Paul O’Connell’s Hamstring Injury

I’m currently doing an MSc tracking hamstring injuries in athletes and watched in horror as Paul O’Connell sustained one of the most severe types of hamstring injuries ending his World Cup involvement and putting a sombre note on Ireland’s fantastic win over France at the weekend

From replaying his injury and the little bits of info on his injury that are being fed to the media…I am taking a stab at guessing he has sustained an avulsion of his proximal hamstring tendon.

This is the most severe of all hamstring injuries.
Hamstring avulsion fractures are very uncommon and if they occur, they are more likely in adolescents, where the bone onto which their hamstrings attach, hasn’t reached full maturity.

Hamstring Avulsion. Ischium, Semitendinosus, Semimembranosus, Biceps femoris. A complete hamstring tear, or avulsion, requires surgery to reattach the torn tendon to the ischium.MendMeShop TM ©2011

Looking back at the video of O’Connell’s injury you can see where the force of the tackle was taken through his right hamstrings as he tried to lean forward from the trunk against the tackle. At this point, the upper hamstring tendon was in an elongated position, working eccentrically at a mechanically weaker position and this is presumably the moment when the injury occurred.
The hamstring tendons absorbed the high force of the tackle and tore at it’s attachment to the pelvis via the ischial tuberosity.

More guesswork…but I am thinking O’Connell’s inability to weight-bear immediately post injury and requiring oxygen on the pitch increases the likelihood that he had a higher grade avulsion fracture of the hamstring tendon where there is up to 7cm displacement of the hamstring down the leg and possibly bony displacement of the tendon’s bony attachment.

In this type of injury, MRI is the scan of choice and early surgical intervention involves the hamstring tendon being sutured back to it’s bony attachment at the ischial tuberosity. Care is taken to avoid the sciatic nerve which lies in close proximity to the upper hamstring tendons.

Rehabilitation is usually progressive partial weight bearing up to 6 weeks post op, no running up to 12 weeks post-op and up to 1 year for return to full fitness and competitive sport. As reported in the media, we are unlikely to see the legend in an Irish Jersey again and wish him all the best in his recovery!

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