The Hamster Club: Repairing a Proximal Hamstring

By Debbie Roberts, LMT
November 8, 2017

The Hamster Club: Repairing a Proximal Hamstring

By Debbie Roberts, LMT
November 8, 2017

If you look up "Proximal Hamstring Repair" on Facebook you will find a group that fondly refers to themselves as "The Hamster Club." There are now 697 members who have shared their recovery stories, including what helped and what didn't.

I wanted to share my friend / client's story because it's important to know that massage therapy played an integral role in her recovery, however the correct application and strength at which it is applied is also dire. There were times when a normal massage had an unpredictable outcome — one because of the severity of the injury, and two because of the proximity of the sciatic nerve. It's important to note that this type of repair has different phases, therefore the massage therapy must respectively do the same.

A Story About Patience

The following is a collection of questions and answers between us during our sessions.

Q: How did you tear your hamstring?
A: I slipped and fell on a wet patch of floor. It was the middle of the night during a hurricane.

Q: How long did you wait to see the doctor?
A: Because of the hurricane I waited about 16 hours to go to the ER. Four days later I saw my orthopedic surgeon, and two days following the MRI I had surgery.

Q: Why did the doctor suggest surgery in your case?
A: I avulsed all three tendons (of the hamstring) 6.5 centimeters. My doctor said that without surgery my activity would be limited, I would have poor stability, and possibly chronic pain for the rest of my life.

Q: After surgery how long did you have to keep your hamstring in flexion?
A: I wore a knee brace for 8 weeks at a 60 degree angle.

Q: How long did you see a physical therapist?
A: Nineteen weeks.

Q: What degree of pain was there initially and throughout?
A: After surgery it was a 10 for about three days. The biggest problem for me was the sciatica, which was on and off, but became worse at about week 15. It gradually decreased from then on.

Q: When did you feel you had turned the corner?
A: At about seven months, but it was a rocky road, with lots of difficulties. One day you are doing well and the next you are in pain. It's hard to predict, but usually based on your level of activity.

Q: Has the Facebook page been helpful? If yes, why?
A: Yes, very helpful because I knew very little about this injury. Extremely helpful in recovery, to find aides that would help you sit, and also connecting with people all over the world that were going through the same thing.

Q: How many weeks are you at now in the rehabilitation process?
A: I am 11 months post surgery, still not fully returned to the pre-injury stage.

Q: What activities of daily living have been most interrupted?
A: The main thing that was difficult for the first seven months was sitting without pain (think about this as you sit to go to the bathroom). So, using the bathroom continued to be a challenge.  For regular sitting, I had different types of pillows recommended by members of the Facebook group.

Q: How do you feel massage therapy helped?
A: Massage, if nothing else, helped to reduce the stress of being limited in my abilities, and promoted relaxation. I would probably say no massage to the affected area until released by the physical therapist.

Q: What has been the most helpful with this journey?
A: Patience, realizing that recovery is a very long journey.

The Massage Therapy

Well as you can tell from her story massage was a bit challenging. As I stated earlier the massage had to come in phases. When she first came to see me she was in a wheel chair with her knee flexed to the 60 degree angle. We used lots of pillows to take the stress off the leg during the massage, and to accommodate the brace. Initially we had to attend to her neck and shoulders because the use of her upper body was so extensive. Just to help you understand how the leg would feel, curl your arm into a bicep curl try holding that angle for at least five minutes; now imagine holding that for eight weeks. Yikes! You are going to have some very hypertonic fascia.

I didn't start any leg massage until she was released from physical therapy. Her physical therapist was doing friction massage to her scar, which he asked me to continue. A few visits later, I attempted light cupping over the scar tissue, but it started up her sciatic nerve down to her calf. So I stayed clear of cupping this area and just did light friction. I did however cup the belly and lower distal portion of the hamstring without any repercussion.

Recovery Challenges

In this type of repair the hardest thing and challenge for the therapist is that the scar tissue (as it is being laid down) can entrap the sciatic nerve. I found that counter/strain or bunching up the tissue around the site worked better than trying to lengthen the hamstring. Any attempt at lengthening seemed to just work against us.

When I attempted even a 10 percent isometrics, this also set off the sciatic nerve. Because of this reaction I always let her do her own stretching to the hamstring after the massage. I do not recommend passive stretching for this type of client. Letting the client actively engage their own quadricep and then actively lengthening the hamstring would probably be best. Within the last few months my experience has taught me it doesn't take much to set off the sciatic nerve in a proximal hamstring repair. I have been an active part of her exercise rehabilitation and it is a slow process. She is not able to go over a two incline on the treadmill without pain (most people can go to 10). The pace at which she walks is at a 2.5 (most people are at least a 3.5 and up). But overall she is gaining strength.

One of the problems is that the repair made the right leg stronger and made her left knee and hip crazy. She is now dealing with left hip bursitis and the old medial meniscus repair of her left knee is really taking a brunt from her uneven gait. She did visit her orthopedic surgeon and he injected her left knee, which helped a great deal in her gait.

My Advice

Always be willing to adapt your touch and therapy to the client. Listen and be sensitive to the needs of each individual client. There is no ABC recipe to treat this type of severe injury. Like she said, the most helpful part to her recovery was "patience," you will need a healthy dose as well. Go the extra mile, it is never crowded. Happy Therapy, Debbie.