Patient Education · Hip

Proximal Hamstring Repair

The injury people are told is a pulled muscle for six months. Here is what actually tore, and why it usually needs fixing.

Dr. Darin W. Allred Darin W. Allred, MD Board-certified orthopedic surgery & sports medicine
~1.5 hrsTypical time for the operation
6 weeksToe-touch weight bearing only
SoonerBest repaired early, before the tendon retracts
6–9 moBack to running and sport

What tore

Your three hamstring muscles all start at the same place: the sitting bone, the bony point you rest on in a hard chair. From there they run down the back of the thigh to below the knee.

A proximal hamstring avulsion is those tendons pulling clean off that bone. It is not a pulled muscle. It is a detachment.

The classic mechanism is a sudden forward split — the leg goes forward while the hip flexes and the knee straightens, against resistance. Water skiing is the textbook cause. So is slipping on ice or wet ground, missing a step, or a fall where one leg shoots out in front.

How you know

  • A pop and severe pain at the sitting bone at the moment of injury.
  • Dramatic bruising spreading down the back of the thigh over the next few days.
  • Sitting hurts — specifically sitting on that side, on a hard surface. People start shifting their weight or standing at meetings.
  • Weakness and a feeling that the leg will not push off, particularly going uphill or upstairs.
  • Sometimes numbness or shooting pain down the leg, because the sciatic nerve runs right next to where the tendons tore.
This injury is missed constantly. It gets called a hamstring strain, a bad bruise, or sciatica, and people are told to rest and stretch for months while the tendon retracts further down the leg. If you had a sudden pop at the sitting bone with heavy bruising and sitting still hurts weeks later, that story deserves an MRI.

Why the timing matters

Once the tendons detach they retract, and the space they came from scars in. Repaired within the first weeks, the tendon reaches its footprint easily. Left for months, it must be freed from scar and dragged back — a bigger operation, closer to the sciatic nerve, with a less predictable result.

Chronic tears can still be repaired and often should be. But early is better, and this is one of the reasons I would rather see you sooner.

Who needs surgery

  • All three tendons torn off, particularly with retraction — this is the clearest indication.
  • Two tendons torn with significant retraction.
  • An active person who needs the leg to push off and sit comfortably.
  • Ongoing pain and weakness months after a tear that was treated without surgery.

Partial tears with the tendons still attached and undisplaced often do well with rehabilitation, and that is a reasonable path when the MRI supports it.

How the operation goes

  1. Anesthesia. General anesthetic. You lie face down for the operation.
  2. An incision in the crease under the buttock, so the scar sits where it will not rub.
  3. Find and protect the sciatic nerve. It runs immediately alongside the tendons, and identifying it is the first priority.
  4. Retrieve the tendon ends, freeing them from scar if the tear is not fresh.
  5. Prepare the footprint on the sitting bone and set suture anchors into it.
  6. Pull the tendons down and tie them onto the bone, with the hip and knee positioned to take tension off the repair.

Recovery

This recovery asks a lot in the first six weeks, and understanding why makes it easier to stick to. The repair is pulled apart by two things: straightening the knee while the hip is bent, and the hamstrings contracting. Almost every restriction follows from that.

  • Weeks 0–6Toe-touch weight bearing only — your foot may rest on the floor for balance, but it does not take weight. Crutches, and a brace positioned to keep tension off the repair. No hamstring contraction at all, and avoid lifting the thigh actively. Therapy within two weeks. Gentle assisted motion from about week 2, keeping hip bend under about 45 degrees. Aspirin 81 mg twice daily for two weeks.
  • Weeks 6–9Weight comes back gradually to full, and a normal walking pattern is rebuilt. Everyday activities become comfortable.
  • 3–5 monthsProgressive hamstring strengthening, carefully staged. This is slow work — the tendon is strong but the muscle has been quiet for months.
  • 6–9 monthsRunning and sport, on strength testing rather than dates.

Practical advice from patients who have done it: sort out a cushion arrangement before surgery, because sitting is the thing you will notice most. A wedge cushion that unloads the sitting bones is worth having on day one.

The risks, honestly

  • Sciatic nerve irritation The risk we take most seriously, since the nerve sits right against the repair. Temporary numbness or shooting pain down the leg is not unusual and usually settles. Lasting injury is rare.
  • The repair pulls off Uncommon, and nearly always from putting weight on the leg or working the hamstrings too early.
  • Lingering discomfort sitting Some tenderness over the repair when sitting on hard surfaces can persist for many months.
  • Wound problems The incision sits in a crease, which makes hygiene and dryness important early.
  • Blood clots A genuine consideration with six weeks of limited weight bearing — keep moving what you can, and take the aspirin.
  • Residual weakness Most people regain the great majority of their strength, but a small deficit compared with the other leg is common.
This page is general education. It describes how I approach this and what most patients experience. If anything here does not match what you were told in clinic, ask — your own instructions always come first.