Ace Physiotherapy and Sports in Singapore
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ACE PHYSIO SPORTS
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Avulsion Fracture of Hamstring Origin
Avulsion Fracture of the Ischial Tuberosity
An avulsion fracture happens when the hamstring tendon pulls a fragment of the ischial tuberosity (sitting bone) away from the pelvis. The pelvis connects your trunk to your lower limbs and serves as an attachment site for many muscles. It is composed of three parts: the ilium, ischium, and pubis. The posterior (back) part of the pelvis is the ischium, which includes the bony prominence called the ischial tuberosity. The hamstring muscles—the biceps femoris, semitendinosus, and semimembranosus—attach here, enabling hip extension and knee flexion.
When you injure your hamstrings, it usually involves tearing the muscle fibers in the muscle belly. In more severe cases, the hamstring can tear away from its origin at the ischial tuberosity, which is known as a hamstring origin avulsion. In extreme instances, an avulsion fracture occurs, where the hamstring pulls a fragment of bone off the pelvis. This typically happens during a sudden, forceful eccentric contraction of the hamstrings with the hip flexed, such as during hurdling or performing the splits. When this injury occurs, surgery is usually required to reattach the bone.
An open reduction internal fixation (ORIF) procedure involves surgically opening the buttock to reattach the bony fragment to the pelvis using screws. During the procedure, your hamstring is carefully exposed beneath the gluteal muscles, and any scar tissue is removed. Special care is taken to protect the sciatic nerve, which runs close to the hamstring’s insertion on the ischium, while the ischial tuberosity is securely reattached to the pelvis.
This injury is often mistaken for a regular hamstring tear, which can delay surgery. acephysiosports.com can help manage your symptoms during this period by minimising muscle atrophy, reducing contractures, and preparing you for post-surgical rehabilitation.
A hamstring avulsion fracture is accurately diagnosed using an MRI scan. If an avulsion fracture is suspected, you may also notice visible shortening of the hamstring, with a “popeye”-style bulge forming toward the knee.
Physiotherapy prior to Surgery for an Avulsion Fracture of the Ischial Tuberosity
Prior to surgery for an avulsion fracture of the ischial tuberosity, physiotherapy can help manage your symptoms and daily activities while preparing you for surgery. acephysiosports.com will not only strengthen your lower limb but also provide a solid foundation for post-operative rehabilitation, ultimately supporting a quicker and more successful recovery. Treatment may include:
- Pain management – techniques to reduce discomfort and inflammation.
- Gentle range of motion exercises – maintaining mobility without stressing the injury.
- Muscle activation – preventing atrophy in surrounding muscles.
- Strengthening exercises – for the non-injured muscles of the lower limb and core.
- Posture and gait training – maintaining normal movement patterns and reducing compensatory strain.
- Education – advice on activity modification and safe daily movements.
Symptoms following Surgery for an Avulsion Fracture of the ischial Tuberosity
Following surgery, your leg will be immobilised, you will be provided with crutches, and you will be restricted to non-weight-bearing activities for approximately 2 weeks. After surgery, it is normal to experience common symptoms, including:
- Pain and soreness around the buttock and hamstring area.
- Swelling and bruising at the surgical site.
- Stiffness in the hip and hamstring muscles.
- Muscle weakness due to immobilisation.
- Limited range of motion in the hip and knee.
- Numbness or tingling if the sciatic nerve was irritated during surgery.
Physiotherapy following Surgery for an Avulsion Fracture of the Ischial Tuberosity
Following surgery for an avulsion fracture of the ischial tuberosity, physiotherapy is a critical part of your rehabilitation. acephysiosports.com will provide a thorough assessment of your entire lower limb and back, along with a clear explanation of your treatment. We will then develop a comprehensive rehabilitation programme that addresses all related issues, initially focusing on acute management and gradually progressing toward a full return to functional and sporting activities.
Weeks 0-2
The initial focus at acephysiosports.com will be on post-surgical management and reducing acute symptoms. Treatment may include:
- Pain relief strategies – ice, gentle massage, and positioning to reduce discomfort.
- Swelling management – compression and elevation techniques.
- Gentle range of motion exercises – maintaining mobility without stressing the surgical site.
- Muscle activation exercises – preventing atrophy in surrounding muscles.
- Crutch training and gait practice – ensuring safe mobility while non-weight-bearing.
- Education – guidance on activity modification, posture, and safe daily movements.
Weeks 2-4
During this stage, your resting splint will be gradually adjusted to allow more leg bend. You will progress to partial weight-bearing and be encouraged to stretch within your comfort levels. Any muscle imbalances will be addressed to restore proper pelvic alignment, reducing strain on your hamstrings. Treatment may include:
- Controlled stretching exercises – improving flexibility safely.
- Strengthening exercises – targeting hamstrings, glutes, and core muscles.
- Balance and proprioception training – enhancing stability and coordination.
- Gait retraining – refining walking and movement patterns.
- Manual therapy – soft tissue mobilization to reduce stiffness and improve function.
- Education and activity guidance – safe progression of daily and sporting activities.
Weeks 4-8
Four weeks after surgery, your range of motion will gradually improve, and you will be able to progress to functional and then full weight-bearing without crutches. Initial strengthening exercises can begin, with continued focus on regaining mobility and functional use of your leg. Treatment may include:
- Progressive strengthening exercises – targeting hamstrings, glutes, and supporting muscles.
- Range of motion exercises – to maintain and improve flexibility.
- Functional training – activities that mimic daily movements.
- Balance and coordination exercises – restoring stability and proprioception.
- Gait retraining – ensuring normal walking patterns.
- Education – advice on safe activity progression and injury prevention.
Weeks 8-12
Following 8 weeks of rehabilitation with acephysiosports.com, you will notice significant improvements in your range of movement. Proprioceptive training will be incorporated, and you will be encouraged to begin strengthening your hamstrings. A major focus will be on enhancing stability throughout the range of motion to prevent re-injury and maximise rehabilitation potential. Treatment may include:
- Advanced hamstring strengthening exercises – including eccentric and functional movements.
- Proprioception and balance training – to improve coordination and prevent falls.
- Core and pelvic stability exercises – supporting optimal lower limb mechanics.
- Functional movement drills – preparing for daily and sporting activities.
- Gait and movement pattern training – ensuring safe and efficient motion.
- Education – strategies to minimise risk of re-injury and maintain progress.
Months 3-6
The final stage of rehabilitation with acephysiosports.com will focus on regaining full range of motion, restoring full hamstring strength, and incorporating sport-specific activities. The primary goals are to return your leg to its pre-operative condition and prevent secondary issues. Full recovery may take up to 6 months, with acephysiosports.com providing an intensive and comprehensive rehabilitation programme to ensure a complete and effective recovery. Treatment may include:
- Advanced strengthening exercises – targeting hamstrings, glutes, and supporting muscles.
- Sport-specific drills – tailored to your activity or sport.
- Plyometric and agility training – improving power, speed, and coordination.
- Full range of motion exercises – ensuring flexibility and functional mobility.
- Functional movement assessments – addressing any residual deficits in movement patterns.
- Injury prevention strategies – education and exercises to reduce the risk of re-injury.
Summary
An avulsion fracture of the ischial tuberosity occurs when a fragment of bone separates from your ischium during a forceful contraction of your hamstrings. The ischium is your sitting bone, so when a fragment breaks off, it causes pain and usually requires surgery to reattach the bone to your pelvis using screws. Following surgery, a rehabilitation programme is essential to restore full function of your leg. acephysiosports.com will develop a comprehensive rehabilitation plan focusing on movement, strength, and function, with clear, patient-directed goals to guide your treatment. For more information or to book an appointment, contact acephysiosports.com or call +65 81535374.
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