Hamstring Injury Treatment: What the Evidence Actually Says

Early, progressive loading is the evidence-based foundation of hamstring rehabilitation, not prolonged rest. Eccentric exercises are an important component of recovery and prevention, working within a comprehensive programme that includes progressive running and sport-specific exposure.

Concerned about why your hamstring keeps re-tearing? Read: Why Hamstring Injuries Keep Coming Back

The Framework: Protection to Sport-Specific Demands

Hamstring rehabilitation is not rest versus loading. It is a staged progression:

• Appropriate protection in the early phase, to allow the initial response to settle without unnecessary loss of strength from prolonged unloading.
• Progressive strengthening, building capacity systematically before returning to running.
• Progressive running exposure, low-speed first, then submaximal, then maximal velocity work.
• Sport-specific demands, the actual patterns of acceleration, change of direction, and repeated sprint effort the athlete faces in their sport.

Each stage prepares the body for the next. Skipping stages is where re-injury risk compounds.

Early Loading: Why Rest Alone Is Not Enough

Prolonged unloading leads to loss of strength and physical capacity, and does nothing to prepare the muscle for the demands of sprinting. High-intensity eccentric loading can be introduced relatively early in rehabilitation when exercise-specific progression criteria are met, this is supported by evidence from a 2022 cohort study showing it can be done safely when individuals progress according to their ability to perform each exercise rather than a fixed calendar.

Eccentric Exercise: Important, But Part of a Larger Plan

Eccentric exercises, where the muscle is loaded while it lengthens, are an important component of hamstring rehabilitation. They can improve muscle strength and capacity at longer muscle lengths, helping the hamstring tolerate the high-force, high-speed demands of sprinting.

A 2015 systematic review and meta-analysis found that adding eccentric exercises to a conventional programme significantly reduced time to return to play (HR 3.22). It did not demonstrate a significant reduction in reinjury rate, underscoring that eccentric loading is one important component, not the complete solution.

Exercise progression: how loading typically builds

• Early in rehabilitation: isometric holds, gentle bridge exercises, pain-free range work.
• Building phase: progressive hamstring curl, Romanian deadlift, single-leg deadlift.
• Later phase: Nordic hamstring exercise, slider curl, high-load lengthened-position work.
• Final phase: progressive high-speed running, sprint mechanics work, sport-specific loading.

The Nordic hamstring exercise places substantial eccentric demand on the hamstrings at relatively long muscle lengths, making it a useful component of many rehabilitation and prevention programmes. It has been consistently associated with meaningful reductions in hamstring injury incidence when athletes adhere to it systematically.

Exercise selection should always reflect where you are in recovery and what the tissue can currently tolerate, not what a standard protocol prescribes at a given week.

Stretching: Part of the Programme, Not the Solution

Stretching has a role in hamstring rehabilitation but is not a substitute for progressive strengthening and running exposure. The goal is to restore the muscle's capacity to tolerate force and high-speed lengthening, not simply to feel looser. Early in recovery, aggressive stretching may be inappropriate depending on injury location and tissue irritability. As symptoms settle, mobility work can be incorporated alongside strengthening and progressive running.

Running: The Stage Most Commonly Missed

One of the most frequent errors in hamstring rehabilitation is progressing from gym-based strengthening directly back to sport without systematic running exposure. Running is reintroduced progressively once the injury can tolerate the required loading, the appropriate starting speed and volume depend on the severity, location, and stage of recovery. The hamstring must experience submaximal and then maximal running speeds in a controlled rehabilitation context before encountering them in competition.

How IP Physio Builds Your Programme

We use hand-held dynamometry to track your hamstring strength objectively at regular intervals, and ForceDecks to assess force production during dynamic tasks. Running analysis can identify changes in mechanics following injury that may be relevant when progressing back to high-speed running. Your programme is adjusted based on what the data shows at each stage, not a fixed template.

Get in touch with us today to start a structured, individually prescribed hamstring rehabilitation programme.

References

• Martin RL, et al. Hamstring strain injury in athletes: clinical practice guidelines. J Orthop Sports Phys Ther. 2022;52(3):CPG1, CPG44. doi:10.2519/jospt.2022.0301.
• Pas HIMFL, et al. Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries. Br J Sports Med. 2015;49(18):1197, 1205.
• Hickey JT, et al. Early introduction of high-intensity eccentric loading into hamstring strain injury rehabilitation. J Sci Med Sport. 2022;25(9):732, 736. doi:10.1016/j.jsams.2022.06.002.
• van der Horst N, et al. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players. Am J Sports Med. 2015;43(6):1316, 1323. doi:10.1177/0363546515574057.