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Proximal Hamstring Tears


Anatomy of the hamstrings

The hamstrings are a group of three strong muscles that run down the back of the thigh.

  1. The semitendinosus muscle
  2. The semimembranosus muscle
  3. The biceps femoris muscle

Proximal Hamstring Tears


The hamstring muscles are attached to the pelvis bone and leg bones by tendons. Tendons are a fibrous connective tissue that attach all muscles to bones. All muscles have origin and insertion points, where their tendons attach muscle to bone.

In the pelvis, the hamstring originates at the bottom of pelvis on a bone called the ischial tuberosity, commonly referred to as the sit bone. As the name implies, the sit bone is located on the bottom back side of your buttocks. At this point, the (1) semitendinosus and (3) biceps femoris muscles blend together and share a common origin at the conjoint tendon. The (2) semimembranosus tendon has a separate origin just to the outside (lateral to) the conjoint tendon origin. The tendon origin is from a large area of bone called the “footprint.”

The hamstring muscles and tendons control critical everyday movement of the hip and knees, such as walking, running, jumping and even sitting. More precisely, the hamstring muscles contribute to hip extension and knee flexion.

Proximal hamstring sprains and tears

Proximal hamstring sprains and tears involve straining or tearing of one or more of the hamstring tendons from their attachment to the ischial tuberosity.

While the hamstrings and their tendons are very strong, they are in constant use, and therefore prone to injury. Proximal hamstring tears are among the most common sports-related injuries. Injuries to the hamstring are generally acute in nature. Meaning, the result of a specific impact or traumatic event. However, proximal hamstring sprains and tears can result from chronic wear and tear, particularly from activities that require repetitive motion.

What causes a proximal hamstring tear?

Acute Proximal Hamstring Tears – As mentioned above, most proximal hamstring tears occur from an acute traumatic event. The event being a sudden hip flexion or knee extension causing the hamstring to rapidly contract with so much force the tendon tears. An acute proximal hamstring tear is a rather dramatic event with patients describing the sensation of being shot in the posterior thigh, followed by difficulty walking. Tears are more common among athletes who take part in sports like snow skiing, water skiing, hurdles, soccer, basketball, gymnastics and track, and they can occur in runners and other athletes as well.

Chronic Proximal Hamstring Tendinopathy – Proximal hamstring tears can be the result of degeneration (wear and tear). Chronic proximal hamstring tendinopathy usually begins with one or more of the following conditions:

  • A previous tear of the tendon (an acute injury) that failed to properly heal
  • Chronic tendinitis, an inflammatory tendon condition that can lead to non-inflammatory, degenerative changes to the structure or composition of the tendon, thus weakening it and making it more susceptible to tear (called tendinosis or chronic tendinopathy)

What are the symptoms of a proximal hamstring tear?

Acute sharp pain in the upper posterior thigh, with an audible pop with activity. Other symptoms include:

  • deep buttock pain
  • pain with sitting
  • weakness and limping
  • difficulty controlling the leg
  • often accompanied by significant bruising in the posterior thigh

How is a proximal hamstring tear diagnosed?

Proximal hamstring tears are graded on the following scale:

  • Grade 1 – mild strain
  • Grade 2 – moderate partial tear
  • Grade 3 – total rupture (complete tear), also referred to as, proximal hamstring avulsions, where the tendon is ripped off the bone and can take a small portion of bone with it

A proximal hamstring tear is diagnosed through physical examination and imaging. A physical examination is often difficult to determine the exact nature of the injury due to the deep location of the hamstring muscle group. However, it will afford Dr. Cooper the ability to understand how the injury occurred, your level of pain, and your desired outcome. Through imaging, including X-rays, ultrasound, and magnetic resonance imaging (MRI), Dr. Cooper will have a full understanding of the injury and its severity.

How is a proximal hamstring tear treated?

Treatment is determined by the severity of your injury, your needs and goals.

Non-surgical Treatment

Non-surgical treatment consists of rest, ice, modalities, non-steroidal anti-inflammatory drugs (NSAIDs), gentle stretching, therapeutic exercise, and gradual return to athletic activity, over approximately 4 to 6 weeks. Dr. Cooper at DOCS Spine+Orthopedics guides a tailored physical therapy and rehabilitation program to help patients recover as quickly as possible from proximal hamstring injuries.

Surgical Repair

Then the tendon may be reattached to the pelvic bone (or more specifically, to the ischial tuberosity) using special suture-anchors designed to be used in bone. This procedure has a high success rate in treating pain and restoring strength to the hamstring muscles. If the proximal hamstring tear is too large or too retracted, a tendon graft may be used.

After surgical repair of a proximal hamstring tear

After surgery, your activity will be restricted for several weeks to allow the area to heal. You will use crutches and wear a hip brace to prevent strain on the muscle during the early stages of healing. Dr. Cooper may recommend treatment with platelet-rich plasma injections to accelerate healing. Rehabilitation will begin almost immediately to restore range of motion, strength and flexibility and take at least 6 months. A majority of patients recover full function after rehabilitation.

Dr. Joe Cooper is a preeminent orthopedic surgeon at the prestigious DOCS Spine+Orthopedics in Los Angeles California whose focus is on helping you get back to play and help you to prevent reinjury. Contact him to schedule a consultation. He welcomes national and international patients.

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