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Exercises and advice after hamstring lengthening surgery

This resource has been designed to help you remember the exercises and advice the therapist went through with you whilst in hospital.

The exercises should be done slowly and smoothly. Your child may have some discomfort whilst doing these exercises after surgery. If pain is limiting doing the exercises, then timing them around pain relief or muscle relaxant medication may be helpful. However, if pain becomes worse please seek advice from a healthcare professional and stop the exercises.

After muscle lengthening surgery it is important for the muscles to heal in their new lengthened position. In order for the surgery to be successful it is important to follow the daily program as instructed by your child’s therapist.

Passive hamstring stretch

Start lying your child on their back.

With one hand underneath their heel, place your other hand above the knee to make sure the hip and knee remains at a right angle.

Illustration of child laid on their back with someone holding their leg up bent at the hip and knee

Slowly straighten the leg with the toes moving upwards until resistance is felt. Hold this position for 15 to 20 seconds.

Illustration of child laid on their back with someone helping them straighten their leg at the hip, in the air

Return back to the starting position. Repeat 10 times on each operated leg.

Long sitting position

This can be on the floor, in bed or in the wheelchair. Your therapists will discuss which position is most appropriate for your child.

It is best to put the gaiters or braces on with your child lying on their back or in reclined sitting. Assist your child to sit up with their back against a supported surface and their legs out straight, or as straight as they can achieve. Make sure their back is supported to maintain an upright position. The more upright they are positioned the more of a stretch they will feel. If your child is unable to sit independently talk to your therapist about alternative ways to achieve this. Stay in this position for a minimum of 20 to 30 minutes and gradually increase duration each time.

Illustration of child sitting up with legs stretched out and gaiters on their leg

Knee bends

Start lying your child on their back or reclined sitting.

Support your child’s leg under their heel and at their knee. Bend their knee by moving the heel towards the bottom.

Illustration of child laid down with their knee up and their foot towards their bottom

Return to the starting position. Repeat 10 times.

Static quads (knee squashes)

For children who are able to, trying to strengthen their thigh muscles can help with tightness in the hamstring muscles that bend the knee.

Start lying on your back.

Push your knee down firmly against the bed. Keep your leg straight with your knee and toes pointing upwards. Hold for 5 seconds.

person laid on floor with one knee bent

Repeat 10 times.

How many times should I perform these exercises?

Exercises should be completed a minimum of 3 to 4 times a day and they should be staggered throughout the day. Any positive positions your child’s therapist has advised should be adopted whenever your child is resting. If your child is very active then you should ensure that they rest in the positive position for a minimum of 30 minutes 3 times a day and overnight.

What else can improve the outcome of my child’s  surgery?

Holding a positive position for a prolonged period of time helps increase muscle length. Sitting for long periods increases hamstring tightness therefore reducing sitting time or adapting your child’s sitting position will help.


After surgery your child will be given gaiters or braces to wear on their legs which hold the legs straight to achieve a positive position.

Keeping the legs straight allows the hamstring muscles to heal in their new lengthened position. It is recommended to wear the gaiters all the time, day and night for the first 2 weeks.

After 2 weeks they should be worn overnight and for a minimum of 1 hour of long sitting a day. After this period this can be reduced to wearing gaiters at night time only.

Do not put pillows under your child’s knees or use the bed function to allow them to bend their knees as this does not promote a positive position for healing.

Standing, walking and hydrotherapy

Children who are able to walk are encouraged to wear their gaiters when walking if safe to do so. Children who access a standing frame are encouraged to wear their gaiters when standing and they should start accessing their standing frame as soon as they can tolerate it. Once your child’s wounds have healed they can return to or start hydrotherapy and rebound therapy.

Illustration of child strapped into a standing frame to support their standing and walking

Managing pain

Your child may have increased pain or discomfort when wearing gaiters. Having appropriate pain and muscle relaxant medication can help manage this.

It is important to make sure there is no pressure damage by regularly checking the skin for redness or evidence of rubbing. Any red marks should disappear after 30 minutes of the gaiters being removed.

If marks do not disappear and pain continues discuss this with your child’s therapist. Increased tolerance and time wearing gaiters will increase the effectiveness of the surgery but issues around pain and skin integrity must be addressed.

What happens next?

We will contact your child’s local therapist to pass on any important information and ask them to see you at home or in school. Your therapist will review your child’s muscles length, exercises and positioning. It is important that you see your therapist once you leave the hospital so they can continue to help with your child’s exercises and rehabilitation. Your therapist can guide your child’s rehabilitation however it is your responsibility to make sure your child completes the necessary exercises. You should speak with your child’s therapist and school to make a plan for returning to school.

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

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