Hamstring Tendon Repair Rehabilitation.
What is hamstring tendon repair?
Hamstring tendon repair surgery reattaches the proximal hamstring tendons — the conjoined tendon of the biceps femoris and semitendinosus, and the semimembranosus tendon — to the ischial tuberosity, the bony prominence of the pelvis from which they originate. It is performed following a complete proximal hamstring avulsion — where the tendon tears entirely from its bony attachment — or a severe partial tear that has failed conservative management.
Proximal hamstring avulsions are relatively uncommon injuries but are serious when they occur. They typically result from a sudden forceful stretch of the hamstrings with the hip flexed and knee extended — a water skiing fall, a slip with the legs spreading apart, or an explosive sprinting or jumping movement. The injury produces immediate severe posterior thigh pain, bruising that migrates distally over the days following injury, and a characteristic weakness of knee flexion and hip extension. A palpable gap in the proximal hamstring may be present in complete avulsions.
Not all proximal hamstring injuries require surgery. Grade 1 and many grade 2 strains, and partial avulsions with less than 2cm of retraction, are managed conservatively with structured physiotherapy. Surgery is generally considered for complete avulsions — particularly those with significant tendon retraction — in active patients who want to return to demanding activities, where conservative management has failed, or in delayed presentations where chronic hamstring weakness and ischial pain from scar tissue are significantly impairing function.
Why is physiotherapy essential after hamstring tendon repair?
The surgery reattaches the tendon to bone — but the surrounding muscles, the hip and knee mechanics, and the neuromuscular patterns that govern safe hamstring loading have all been disrupted by the injury, the surgical procedure and the period of immobilisation.
Physiotherapy is critical to successful recovery, helping restore flexibility and strength, regain normal movement patterns, reduce stiffness, and ensure the repair is not overstressed during healing.
The repaired tendon requires a prolonged period of protected loading while the tendon-to-bone healing occurs — the biology of proximal hamstring repair is slower than many patients expect — and systematic rehabilitation to rebuild the strength and neuromuscular control needed for safe return to the high-demand activities that caused the original injury.
What does rehabilitation involve?
What precautions should be taken? Adhere to movement restrictions — avoid bending at the hip or overstretching the hamstring in the early phase. Limit weight-bearing as directed. Avoid sitting for extended periods — use cushions or modify positions to reduce strain on the hamstring origin.
In the first six weeks the repaired tendon is protected from tensile loading — specifically from positions that stretch the hamstring by simultaneously flexing the hip and extending the knee. Crutches are typically used and a hip brace limiting hip flexion may be worn in the early weeks to protect the ischial attachment. Physiotherapy during this phase focuses on gentle range-of-motion within the permitted hip flexion limits, quadriceps and calf maintenance exercises, and upper body conditioning. Prone and supine positions are typically more comfortable than sitting, which places direct pressure on the ischial tuberosity.
From six to twelve weeks gentle strength and mobility exercises begin, with rehabilitation exercises introduced progressively: early stages include ankle pumps, gentle leg lifts, and isometric hamstring contractions. Mid-stages progress to glute bridges, gentle heel slides, and controlled hip extensions. Progressive loading of the hamstrings begins carefully — starting with exercises that load the hamstring in shorter muscle lengths (knee bent, hip less flexed) before gradually working toward longer lengths as the tendon healing progresses.
From three to six months, progressive hamstring strengthening through increasing ranges of hip flexion — including the lengthened positions that were initially restricted — forms the core of rehabilitation. Nordic hamstring curls, Romanian deadlifts and hip extension exercises with progressive loads systematically rebuild the hamstring's eccentric strength capacity. Hip and gluteal strengthening is equally important — the gluteals and hamstrings function synergistically in hip extension activities, and gluteal strength supports the repair by sharing load during functional movements.
From six to twelve months, sport-specific rehabilitation is introduced for athletes — including sprinting mechanics, change of direction, jumping and landing. Return to full sport is guided by objective strength testing — typically requiring at least 90% limb symmetry in hamstring strength testing before high-demand activities are cleared. Rushing return to sprinting is the most common cause of re-injury after hamstring tendon repair.
Real time ultrasound monitors healing and muscle activation quality. Clinical Pilates provides a controlled environment for progressive hip and lower limb loading during the mid-rehabilitation phase when full sport training is not yet appropriate.
For patients whose injury occurred in a workplace or motor vehicle context, WorkCover and CTP funded rehabilitation is available.
Our physiotherapists Eliane Machado and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in post-surgical lower limb rehabilitation and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the hamstring loading and return-to-sport testing central to this rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Hamstring tendon repair surgery reattaches the proximal hamstring tendons — the conjoined tendon of the biceps femoris and semitendinosus, and the semimembranosus tendon — to the ischial tuberosity, the bony prominence of the pelvis from which they originate. It is performed following a complete proximal hamstring avulsion — where the tendon tears entirely from its bony attachment — or a severe partial tear that has failed conservative management.
Proximal hamstring avulsions are relatively uncommon injuries but are serious when they occur. They typically result from a sudden forceful stretch of the hamstrings with the hip flexed and knee extended — a water skiing fall, a slip with the legs spreading apart, or an explosive sprinting or jumping movement. The injury produces immediate severe posterior thigh pain, bruising that migrates distally over the days following injury, and a characteristic weakness of knee flexion and hip extension. A palpable gap in the proximal hamstring may be present in complete avulsions.
Not all proximal hamstring injuries require surgery. Grade 1 and many grade 2 strains, and partial avulsions with less than 2cm of retraction, are managed conservatively with structured physiotherapy. Surgery is generally considered for complete avulsions — particularly those with significant tendon retraction — in active patients who want to return to demanding activities, where conservative management has failed, or in delayed presentations where chronic hamstring weakness and ischial pain from scar tissue are significantly impairing function.
Why is physiotherapy essential after hamstring tendon repair?
The surgery reattaches the tendon to bone — but the surrounding muscles, the hip and knee mechanics, and the neuromuscular patterns that govern safe hamstring loading have all been disrupted by the injury, the surgical procedure and the period of immobilisation.
Physiotherapy is critical to successful recovery, helping restore flexibility and strength, regain normal movement patterns, reduce stiffness, and ensure the repair is not overstressed during healing.
The repaired tendon requires a prolonged period of protected loading while the tendon-to-bone healing occurs — the biology of proximal hamstring repair is slower than many patients expect — and systematic rehabilitation to rebuild the strength and neuromuscular control needed for safe return to the high-demand activities that caused the original injury.
What does rehabilitation involve?
What precautions should be taken? Adhere to movement restrictions — avoid bending at the hip or overstretching the hamstring in the early phase. Limit weight-bearing as directed. Avoid sitting for extended periods — use cushions or modify positions to reduce strain on the hamstring origin.
In the first six weeks the repaired tendon is protected from tensile loading — specifically from positions that stretch the hamstring by simultaneously flexing the hip and extending the knee. Crutches are typically used and a hip brace limiting hip flexion may be worn in the early weeks to protect the ischial attachment. Physiotherapy during this phase focuses on gentle range-of-motion within the permitted hip flexion limits, quadriceps and calf maintenance exercises, and upper body conditioning. Prone and supine positions are typically more comfortable than sitting, which places direct pressure on the ischial tuberosity.
From six to twelve weeks gentle strength and mobility exercises begin, with rehabilitation exercises introduced progressively: early stages include ankle pumps, gentle leg lifts, and isometric hamstring contractions. Mid-stages progress to glute bridges, gentle heel slides, and controlled hip extensions. Progressive loading of the hamstrings begins carefully — starting with exercises that load the hamstring in shorter muscle lengths (knee bent, hip less flexed) before gradually working toward longer lengths as the tendon healing progresses.
From three to six months, progressive hamstring strengthening through increasing ranges of hip flexion — including the lengthened positions that were initially restricted — forms the core of rehabilitation. Nordic hamstring curls, Romanian deadlifts and hip extension exercises with progressive loads systematically rebuild the hamstring's eccentric strength capacity. Hip and gluteal strengthening is equally important — the gluteals and hamstrings function synergistically in hip extension activities, and gluteal strength supports the repair by sharing load during functional movements.
From six to twelve months, sport-specific rehabilitation is introduced for athletes — including sprinting mechanics, change of direction, jumping and landing. Return to full sport is guided by objective strength testing — typically requiring at least 90% limb symmetry in hamstring strength testing before high-demand activities are cleared. Rushing return to sprinting is the most common cause of re-injury after hamstring tendon repair.
Real time ultrasound monitors healing and muscle activation quality. Clinical Pilates provides a controlled environment for progressive hip and lower limb loading during the mid-rehabilitation phase when full sport training is not yet appropriate.
For patients whose injury occurred in a workplace or motor vehicle context, WorkCover and CTP funded rehabilitation is available.
Our physiotherapists Eliane Machado and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in post-surgical lower limb rehabilitation and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the hamstring loading and return-to-sport testing central to this rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
