Date of Graduation


Document Type


Degree Type



College of Physical Activity and Sport Sciences


Athletic Training

Committee Chair

Michelle Sandrey.


Context: Hamstring strains, primarily grade one and two strains, are represented in the literature. However, there is contradicting evidence-based research for rehabilitation of the hamstring as well as limited evidence-based research for preventing de-conditioning of the entire body during the rehabilitation process. Objective: This study combined evidence-based practice and the best clinical experienced to: 1) design a complete program to rehabilitate the hamstring complex and prevent de-conditioning of the entire body with involvement of hamstring researchers, strength and conditioning and athletic training professions; and 2) determine the inclusion of concepts and components of a Five Phase Recovery Process incorporated in the hamstring complex rehabilitation program specifically for National Collegiate Athletic Association Division I Football athletes. Design: Survey study was modeled after the Modified Delphi Technique, using two rounds of questionnaire. Setting: This study took place at West Virginia University; Morgantown, West Virginia. Patients or Other Participants: Of seventy-three potential candidates contacted, the panel consisted of three Athletic Trainers employed with Division I football for more than five year, as well as, one Hamstring Researcher, who had more than five presentations and publications in the area of hamstring injury, rehabilitation or strength training. For the Second Round questionnaire, there were two dropouts. The panel concluded with one Athletic Trainer and one Hamstring Researcher. To qualify for the panel, an athletic trainer and strength specialist must have worked with a Division I Football team for five or more years, and the researcher must have five or more presentations and/or publications in the area of hamstring injury, rehabilitation, or strength training. Interventions: The information was acquired through the Modified Delphi Technique through two rounds of a questionnaire that formulated a consensus on what components and concepts were included in a complete hamstring complex rehabilitation program for Division I football athletes. The qualified panel of experts derived a consensus of 75% choosing strongly agree or agree with a mean score of 4 or more on components and concepts within specified categories: baseline, contraindications, flexibility focus, range of motion/strength with ATC, core exercise focus, strength and conditioning with SS, and progression to the next Phase. The categories were based on a 5-Phase program following the Recovery Process of the athlete and their interaction and involvement with the Athletic Trainer. The responses were deemed significant through the use of the Likert scale, with available opportunity for panelists to comment further on the specifics of the questionnaire over the course of two rounds. The First Round questionnaire provided the initial rating on related components and concepts on the hamstring complex. The second questionnaire displayed the percentages of panelistsf responses as well as additional comments allowing them an opportunity to critique and refine group consensus. The Second Round responses were used to develop the complete hamstring complex rehabilitation program. Cover letters and follow-up cover letters were sent electronically via to encourage participation for the two rounds. Main Outcomes Measures: Responses from the participants using the Modified Delphi Method: baseline, contraindications, flexibility focus, range of motion/strength with ATC, core strengthening, strength and conditioning with Strength Specialist, and progression to the next phase. Results: The First Round questionnaire included 223 rehabilitation components and concepts from best clinical practice and evidence--]based research. Prior to the Second Round questionnaire, the expert panel provided an additional twenty--]one concepts for evaluation. After the completion of the Second Round questionnaire with additional concepts included, 126 rehabilitation components and concepts met consensus and were included to design the final complete hamstring complex rehabilitation program. Conclusion: The responses from the Second Round by the qualified panel of experts designed the Complete Hamstring Complex Rehabilitation Program specifically for NCAA Division I football athletes. Although there was a dropout of two participants between rounds and no representation of strength specialists on the panel, this rehabilitation program can be utilized as a guideline for clinicians and strength specialists dealing with hamstring injuries throughout the football season. Future research is required for further design and development of the complete Hamstring Complex Rehabilitation Program for NCAA Division I football athletes with the inclusion of strength and conditioning specialists on the panel of experts.