Hamstring Tears

The hamstring muscles are located at the back of the thigh and play a key role in walking, running, and bending the knee. A hamstring tear is an injury to one or more of these muscles or their tendons, and it can range from a mild strain to a complete rupture.

Hamstring injuries are common in sports and activities that involve sprinting, sudden acceleration, or overstretching the leg. Understanding the basics of hamstring tears can help you recognize symptoms early and explore treatment options.

Hamstring Anatomy

The hamstrings are a group of three muscles at the back of the thigh:

• Biceps femoris

• Semitendinosus

• Semimembranosus

These muscles start at the ischial tuberosity (sit bone of the pelvis) and extend down to the bones of the lower leg. They work together to:

• Bend (flex) the knee

• Extend the hip

• Help stabilize the pelvis during movement

The tendons near the hip are especially important and, when injured, can lead to significant pain and weakness.

Types of Hamstring Injuries

Hamstring tears can be classified based on severity and location:

• Muscle strain or partial tear: Damage to some muscle fibers, often due to overstretching or overload.

• Complete muscle tear: Full-thickness tear of the muscle belly.

• Proximal hamstring avulsion: Complete tear of the tendon from its attachment at the pelvis, sometimes with retraction of the tendon away from the bone.

Proximal avulsions are more severe and may require surgical repair, especially in active patients or those with significant tendon retraction.

Causes of Hamstring Tears

Common mechanisms of injury include:

• Sudden acceleration or sprinting

• Quick change of direction

• Overstretching the leg, such as during a slip or fall

• Direct trauma to the back of the thigh

Athletes in sports like soccer, track, football, and water skiing are particularly at risk.

Symptoms of a Hamstring Tear

Typical symptoms include:

• Sudden, sharp pain in the back of the thigh

• Swelling or bruising

• Weakness when bending the knee or extending the hip

• Tenderness at the site of injury

• In severe cases, a palpable gap or "balling up" of the muscle

For proximal avulsion injuries, patients often report difficulty walking or sitting due to pain near the sit bone.

Diagnosis

Diagnosis includes:

• Physical examination: Assessing tenderness, strength, and range of motion.

• Imaging studies: MRI is the most accurate way to determine the severity of the tear and whether the tendon has retracted.

Accurate diagnosis is important to guide appropriate treatment.

Treatment Options

Treatment depends on the severity of the tear and patient activity level.

• Non-Surgical Treatment:

  • Rest and activity modification

  • Physical therapy focused on gradual stretching and strengthening

  • Pain management, including anti-inflammatory medications

  • Gradual return to activity over several weeks to months

• Surgical Treatment:

  • Reserved for complete tears, especially proximal hamstring avulsions, or cases with significant weakness or tendon retraction.

  • Involves reattaching the tendon to the bone using strong sutures and anchors.

  • Surgery aims to restore strength, reduce pain, and improve function, particularly for active individuals.

Recovery and Outlook

• Non-Surgical:
  Recovery varies based on severity but generally takes several weeks to a few months with physical therapy.

• Surgical:
  After proximal hamstring repair:

  • Protected weight-bearing and limited hip motion early in recovery

  • Physical therapy to gradually restore range of motion and strength

  • Return to sports and high-level activities typically occurs between 4–6 months, depending on progress

Rehabilitation and adherence to post-operative protocols are key to a successful recovery.

Conclusion

Hamstring tears are a common and potentially serious injury, particularly in active individuals. Early diagnosis and proper treatment are important to restore strength, prevent long-term weakness, and return to your desired activities.

If you are experiencing pain in the back of your thigh or difficulty with walking or activity, contact our office for a full evaluation and personalized care plan.