Hamstring Injuries - What to Know

Your hamstring is a group of three muscles: the biceps femoris, semimembranosus, and semitendinosus. These muscles stretch along the back of your thigh from the lower pelvis to just below the knee. They help bend your knee and extend your leg behind you. When they are injured, even simple activities can become challenging and painful. Hamstring strains and tears are one of the most seen sports injuries, especially in activities that involve sprinting, quick changes of direction, or explosive movements. They happen at a rate of 5.6 injuries for every 1,000 hours of training. Most strains occur where the muscle connects to the tendon. Of the three hamstring muscles, the biceps femoris is injured most often. Symptoms of an injury include a sudden sharp pain in the back of the thigh, swelling, bruising and difficulty walking or running. A complete tear near the top of the tendon is rare, but it can cause more severe pain and weakness. It is important to see a physician when hamstring pain occurs.

What Causes a Hamstring Injury

A strain or tear in your hamstring often occurs due to muscle overload, poor stretching, and muscle imbalances. The injuries occur when the individual is in an eccentric load, and the knee is in extension. In other words, the muscle is actively lengthening under tension while resisting a force. This position is commonly seen in activities such as water skiing, jet skiing, sprinting, tennis, volleyball, martial arts, horseback riding or falling. Hamstring injuries can also be observed in individuals who play sports that involve sprinting with sudden stops and starts, including soccer, basketball and football.

Types of Hamstring Injuries

There are four common hamstring injuries, including:

• Type 1: Ischial tuberosity fracture (more commonly seen in children)
• Type 2: Muscle-tendon junction injury
• Type 3: Incomplete tear
• Type 4: Complete tear with minimal displacement

Signs and Symptoms of an Acute Rupture

The main symptoms commonly seen in an acute rupture include a sudden, painful “pop” in the back of the thigh. Significant bruising and swelling will follow within 3-4 days. You will feel as though you cannot control your leg as well as before. In chronic cases, individuals will have recurring cramping, weakness, or occasional nerve-related pain.

Partial Hamstring Ruptures

Partial ruptures often occur without a single, memorable, traumatic event. This injury is commonly seen in active women aged 50-65, caused by activity that is beyond the healing capacity of the aging degenerative tendon. You will feel pain while sitting in the upper thigh/buttocks area with occasional radiation down the back of your leg.

Imaging and Diagnosis

An MRI scan can show a complete tear of the hamstring’s origin point, along with swelling, bleeding, muscle retraction and scarring in chronic cases.

“Hamstring injuries have long been thought of a simple muscle strain injuries that always heal. As we’ve learned more about the spectrum of hamstring injuries, we’ve come to understand that injuries to the attended insertion of the hamstring muscles can occur with a higher frequency than previously known. These injuries don’t always recover on their own and occasionally require more demanding treatment, including surgical repair,” says Dr. Peter Sallay, an orthopedic surgeon at Forté Sports Medicine and Orthopedics.

Surgical Options

Surgery is recommended for individuals with complete or severe tears. There are different incision approaches depending on the patient and their injury. Your surgeon will ensure that your sciatic nerve is located and protected. Your tendon will be reattached to the bone with suture anchors, with distal muscle lengthening in some chronic cases. An Achilles tendon graft can be used for severe chronic cases. It is important to talk with your physician to determine whether surgery is the right option for you.

Contact Us Today

At Forté Sports Medicine and Orthopedics, more than 90% of patients regain function after a hamstring injury, and 75-90% return to play. Our orthopedic surgeons and physical therapists specialize in creating personalized treatment plans designed to meet your unique needs. Contact us today to start your journey back to pain-free movement.

"Healthcare - it's like any other business," says Dr. Peter Sallay, Orthopedic Surgeon specializing in the knee and shoulder with Forté Sports Medicine and Orthopedics. "The bigger the entity that controls the decision-making, and the more removed that entity is from the person those decisions are affecting, the less involved with the care the owners are going to be. An independent practice is a more efficient and patient-centric way of practicing medicine.”

Forté has been an independent practice since inception, nearly 40 years ago, explains CEO Marty Rosenberg. Starting as three solo practices, Forté became a group practice when these three founding surgeons joined forces to form a Sports Medicine group.  Following the expansion with other orthopedic groups and growth, Forté morphed into a large comprehensive orthopedic group covering central Indiana. All of the owners are surgeon partners of the group. "What that means," Rosenberg emphasizes, "is that our doctors truly have control to decide the best treatment for our patients."

There are a lot of sacrifices physicians in independent practices make – not only is quality time spent with patients, it also takes time to run the business. It's like having two full-time jobs. “As CEO,” says Rosenberg, “I work side by side with the doctors. This way, we have a deep content knowledge on the business side of medicine, as well as of orthopedic surgery. This combination of unique skill sets brings our practice to a high level that’s respected on all counts."

Dr. Sallay agrees. "In our own practice," he says, "I can direct care in a way that is most efficient and in the best interest of the patient. I’m not told whom to hire. I don’t have to ask permission to make a change I think will improve care for the patient. If we have someone who isn’t providing the type of care we want, we have the ability to change personnel. Because there are fewer hands involved in your care, fewer mistakes are made."

It's a mindset, says Rosenberg - taking care of patients as owner and physician.