Phase 01

Note from the surgeon

Please note that the timeframes mentioned are general and will vary from patient to patient depending on their individual presentations, pre-injury activity levels, delay in presentation, goals, sciatic nerve involvement etc. They are meant to be guidelines only. Please check with the surgeon if there are any major variances during the rehab journey.

Phase 02 · Weeks 0 – 2

Phase 1 – Acute phase

Goals

Physiotherapy intervention is at a minimum.
No muscle tension passive or active — i.e. hip flexion must only occur with simultaneous knee flexion.
Gentle neural mobilisations (off-loading — not stretching).

Phase 03 · Weeks 2 – 6

Goals

Scar management and protection.
Restore normal gait pattern and full weight-bearing status.
Pain-free, non-resisted full hip AROM with the knee >90° flexion.
Pain-free, non-resisted full knee AROM with the hip at 0° in supine or side-lying.
Dynamic core stability and gluteal strengthening.
No scar massage until 4 weeks post-op. Use Micropore tape and other scar management treatments such as Cica Care or Kelocote.

Lying: supine heel slides — hip and knee flexion to hip and knee extension. Progression: gradually sit up while doing the heel slides.
Supine crook-lying single-leg press against theraband. Progression: supporting leg can hover or be raised whilst affected leg performs the leg press motion.
Supine over-the-bed knee extensions — open-chain progressive resistance for quads strengthening and neural mobilisation. NB: not sitting.
Standing: double-leg calf raises. Progression: single-leg calf raises.
Glute strengthening: standing hip hitching and standing-to-side-lying straight-leg abduction.

Phase 04 · Weeks 6 – 12

Goals

Standing: walking on flat ground as able but not as a form of exercise (comfortable pace for 10 mins, progressing to 30 min by week 12).
¼ squats with light hand-weights adding up to <¼ of body weight.
Standing theraband exercises (hip Abd/Ext): theraband attached to ankle, pulling involved leg out to side and backwards against a gentle resistance.
Exercise bike as tolerated.
Lying: double-leg bridging in crook lying with feet on the floor. Progression: decrease arm support from by the side to across the chest; add a box under feet then progress to legs on chair.
Lumbar spine mobility with lower legs on a Swiss ball — rolling the ball forward and back and side-to-side.
Core stability progressions: Pilates reformer leg press (light springs).
Prone leg curls, no added weight resistance. Progression: standing leg curls (no weights until 12 weeks).

Phase 05 · Weeks 12 – 16

Goals

Standing: fast walking (flat ground — no hills).
Walk and balance on mini-tramp/foam balance.
Pilates scooter and home scooter with theraband. Slow and controlled with progressive increase in resistance.
Lying: continue standing theraband exercises (increase resistance).
Stretching: straight leg raise or sitting knee extension to a gentle discomfort (2/10 VAS).
Hamstring strengthening with added resistance. Progression: prone — standing — machine leg curls.
Swiss ball double-leg bridges with core pre-activation.
Single-leg ¼ squats holding up to ¼ body weight.
Progress gluteal strengthening: supine theraband hamstring pull downs.
Leg press: initially double leg, progressing to single leg. Progressive resistance.

Phase 06 · Weeks 16 – 24

Goals

Lying: Swiss ball bridges. Progression: double leg on Swiss ball, pull heels towards buttock, slow and controlled. Maintain a stable pelvis and slowly decrease arm support.
Increasing core stability exercises (advanced Pilates).
Sitting: continue leg press > body weight.
Hamstring curls in positions gradually increasing hip flexion.
Standing: fast walking up hills.
Progress hamstring resisted weight training: suggestions — double leg, single leg, 2-up concentric and 1-down eccentric. Gradually increase the speed.
Balance on involved straight leg; bend over to touch the floor in front of you, then to the left, right and with alternate hands. Return to standing and repeat.
Scooter: resistance on Pilates reformer machine or with theraband.
Plyometrics: jumping, hops and landing with ¼ – ½ turns.
Sciatic neural mobilisation: swinging leg and head nods.
Light jogging on flat surface, starting with intervals of 100 m with walking in between (e.g. 30 m acceleration / 40 m jog at 50% / 30 m deceleration). Increase intensity as appropriate.
Backwards striding. Increase speed gradually, focusing on deceleration control.

Phase 07 · From week 24

Goals

Return to sport.
Running to sprinting.
>80% hamstring strength of involved side vs non-involved side by 24 weeks.
>85% hamstring strength of involved side vs non-involved side by 18 – 24 months.

Sport-specific drills.
Plyometrics: alternate jump/split/scissor mini squats and mini lunges. Progression: add hand weights.
Running drills: increase speed work and multi-directional.
Straight-leg dead lifts.
Nordic hamstring curls (eccentric, then concentric and eccentric).

Last reviewed: 2025-10-15.