The hamstring assists the body in movements and functions such as bending the knee and straightening and rotating the leg. In athletes, these actions occur much more frequently than in the general public. Four muscles on the back of the thigh make up the hamstrings, and a tendon attaches each muscle to the bone. Three hamstring tendons are at the proximal end (toward the buttock) and originate at the rear of the pelvis.
A pull or tear of the hamstring can occur when the tendons connecting the hamstring to the bone get stretched too far or take on too much force.
A proximal hamstring tear is a debilitating injury that must be surgically operated on to heal. The name refers to tearing one or more of the hamstring tendons at the top of the thigh. It’s a common sports injury, particularly for soccer, baseball, and gymnastics athletes. A torn proximal hamstring can cause pain, weakness, and limping.
Complete hamstring tears most often require surgery. Surgery is favored for active persons and athletes and improves return-to-spot rates. Thankfully, operations for proximal hamstring tears often result in pain reduction. If necessary, a surgeon and physical therapist will assist you in creating a “return to sport” plan for athletes. The earlier intervention happens, surgical or otherwise, the sooner an athlete can return to sport. If left unchecked, the results can be catastrophic.
Non-Operative Treatment
Not all proximal hamstring tears require surgical intervention right away. It’s possible to heal and recover more naturally. Taking over-the-counter anti-inflammatory pain medication and getting rest can allow all the proper healing to occur. Physical therapy can help to strengthen the hip muscles and relieve pain.
A single-tendon rupture that has only retracted one or two centimeters can heal with conservative treatment. A partial tear can also be treated with an ultrasound-guided cortisone injection. For athletes, return-to-play will need to be properly timed and discussed with your physician.
In some cases, a proximal hamstring tear can be repaired endoscopically with a minimally invasive procedure. Return to activity without surgery also depends on the location of the tear, the severity, and the type of activity the patient needs to perform.
After a few weeks, if sufficient conservative measures haven’t been enough to improve pain or motion, a referral for surgical intervention may become essential. Proximal hamstring tears usually require surgery.
Surgical Treatment
Surgery is generally recommended for acute, traumatic injuries and those for whom conservative measures have been unsuccessful. The repair of a proximal hamstring tear can sometimes be performed arthroscopically with a tiny camera and keyhole incision sites. In many instances, arthroscopic repair gives way to better visualization for the surgeon. An arthroscopic approach can significantly reduce recovery time. Larger, more complex cases will require an open surgical repair procedure allowing the surgeon to use stitches to reattach the tendons to the bone.
After surgery, it’s imperative to follow the discharge instructions provided by the surgeon. The following is an overview of what the suggestions might look like after you go through an operation:
1. 24 Hours Post-Op
· Remain in the hospital
· Try to reduce discomfort as much as possible
· Potentially wear a brace to prevent overstretching
2. First Week Post-Op
· Control pain
· Manage the swelling
· Decrease inflammation
· Allow scar to form
· Partial weight-bearing (25%) on crutches
· Perform core stability exercises
· Avoid sitting on repaired tendons
3. Two to Six Weeks Post-Op
· Begin driving short distances
· Engage hips in gentle bending exercises
· Do stationary bike aerobics if comfortable
· Progress toward normal weight-bearing
4. Six Weeks Post-Op
· Walk as comfort allows
· Build strength with resistance bands or exercises in the gym
· Slowly increase your pace from jogging to running
5. After Six Weeks
· Regain full motion in knee and hip
· Fully resume running
· Begin sprinting and change of direction activities
Proximal Hamstring Repair Recovery Time
Generally, athletes can expect to return to sports anywhere between 16-29 weeks after surgery, depending on when they received the surgery in relation to the injury and the unique demands of their sport.
The number one thing you can do is to be proactive and prevent injury to the best of your abilities. A balanced conditioning program that emphasizes flexibility, strength training, and neuromuscular control is the best way to avoid hamstring tears.
Recovery after surgery involves up to six weeks of reduced activity and weight-bearing. Physical therapy will also be essential for regaining strength, conditioning the hamstring muscles, and restoring hip function.
Mild irritation may occur when returning to regular activity after surgery due to scar tissue breaking up as the tendons adjust to increased movement.
Unfortunately, hamstring injuries present a high recurrence rate, so it’s important to implement preventative measures when possible. Talk to a provider immediately if you have sudden or severe pain.
Get in touch with the American Hip Institute & Orthopedic Specialists for treatment options regarding your proximal hamstring tear.
