • Start walking and running as a pain free progression
  • Restore mobility
  • Restore balanced and symmetrical strength (with an emphasis on agility and plyometric exercise)
  • Balance and motor control restoration
  • Lumbar Spine and gluteal referred pain/tension treatment
  • Lumbopelvic and hip mechanics and strength
  • Gait analysis
  • Orthotics
  • Treatment should not be limited to only one of these components
  • Combination of strengthening exercises and movement re-education

Seek guidance from one of our experienced Richmond Physiotherapy Clinic physiotherapists regarding the expected progression through any hamstring rehabilitation programme.


The information contained in this site is not intended as a substitute for advice from a qualified health care professional. Always obtain advice from a qualified health care professional before starting any exercise, stretching or health care program. The author and everyone involved in the production of this site disclaim any liability for any adverse effects resulting from the use of the information presented.


Hamstring strain assessment and prevention research

Price Warren is a Sports Physiotherapist (APA titled) and a Master of Physiotherapy (Hamstring Strains AFL Football-original research-Centre for Health, Exercise and Sports Medicine, University of Melbourne).

He is a member of Sports Medicine Australia , the Musculoskeletal Physiotherapy Association and is a past president and ongoing member of Sports Physiotherapy Australia. Price was physiotherapist to the Richmond Football Club (1988-89) and Melbourne Football Club (1991-1999). His hamstring strain research involved scientific collaboration with Victoria House Radiology and Monash University.

Price is one of the few physiotherapists in clinical practice to have scientific manuscripts published in 2 of the most prestigious peer reviewed Sports Medicine journals in the world.

Price has assessed, treated and rehabilitated many hundreds of hamstring injured athletes due to his frequent invitations to liaise with and lecture to Australia’s most senior Sports Physicians and Sports Physiotherapists, many associated with elite teams (Australian Rugby Union Team, Brumbies Rugby Union Team, The Socceroos, Brisbane Bronchos, AFL teams, Gold Coast United etc).

Price Warren is available to run workshops or lecture to your physiotherapy or medical clinic or organization on muscle or hamstring injuries or hamstring injury prevention / rehab etc. He is also consults, treats/advises athletes and patients online (e.g. via Skype) – for optimal results this is done in conjunction with the treating practitioner.

Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers (Published in the British Journal of Sports Medicine, 2008).

A Comparison Between Clinical Assessment and Magnetic Resonance Imaging of Acute Hamstring Injuries (Published in the American Journal of Sports Medicine, 2006).

The influence of rehabilitation factors on recurrence of hamstring injury in elite Australian footballers