Surgical and therapeutic management of a complete proximal hamstring avulsion after failed conservative approach

Amy Kirkland, Craig Garrison, Steve Singleton, Juan Rodrigo, Friedrich Boettner, Sarah Stuckey

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Fish eye STUDY DESIGN: Case report. Fish eye BACKGROUND: After 2 attempts at conservative care for a diagnosis of hamstring strain, the patient had a surgical hamstring allograft reconstruction. The purpose of this report is to describe the physical therapy approach to postoperative management of a hamstring reconstruction. Fish eye CASE DESCRIPTION: A 24-year-old female coach who sustained a complete avulsion of the proximal hamstring tendon while playing softball had a surgical hamstring reconstruction using an Achilles tendon allograft. Precautions concerning range of motion and stretching, weight-bearing status, and brace were followed to protect the surgical graft. Treatment incorporated cardiovascular, strength, and proprioception exercises, and progressed with the focus on correct movement patterns and eccentric muscle control during functional movements. Fish eye OUTCOMES: The patient attended 25 physical therapy sessions over 7 months. Muscle strength improved from 4/5 to 5/5. Straight-leg raise range of motion decreased from 145° to 90°. Lower Extremity Functional Scale (LEFS) scores improved from 15/80 to 70/80. Fish eye DISCUSSION: A complete avulsion of the proximal insertion is rare. Conservative management of hamstring tears has traditionally focused on end-range passive stretching, modalities, and direct hamstring strengthening. New evidence recommends a program that is more protective of the injured tissue and includes exercises such as core stabilization; indirect hamstring strengthening may be beneficial in the treatment of hamstring injuries. This concept was taken into account when considering the rehabilitation protocol and progression for this patient. Fish eye LEVEL OF EVIDENCE: Therapy, level 4.

Original languageEnglish (US)
Pages (from-to)754-760
Number of pages7
JournalJournal of Orthopaedic and Sports Physical Therapy
Issue number12
StatePublished - Dec 2008
Externally publishedYes


  • Achilles allogratt
  • Hamstring reconstruction
  • Physical therapy

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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