Q: I am 57 years old and went on a zip line at an amusement park with my grandkids. When I landed against the pad at the end, I hit so hard, I felt something snap in my butt.  I completely ruptured my hamstrings. What are my chances for a full recovery?

A: Hamstring injuries are not uncommon in active adults. Athletes are especially prone to these types of injuries. Hamstring ruptures associated with zip line rides has not been reported in the literature. But there are studies involving athletes of all ages who injure their hamstring muscle as a result of falls, waterskiing, running or sprinting, soccer, football, hockey, in-line skating, dancing, tennis, and wrestling (to name a few). With your report, we can add zip line rides to the list.

There are three separate tendons that meld together at this site. For a complete rupture, all three tendons are torn. The rip or tear could be anywhere along the muscle. Tears at the ischial tuberosities are called proximal tears. Tears farther down toward the knee are referred to as distal hamstring tears. If it's the tendon that is torn and the attachment is pulled away from the bone, it's called an avulsion.

Treatment and recovery are based on several factors. First, how far from the bone did the tendon retract (pull away)? If the tendon only springs back a little bit (less than two centimeters), then conservative care may be all that's needed. In these cases, surgery usually isn't needed.

If the tendon pulls back more than that (and especially if it pulls a bit of bone along with it), then surgery is most likely needed. That's because larger displacement of the tendon usually means more pain, weakness, and loss of function.

A second factor guiding treatment is how long ago was the injury? Chronic injuries (those that occurred more than a month ago) that are asymptomatic (no symptoms, no pain) can be treated conservatively (without surgery). But for the athlete with significant pain who can't fully engage in his or her sport, surgery is indicated.

Without surgery, you can expect at least a six to eight week period of time for recovery. Depending on the location and severity of injury, recovery can be months up to two years or more. Patients must be careful not to restrain the tendon/muscle before complete healing has taken place. If together, you and your surgeon decide a conservative approach is best, then most likely you will be seeing a physiotherapist to guide you through the process. Patient compliance (following your surgeon and therapist's advice) are key to a good result.

Zip lines, bungee jumping, in-line skating, skiing and other similar activities with the grandkids might have to take a back seat for awhile. Your therapist will give you specific guidelines of what you can and can't do doing rehab. But don't worry, time with the grandkids won't be on the "do not do" list!

Reference: Patrick Birmingham, MD, et al. Functional Outcome After Repair of Proximal Hamstring Avulsions. In The Journal of Bone and Joint Surgery. October 5, 2011. Vol. 93-A. No. 19. Pp. 1819-1826.