Phase/Programme description Acute Phase
(Days 1-2)
Sub-acute Phase A
(Days 3-7)
Sub-acute Phase B
(Days 8-15)
Physiotherapy Objectives









1. Swelling – Hematomastabilization
2.  Prevention of relapses
3. Painreduction
4. Initializing-Acceleratinginflammatoryrehabilitationprocess





1. Reducing/removing hematoma - swelling
2.Initializing alignment and reattachment of muscle fibres
3. Minimizing development of scared tissue
4. Reduce pain
5. Regaining strength and agility
1. Achieving elasticity of the scar tissue
2. Regainingfunctionalmuscleability (agility-strength-endurance-proprioception)








Aggressive  Physiotherapy
Techniques


1. Cryotherapy
2. Elevation
3. Immobilization
4. Useofcrutches
5. Compression (Soft-wrapped bandage)
6. Therapeutic non-warm ultrasound
(0.5 W/cm2 /1- 3-MHz/10΄)
1. Diathermy (10΄)
2. Massage (15΄)
3.Cuppingmassage (8΄)
a) Static application on the injury site (5’)
b) Dynamic application with cups motion towards the core(3’)
4. Strippingmassage  (5΄)
a) centrally to injury site
b) directly upon injury site with direction towards the trank
5. IASTM Stripping massage (2’) (application same as above)
6.Cryotherapy  (20΄)
7. Cryokinetic
Isometric exercises of hamstring muscles
(4 setswith 10 isometric contractions) (6΄΄of progressive contraction -2΄΄ break)
8.Cryostretching
Stretching through active motion -Stretching of antagonist muscles (12΄΄ stretch  -12΄΄ relaxation)
9. Electrotherapy
Therapeutic Ultrasound-
ΤΕΝS
10. Core stabilisationexercises  (planks  in supine - lateral and prone position)
1. Diathermy (15’)
2. Massage
2.1. Strippingmassage (5΄)
a) centrally to injury site
b) directly upon injury site with direction towards the trank
2.2 Strippingmassageincombinationwithgentleeccentrichamstrings’contraction (with elastic band/5’)
3. Cryotherapy  (20΄)
4. Cryokinetic
Isotonic- concentric contraction of hamstrings with the use of elastic bands
(4-5 sets 10-12 repetitions)
5. Cryostretching
2 setsx 5 stretchingrepetitionsfor 30΄΄  (1 setwith extended knee – 2ndset with flexed knee)
6. Electrotherapy
Τ.Ε.Ν.S ,Therapeutic Ultrasound
7. Core stabilisationexercises  (planks  in supine - lateral and prone position)
8. Balanceexercises
Home-based Rehabilitation Rest/ Cryotherapy (Continuous application 20΄-30΄ with a 90΄ break.) 1.Hamstrings’ stretching  (2 sets of 7 repetitions for 30΄΄ with extended and flexed knee position)
2.Isometric exercises (4 sets of 10 contractions (6΄΄of progressive contraction-2΄΄ of relaxation)
3. Low resistance exercises in a pool – swimming
1. Hamstrings’ stretching: 2 setsof 7 repetitionsfor 30΄΄ (with extended and flexed knee position)
2. Strengthening with elastic bands : (daily 6-7 sets of 10-12 repetitions in sitting and standing positions)
3. Myofascial release exercises with Foam roller on hamstrings (10 repetitions for 1΄ with a 1΄ relaxation break)
Functional rehabilitation in the field   1. Trunk  and upper limbs strengthening exercises in the gym
2. Upper body ergometer
3. Afterday 4, beginningorganized gait (forward and backward)
5thday - walking 10΄
6thday-  walking 15΄
7th day  - walking 20΄ (2x10΄)
8th-10th  Days
Aerobic training: Running (2x10΄/ 30-40%  Vo2max)
Skipping routines/Stretching
Trunk-pelvis stabilisation exercises 
Combinedexercises  (proprioception-agility-balance)
11th -13th  Days
Aerobic training: Running (2× 10΄/ 50%  Vo2 max)
Skipping routines - Stretching/pelvis stabilisation exercises
10x50m (60% Vo2 max) / 5x100 (60% Vo2 max)      
Ballistichipexercises (dynamicstretching)/10x50m (60% Vo2max) /5x100 (alternating intensity rhythm: 50m at 50% and 50mat  60-70% Vo2max)      
14th -15th  Day
Aerobic training: Running (2x10΄/ 50%  Vo2 max)
Isokinetic strengthening (concentric –eccentric contraction)/ Skipping routines – Stretching/ Pelvis stabilisation exercises / Ballistic hip exercises/5x100m (70% Vo2 max)
Dynamic proprioception exercisesof lower limbs
5x100 (alternating intensity rhythm: 50m at 60% and 50m at 70-80% Vo2 max)/10x40m (alternating intensity rhythm: 20-20m at 60%/80-90% Vo2max) Soccer mimetic exercises- plyometric strengthening    
Precaution - rehabilitation   Kinesiotaping Kinesiotaping
Criteria for progression to the next phase   1. Swelling – pain minimization
2. <5οrange of motion deficit
3. Minimumpain (2-3 VASSCALE) during compression of the area
1. Isokineticstrengthsymmetry (concentric 60ο /180ο /300οsec.-eccentric 60/180osec)
2. Fullrangeofmotion
3. Performingsoccerburstexercises (changing direction-sprint etc.) without discomfort
4. Goodpsychological state -confidence of the athlete
Table 1: Aggressive rehabilitation program for grade I hamstrings strain in a professional soccer player.