Proximal Hamstring Tears
The hamstring muscles originate at the ischial tuberosity — the bony prominence of the pelvis you sit on — through a shared tendon called the proximal hamstring tendon. When this tendon is partially or completely torn from its attachment, it causes significant pain, bruising, and functional impairment. Proximal hamstring tears are particularly common in water skiers, sprinters, and individuals who sustain sudden forceful hip flexion with the knee extended.
Symptoms
The classic presentation is sudden, severe pain in the buttock or upper thigh, often accompanied by an audible or palpable pop at the moment of injury. Significant bruising typically appears in the posterior thigh within 24 to 48 hours. Patients report difficulty walking, climbing stairs, or sitting comfortably. Weakness during hip extension and knee flexion activities is prominent.
Diagnosis
Dr. Cooper evaluates proximal hamstring tears with a targeted physical exam assessing strength, tenderness at the ischial tuberosity, and the presence of a palpable gap in the tendon. MRI is the gold-standard imaging study, precisely characterizing the number of tendons involved, the degree of retraction, and the condition of the remaining tissue.
Treatment
Treatment depends on injury severity. Partial tears with minimal retraction can often be managed non-operatively with a structured physical therapy program emphasizing progressive loading of the tendon during the healing process. Complete tears — particularly those involving all three hamstring tendons — benefit significantly from surgical repair, especially in active patients. Chronic tears with significant tendon retraction require more complex surgical reconstruction.
Dr. Cooper performs proximal hamstring repair through a minimally invasive posterior approach, reattaching the torn tendon to the ischial tuberosity with suture anchors. Early surgical intervention (within four to six weeks of injury) yields the best outcomes, as the tendon becomes increasingly retracted and scarred over time.
Recovery
Following surgical repair, patients avoid sitting on the operative side and limit hip flexion for several weeks to protect the repair. Physical therapy progresses through a careful loading protocol over six to nine months. Most patients return to recreational sport within six to nine months, with full return to competitive sport and heavy manual labor typically occurring between nine and twelve months.
