Surgical repair of a complete hamstring tear (a hamstring avulsion), has become more common than in the past. An MRI or x-ray may be necessary to make an accurate diagnosis of a complete tear. An x-ray will show if a small piece of bone has been torn away from the ishium. An MRI produces an image of the muscles, tendons, and ligaments that may have been damaged or displaced during or following the injury.
If the hamstring tendon has retracted less than 1-2 cm, it may be possible to treat it with conservative measures. This will often depend on the activity level of the patient and what is required of the muscle following rehabilitation. If surgery is not necessary, rest and immobilization of the leg with a knee splint is highly recommended to reduce the possibility of the tendon retracting further away from the ishium (or shinbone). Ideally, the tendon will reattach itself to the bone with a bridge of scar tissue, however, the placement of the tendon and the scar tissue growth can be uncertain.
If the hamstring tendon has retracted too far from the bone to repair itself, or the two sides of the torn muscle have pulled away from each other, surgery will be necessary.
During surgery, an incision is made between the buttock and the top of the leg in the gluteal crease. The surgeon removes any scar tissue that has started to form since the injury and pulls the torn hamstring back into place. To surgically repair a tear in the muscle body, the surgeon wil suture the muscle fibers together with stitches. If the repair is necessary to attach the tendon to the bone, stitches or staples are used. If a bone fragment has been pulled away with the tendon, a screw is used to reattach the bone.
Regardless of whether the tear is repaired with surgical or non-surgical methods, scar tissue forms to “heal” the tear by reattaching the torn tissue together. However, this scar tissue is tough and fibrous and less elastic than the normal healthy tissue that existed before the injury. As a result, the hamstring is left weaker and more prone to re-injury. It is important to follow an appropriate rehabilitation plan, treat the scar tissue that has built up during healing (see treatment section below on how to do this), and return to activity slowly.
Neurolysis of the sciatic nerve involves breaking up adhesions (scar tissue) to free the nerve and relieve the pressure and pain from inflammation..
Following surgery your doctor will prescribe rest and cold compression therapy to treat pain and swelling. In addition, cold compression treatments will reduce tissue damage that is caused by swelling and fluid leakage from injury or surgery – reducing the amount of healing that will be needed. You will be given crutches and possibly a brace to keep your hamstring muscles relaxed to avoid straining the repaired tissue.
Once your surgeon gives you the go-ahead (approximately 6 weeks after surgery), you canbegin a physical therapy program of gentle stretching to improve flexibility in the hip, knee, and hamstrings.Strengthening exercises are added gradually under the guidance of your physical therapist to avoid re-injuring the hamstring. Do not return to sports, running, or other strenuous activities until you have permission from your doctor. Returning to sports too early increases your risk of re-injury, permanent damage, or a chronic hamstring condition. For most patients, with cold compression therapy, guided physical therapy, and scar tissue treatments, it is possible to recover with full function of your hamstring muscles.
The estimated times before returning to athletics after surgery are; 6 months for reattachment of the hamstring tendon to the ischium and 3 months for a distal hamstring reattachment to the shinbone.
Surgery enforces a mandatory rest period, which is one of the main treatment recommendations for hamstring injuries. Keep in mind the longer you have your symptoms prior to surgery, the longer it will take to recuperate. If you return to your activities too soon, you could cause permanent damage. You want to ensure the strength, flexibility and stability of your hamstring muscles, before taking on too much.
Post-Operative Hamstring Treatments
Treating your hamstring avulsion promptly and correctly is essential to getting rid of your pain and restoring function to your upper thigh. Proper treatment will give you a better chance of restoring full function in your hamstring muscles, stop your pain, and get you back to regular activities sooner.
Whether you are treating your hamstring avulsion with non-surgical methods or healing your hamstring after surgery, there are home therapies that can help. Cold compression therapy and Blood Flow Stimulation Therapy™, BFST® can speed your recovery and leave your hamstring tissue stronger and healthier than if left to heal on its own.
To restore strength and range of motion in your hamstrings, treatment should focus on preventing scar tissue formation and muscle atrophy (shrinkage and weakening of the muscle). This requires rest and the appropriate therapies at the right time. Initial treatment following injury or surgery is cold compression therapy, a therapy that has been used for centuries to treat pain and swelling. BFST® will further promote healing while strengthening your tendon and muscle tissue to restore the health and function of your hamstring muscles.