Treatment for a torn hamstring depends entirely on the injury’s severity and specific location. The hamstring group consists of three muscles—the biceps femoris, semitendinosus, and semimembranosus—which run along the back of the thigh. These muscles are primarily responsible for bending the knee and extending the hip. A tear is a muscle strain involving the rupture of muscle fibers or the tendon connecting the muscle to the bone. Most hamstring injuries are minor and heal without surgery, but a complete rupture often requires a procedure to reattach the tendon.
Classifying the Severity of Hamstring Tears
Medical professionals classify hamstring injuries using a standardized grading system based on tissue damage. A Grade 1 injury is a mild strain involving microscopic tearing of muscle fibers. Patients experience minor discomfort and little strength loss, and these injuries are managed with conservative treatment alone.
A Grade 2 injury is a partial tear of the muscle fibers, causing significant pain, swelling, and reduced muscle strength. Patients often limp and feel pain twinges during activity. The tear sometimes occurs at the musculotendinous junction. These moderate injuries require a structured rehabilitation program to restore full function.
The most severe category is a Grade 3 injury, a complete rupture of the muscle or tendon, causing intense, sharp pain and total loss of function. This injury often involves the tendon tearing completely away from the bone, known as an avulsion injury. Proximal tears near the hip (at the ischial tuberosity) are typically more complex than distal tears near the knee.
Specific Indications for Surgical Repair
Surgery is reserved for the most severe hamstring injuries, primarily complete Grade 3 ruptures. The most common condition requiring an operation is a proximal hamstring avulsion. This occurs when the tendons tear off the ischial tuberosity, the bony prominence in the pelvis. These avulsion injuries often require surgical reattachment to restore normal hip and knee function.
The degree of tendon retraction guides the decision for surgery. Retraction is the gap created when the torn tendon end pulls away from the bone. If a tear involves two of the three tendons and the gap is greater than two centimeters, surgical repair is recommended to prevent chronic weakness and pain. Tears involving all three tendons are candidates for immediate surgical intervention.
The surgical goal is to re-anchor the torn tendon back to the ischial tuberosity using strong sutures and bone anchors. Early surgical intervention, ideally within a few weeks, is preferred for severe ruptures. This prevents excessive scar tissue formation and makes mobilizing the retracted tendon easier. Non-operative management of complete, retracted tears can lead to long-term issues like persistent pain, muscle atrophy, and weakness.
Non-Surgical Management and Recovery
The majority of hamstring injuries, including all Grade 1 and most Grade 2 tears, respond successfully to conservative management. The initial acute phase focuses on reducing pain and swelling, often following the RICE protocol:
- Rest
- Ice
- Compression
- Elevation
Limiting strenuous activity and using crutches for painful Grade 2 injuries helps protect the healing tissue.
Following the acute phase, rehabilitation transitions into a structured physical therapy program. This phase restores strength and flexibility to the injured muscle and is divided into progressive stages. The program starts with gentle, pain-free range-of-motion exercises. This is followed by submaximal strengthening emphasizing eccentric contractions, where the muscle lengthens under tension.
The final stage involves advanced strengthening, agility drills, and sport-specific activities to prepare the patient for a full return to activity. Recovery for a Grade 1 strain is quick, often taking one to three weeks. A moderate Grade 2 tear requires four to eight weeks of rehabilitation, but a premature return to sport increases the risk of re-injury.