I am a kicker for a college football team. I’m only in my second year, so I hope to have a few more good years on the field. However, I’ve started to develop what the team physician calls hamstring syndrome. I’m seeing a physical therapist, but the doc said I may need surgery. What kind of surgery would they do for this problem? And how successful is it?

The hamstring syndrome was first discussed in the late 1980s. Athletes involved in many different types of sports have experienced the pain, tenderness, and weakness that occur with this syndrome. At first it was only called hamstring syndrome. But more recently, it was renamed proximal hamstring syndrome to indicate a more precise location of the problem.

Symptoms include pain in the buttock that goes down the back of the thigh to the knee with weakness of the hamstring muscle. When the examiner presses on the ischial tuberosity, it reproduces the pain or is tender.

The ischial tuberosity refers to the part of the pelvic bone that we sit on. This is where the proximal (or upper portion) of the hamstring muscle attaches to the pubic bone. Sitting or stretching the hamstrings also brings on the painful symptoms. Running, sprinting, and kicking activities are extremely difficult with this problem.

If conservative care is unable to provide pain relief and return of strength and function, then surgery may be advised. The sciatic nerve is released from the hamstring muscle where the two have become tethered or attached by adhesions or scar tissue. The sciatic nerve is carefully cut away from the hamstrings. Scar tissue and any areas of obvious tendon scarring or degeneration are removed. The surgeon is careful to avoid disturbing the nearby posterior femoral cutaneous nerve.

There aren’t very many studies reporting results of treatment for this problem. But between 75 and 80 per cent of athletes are able to get back to sports participation and are happy with the results. In a few cases, pain is not relieved. Complications such as wound infection and nerve injury can occur. This doesn’t happen very often, but the patient must be prepared for the possibility.

Rehab and recovery are fairly short. Running activities can begin four to six weeks after surgery. The athlete gradually progresses his or her training program. By 12 to 16 weeks, the player is back to full sports participation.