A hamstring tendon tear at the hip (proximal hamstring avulsion) is when the tendons that anchor your hamstrings to the sitting bone pull away from the pelvis. It usually happens in one sudden moment, often a slip into the splits or a forceful stretch with the knee straight.
If two or three tendons have come off and pulled well away from the bone, surgery to reattach them is usually advised, and TIMING matters. Repairs done within about 4 weeks tend to do better than late ones.
Smaller or partial tears often recover without surgery. Either way, expect several months of rehab before full sport.
Signs it’s more than a strain
- A pop or tearing feeling high in the back of the thigh or buttock, with sudden sharp pain
- Heavy bruising that spreads down the back of the thigh, sometimes past the knee, over the next few days
- Weakness bending the knee or pulling the leg back
- Pain sitting on the sitting bone
- A gap or bunching of muscle further down the thigh
- Tingling or numbness down the leg, because the sciatic nerve runs right next to these tendons. See sciatica
A common hamstring strain is a tear in the muscle belly, lower down, and usually heals well with rehab. A tear right at the bone behaves differently and is easy to miss if nobody checks.
Getting the right diagnosis
- Get seen within days, not weeks. A sports doctor, orthopedic surgeon or experienced physio can examine for a tendon tear
- An MRI scan shows how many tendons are torn and how far they’ve pulled back. That decides the plan
- Don’t wait for the bruising to settle before asking for a scan if you felt a pop and are struggling to walk
When surgery matters
- Complete tears of two or three tendons, pulled back more than a couple of centimeters: surgery is usually recommended, especially if you’re active
- Early repair is easier and does better. After about 4 weeks the tendon shortens and scars down, often around the sciatic nerve. Late repairs are harder and results are less reliable
- Late repair is still possible. Many people treated months later still improve, so a missed window isn’t the end of the road
- Partial tears or one tendon, with little pulling back: usually treated with rehab
- Less active or older people with a complete tear sometimes choose rehab alone and do reasonably well, though with some lasting loss of strength. It’s a real choice to make with your surgeon
A hamstring tear at the bone is a clock, not a bruise. Get the scan early and keep your options open.
Rehab after repair
Your surgeon’s protocol comes first. A typical outline looks like this:
- Weeks 0 to 2: crutches, and avoiding bending forward at the hip with the knee straight. Some surgeons add a brace. See weight bearing after surgery
- Weeks 2 to 6: off crutches, walking normally, gentle hip and core work. Light hamstring tightening without movement begins around weeks 4 to 6
- Weeks 6 to 12: strengthening builds up, with bridges and hamstring exercises that move the joint. No hard stretching yet
- Around 3 to 4 months: jogging starts, once strength is close to the other side and hopping is pain-free
- Around 4 to 6 months: sprinting, change of direction and sport drills, then return to play once testing shows strength close to the other leg
Return to sport
- Most people get back: about 4 in 5 return to their sport after repair
- Full rehab often takes at least 6 months, sometimes longer for sprinters and kicking sports
- Re-tears are uncommon, under 1 in 10, and most happen in the first months. That’s why the early rules matter
- Numbness down the leg after surgery affects a small number of people and usually settles within a few months
AAOS OrthoInfo describes hamstring tendon tears and their repair if you want a surgeon’s overview.
High hamstring tendinopathy: the slow version
- What it is: an irritated, overloaded tendon at the sitting bone, not a tear. It builds up over weeks, often in runners
- How it feels: a deep ache at the sitting bone, worse sitting on hard chairs, running uphill and bending forward
- What helps: a graded strengthening program, starting with holds and building to heavier loading over about 3 months
- What to avoid: hard hamstring stretches and long sitting on hard surfaces. They press the tendon against the bone and keep it irritated
- Surgery is rarely needed
Get seen today if
- You felt a pop high in the thigh and can’t walk more than a few steps without a lot of pain
- Your foot is weak or floppy, or the leg is numb
- After surgery: your calf is swollen, warm or painful, or you’re short of breath. See blood clot after surgery
Get it checked if
- Bruising has spread down the back of the thigh after an injury
- You still can’t bend the knee against resistance or run a week or two after a “strain”
- Pain at the sitting bone has lasted more than 6 weeks
- After repair, the wound is red, hot or leaking, or you have a fever
A strain can wait for rehab. A tendon off the bone needs a scan within weeks.