The hamstring is actually a group of three muscles that bend your knee: The biceps femoris, semimembranosus and semitendinosis. Most of the muscles attach to the ischial tuberosity, or the bone you sit on when seated, and then travel down past your knee to the leg bone just below the knee in the back.
A tear or strain of the hamstring occurs when one or more of these muscles are pulled beyond normal limits and tears apart at one of several spots. Most commonly, a tear occurs in the middle of the muscle, but tears can also occur at either at the attachment point to to the pelvis or the leg.
The symptoms of a tear may range from mild pain in the back of the leg to a sensation of a pop or snap followed by severe pain and tenderness. Tenderness is found over the area of injury. This may be at bony attachment point on the pelvis, or in the middle of the back of the thigh. The muscle can appear swollen. Bruising may occur over a few hours or days. Weakness may be uncovered with resistance on bending of the knee.
Rarely, an X-ray of the pelvis may show a piece of bone that has pulled off with the hamstring, although this is rare. An MRI study can be helpful to understand the severity of the injury.
Nonoperative treatment is the usual plan after a hamstring tear. Rest, ice, compression and elevation is the first approach. Icing can help decrease the spread of inflammation in the injured area. Compression reduces bleeding and the level of the inflammatory response. Typically after a week of rest, gentle stretching of the muscle will help the healing process. Starting therapy too soon after injury has been shown to increase the production of scar tissue and can limit muscle recovery. Physical therapy can be very helpful in guiding recovery.
Resolution of pain, full restoration of range of motion, and assessment to be sure muscle strength has reached a comparable level with the uninjured side.
The need for surgery is rare, and your options be carefully discussed with your orthopedic surgeon. Complete rupture of all three muscles from the pelvic bone or at its attachment from the tibia is a reason for surgery.
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Reference:
Clanton TO and Coupe KJ: Hamstring Strains in Athletes: Diagnosis and Treatment, JAAOS, 1998, vol 6, no 4: 237-248.
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