Hamstring Injuries Treatment Options

Can a hamstring injury be treated without surgery? 

Most hamstring tendon injuries are treated successfully without surgery. Non-operative treatment of hamstring tendon injuries includes rest, icing, compression, elevation, anti-inflammatory medications, and after 48 hours, gentle stretching and strengthening exercises. However, progression depends upon pain. Physical therapy may be indicated. When necessary, Platelet Rich Plasma (PRP) injections under ultrasound guidance can improve the condition. PRP uses your own blood to create a concentrated solution of platelets to heal muscle strains. It is a minimally invasive procedure that may be recommended along with conservative measures to treat pain and facilitate a quicker return to play in athletes with a hamstring strain or partial tearing of the hamstring. Typically, most mild hamstring injuries will resolve within 6-12 weeks of conservative treatment. It is not uncommon for patients to experience a persistent loss of about 10% of overall hamstring strength following a hamstring injury that is treated without surgery.

What are the surgical options for a hamstring injury?

Severe or complete tears of the proximal hamstring tendon may require surgery if symptoms persist or overall function is limited. Hamstring surgery involves reattaching the proximal hamstring tendon back to its insertion on the ischial tuberosity of the pelvis bone. Surgery can be performed either endoscopically (minimally invasive) or as an open procedure, that is typically completed within 1-1.5 hours as an outpatient procedure.  When there is also an avulsion injury, meaning the tendon is torn along with a piece of bone, surgery is almost always indicated. Surgery may be recommended for active and professional athletes when conservative measures fail to relieve pain, or if time lost to conservative treatment is too costly to the athlete.

How are hamstring tendons repaired?

Hamstrings can be repaired through an open minimally invasive hamstring repair technique or through a scope (endoscopic hamstring repair). For small hamstring tears without significant retraction, endoscopic hamstring repair can be performed. A special camera, called an endoscope, is inserted into the buttock area where the hamstring is torn. Small surgical instruments are also inserted through separate incisions and are used to perform the repair using a minimally invasive approach. Alternatively, an minimally invasive repair through a small incision hidden in the gluteal crease can be performed  for tears that involve more than one tendon, is chronic in nature, or where there is significant retraction.

What are the long-term effects of untreated hamstring tendon injuries?

The best results are achieved when the hamstring tendon injury is treated within 24 to 48 hours after injury. When left untreated, hamstring tendon injuries can progress in severity.