Sport Injury Series: Hamstring Injury Q & A

With summer on our doorstep, we are becoming more active and prone to sports injuries. Our Q&A series will cover the more common sports injuries, how to prevent them or treat them.

Mr Gurdeep Biring, Consultant Orthopaedic and Trauma Surgeon at BMI The Chiltern Hospital and BMI The Shelburne Hospital, offers his insights on a rather common sports injury: the hamstring injury. Mr Biring explains how we can injur this area, what are the treatment options and the recovery. You can also read about Mr Biring's advice about groin strains.

What is the injury?

Hamstring injuries are common in athletic population is and can affect all levels of athletes. The hamstrings are a group of muscles on the back of your thigh which originate from the ischial tuberosity (the bone in the buttock that you sit on). The muscles include the semimembranosus, semitendinosus and biceps femoris. Typically there is a history of a traumatic event with forced hip flexion and the knee in extension. Any sporting activity requiring rapid acceleration and deceleration can also cause these injuries. Grades of injury include:

  • Grade 1: a mild strain, with few muscle fibers being torn
  • Grade 2: a moderate strain, with a definite loss in strength
  • Grade 3: a complete tear of the hamstrings

What are the symptoms?

Athletes typically describe a popping or tearing sensation with associated pain and bruising over the posterior buttock. Patients also get pain at the back of the thigh and lower buttock when walking, straightening the leg or bending over. There is hamstring tenderness and bruising. Patients may experience sciatica type pain due to irritation of the sciatic nerve.

What tests are required for diagnosis?

Plain x-rays exclude fractures. The gold standard test is an MRI scan which allows for an accurate measurement of the amount of tendon damaged and the degree of tendon retraction after rupture.

What treatment is required?

Non-operative treatment is commonly recommended in the setting of partial tears. Initial treatment consists of active rest, non-steroidal anti-inflammatory drugs and a physical therapy program consisting of a gentle hamstring stretching and strengthening program. Injections of platelet rich plasma (PRP) can also help the healing process in selected cases. Patients with failure of non-operative treatment may benefit from surgical repair.

When do you require surgical treatment?

Failed non-operative treatment or if the hamstring tendons are retracted more than 2 cm with persistent pain. Early intervention should be considered before the torn tendon sticks to the sciatic nerve and makes operative intervention harder.

How long will it take to recover?

If treated conservatively recovery should occur up to 6 weeks. If surgical intervention is required then the patients are placed in a brace restricting knee extension. Patient's walk on crutches with toe-touch weight-bearing for 2 weeks and then full weight-bearing by 4- 6 weeks. The brace is removed at 6-8 weeks. Hamstring strengthening can begin at 6-10 weeks, and dry land and sport specific training are initiated at 12 weeks. Full return to sports typically between occurs 5-8 months.