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Writer's pictureChristopher Nour

Managing a Grade 4 Hamstring Tear with Physiotherapy

A Grade 4 hamstring tear represents a severe injury characterised by a complete rupture of the muscle fibres, leading to significant pain, swelling, and loss of function. While daunting, effective management through physiotherapy is crucial to facilitate healing, restore function, and optimise long-term outcomes. In this comprehensive guide, we'll explore the principles of physiotherapy for managing a Grade 4 hamstring tear, providing guidance and support for individuals navigating their recovery journey.


Understanding Grade 4 Hamstring Tears

Grade 4 hamstring tears involve a complete rupture of the muscle fibres, often accompanied by extensive tissue damage and hematoma formation. Common causes include forceful overstretching or eccentric loading of the hamstring muscles, resulting in severe pain, swelling, bruising, and functional impairment. Grade 4 tears typically require comprehensive rehabilitation, which may include surgical intervention to repair the damaged tissues and restore function.


Effective Physiotherapy Management Strategies:

  1. Immediate Medical Attention: Seek immediate medical evaluation and intervention from a healthcare professional, such as an orthopaedic specialist or sports physician, to assess the extent of the injury and determine the most appropriate course of treatment. Diagnostic imaging, such as MRI, may be necessary to confirm the diagnosis and evaluate the severity of tissue damage.

  2. Rest and Protection: In the acute phase of injury, prioritise rest and protection of the injured leg to prevent further damage and facilitate tissue healing. Use crutches or a knee immobiliser to offload weight from the injured leg and minimise stress on the healing tissues. Avoid weight-bearing activities or active movement until cleared by a healthcare professional.

  3. Pain Management and Inflammation Control: Employ a combination of pain-relieving modalities, such as ice therapy, compression, and elevation, to alleviate pain, reduce swelling, and promote tissue healing. Apply ice packs to the affected area for 15-20 minutes every 2-3 hours, use compression bandages or wraps to minimise swelling, and elevate the injured leg above heart level whenever possible to facilitate drainage of excess fluid.

  4. Gradual Rehabilitation and Progressive Loading: As pain and swelling subside, initiate a structured rehabilitation program focused on restoring strength, flexibility, and functional movement patterns. Begin with a gentle range of motion exercises, such as passive stretching and active-assisted movements, to improve flexibility and prevent stiffness in the hamstring muscles. Progress to progressive loading exercises, such as eccentric and concentric strengthening, to rebuild muscle strength and endurance gradually.

  5. Strengthening Exercises: Incorporate targeted strengthening exercises to rebuild muscle strength and stability in the hamstring muscles. Focus on eccentric exercises, such as Nordic hamstring curls and single-leg deadlifts, to eccentrically load the muscle fibres and promote tissue remodelling. Gradually introduce concentric exercises, such as hamstring curls and bridging variations, to improve dynamic strength and functional capacity.

  6. Stretching and Flexibility: Implement regular stretching exercises to improve flexibility, reduce muscle tightness, and prevent scar tissue formation in the hamstring muscles. Perform static stretches targeting the hamstrings, quadriceps, and hip flexors, holding each stretch for 20-30 seconds and repeating several times. Incorporate dynamic stretching and mobility drills to enhance range of motion and prepare the muscles for functional activities and sports-specific movements.

  7. Core and Hip Stability Training: Address any underlying muscle imbalances or weaknesses that may predispose to hamstring injury by incorporating core and hip stability exercises into the rehabilitation program. Strengthening the core muscles, glutes, and hip abductors can improve pelvic stability, reduce excessive strain on the hamstrings, and enhance overall lower limb biomechanics. Examples include plank variations, side-lying leg lifts, and clamshell exercises.

  8. Functional Rehabilitation and Return to Activity: Progressively integrate functional rehabilitation exercises that mimic real-life movements and activities to prepare for a safe return to sport or activity. Emphasise exercises that challenge balance, coordination, and proprioception, such as single-leg squats, lateral lunges, and agility drills. Gradually increase the intensity, duration, and complexity of activities while monitoring for any signs of pain or instability.


Managing a Grade 4 hamstring tear with physiotherapy requires a comprehensive and individualised approach tailored to the specific needs and circumstances of each individual. While the road to recovery may be long and challenging, with dedication, patience, and perseverance, individuals can overcome a Grade 4 hamstring tear and regain function and mobility. 


At Urban Physiotherapy, our experienced team is dedicated to providing personalised care to manage severe injuries like Grade 4 hamstring tears. Contact us today to discover how our tailored treatment plans can support your recovery journey.


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