Physical Therapy in Seattle for Hamstring

Q: I am a hockey player with a rupture of the distal hamstring (the semitendinosus portion). Would surgery early on get me back on the ice sooner? It's been two weeks since I hurt myself.

A: Nothing is more frustrating for an athlete than an injury -- especially one that doesn't heal. Knowing when to have surgery right away and when to treat the problem conservatively (without surgery) can be a real challenge. That's the case with tendon ruptures such as the hamstrings.

The semitendinosus is one of three main parts of the hamstring muscle located along the back of the thigh. Distal semitendinosus tells us the tear occurred down by the knee where the semitendinosus inserts (attaches) to the bone.

Hamstring injuries of the muscle belly are fairly common among athletes. But usually, it's the biceps femoris portion of the muscle that ruptures. This type of distal semitendinosus injury that you have is uncommon but not rare. The decision whether to go to Physical Therapy or to the operating room can be difficult. There are no known predictive factors to guide patient and surgeon.

Predictive factors are characteristics of the patient or injury that are linked with success or failure. With some injuries, the surgeon knows the chances are good (or bad) for a complete recovery (or failure) if X, Y, or Z factors are present. Predictive factors can be things like the patient's age, severity of injury, sex (male versus female), body part injured, and so on.

We do have some data that might help based on a study of two orthopedic surgeons involved with 25 professional athletes who had a complete rupture of the distal semitendinosus muscle. They report the treatment results after months of follow-up.

The players who had surgery early on were off the field for about 10 to 12 weeks total. In contrast, the athletes who followed a conservative approach and then needed surgery anyway were out of the game for more than half a year.

The authors suggested based on their findings that athletes with a distal semitendinosus rupture have surgery right away in order to speed recovery and return to competitive play. But their patients were all professional athletes in national league football or major league baseball.

Conservative care is usually advised. When symptoms such as loss of knee motion, tender mass, knee swelling, and inability to walk normally without a limp don't go away with rehab, then surgery may be advised.

Surgery may provide a faster route to recovery and return to competitive play. Your decision should be made with the surgeon's help. When needed, MRIs can be used to confirm the diagnosis and severity of injury.

Reference:  Daniel E. Cooper, MD, and John E. Conway, MD. Distal Semitendinosus Ruptures in Elite-Level Athletes. In The American Journal of Sports Medicine. June 2010. Vol. 38. No. 6. Pp. 1174-1178.