Post-Operative Instructions:
Hamstring Repair

Pain Medications

  • In most cases local or regional nerve blocks will provide 8-12 hours of numbness. As soon as you start to feel the numbness wearing off, begin taking oral pain medication.

  • Take Tylenol 500mg one tab every 8 hours.

  • Take Aleve 220mg one to two tabs every 12 hours.

  • If you still have pain after Tylenol and Aleve, take one Norco tab (5mg/325mg).

  • If you still have pain after all of the above, take a second Norco tab.

  • Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol. DO NOT exceed 3500mg of Tylenol over 24 hours. 

  • It is illegal to drive or operate machinery with narcotic medications. 

  • Do not combine alcohol or other sedatives with narcotic medications.

  • You do not need to take Tylenol or Aleve once you no longer have pain. You should stop Norco first (usually after a few days).

Other Medications

  • Take Aspirin 325mg one tab once a day for the first 4 weeks to prevent blood clots.

  • Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).

  • Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.

Activity

  • Use crutches to assist with ambulation.

  • You may bear 25% of your weight on your operative extremity.

  • Elevate your leg on pillows above the heart level as much as possible to decrease swelling.

  • Avoid prolonged periods standing to prevent excessive pain and swelling.

Recovery Equipment

  • You should wear the brace at all times (except for hygiene, but always keep knee bent at 45 degrees).

Cold Therapy

  • We recommend cold therapy use as much as possible in the first two weeks. 

  • Cold therapy units may be used continuously as instructed.

  • Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.

  • Do not apply ice directly to the skin to avoid burning.

Recovery Exercises

  • You may perform ankle exercises as instructed in your preoperative packet.

  • You will begin physical therapy 4 weeks after surgery.

Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Post-Operative Rehabilitation: 
Hamstring Repair

Therapy Plan: Twice per week for 1-3 months, once per week for 3-6 months

ROM Progression

Brace locked at 45 degrees knee flexion for 0-4 weeks.

  • NO combined hip flexion and knee extension for 12 weeks

  • Weeks 4-6: Progress ROM 30-90 degrees

  • Weeks 6-12: Progress to full knee ROM with hip extended

  • Weeks 12+: Progress to full symmetric hip and knee ROM

Weight Bearing Progression

Initial weight bearing 0-4 weeks after surgery should be 25% body weight.

  • Progress weight bearing over weeks 4-6 with the goal of removing crutches at 6 weeks

  • Do NOT progress to one crutch - gait must be pain free and non-compensatory to remove both crutches

  • Brace should remain in place until strength is sufficient for gait stability

Initial Post-Operative Physical Therapy Visit (4 weeks)

  • Correctly perform 25% body weight bearing with crutches

  • Correctly instruct in bracing unlocked 30-90 degrees at rest, locked for ambulation

  • Isometric exercises for core, glutes

  • Soft tissue mobilization

Phase 1 Physical Therapy (4-6 weeks): protect the repair and avoid irritation

  • NO open-chain exercises

  • Manual therapy 20+ minutes per session

  • Progress gentle stretching as above

  • Initiate progressive weight bearing with tactile and verbal cueing to enable non-compensatory gait 

  • Soft tissue mobilization, isometric exercises, core strengthening

Phase 2 Physical Therapy (6-12 weeks): non-compensatory gait and progression

  • Tactile and verbal cueing to enable non-compensatory gait patterning, wean off crutches and brace

  • Progress gentle stretching as above

  • Soft tissue and joint mobilization, isometric exercises, core strengthening

Phase 3 Physical Therapy (12-24 weeks): return to pre-injury level

  • Progressive strengthening as tolerated with closed-chain exercises

  • Soft tissue and joint mobilization, core strengthening

  • Focus on functional exercises in all planes, advance only when fully controlled

  • Elliptical may begin at 12 weeks, running may begin at 14 weeks, sprinting may begin at 20 weeks

Phase 4 Physical Therapy (24+ weeks): return to sport

  • Full return may take a full 6-12 months or more and requires functional assessment prior to return

    • Functional assessment includes less than 10% strength deficit compared to contralateral side

  • Soft tissue and joint mobilization, closed-chain exercises, core strengthening

  • Plyometric and sport-specific drills may begin at 24 weeks