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