The hamstrings are a group of muscle-tendon units that originate from a bony prominence in the back of the pelvis: the ischium. The hamstrings run down the back of the thigh and then insert as tendons on the fibula bone and tibia bone just past the knee joint. The hamstring tendons function together to help support the hip and the knee joint. The hamstrings can be injured at three common locations: the ischium (pelvis), the mid-thigh (musculo-tendinous junction), or at the insertion site on the tibia or fibula. The most common location for injury is at the musculo-tendinous junction in the back of the thigh. These injuries are common in certain cutting athletes, particularly football and soccer players. Middle-aged athletes may develop partial tearing of the hamstrings off of the pelvis (ischium); this condition is called tendinosis. Complete tears off of the pelvis are most common in water skiers.
- Pain and swelling in the buttocks or back of the thigh
- Bruising in the back of the thigh
- Pain and weakness with acceleration or cutting
Diagnosis And Treatment
Dr. Keller considers each patient’s symptoms, as well as a detailed physical examination, x-rays, and often an MRI of the pelvis or knee to make the diagnosis of hamstring injury.
In most patients with injuries at the musculo-tendinous junction, non-surgical treatment with physical therapy is usually very helpful. The physical therapy program focuses on reducing swelling, stimulating healing of the injured tissue, and ultimately strengthening of the core and hip muscles (including the hamstrings) around the hip joint. Non-surgical treatment also includes activity modification (limited sports participation for 4-6 weeks), non-steroidal anti-inflammatory drugs, and on occasion, steroid, PRP, stem cell, or anesthetic injections. In those patients with full thickness tears off of the pelvis or with chronic tendinosis, surgical intervention may be the best option.
In those patients who require surgery, Dr. Keller performs surgery either with an open technique (larger incision) or with a less invasive, endoscopic technique (with a camera). During surgery, Dr. Keller identifies the area of tearing off of the pelvis and prepares the ischium for repair of the injured hamstring(s). Dr. Keller uses strong sutures to repair the injured hamstring(s) back down to the bone. The sutures are secured to the bone with suture anchors (medical screws).