Hamstring Syndrome Surgery-A Runner’s 4-Year Struggle with Injury

For the last four years I’ve struggled with chronic high-hamstring pain. After trying endless treatments with no avail, I finally came across a condition known as “hamstring syndrome;” a chronic form of high hamstring tendinopathy that occurs when scar tissue builds up, irritating the sciatic nerve and hamstring insertion. Now that I’m 8-weeks post-op from hamstring syndrome surgery, I wanted to share some insight on the condition and what ultimately led me to chose this operation.

My symptoms: 

My pain first started during my senior year of college back in March 2013. There wasn’t one particular workout where I keeled over, but after a hard speed session I noticed pain in my high hamstring, way up in the awkward spot known as the ischial tuberosity. I took a few days easy but since it was my last collegiate track season I decided to push through a great deal of pain, and was able to manage it with active release, graston, and chiropractic adjustments. By May of 2013 I could barely even run my warm-up before races, so I shut down my season after the USA Outdoor Track Championships. An MRI revealed “high hamstring tendinopathy” (HHT) but no visible tear. The following summer and fall I rested and began consistent physical therapy. This helped me get back to the starting line and run several lifetime bests in 2014, but eventually the exact same pain returned. Being the stubborn runner that I am, I once again pushed though months of pain leading up to USA’s. This time, however, the pain became much worse and forced me to quit high level training and racing.

Over the next two years it was a constant battle. Despite months of rest, slow build-ups back to training, physical therapy, massage, and chiropractic work, my pain never had any lasting improvement. I had multiple MRI’s, x-rays, bone scans, ultrasound, an EMG, and bloodwork; all of which provided no further diagnosis. I tried every treatment option under the sun, including rounds traditional PT with eccentric exercises, rounds of PRP and cortisone injections, pelvic floor therapy and trigger point injections, dry needling, active release, biomechanical analysis, shockwave therapy, and even had surgery to repair a labral tear on my hip, (the thought behind this was that my labral tear was causing instability in my hip, which had forced my hamstring to take on more stress and therefore was constantly being strained).  Although that operation was successful at fixing my hip impingement (FAI), it did not resolve my gluteal/hamstring pain.


When my one of my physical therapists, Simon Gutierrez, first told me about “hamstring syndrome” I was intrigued. All of my symptoms matched perfectly: pain in the high hamstring that would radiate down the leg (the path of the sciatic nerve), pain and tightness throughout the glute muscles, pain running at fast paces, making sharp turns or quick changes in pace, pain that also increased with the duration of the run (I had to cut my mileage to less than half of normal because of this) pain sitting more than 20min, (particularly driving), and a long history of HHT that did not improve with traditional PT.  Hamstring syndrome can be defined as “a gluteal sciatic pain, in which posttraumatic or congenital hard fibrotic bands irritate sciatic nerve at the insertion site of hamstring muscles to ischial tuberosity.” ¹(Migliorini S, Merlo M) Basically, hamstring syndrome is when HHT becomes chronic to the point where scar tissue and adhesions build up along the tendon and tether it to the sciatic nerve, leading to chronic pain.

Post-Op with Dr. Sakari Orava

I decided to contact Sakari Orava, a Finnish surgeon who pioneered surgical management for hamstring syndrome back in the 1980’s, along with his colleague Lasse Lempainen at hospital NEO in Turku Finland. Being that they are two of the top sport surgeons in the world (Dr. Orava has previously operated on David Beckham and Haile Gebrselassie,) I trusted their input. I sent them several of my MRI’s and they noticed some oedema (inflammation) and a small tear in the hamstring tendon on one of my old MRI’s (just goes to show how radiologists sometimes miss things!). The tear was small enough that it healed on its own, but in the process large amounts of scar tissue built up over the years. Based on my symptoms, the length of time I’d been in pain, and having tried all other treatment options, they decided surgery was the best option.

The type of surgery performed by the doctors in Finland is very different from the type of surgery I was offered in the U.S.A. Most surgeons here are only trained to operate on partial or full-tears (avulsions) and these operations involve completely detaching the hamstring tendon and reattaching it with an anchor. Since my hamstring tendon attachment was fully intact, there was no point in causing even more damage, not to mention the recovery time from traditional hamstring surgery vs. hamstring “syndrome” surgery was the difference of 6-12 months of recovery vs. 8-10 weeks! There was also a major difference in cost; the cost of surgery in Finland was about 1/5th or less of what the operation would cost in the U.S.A.  After doing all the research, and once I realized this may be my only hope at returning to competitive running, I decided to go for it and my husband and I booked our tickets to Turku, Finland.

The Surgery

When I arrived in Finland I met with Dr. Lempainen for a physical examination before I made my final decision on surgery. Based on several tests including the “Puranen-Orava” stretch test (seen below), he determined that I was indeed a good surgical candidate. My operation was performed the following day, 1/17/17. You can read more about the surgical technique in this article², but basically I was in prone position (lying on stomach) while they created a vertical incision from my ischial tuberosity down about 5″ (yeah it’s a pretty long scar, scroll down and see it if you dare!) I was awake the whole time, which was interesting, although under spinal anesthesia (obviously!) The technical terminology for the procedures performed were a fasciotomy, partial semimembranosus tenotomy, debridement, and sciatic nerve liberation. A lot of adhesions were found between my glute muscles, hamstring, and sciatic nerve. They also anchored my SM tendon to my biceps femoris muscle.

Puranen-Orava test

Puranen-Orava test: Actively stretching the hamstring muscles in standing position with hip flexed and knee fully extended. Significant difference left vs right can indicate a strain or HHT.

 It was a fairly quick operation,(about an hour-and-a-half I believe) and I was able to leave the hospital that same day. The trickiest part was figuring out how to avoid sitting thereafter. Post-op protocol involved no sitting for the first 4-weeks as well as no active stretching. I had a fun time being wheeled out of the hospital on a stretcher and into a handicap taxi, (which felt more like an ambulance). The rest of my week in Finland I spent resting up in bed, but was able to use crutches, full-weight bearing, from day one. Overall, my stay at hospital NEO was top-notch. The doctors and nurses were very kind, and Dr. Lempainen and Dr. Orava were very welcoming, encouraging, and answered all of my questions about making a comeback from this surgery.


I flew home from Finland four days later. First-class made it easy to lay down, but travelling on crutches is never exactly fun! The following two weeks I stayed at home on the couch/bed, and was lucky to have my mom there to take care of me and drive me to PT appointments. The following weeks looked something like this:

  • One Week Post-Op: Started gentle massage and micro-current therapy.
  • Two Weeks: Off crutches and started some light quad strengthening exercises, core (mainly gentle transverse abdominis activation exercises), gentle leg swings, clams, and isometric glute activation. Cryotherapy treatments helped bring the swelling down.
  • Three Weeks: Added standing arm bike to get my heart rate up and keep me from going crazy. Also got in the pool to do some light aqua jogging (just for range of motion, not cardio), along with swimming with my arms-only and a buoy between my legs.
  • Four Weeks: Added in some very gentle stretching and nerve glides, along with some hip flexor strengthening and bridges. I finally was able to sit again!!! But I limited it to as little sitting as possible.
  • Five Weeks: Was cleared to do 20-30min sessions on the elliptical and started sitting for longer periods.
  • Six Weeks: Took my outdoor ElliptiGo bike for a ride to enjoy the glorious great outdoors.
  • Seven Weeks: Continued to gradually increase my aqua-jog, swimming and elliptical minutes.
  • Eight Weeks: Hoping to try Alter-G treadmill soon!
  • The goal is to jog at the 10-week mark, but I’m taking it one week at a time and listening to my body 🙂

So you think you have hamstring syndrome? 

I realize that a lot of readers out there are probably like me. You found this blog and you’re saying to yourself “Oh my gosh, this sounds just like my symptoms, I better get this surgery!” I know this because I’ve been there before, and I have received many comments on the blog I wrote about my last surgery. While I do recommend hamstring surgery for anyone who has dealt with chronic hamstring syndrome and has exhausted all other options, I am not a doctor and am not trying to diagnose/give medical advice here. There are a lot of other injuries that can cause similar pain. I suggest consulting with your doctor, and ruling out other conditions such as a lumbar disc injury, disc degeneration, piriformis syndrome, a full or partial hamstring tear, sports hernia, compartment syndrome, pelvic floor dysfunction, labral tear, hip impingement, neurological problem, stress fracture, etc. If you’re still in the early stages of HHT, I recommend this article.

If you are like me and have tried everything else, I’d be happy to share more info about my experience. The main reason I am writing this blog entry is to provide more info on hamstring syndrome since there are limited resources on the web from actual patients. Feel free to message me on my contact page or Facebook. This injury can be a real pain in the butt, so I feel for you all!

Okay, now for the fun part, pictures of the scar…








Left: Two days post-op, Right: 8-weeks post-op, stitches removed (kind of looks like a caterpillar if you ask me. But if anyone asks…I was clawed in the butt when running from a mountain lion!)


¹ Migliorini S, Merlo M
The hamstring syndrome in endurance athletes


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  1. Hi Amanda,
    Thanks so much for sharing your story and I hope the recovery is going well! I have been dealing with very localized high hamstring pain for 17 months and all signs point to high hamstring tendinopathy (HHT). However, when I got my MRI results last week I was shocked to see “Femoral Acetabular Impingement and Torn Labrum” with no mention of any hamstring issue, the exact diagnosis you had in 2015. Knowing what you know now would you even go through with the Labrum repair? My symptoms don’t fit any of those typically found in patients with labrum tears. Do you know of any doctors in the New York City area that are familiar with HHT?

  2. This sounds so familiar. Labrum, etc. hip injection did not help. What have you found out about your hamstring? I need an answer as to what is causing my buttock, hip, and thigh pain. Thank you

  3. I just came across your blog and wanted to thank you Dr taking the time and effort to write this! My pain symptoms seem so similar to yours and reading this has been extremely helpful. I had a few questions – Did you ever have hip flexor or it band pain/tightness and did you ever see a Doctor in the US for the high hamstring pain before going to Finland for the surgery? Thank you again!!

    • I never really had hip flexor pain. My pain was always more in the back of the leg, anteriorly and medially (slightly to the inside of my leg at the adductor). I did see several orthopedic doctors regarding my high hamstring here in the USA, at least 5 or more. I would suggest seeing a few different doctors here before pursuing surgery over seas, but if you would like more info on that pleased contact me directly through my contact page. I’m not a doctor but happy to share my experience.

  4. Amdana Rego Thank you for your story. I have been dealing with this problem for longtime now . I have doctor visit in NYC next week . This must have cost a lot of money but sounds like you had success ,you can’t put a price on your health.

    • You’re welcome James. Yes, surgery can be expensive, but so far it has been worth it now that I’m able to run further and faster than I had in years.

  5. Hi Amanda! I’m truly sorry for the long suffering but also glad you are finally getting better! I’m so happy to have found this blog! It’s giving me hope that I can be pain free soon and live normal active life! I’m very lucky in this case to actually live in Finland, so I can get the same procedure done. It would be nice to discuss some details with you if possible! Kind regards Kariina

  6. Hi Amanda,
    Thank you for sharing your story. I have suffered with PHHT for over a year and have started with my 4th physical therapist. I’ve tried accupuncture, myofascial release, and one cortisone injection (did nothing). With my new PT, we have begun a gentle stretching/strengthening program which seems more appropriate for this condition. There is also a possibility of Prolotherapy in Boston. It is nice to know that if all else fails, there is Finland!

    • Judy,
      You’re welcome. I would definitely try the strengthening routine for awhile and see if it helps. When my hamstring pain first started, I was able to keep it under control by doing a strengthening routine regularly. However, once I backed off from that and started pushing the envelope in my track workouts is when it got much worse. So be patient and be careful!

  7. Hi Amanda,
    Thanks for posting in what I found very interesting. I’ve had HHT for 2 years and gone through all the traditional strengthening exercises and for the last year have had shock wave but I don’t really see much of an improvement. The MRI scan didn’t show any scar tissue and I am now starting to think surgery might be the only option to get my life back. I know there is nothing available with our health service, I live in the UK, but will explore what is available privately. Will keep everyone updated.


    • Mike,
      I understand how frustrating that can be! I went the same route and tried traditional physical therapy exercises and shockwave before I ever considered surgery. I also tried many other treatments you can read about in some of my previous blogs. My suggestion to ANYONE out there dealing with this is to try all conservative options first. However, I will say that scar tissue doesn’t always show up on MRIs. It wasn’t until after my surgery that Dr. Orava confirmed that I did indeed have a lot of scar tissue that they had to remove, and for that reason I’m glad I took the chance and went ahead and did the surgery. Also, I have heard from a few other people who had surgery in places such as Italy, Portugal, and New Zealand. So I would explore your options in your home country and nearby places. For me, I would not have health coverage for this operation in the USA which is why I went to Finland. Not to mention that Dr. Sakari Orava is arguably the most known surgeon for this condition.

    • Hi Mike, there are surgeons in the UK who can operate for persistent HHT. Come over to our Facebook group Proximal Hamstring Injury and Surgery and you can either ask on the page for recommendations or PM me.

  8. Amanda,

    Thanks for your excellent story. As other readers I was surprised to see that many of the symptoms you describe were fully similar to mine. I am an age group triathlete and have been struggling with hip issues for well over a year, and am now considering surgery. I live in the US, and I believe the surgery you had is performed in the states, so will try my luck here.

    Peter Ladegaard

  9. Any one looking for recommendations for surgeons will find a wealth of experience and knowledge in the FB group ‘Proximal Hamstring Injury and Surgery’

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