What exercises are recommended for hamstring rehabilitation, including neuromuscular control and concentric strengthening exercises?

Hamstring Rehabilitation: Neuromuscular Control and Concentric Strengthening Exercises

Neuromuscular control exercises for the hamstring include training on unstable surfaces (balance pads or foam rollers), single-leg dynamic balance exercises, plyometric activities (running, jumping, agility drills), and progressive agility exercises combined with trunk stabilization, while concentric strengthening involves traditional resistance exercises like hamstring curls performed through full range of motion at moderate to slow controlled speed. 1

Neuromuscular Control Exercises

Motor Control and Proprioception Training:

• Unstable surface training using balance pads or foam rollers to improve knee joint proprioception, particularly effective in early and intermediate rehabilitation phases 1
• Single-leg dynamic balance exercises that challenge postural control and increase hamstring muscle activation 1, 2
• Backward walking on an inclined treadmill as part of comprehensive motor control programs 1

Plyometric and Agility Training:

• Plyometric exercises including running, jumping, and agility activities provide additional benefit during advanced rehabilitation phases for subjective function and functional outcomes 1
• Progressive agility exercises combined with trunk stabilization have shown effectiveness in reducing recovery time, though evidence is limited 3
• Sport-specific exercises integrated into neuromuscular training programs 1
• The combination of plyometric and eccentric training demonstrates superior improvements in balance, subjective function, and functional activities compared to either method alone 1, 4

Important Caveat: Single-leg landing exercises are particularly effective at increasing hamstring muscle activity compared to single-leg stance or squat exercises, with female athletes showing greater increases in medial hamstring activity with unstable devices 2

Concentric Strengthening Exercises

Exercise Prescription:

• Traditional hamstring curls performed at 8-12 repetitions for adults under 50-60 years, or 10-15 repetitions at reduced resistance (40% 1-RM) for older individuals 1
• Moderate repetition duration: 3 seconds concentric phase, 3 seconds eccentric phase 1
• Single-set programs performed minimum 2 days per week are highly effective and promote adherence during initial training 1
• Exercises should be performed through full range of motion at moderate to slow controlled speed, avoiding breath-holding 1

Progression Strategy:

• Start with isometric exercises in the first postoperative week (if not causing pain) 1
• Progress to concentric exercises after the initial phase 1
• Eventually advance to eccentric exercises in closed kinetic chain 1

Evidence on Effectiveness:

• Both concentric and eccentric training improve quadriceps and hamstring strength without significant differences between training types 1, 4
• Concentric hamstring strength increases with eccentric training (mean difference 14.29 N·m), concentric training, blood flow-restricted training, whole-body vibration, heavy back squat, FIFA 11+, and plyometric training 5

Stretching for Flexibility

Stretching Protocols:

• Static stretching produces greater flexibility gains (mean difference 10.89°) compared to proprioceptive neuromuscular facilitation (9.73°) or dynamic stretching (6.25°), though effects are more transient 5
• Increased daily frequency of hamstring stretching (4 times daily versus once daily) significantly reduces time to return to normal function by 1.8 days 3
• Hold duration: 15-30 seconds per stretch, 2-4 repetitions per stretch, performed 2-3 days per week 1
• Neither PNF nor static stretching demonstrates superior effectiveness for immediate hamstring flexibility improvements 6

Integration and Progression

Combined Approach:

• Strength training should be augmented with neuromuscular and motor control re-education exercises for optimal outcomes 1, 4
• Both motor control and strengthening modules significantly improve quadriceps and hamstring strength when combined 1
• Balance and proprioception training show no difference in subjective function or functional outcomes compared to strength training alone, but the combination is recommended 1

Critical Pitfall: Avoid focusing solely on strength training without neuromuscular components, as eccentric training specifically reduces hamstring injury incidence by 56.8% to 70.0% and improves functional H/Q ratio, fascicle length, and limb asymmetry 5, 7