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Proximal Hamstring Tear

What is a hamstring muscle?

The hamstring muscles (x 3) are large muscles that run down the back of the thigh from the pelvis, cross over the knee and attach at the upper end of the shin bones. The muscles are attached by tendons to the bones. These muscles allow us to extend the knee. The hamstrings are balanced by the quadriceps muscles on the front of the thighs. The power and stability of the knees are controlled by these muscle groups.

Hamstring tears are common injuries due to overloading and overuse. A muscle strain, or pulled hamstring, stretches the muscle fibers and/or the tendon. The injury can range from a mild strain to a partial or a complete rupture (tear). On occasion, the tendon can pull a piece of bone with it when the tendon tears, which is called an avulsion injury. Avulsion injuries occur from a burst of speed seen in ice skating, weightlifting, and waterskiing.

A proximal hamstring tear involves tearing of one or more of the hamstring tendons from their attachment to the ischial tuberosity, located deep in the gluteal fold, near the buttocks. Injuries to the hamstring are generally acute in nature; more common in athletes involved in soccer, baseball, gymnastics, and waterskiing. Proximal hamstring tears may cause persistent pain located in the gluteal fold or buttock with prolonged sitting. They may also cause weakness, limping, and possible sciatica like symptoms given its proximity to this nerve.

Muscle overload is the main cause of a hamstring tear. Risk factors include muscle tightness, muscle imbalance (the quadriceps are stronger than the hamstrings), poor conditioning, muscle fatigue and sports that involve lunging, sprinting, running, and jumping such as in tennis, track, soccer, football and basketball. A sudden jump, stretch, lunge or impact can tear the muscle. However, the muscle can be strained or torn simply by running, kicking and walking down stairs.

The most common site for a muscle tear is the middle of the hamstring muscle. A mild strain may feel like an ache or pull with pain that worsens with activity and gradually improves with rest, regenerative medicine injections such platelet-rich plasma or stem-cell injections and physical therapy.

Grades 2 and 3 symptoms include:

  • A sharp pain in the back of the thigh near the sit-bone of the buttocks
  • Difficulty putting weight on the injured leg causing limping
  • Swelling
  • Bluish bruising and discoloration
  • Hamstring weakness
  • Muscle spasms
  • Some people hear a “pop” when the muscle is injured
  • Sciatica

The expert team at LALL Orthopedics + will review your medical history and ask you about the circumstances surrounding your injury. They will conduct a physical examination checking for bruising, pain, weakness and swelling. If the tendon has pulled away from the bone, the muscle will appear balled up at the back of the thigh. Imaging tests will confirm the diagnosis. X-rays will reveal an avulsion, if one exists, when the tendon tears a piece of bone away with it. An MRI will provide detailed images of the muscle and tendon retraction.

Some hamstring and tendon injuries can heal without surgery. Mild injuries tend to heal well. Severe hamstring injuries tend to be debilitating and often require surgical management. The goal is to restore function and prevent scarring of the muscle.

Conservative treatment involves rest, ice, compression, and elevation, anti-inflammatory medications, regenerative medicine injections such platelet-rich plasma (PRP) or Stem-Cell injections and activity modifications. In addition, physical therapy may be recommended to improve range of motion and strength. Healing should occur within 6-8 weeks.

Treatment for a severe tear may include surgery to directly visualize and repair the torn muscle, tendon, or bone. Gentle early stretching and range of motion followed by focused sports specific physical therapy exercises are an important part of the rehabilitation process. Patients treated in a timely fashion (1-3 weeks since injury) have been shown to have excellent outcomes following treatment from expert level of care.

Dr. Ajay C. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified and triple fellowship-trained hip surgeon. Dr. Lall and the team at LALL Orthopedics + specializes in diagnosing and treating hamstring tears. Schedule a hip consultation today.

LALL Orthopedics + has offices in Paramus, NJ, Philadelphia, PA and Belvidere, IL. Our team regularly sees patients from Bergen County, Hackensack, and Morristown, NJ.

At a Glance

Ajay C. Lall, MD, MS, FAAOS

  • Board Certified – Orthopedic Surgery
  • Triple Fellowship Trained
  • Performs over 750 Surgeries Per Year
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