Treatment of Complete Hamstring Muscle Tears

Hamstring muscle injuries are common, especially in athletes. Most often, hamstring muscle injuries are partial tears of the muscle. These types of injuries, called muscle strains, occur when the fibers that make up the muscle are stretched beyond their normal limits. Symptoms of a hamstring muscle strain can include pain, bruising, swelling, and difficulty with certain movements, particularly athletic activities.

Sometimes, the injury to the hamstring is more severe. Complete tears of the hamstring typically occur when the tendon is torn away from the pelvis at the top of the muscle. When the tear is incomplete, the hamstring muscle is simply stretched too far, but not completely detached. When these tears become complete, the injury is more significant, and the ends of the muscle are no longer connected.

These complete tears need to be recognized as different injuries. While typical hamstring strains can be treated with simple steps (rest, ice, anti-inflammatory medications, therapeutic activities), complete tears of the hamstring may require more invasive treatments.

How Tears Occur

A complete hamstring tear typically occurs when there is a sudden flexion of the hip joint and extension of the knee joint. When the hamstring muscle contracts in this position, it can be stretched beyond its limits.

People who sustain this type of injury typically describe a sharp stabbing in the back of the thigh, as if they have been shot in the upper thigh. The injury may occur in a high-level athlete or a middle-aged individual—not every person who sustains a complete hamstring injury is an elite athlete.

Symptoms

People who sustain this injury typically experience a sudden sharp pain. The pain level can be quite significant, and it is typically difficult to walk following the injury. Some of the common signs of a complete tear of the hamstring include:

• Sharp pain at the junction of the buttock and thigh
• Difficulty walking
• Spasm and cramping sensations in the back of the thigh
• Swelling and bruising in the back of the thigh; later, the bruising travels further down the leg
• Weakness in the leg, particularly with bending the knee or lifting the leg behind the body
• Numbness in the leg as a result of sciatic nerve irritation

The symptoms may be difficult to see in the earlier stages, but following a complete hamstring tear there is usually significant swelling and bruising that develops in the back of the thigh. Over time, this bruising will migrate down to the back of the knee and calf and possibly into the foot. Sitting can often be difficult, since the edge of a chair will place pressure directly on the site of the injury.

Diagnosis

An X-ray of the hip or thigh is typically obtained. In some situations, a fragment of bone will be pulled off the pelvis along with the attachment of the hamstring muscle. More commonly, X-rays are normal. MRI testing can be performed to evaluate the attachment of the hamstring. The MRI can define critical features of a complete hamstring muscle tear, including:

1. The number of hamstring tendons involved
2. Complete versus incomplete tearing
3. The amount of retraction (how far pulled back the tendons have become)

These are the features that will guide treatment of the injury.

Treatment

The treatment of a complete tear of the hamstring will depend on several different factors. As mentioned above, the MRI can give valuable information about the severity of the injury, and these factors can help guide treatment. The other variable is the patient and their expectations. Treatment is generally more aggressive in younger, high-level athletes. Treatment is typically less aggressive in people who are more sedentary.

Most often, a single hamstring tendon tear can be treated nonsurgically. When only one tendon is involved, it is typically not pulled back very far from its normal attachment and will scar into a good position. On the other hand, when three tendons have been torn, they are typically pulled more than a few centimeters away from the bone, and often these patients will do best with a surgical repair of the tendons.

There is also a controversial middle ground when two tendons are torn. Most surgeons will use patient characteristics (high-level athlete or more sedentary individual?) to guide their treatment recommendations.

Rehabilitation

Rehab following surgery takes about 3-6 months or longer before athletes can return to sports. The first six weeks are confined to limited weight-bearing with the use of crutches. Patients may wear a brace to limit the amount of tension on the repaired hamstring tendons.

Following that early phase of rehabilitation, people will gradually increase the range of motion. Significant strengthening will not begin until at least three months postoperatively, and even light jogging activities are typically delayed beyond that.

While full recovery from a complete hamstring muscle injury can take time, numerous studies have shown even high-level athletes are able to resume competitive sports after undergoing repair of an acute hamstring muscle injury.

Delayed surgical treatment may not always lead to an optimal result. Once the tendon is torn away from its normal attachment, it will begin to scar down to the surrounding soft tissues. When there is a delay of more than a few weeks following the initial injury, regaining the full length of the tendon and muscle can be difficult. This may delay the rehab progression and may also limit the potential for full recovery.

Because of this long recovery timeline, some individuals who were not previously athletic may choose nonsurgical treatment. However, sometimes these people experience symptoms of discomfort from sitting in certain positions, and they may exhibit long-term weakness of the hamstring muscle.

A Word From Verywell

Complete tears of the hamstring muscle are unusual injuries, but they can occur in both athletes and non-athletes. Determining the optimal treatment depends on a number of factors, including the severity of the tendon tear and the expectations of the individual who sustained the injury. With more severe injuries, there is a better chance of full recovery with surgical repair, but this does entail a long recovery and a significant commitment to postoperative rehabilitation.