Proximal Hamstring Tears
A proximal hamstring tear is an injury where one or more of the hamstring tendons are torn from their attachment at the top of the thigh bone (ischial tuberosity), just below the buttock.
Causes
Proximal hamstring tears often occur during:
- Sudden acceleration or sprinting
- Slipping into a “splits” position or overstretching the leg forward
- Sports that involve explosive movements such as water skiing, football, or running
- A direct fall or impact on the buttock
Risk increases with poor flexibility, fatigue, or previous hamstring injuries.
Anatomy
The hamstrings are a group of three muscles — biceps femoris, semitendinosus, and semimembranosus — that run along the back of the thigh. They start from the ischial tuberosity (the “sitting bones”) and extend down to the knee, helping to bend the knee and extend the hip. At their upper (proximal) end, these muscles are connected to the pelvis by strong tendons that can tear during sudden or forceful movements
Proximal Hamstring Tears
Symptoms
Typical symptoms include:
- A sudden sharp pain in the buttock or upper thigh
- Bruising and swelling that may extend down the leg
- Weakness when bending the knee or pushing off
- A visible gap or lump at the back of the thigh in complete tears
- Difficulty sitting comfortably due to pain under the buttock.
Diagnosis
Your doctor will examine the leg for bruising, swelling, and loss of strength.
Investigations may include:
- Ultrasound or MRI scans to confirm the tear and assess its size, severity, and degree of tendon retraction.Your doctor will examine the leg for bruising, swelling, and loss of strength.
- Investigations may include:
- Ultrasound or MRI scans to confirm the tear and assess its size, severity, and degree of tendon retraction.
Treatment
Treatment depends on whether the tear is partial or complete:
- Non-surgical management is suitable for partial tears and involves:
- Rest, ice, compression, and elevation (RICE)
- Gradual physiotherapy to restore flexibility and strength
- Avoiding high-speed activities until full recovery
- Surgical repair is usually recommended for:
- Complete avulsion injuries (when all tendons pull off the bone)
- Tears involving significant retraction (>2 cm) or in very active patients
- Surgery involves re-attaching the tendons to the bone using strong sutures and anchors.
Recovery
Non-surgical treatment may take 3–6 months, depending on the severity of the tear.
After surgery:
- Patients use crutches and a brace for the first few weeks to protect the repair.
- Physiotherapy begins early to restore motion and strength.
- Return to running or sport typically occurs around 6–9 months after surgery.
Possible Complications
While outcomes are generally excellent, possible complications include:
- Persistent weakness or tightness
- Numbness due to sciatic nerve irritation
- Re-tear or incomplete healing
- Ongoing discomfort when sitting
- Stiffness or scarring around the tendon.
When To Seek Help
Seek medical attention if you experience:
- A sudden sharp pain in the buttock or upper thigh
- Bruising, swelling, or weakness after a sporting injury
- Difficulty walking, running, or sitting comfortably.
