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Discharge Instructions & Physical Therapy Protocol for Open Hamstring Repair

Recovery after your surgery entails controlling swelling and discomfort, healing, return of range-of-motion of the hip joint, regaining strength in the muscles around the hip joint, and a gradual return to activities. The following instructions are intended as a guide to help you achieve these individual goals and recover as quickly as possible after your hamstring repair.

Comfort

  • Swelling - Ice controls swelling and discomfort by slowing the circulation at your surgical site. Place crushed ice in a plastic bag over your incision area for no more than 20 minutes, three (3) times a day. If you develop tingling down your leg remove the ice
  • Pain Medication - Take medications as prescribed, but only as often as necessary. Avoid alcohol and driving if you are taking pain medication
  • Antibiotic Medication - If an antibiotic has been prescribed, start taking the day of your surgery. The first dose should be around dinnertime. Continue taking until the prescription is finished
  • Brace - A Hip Flexion Brace has been applied. Wear this at all times including during sleep. You may remove it briefly to wash and dress. This brace will be used for approximately 4 - 6 weeks
  • Driving - Driving is NOT permitted for four to six weeks following surgery

Activities

  • Range-of-Motion - Move your knee through range of motion as possible to prevent stiffness. Motion of your hip will begin after your first post-operative visit
  • Exercises - These help prevent complications such as blood clotting in your legs. Point and flex your foot and wiggle your toes. Thigh muscle tightening exercises should begin the day of surgery and should be done 10 to 15 minutes, 3 times a day
  • Weightbearing Status - You are NOT allowed to put any weight on your operative leg. Walk using two crutches or a walker. You may touch your foot on the floor for balance. Do this within the limits of pain
  • Physical Therapy - PT should be started 1 - 2 weeks after surgery. You should call the physical therapist of your choice for an appointment as soon as possible after surgery. A prescription for physical therapy, along with physical therapy instructions (included in this packet) must be taken to the therapist at your first visit
  • Athletic Activities - Athletic activities, such as swimming, bicycling, jogging, running and stop-and-go sports, should be avoided until allowed by Dr. Forsythe
  • Return to Work - Return to work as soon as possible. Your ability to work depends on a number of factors - your level of discomfort and how much demand your job puts on your legs. If you have any questions, please call Dr. Forsythe

Wound Care

  • Tub bathing, swimming, and soaking of the incision area should be avoided until allowed by your doctor - Usually 2 - 3 weeks after your surgery. Keep the dressing on, clean and dry for the first 3 days after surgery
  • Remove the dressing 3 days after surgery. The steri-strips (small white tape that is directly on the incision areas) should be left on until the first office visit. You may apply band-aids to the small incisions around your buttocks
  • You may shower 5 days after surgery with band-aids on. Apply new band-aids after showering

Eating

  • Your first few meals, after surgery, should include light, easily digestible foods and plenty of liquids, since some people experience slight nausea as a temporary reaction to anesthesia

Call your physician if

  • Pain in your buttocks persists or worsens in the first few days after surgery
  • Excessive redness or drainage of cloudy or bloody material from the incision (Clear red tinted fluid and some mild drainage should be expected). Drainage of any kind 5 days after surgery should be reported to the doctor
  • You have a temperature elevation greater than 101°
  • You have pain, swelling or redness in your calf
  • You have numbness or weakness in your leg or foot

Return to the office

  • Your first return to our office should be within the first 1-2 weeks after your surgery. Call Dr. Forsythe’s office to make an appointment for this first post-operative visit

Hamstring Avulsion Repair Physical Therapy Protocol

Phase I (Weeks 1 - 4)

  • TTWB approximately 10 - 14 days
  • 25% WB at 14 days and increasing 25% per week until off crutches at Week 5
  • PROM as tolerated, starting in Week 2, with hip and knee ROM
  • Initiate gentle AROM around Week 3 or 4
  • Discontinue brace approximately 4 - 6 weeks after surgery depending on repair strength

Phase II (Weeks 4 - 8)

  • FWB is permitted if the patient demonstrates normal gait patterns
  • Aquatic walking and ROM
  • Closed chain emphasis with limited ROM
  • Isotonics in limited range-of-motion, avoid terminal range of extension
  • PROM knee extension and hip flexion
  • Initiate core pelvic strength training

Phase III (Weeks 8 - 12)

  • Progress isotonic strength training
  • Advanced dynamic training
  • Concentrate on core pelvic training
  • Strength evaluation at 10 weeks - isometric mode only at 60° of knee flexion

Phase IV (Weeks 10 - 24)

  • Begin dry land jogging/running
  • Full isokinetic evaluation at 60°, 120° and 180°/sec, bilateral comparison
  • Functional hop testing
  • Sport specific activities
  • Sport specific training

Phase V

  • Return to activity