Hip Hamstring Tears: Overview

Hip Hamstring Tears: Overview

The hamstrings are a group of 3 muscles located at the back of the thigh. They include the semimembranosus, semitendinosus, and biceps femoris muscles. All 3 muscles attach to the ischial tuberosity, a bony bump on the pelvis, by their tendons and connect to the bones of the lower leg.

The hamstrings are the main muscle group that bends the knee, but they also help control motion at the hip needed for everyday movements. This is because the hamstrings cross 2 joints: the hip and the knee. The hamstrings are especially important for controlling motion of the legs when stepping forward during walking or running.

Hamstring injuries are 1 of the most common sports injuries, making up 12-16% of all sports injuries. While the muscles are more likely to be injured, injuries that affect the hamstring tendons at the hip are more serious and make up about 10% of all hamstring injuries.

The hamstrings are at risk for injury when the muscles are rapidly stretched when the leg is lifted in front of the body with the knee straightened. This commonly occurs with running, sprinting, and sports that involve jumping and kicking, such as hurdling, soccer, and gymnastics. This can cause the muscles or any of the tendons that attach the hamstrings to the hip to tear.

Partial tendon tears occur when part of a hamstring tendon pulls away from the bone. These types of tears can occur slowly over time from ongoing tendinopathy, often called tendinitis, that causes irritation and weakening of the hamstring tendons over time. In other cases, partial tears can occur suddenly with injury when the hamstrings are rapidly stretched, causing forceful tension on the tendons from the muscles being pulled.

This type of injury can also result in a complete tendon tear, where the entire hamstring tendon pulls away from the bone. Depending on the level of injury, this can cause tendon retraction, where the torn tendon moves down the thigh away from the hip. Hamstring tendon tears at the hip can affect anywhere from 1 to 3 tendons. The most common tendons to be injured are those from the semitendinosus and biceps femoris, which join together to form the conjoint tendon. The semimembranosus, which attaches to the hip by its own tendon, is least commonly injured.

Regular hamstring stretching, warming up before exercising, taking adequate rest, and strength training to decrease muscle imbalances in the hip and thigh can help prevent hamstring injuries.

At the time of injury, patients will often feel a popping or snapping sensation followed by immediate pain and bruising in the back of the buttocks and/or thigh. It is also common for patients to have difficulty walking. Because the sciatic nerve sits underneath the hamstrings, hamstring injuries can also damage or irritate the sciatic nerve, causing symptoms like shooting or burning pain, numbness, and tingling to travel down the leg.

During a physical examination, a health care provider will examine the back of the thigh. They will check for bruising, swelling, deformity of the muscles, and tenderness to touch, and will check the patient’s hamstring strength. They will also perform tests that look at the sciatic nerve, including checking a patient’s strength and sensation of the lower leg.

Imaging studies will help confirm a diagnosis of a hamstring injury. X-rays will not show tendons or muscles but may be performed to make sure that no piece of bone has broken off from the pelvis. Ultrasound can be used to see if any of the hamstring tendons have torn, while MRI is more detailed to see how many tendons are affected and if there is tendon retraction, which will help guide what treatment is needed.

Hamstring tendon tears at the hip are generally graded as either: grade 1, mild tendon strain; grade 2, partial tendon tear; or grade 3, complete tendon tear. Further classification systems may also be used, taking into consideration how much tendon retraction has occurred and whether there is also associated sciatic nerve injury. A health care provider will use the patient’s symptoms and grade of the tear along with other characteristics of the injury to determine the most appropriate treatment option for recovery.