What is a hamstring tear?
A hamstring tear is an injury to one or more of the muscles in the posterior thigh. The main hamstring muscles are the semimembranosus, the semitendinosus and the two heads of the biceps femoris. They are important muscles in flexing the knee joint and extending the hip joint. They are important in running sports and according to a variety of datasets are the most commonly injured muscles in the athlete.
Our patient, a male ‘weekend warrior’ playing recreational football, in his late 30’s, presented with pain and bruising in his posterior thigh extending down to the back of his knee. He had never injured his hamstring before and reported a sudden pain and cramping sensation when sprinting after a through ball. He limped off and in the next 2-3 days noticed significant bruising behind his knee and in the lower third of his hamstrings. Once assessed it was clear he had a significant tear to his hamstring and a subsequent MRI scan confirmed a grade 3c tear to his long head of biceps.
The patient was educated on the scan findings and shown the images. He then embarked on a rehab programme which, due to the high grade of injury, was going to take 10-12 weeks. Initially he was given some soft tissue work and was shown some very low-level loading for the hamstrings and gluteal muscles. As the bruising resolved he was tested using a handheld dynamometer which gave us some primitive strength scores for comparison of left versus right. As he progressed, the loading became more challenging and he was gradually strengthened using gym-based exercises such as sliders, swiss-ball curls, Romanian dead lifts and eventually Nordic hamstring exercises. By week 8 he was ready to begin jogging and had restored full length on his hamstring stretch. He very gradually increased his running speeds alongside his strength loading and as his confidence returned alongside his strength markers, he was gradually returned to team training.
After 12 weeks he was training with his team and on 14 weeks played his first part of a game with no issue, He continued his strength work twice a week and had no further problems.
Hamstring injuries are usually mild and can take anything from a week or two to get back to sport, to the more significant injuries which can take months. We advise early assessment and appropriate imaging where indicated. Not all hamstring injuries need scanning.