Let's Talk About Hamstring Avulsion

Hamstring strains are common sports injuries. 

Complete hamstring avulsions, where the tendon tears completely off the bone, are uncommon. 

Water skiing is the most common sport where this occurs because it sets up the mechanics just right.  Hamstring muscle contraction coupled with hip flexion with a straight knee and tremendous force & load placed suddenly to lurch the body forward is the recipe for disaster.   

Hamstring strains and avulsions are the most common yoga injuries.  Michelle and I were doing morning sun salutations about an hour before the injury, though I am sure that is incidental and not contributory to my injury.

Rehab protocols vary a little bit but all have one thing in common: do nothing but rest and heal with toe touch weight bearing with axillary crutches, pretty much just up to the bathroom for the first 6 weeks.  Gradually, I can increase weight bearing at that point.

It takes about 3 weeks for the incision to heal, but it takes 12 weeks really for the tendon to completely heal back to the bone.  After 6 or 7 weeks, the tendon is healed to the point where full weight bearing is allowed.

The process of strengthening the muscle again to a functional level will be a long and arduous task.  At around 9 months, it is considered excellent if my strength on the left side is 80% of the strength on the right. 

The literature supports repair and outcomes are much better when repaired early.  Amazingly, some people hobble along for months (14 months in one instance someone reported on a “runners world” internet forum) with a diagnosis of “hamstring strain” when in fact the muscle is avulsed.  Eventually, when PT fails to bring back function, an MRI is performed and the avulsion confirmed.  These are harder to repair as the muscle has retracted so far with so much scar tissue that harvesting tendon from other areas, usually the achilles tendon, is required.  There is more risk of sciatic nerve entrapment in delayed repair due to a pseudo sheath of scar tissue that may form, which sounds horrendous.  What is my takeaway? Glad I had the early repair!  Dr. Greis did excellent work putting it back together, now it’s my job to protect it.