Phase I: Protection and Early Recovery (0–6 Weeks)

Immobilisation:

• No brace routinely required

• Crutches for ambulation as needed

• Weight bearing as tolerated with crutches

Precautions:

• Avoid hip flexion beyond 60–90° (as directed)

• Avoid combined hip flexion with knee extension

• Avoid active hamstring contraction

• Avoid stretching of the hamstrings

• Avoid rapid or uncontrolled movements

Therapy:

• Gentle range of motion within safe limits

• Emphasis on avoiding excessive hip flexion

• Quadriceps and gluteal activation exercises

• Core strengthening

• Gait retraining with shortened stride

• Swelling management

Criteria to Progress:

• Controlled pain and swelling

• Safe ambulation with or without aids

• Adherence to precautions

Phase II: Progressive Motion and Early Strengthening (6–12 Weeks)

Precautions:

• Avoid aggressive hamstring stretching

• Avoid high-load hamstring contraction

• Avoid sudden hip flexion movements

Therapy:

• Gradual increase in hip flexion range

• Initiate gentle hamstring activation

• Closed chain strengthening

• Gluteal and core strengthening progression

• Balance and proprioception

• Stationary cycling (low resistance)

Criteria to Progress:

• Improved range of motion

• Good neuromuscular control

• Minimal pain and swelling

Phase III: Advanced Strengthening (12–16 Weeks)

Precautions:

• Avoid explosive or high-speed movements early in this phase

Therapy:

• Progressive hamstring strengthening

• Eccentric strengthening introduced gradually

• Functional strengthening (lunges, step-downs)

• Advanced balance and control exercises

• Cardiovascular conditioning

Criteria to Progress:

• Good strength and control

• No significant pain or swelling

• Functional independence

Phase IV: Return to Function and Activity (4–6 Months)

Precautions:

• Gradual return to higher-level activity

• Avoid premature sprinting or high-speed loading

Therapy:

• Running progression

• Advanced strengthening including eccentric loading

• Plyometrics and sport-specific training

• Criteria for Return to Activity

• Full range of motion

• Strength at least 90% of contralateral limb

• Good dynamic control

• No pain or swelling

General Recommendations

Work:

• Desk-based work may resume after 2–4 weeks.

• Manual labour is typically deferred until 3–4 months depending on job demands and recovery progression.

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

• In general, for left hamstring surgeries in vehicles with automatic transmission, return to driving may be sooner.

Sports and Leisure:

• Low-impact activities may resume from 8–12 weeks.

• Running may commence around 4–6 months.

• Sprinting and high-speed activities may commence around 4–6 months depending on recovery.

Thromboprophylaxis

• For this procedure, postoperative thromboprophylaxis may be considered, particularly in the setting of reduced mobility. The need for pharmacological thromboprophylaxis will be determined by A/Prof Ernstbrunner and his medical team based on the individual patient’s risk factors and comorbidities.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.