A full or partial rupture of the hamstring muscle tendons can occur at the point where they insert into the back of the knee. Sudden sharp pain may be felt at the time of injury with possible swelling and soreness. Here we explain how the injury occurs as well as treatment, rehabilitation and exercises to return you back to full fitness.
Symptoms of hamstring tendon rupture
Symptoms include a sudden sharp pain in the back of the knee. There may be swelling, tenderness and heat coming from the point where the tendon inserts into the back of the knee. The athlete may feel pain when bending the knee against resistance as the hamstring muscle is put under stress.
Hamstring tendon rupture explained
The hamstring muscles consist of three muscles called the biceps femoris, semitendinosus and semimembranosus. The muscles insert at the back of the knee via tendons which joint muscle to bone. It is possible for these tendons to be torn during an explosive movement or kicking action, in particular, the biceps femoris tendon or the semitendinosus tendon. When sprinting at high speed, a great deal of force is put through the hamstring muscles as they work hard to slow down the lower as it comes through and strike the ground.
If the athlete might have been suffering from hamstring tendon inflammation at that point previously and failed to rest or recover properly then this could be a weak point susceptible to injury.
Treatment of hamstring tendon ruptures
What can the athlete do?
Apply cold therapy or PRICE principles (protection, rest, ice, compression, elevation) as soon as possible. Ice can be applied for 10 minutes every hour during the acute stage which is usually 24 to 48 hours depending on how bad the injury is. Do not apply ice or a gel ice pack directly to the skin but wrap in a wet tea towel. Even better is to use a commercially available cold therapy and a compression wrap.
If a complete rupture of the tendon is suspected seek medical advice as soon as possible. If the injury is to the semitendinosus on the inside back of the knee then it is likely this will be treated conservatively, meaning without surgery. However, in more severe cases a torn biceps femoris tendon may require an operation to fix it.
After the first 2 or 3 days when the tendon has started to calm down alternating hot and cold can be done. Commercially available gel packs are ideal for this purpose as they can be warmed in hot water or carefully in the microwave, or frozen. Wear knee support to support to protect the tendon and retain the bodies heat which will aid the healing process. When returning to running a heat retainer or support can be worn. Tendons work better when they are worn but as a precaution applying ice after a training session can help reduce any inflammation.
What can a sports injury specialist or doctor do?
A doctor may prescribe anti-inflammatory medication such as ibuprofen to help with the pain and inflammation in the early stages. Anti-inflammatory medication may not be as effective in the later stages and may even restrict healing. Do not take this if you have asthma or other contraindications, always check with a medical professional first.
Sports massage may be beneficial in remodelling the scar tissue and improving the condition of the hamstring muscles themselves. Cross friction massage is applied by rubbing transversely across the tendon.
For very severe tendon strains and complete ruptures the knee may be immobilized in a plaster cast or a surgeon may operate to repair the damaged tendon.
A full rehabilitation program consisting of stretching, strengthening exercises should be done to restore the athlete to full fitness.
In the case of mild tendon injuries, stretching and strengthening exercises for the hamstring muscles can begin when pain allows. See hamstring strain rehabilitation exercises for more detailed information.