Hamstring Tears: Signs and Symptoms

Depending on initial severity and location of a hamstring injury, a person can be significantly debilitated and be forced to take extensive time away from activity.¹Marshall S, Covassin T, Dick R, Nassar L, Agel J. Descriptive epidemiology of collegiate women's gymnastics injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train 2007;42:234-40.^,2Caine D, Nassar L. Gymnastics injuries. Med Sport Sci 2005;48:18-58.^,3Feeley B, Kennelly S, Barnes R, et al. Epidemiology of National Football League training camp injuries from 1998 to 2007. Am J Sports Med 2008;36:1597-603.^,4Brooks J, Fuller C, Kemp S, Reddin D. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med 2006;34:1297-306.

Most people who suffer an acute hamstring strain will experience some of the following:

Sharp pain. When the injury occurs, one may feel an abrupt, sharp pain at the back of the thigh or buttocks.

A “pop” sound or sensation. This sudden pain is sometimes accompanied by an audible or palpable “pop” and a sensation of the leg giving way.⁵Garrett W. Muscle strain injuries. Am J Sports Med 1996;24 S2-S8.^,6Ali K, Leland J. Hamstring strains and tears in the athlete. Clin Sports Med 2012;31:263-72.32. Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.^,7Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.^,8Clanton T, Coupe K. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg 1998;6:237-48.

Difficulty moving and bearing weight. Following a hamstring injury, it may be hard or impossible to continue activity. The person may even have trouble walking with a normal gait, getting up from a seated position, or descending stairs.⁹Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.^,10Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8.^,11Cacchio A, Borra F, Severini G, et al. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med 2012;46:883-7. Acute hamstring injury patients can also have a “stiff legged” gait with noticeable limp.⁶Ali K, Leland J. Hamstring strains and tears in the athlete. Clin Sports Med 2012;31:263-72.32. Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.

Bruising. Sometimes bruising and discoloration can be seen along the back of the thigh.

Swelling and deformity. For cases in which there has been a complete tear of the muscle-tendon junction (myotendinous rupture), there may be bruising along with palpable defects, such as muscle lumpiness, under the skin. These defects can be felt and seen with contraction.⁵Garrett W. Muscle strain injuries. Am J Sports Med 1996;24 S2-S8.^,6Ali K, Leland J. Hamstring strains and tears in the athlete. Clin Sports Med 2012;31:263-72.32. Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.^,8Clanton T, Coupe K. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg 1998;6:237-48.

Pain and discomfort when sitting. In avulsion type and proximal hamstring injuries, where the tendon breaks away from the pelvic bone, patients will commonly have sitting pain and discomfort.¹²Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.^,13Puranen J, Orava S. The hamstring syndrome--a new gluteal sciatica. Ann Chir Gynaecol 1991;80:212-4.^,14Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8.^,15Cacchio A, Borra F, Severini G, et al. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med 2012;46:883-7.

In the rare case of a distal avulsion, in which the hamstring tendon has torn away from the tibia or fibula, a patient may experience significant bruising and thickening of soft tissue that can be felt near the site of the injury, which results in an inability to walk without assistance.¹⁶Cohen S, Bradley J. Acute proximal hamstring rupture. J Am Acad Orthop Surg 2007;15:350-5.^,17Folsom G, Larson C. Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 2008;36:104-9.^,18Colosimo A, Wyatt H, Frank K, Mangine R. Hamstring Avulsion Injuries. Oper Tech Sports Med 2005;13:80-8.^,19Domb B, Linder D, Sharp K, Sadik A, Gerhardt M. Endoscopic repair of proximal hamstring avulsion. Arthrosc Tech 2013;2:e35-9.^,20Harris J, Griesser M, Best T, Ellis T. Treatment of Proximal Hamstring Rupture- A Systemic Review. Int J Sports Med 2011;32:490-5.^,21Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 2008;36:1110-5.