Expert Methods for Early Hamstring Strain Management

Despite the advances in rehab science, hamstring strains are still one of the most common injuries in elite sport, and one of the most likely to recur. They remain a source of frustration for both athletes and clinicians alike.

A recent Case Study from expert physio and strength and conditioning coach Q Willey is essential for understanding how to get athletes back on the field safely. In this blog, we’ll cover how Q managed a college football player early after a hamstring strain, aiming for a timely return to play and a reduced risk of reinjury.

If you want to see exactly how an expert manages an athlete back onto the field from a hamstring strain, watch Q Willey’s full Case Study HERE. With Case Studies you can step inside the minds of experts and apply their strategies to get better results with your patients. Learn more here.

Early considerations

The numbers speak for themselves, hamstring strain reinjury rates range from 13.9% to 63.3%. That’s a huge range, and it tells us there’s still a lot of nuance in how these injuries behave, and how athletes respond to rehab.

One big factor Q mentions that we sometimes overlook is the athlete’s own belief about how long their recovery will take. Studies have shown that the player’s perceived return-to-play timeline can be a prognostic factor. Why? Well, first of all, obviously the athlete knows their body best and will base their estimation on how far they feel from full function. But this could also point toward the influence of psychological factors like fear of reinjury, lack of confidence, and uncertainty on recovery and return to play.

It’s important to create a treatment environment that rebuilds the athlete’s confidence in their hamstring. In elite sport, there’s often a temptation to use imaging simply because it’s readily available. But, unless you’re seriously concerned about a full rupture, Q questions the utility of MRI for hamstring strains, see him explain in the below video from his Case Study:

Initial management

One of the key principles in rehabbing a hamstring strain injury for an athlete is early exposure.
Q didn’t have his athlete rest, waiting for the pain to settle — he got him right back into pain-controlled movement from day one to preserve fitness and address potential psychological factors such as apprehension, loss of confidence, and fear of movement. Early re-engagement helps the athlete feel proactive rather than sidelined, which can be just as important as the physical benefits.

Obviously, you don’t want to overdo it in the early stages of hamstring strain, but maintaining a manageable pain threshold of below a 4/10 VAS during early exercises is a useful tip backed by the research. See Q explain what he did with the athlete from day one in this clip from his Case Study:

The next week is then really important for recovery. Q outlines what he did with the athlete:

On-field activities included:

• daily marching
• progressively higher skipping
• ankle dribbling drills
• by day 5: beginning very light accelerations for a short distance
• sled work

Gym training included:

• feet elevated hamstring bridge (isometrics)
• long length hamstring bridge (isometrics)
• Romanian deadlift isometric holds with an empty bar
• 15–20 minutes of underwater treadmill running or assault bike intervals

What stands out here is the balance between confidence-building, capacity-building, and of course, tissue protection. Everything served a clear purpose: restore control, prevent deconditioning, and maintain the athlete’s connection to training, while building a foundation for faster, safer return to play.

After this first week of initial management, Q then applies evidence-based criteria to guide the athlete’s return to running, speed work, and ultimately competition. Check out his full Case Study to see the complete progression in action!

Wrapping up

This case was a great reminder that successful hamstring rehab isn’t just about sets and reps – it’s about context, communication, and confidence.
While reinjury is common in hamstring strains, it is not inevitable. A few takeaways worth carrying into practice are: psychological readiness matters, your athlete needs to trust their hamstring. Imaging isn’t always needed, and in some cases, can be detrimental to the patient’s belief in recovery. Early movement (with control) is not only safe, but essential. And rehab for your athletes should feel like training, not sitting out, keeping them mentally engaged and physically primed for a confident, high-performance return.

We’ve only scratched the surface here, in Q Willey’s full Case Study, you’ll see exactly how he progressed the plan, adjusted loads, and worked with the athlete to return-to-play in a high-performance setting. Watch the full Case Study HERE.