Hamstring Tears

The hamstring muscles are a group of three large, powerful muscles that run from the pelvis down the back of the thigh. They help with hip extension and knee flexion, which is why they are commonly strained in patients that run.

Hamstring muscle strains, or “pulled” hamstrings, are extremely common sports injuries, and occur when one or more of the muscles that runs down the back of the thigh gets stretched and starts to tear. These muscle injuries can be extremely painful and can be slow to heal. Hamstring strains can vary in severity, ranging from mild to severe.

• Grade I: These are mild strains and occur when the muscle is stretched but not torn. This can cause swelling and tenderness along the back of the thigh.
• Grade II: These are moderate strains and occur when the muscle is partially torn. Symptoms can include pain in the back of the thigh, difficulty walking, pain with bending the knee, and hamstring weakness.
• Grade III: These are severe strains and occur when the muscle/tendon is completely torn. Symptoms can include sudden severe pain in the back of the thigh, pain with sitting, muscle spasms and posterior thigh cramping, bruising down the back of the leg to the knee, hamstring weakness, pain with bending the knee, difficulty walking, and sometimes numbness/tingling down the back of the leg. Patients with these symptoms should seek urgent medical examination by an experienced orthopedic specialist like Dr. Stephanie Boden.

Hamstring muscle tears occur with stretching of the hamstring muscle fibers and are almost always treated without surgery. Muscles have a good blood supply, which can cause bleeding and bruising, but this is what allows them to heal on their own. The hamstring tendon is the band of tissue that connects the hamstring muscle to bone. Hamstring tendon tears occur when one or more of the three hamstring tendons are forcefully ripped and can tear completely off the bone, or through the tendon itself. Tendon tears tend not to heal on their own and may require surgery to fix depending on the extent of the tear.

Accurate diagnosis of hamstring tears involves a thorough evaluation by an experienced orthopedic specialist like Dr. Stephanie Boden. She will begin by discussing any history of prior hamstring injuries, which has been shown to put athletes at risk for future hamstring injuries. She will ask about the circumstances surrounding the pain, including the type of activities associated with pain, the mechanism of injury, and the onset and duration of symptoms.

Dr. Boden will provide a thorough physical exam of the hip and thigh assessing for swelling, bruising, tenderness, range of motion, and signs of tendon injury. She will order imaging studies including:

• X-rays: to help assess for bony injuries and fractures that may be associated with hamstring tears.
• MRI scan: to get a detailed image of the soft tissues of the hip, confirm the suspected diagnosis, evaluate severity of the hamstring injury, assess for any tendon retraction, and evaluate for any other associated injuries.

Early Diagnosis Matters

Prompt diagnosis and treatment of a hamstring tears is essential to preventing further injury and ensuring optimal recovery.

The treatment of hamstring tendon tears depends on the severity of the tear and patient-specific factors including age and activity level.

Nonoperative Management

Partial hamstring tendon tears, and one or two tendon tears can often be treated without surgery. In the first few weeks after injury this involves modified activities and RICE (rest, ice, compression, and elevation) to help reduce swelling and pain. Physical therapy focused on gentle stretching and strengthening exercises is started after the initial healing phase. Over time, patients will work with physical therapists to progress back to their desired activities.

Surgical Management

In rare instances, surgery may be needed to repair the torn tendon back to bone. Surgery is generally reserved for young active patients with complete 3-tendon tears.