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A strained hamstring is more common for athletes than a torn hamstring, but tears can still occur with certain sports such as water skiing. When a patient tears their hamstring tendon from their origin off the pelvic bone, they often describe the sensation of being shot in the back of their thigh and buttock. They feel a pop and have immediate pain, swelling, bruising, and can only walk stiff-legged. Patients also describe a lot of pain with sitting.
When a patient comes to my office with a probable hamstring tear, I examine them first and then obtain an MRI scan. The MRI will show whether the patient has sustained a partial tear or a complete tear of their hamstring tendons off of the pelvic bone where they attach, which is your sit bone or ischial tuberosity.
Moreover, the MRI will show whether someone tore all 3 of their hamstring tendons or just one of them. The 3 hamstring tendons that originate off of the ischial tuberosity are called the semitendinosus, semimembranosus, and the long head of biceps femoris.
Surgery is not required if the patient partially tears their 3 tendons or if they completely tear just one of their hamstring tendons off the ischial tuberosity. Treatment for this type of injury consists of rest, ice, physical therapy, ultrasound, anti-inflammatory medications, gentle stretching, and a gradual return to athletic activity over approximately 4-6 weeks.
However, if someone tears all 3 tendons and they are pulled away more than an inch or so, surgery is recommended. Without surgery, patients can experience chronic pain and weakness in hip extension and knee flexion. They can also develop nerve pain in their leg if the torn hamstring tendons scar down to the nearby sciatic nerve and pull on it. Simple things such as sitting can continue to be painful if the tendons are not properly repaired. Therefore, it is best to diagnose and fix these tears early while the tendons can be easily mobilized and not scarred onto the sciatic nerve and surrounding tissues.
Surgery consists of making a transverse incision in the crease just below the buttock (which makes for a scar that is hardly noticeable), isolating the torn tendons, and suturing them back to the ischial tuberosity using suture anchors. Patients are on crutches with limited weight bearing initially, and also placed in a brace after surgery. Hip flexion is avoided to protect the tendon repair. Unfortunately, it can take up to 9 months to return to all sports.
As I mentioned before, fortunately it is much more common for athletes to strain their hamstrings rather than tear them. This usually results from an eccentric contraction. In other words, the muscle is contracting while the muscle fibers are being elongated. Think of catching a heavy object with your hand as it falls off a shelf. Your biceps muscle is suddenly contracting, but your elbow is straightening in an effort to catch the object, thus elongating the biceps muscle fibers.
Eccentric contractions place enormous stress on a muscle tendon unit and can tear it. Hamstring strains typically occur at the muscletendinous junction, or where the muscle fibers start to become tendon fibers. This is the weak link in any muscle tendon unit, whether it be your hamstrings or your biceps. Fortunately, these strains tend to heal uneventfully as they have good blood supply from the surrounding muscle tissue.